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Perfectionism and the Cortisol Response to Psychosocial Stress in Men

Wirtz, Petra H. PhD; Elsenbruch, Sigrid PhD; Emini, Luljeta MS; Rüdisüli, Katharina MS; Groessbauer, Sara MS; Ehlert, Ulrike PhD

doi: 10.1097/PSY.0b013e318042589e
Original Articles

Objective: To test the hypothesis that perfectionism is an important moderator of the neuroendocrine stress response, with higher perfectionism predicting increased neuroendocrine activation.

Methods: A total of 50 middle-aged men underwent an acute standardized psychosocial stress task (Trier Social Stress Test). Perfectionism, cognitive appraisal of the stressful situation, trait anxiety, and various personality characteristics were assessed with questionnaires. Salivary cortisol, plasma epinephrine and norepinephrine, blood pressure, and heart rate were analyzed before and after stress. Circadian profiles of cortisol secretion during the day and in response to awakening were analyzed to assess basal activity of the hypothalamus-pituitary-adrenal (HPA) axis. Multiple regression analyses were conducted to identify predictors of the neuroendocrine stress response.

Results: Perfectionism was significantly associated with area under the total response curve with respect to increase (AUCi) of cortisol (r = 0.322, p = .046), but not with AUCi of norepinephrine (r = −0.217, p = .152) or AUCi of epinephrine (r = 0.116, p = .477). Hence, AUCi of cortisol was the main criterion. As possible predictors, trait anxiety, neuroticism, vital exhaustion, secondary appraisal, depression, and openness were considered. Regression analyses demonstrated that only perfectionism (β = 0.45, p = .002) and secondary appraisal (β = 0.50, p = .001) were independent predictors of AUCi of cortisol, the final model explaining 45% of the total variance in cortisol response (R2 = 0.45, “shrunken” R2 [sR2] = 0.38); perfectionism alone accounted for 18% of this variance (ΔR2 = 0.18, sR2 = 0.19).

Conclusion: The typical cognitions, and presumably the associated emotions, of perfectionists seem to contribute independently to stress-induced bodily responses, including HPA axis activation, in response to psychosocial stress.

HPA = hypothalamic-pituitary-adrenal; TSST = Trier Social Stress Test; AUC = area under the curve; HR = heart rate; BP = blood pressure; PASA = primary appraisal secondary appraisal; MPS = Frost Multidimensional Perfectionism Scale; CMD = concern over mistakes and doubts.

From the Department of Clinical Psychology and Psychotherapy (P.H.W., L.E., K.R., S.G., U.E.), Psychological Institute, University of Zurich, Zurich, Switzerland; Department of Medical Psychology (S.E.), University Clinic of Essen, University of Duisburg-Essen, Essen, Germany.

Address correspondence and reprint requests to Petra H. Wirtz, Department of Clinical Psychology and Psychotherapy, University of Zurich, Binzmühlestrasse 14, Box 26, CH-8050 Zurich, Switzerland. E-mail:

Received for publication Jan 17, 2006; revision received November 20, 2006.

The study was supported by Grant 56233203 from the University of Zurich (P.H.W.).

Copyright © 2007 by American Psychosomatic Society
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