THE RELATIONSHIP BETWEEN PERFECTIONISM AND TRAIT ANXIETY IN UNIVERSITY STUDENTS

ABSTRACT

This study examined the relationship between perfectionism and trait anxiety in university students. A sample of 87 students aged 18 to 29 completed two questionnaires: the Multidimensional Perfectionism Scale and the State-Trait Anxiety Inventory. Results showed that higher levels of perfectionism were linked to higher levels of trait anxiety. In particular, the subscales Concern Over Mistakes and Doubts About Actions had the strongest correlations with anxiety scores. A multiple regression analysis confirmed that these two traits significantly predicted anxiety, accounting for 33.1% of the variance. Female students had higher anxiety scores, while perfectionism levels did not differ significantly by gender. These findings suggest that certain aspects of perfectionism are closely linked to anxiety, highlighting the importance of assessing these traits and developing interventions to reduce perfectionistic thinking in university settings. Limitations include a small, mostly undergraduate sample and the use of self-report data. Future studies should include more diverse participants and explore how these traits change over time.

АННОТАЦИЯ

В исследовании рассматривалась взаимосвязь между перфекционизмом и личностной тревожностью у студентов университета. В выборку вошли 87 студентов в возрасте от 18 до 29 лет, которые прошли два опросника: Многомерную шкалу перфекционизма и Шкалу тревожности Спилбергера (субшкала личностной тревожности). Результаты показали, что более высокий уровень перфекционизма связан с более высоким уровнем личностной тревожности. Особенно сильная корреляция наблюдалась для подшкал «Озабоченность ошибками» и «Сомнения в действиях». Множественный регрессионный анализ подтвердил, что именно эти два показателя значимо предсказывают уровень тревожности, объясняя 33,1% дисперсии. У студенток уровень тревожности оказался выше, а уровень перфекционизма существенно не различался между полами. Полученные результаты указывают на то, что определённые аспекты перфекционизма тесно связаны с тревожностью, подчёркивая важность оценки этих черт и разработки методов, направленных на снижение перфекционистического мышления среди учащихся высших учебных заведений. Среди ограничений небольшая выборка (в основном бакалавры) и самоотчётные данные. В дальнейшем стоит включать более разнообразных участников и исследовать, как меняются эти черты со временем.

Keywords: perfectionism, anxiety, students, psychological traits, mental health.

Ключевые слова: перфекционизм, тревожность, студенты, психологические черты, психическое здоровье.

Exploring the Relationship Between Perfectionism and Trait Anxiety in University Students

Perfectionism and trait anxiety are both associated with psychological problems; however, their relationship, particularly in university students, remains insufficiently explored (Patterson et al., 2021). Perfectionism is often seen as a desirable trait in academic and professional environments. It involves setting high standards and striving for excellence. However, when these standards become excessively rigid or self-critical, perfectionism can shift from being motivating to being a source of psychological distress. Research indicates that maladaptive perfectionism is highly correlated with negative psychological outcomes, and inividuals with this trait struggle with anxiety, symptoms of depression and diminished self-worth (Frost et al., 1990).

Trait anxiety reflects a stable tendency to feel anxious across various contexts and contributes to one’s vulnerability to stress and subsequent psychological disturbance (Spielberger, 1983). Although previous research explored these traits individually, there is a gap in the literature concerning an interplay of these traits in student populations (Limburg et al., 2017). It is important to address this relationship as students are often facing high academic demands and performance pressure, which can increase their anxiety and perfectionistic tendencies (Khanam & Gautam, 2024). Understanding the link between those personality aspects in emerging adults might inform possible interventions and mental support services aimed at reducing distress in emerging adults (Damian et al., 2016). The purpose of this study is to examine the relationship between perfectionism and trait anxiety among young adult students at the University of Nicosia. We aim to investigate whether individuals with higher levels of perfectionistic tendencies report greater levels of trait anxiety. It is important to understand whether students who show high levels of perfectionism are also more likely to experience chronic anxiety, as identifying this association could help raise awareness for psychological interventions or support systems within university environments. This study is informed by the stress-diathesis model, which explains how underlying traits like perfectionism may increase vulnerability to anxiety when individuals face academic stressors (Ingram & Luxton, 2005).

Research Questions and Hypotheses

This research aims to address the following research questions:

1. Is there a relationship between perfectionism and trait anxiety among young adults?
2. Which dimensions of perfectionism are most strongly linked to trait anxiety?

Based on the previous research, we proposed the following hypotheses:

H1. There is a positive relationship between perfectionism and trait anxiety.

H2. Concern Over Mistakes and Doubts About Actions will exhibit a stronger correlation with trait anxiety than other facets of perfectionism (Smith et al., 2018).

Literature Review

Perfectionism

Perfectionism is often linked to psychological disorders. For instance, meta-analyses of 39 studies have concluded that perfectionism has a significant positive correlation with eating disorders (Bills et al., 2023). Eating disorders often involve an altered perception of one’s body and striving for a desirable body shape and weight (Treasure, 2020). As a result, individuals with eating disorders often experience negative emotions toward their body features, which is associated with anxiety and depression (Hong & Ahmad, 2024).

Perfectionism is generally categorized into two dimensions: adaptive and maladaptive. Adaptive perfectionism is defined by the establishment of heightened personal expectations. being well-organized, and engaging in careful planning to achieve goals (Frost et al., 1990). Maladaptive features include high self-criticism, desire to meet unrealistic standards, and fear of making mistakes, which has a negative correlation with psychological health (Newman et al., 2019; Smith et al., 2020).

Maladaptive perfectionism has been associated with the onset of several clinical disorders. One of them is Obsessive-Compulsive Disorder (OCD), which is a widespread psychological disorder characterized by obsessive thoughts, compulsive actions, and repetition of actions (Singh, Anjankar, & Sapkale, 2023). One of the features of the individuals diagnosed with OCD is high personal standards, which might contribute to the onset of their intrusive thoughts and actions. Certain dimensions of perfectionism, in particular, Concern Over Mistakes, are related to interpersonal problems, difficulty cooperating, and being easily offended by criticism (Dimaggio et al., 2015). Higher scores on maladaptive perfectionism are also linked to lower self-compassion, which is defined as a kind way of thinking towards oneself after facing a failure, as opposed to self-judgment (Benedetto, Macidonio, & Ingrassia, 2024). Oskouei et al. (2024) argued that perfectionism is indirectly associated with suicidal ideations of medical workers. More specifically, findings of this study indicated that perfectionism is associated with mental distress, which is linked to suicidal ideation.

Anxiety

Anxiety is an emotional state characterized by worry, tension, and physical symptoms such as elevated heartbeat and sweating. Anxiety differs from fear, which is a response to a present threatening stimulus. Anxiety is a future-oriented emotion, which involves an apprehension of a potential danger (American Psychiatric Association, 2022).

In psychology, there is a distinction between state and trait anxiety. State anxiety refers to a short-term emotional reaction to the stimulus, while trait anxiety is a general disposition to experience worry and perceive different stimuli from the environment as potential threats (Spielberger, 1983).

Weger and Sandi (2018) suggested that trait anxiety can lead to psychological problems, in particular, depression, as it makes individial more vulnerable to stress, which has detrimental effects on one’s health and well-being. This connection between anxiety and depression aligns with the stress-diathesis model, which is based on the interaction between environmental triggers (stress) and either biological or psychological characteristics of a person (diathesis). According to this model, psychological disorders arise when stress surpasses someone’s coping capacity and gives an explanation why people may respond differently to the same stressful circumstances (Ingram & Luxton, 2005; Salomon & Jin, 2013).

Although perfectionism and trait anxiety are distinct psychological concepts, they share common features, such as increased reactivity to failure and high self-criticism. Individuals who score high on perfectionism and anxiety often share negative cognitive patterns, including rumination and fear of mistakes, and become fixated on their failures and fears (Flett & Hewitt, 2002). These overlapping features of both traits suggest that those with high perfectionism scores are also likely to experience anxiety.

 Exploring this connection within a student population may provide insight into whether perfectionistic traits are related to enduring anxiety symptoms, supporting our first hypothesis of a positive association between perfectionism and trait anxiety. Additionally, determining which specific aspects of perfectionism show the strongest link to anxiety directly relates to our second hypothesis and could inform more targeted psychological support strategies.

Method

Participants

Participants were required to be between 18 and 29 years old, currently enrolled in or having completed an undergraduate or postgraduate degree, and fluent in English. The study was conducted among university students, resulting in a relatively small sample that does not represent the general population of Cyprus. While most participants were from the University of Nicosia, a smaller number of students from other universities also completed the survey online. Due to the lack of detailed mental health data, exclusion criteria for individuals with diagnosed anxiety disorders were not applied. Participants had been selected by non-random purposive sampling according to specific requirements, including student status and age range. Recruitment was conducted both online – via social media platforms and messaging applications – and in person by approaching students on campus. To protect anonymity and encourage honest responses, no identifying information such as names or ethnicity was collected. A total of 87 participants completed the survey. Ages ranged from 18 to 29 years, with the largest groups being 21 years (n = 22, 25.3%) and 20 years (n = 18, 20.7%). Other age groups included 22 years (n = 13, 14.9%), 23 years (n = 11, 12.6%), while the remaining participants were distributed across the ages of 18, 19, 24, 25, 26, 27, 28, and 29, each comprising a small portion of the sample. Regarding gender, 55 participants (63.2%) identified as female, 31 (35.6%) as male, and one (1.1%) selected another gender identity. Most participants were undergraduate students pursuing a Bachelor's degree (n = 81, 93.1%), while six (6.9%) were postgraduate students (Master’s or PhD).

Design

This study employed a quantitative, cross-sectional, correlational design to examine the relationship between trait perfectionism and trait anxiety among young adults. A correlational approach was chosen because it allows for assessing the strength and direction of the association between variables without manipulating them. In this study, trait perfectionism and trait anxiety were both measured as continuous variables, with no variables manipulated or controlled. The aim was to investigate whether higher levels of perfectionism are associated with increased levels of trait anxiety. No experimental manipulation was involved, and all data were collected using self-report instruments administered at a single time point.

Measures

Data were collected using Google Forms, distributed primarily via QR code access and direct digital links. The survey consisted of two standardized psychometric instruments. The first one was Multidimensional Perfectionism Scale (MPS; Frost et al., 1990), which is a 35-item scale measures several dimensions of perfectionism, including Parental Expectations, Parental Criticism, Doubts About Actions, Concern Over Mistakes and Organization. A 5-point Likert scale was used, where responses ranged from Strongly disagree to Strongly agree. The MPS has demonstrated good internal consistency (α = .80) and established construct validity. In the current study, Cronbach’s alpha was also high (α = .875).

The second was the State-Trait Anxiety Inventory – Trait Version (STAI-T; Spielberger et al., 1983). This instrument consists of 20 items rated on a 4-point Likert scale and evaluates trait anxiety as a consistent and enduring aspect of one’s personality. The STAI-T demonstrates high internal consistency (α ≈ .89) and has strong construct and concurrent validity, effectively distinguishing anxiety from related emotional states. Cronbach’s alpha in this study was similarly high (α = .874).

All responses were collected anonymously and in English.

Procedure

Participants were recruited through non-random purposive sampling and completed the survey either in person or through digital dissemination. Researchers approached students at key University of Nicosia locations, including the Millennium Building, Bean Bar, Europa Building, and the university library. Printed flyers with scannable QR codes were distributed to facilitate immediate access to the survey. In addition, the survey link was shared via social media platforms, including Instagram, WhatsApp, and Telegram. Lecturers were also asked to distribute the link through official course communication channels. Notably, several university professors assisted in distributing the questionnaire to psychology students, further expanding the sample. During in-person recruitment, students were invited to participate in a psychology research study and informed that participation would take approximately 10-15 minutes. They were assured that responses would remain anonymous and that results could be made available upon request. On the first day of data collection, approximately 30 participants were recruited in person, highlighting the effectiveness of direct engagement compared to passive digital methods. Before beginning the survey, participants reviewed an informed consent form presented on the first page of the Google Forms survey. They then completed the State-Trait Anxiety Inventory – Trait Version (STAI-T), followed by the Multidimensional Perfectionism Scale (MPS). To minimize response bias, the specific focus on perfectionism was not disclosed until after survey completion. A debriefing message appeared on the final page of the form, fully explaining the study’s aim and allowing participants to remove their data if desired. Ethical principles, including informed consent, anonymity, and confidentiality, were upheld throughout the study.

Ethical Considerations

This study followed the ethical guidelines outlined by the American Psychological Association (APA, 2017) and complied with the regulations set by the Social Science Ethics Research Board (SSERB) of the University of Nicosia. The following ethical principles were upheld:

Informed Consent

All participants received an information sheet explaining the study’s purpose, procedures, and potential risks and benefits. Prior to participation, they provided informed consent. It was made transparent to participants that participation in the study was entirely up to them and that they were able to withdraw at any stage without incurring any additional costs.

Confidentiality and Anonymity

Personal information was stored separately from research data and protected through encrypted digital storage. In any publications or presentations, pseudonyms or aggregated data will be used to ensure participants cannot be identified. All data will be destroyed after the completion of the study.

Potential Risks and Mitigation

The study involved two self-report measures: the Multidimensional Perfectionism Scale and the State-Trait Anxiety Inventory. The associated risks were minimal; participants might have experienced mild discomfort, but this was not expected to exceed typical daily stress.

Right to Withdraw

Participants were informed of their right to withdraw at any time without needing to provide a reason. Withdrawal had no consequences and did not affect their relationship with the researchers. Upon request, any data collected from participants who chose to withdraw was deleted.

Ethical Approval

Ethical approval was obtained from the Social Science Ethics Research Board (SSERB) of the University of Nicosia prior to data collection (Approval Number: SSERB 00452). Any concerns regarding the ethical aspects of this research could be directed to the Chair of the SSERB, Professor Mark Sullman, at Sullman.M@unic.ac.cy.

Data Storage and Handling

Data were stored in password-protected digital files, accessible only to the research team. Data will be retained for the duration of the study and permanently deleted afterward.

Deception and Debriefing

The study involved partial deception. Specifically, the focus on perfectionism was not fully disclosed during initial recruitment to reduce demand characteristics which may influence the outcomes of the study (McCambridge, de Bruin, & Witton, 2012). Upon completion of the survey, participants received an on-screen debriefing form explaining the true purpose of the study (i.e., examining the relationship between trait anxiety and perfectionism). Participants were given the option to withdraw their data after debriefing.

Results

Sample Characteristics

A total of 87 students (55 females, 31 males, and 1 identifying as other), aged between 18 and 29 (M = 21.72, SD = 2.26), participated in the study. Required sample size was determined a priori using G*Power analysis, based on an expected medium effect size (0.3), α = .05, and power of 0.80, which suggested a minimum of 84 participants. Most students were undergraduates (93.1%), with the remaining 6.9% enrolled in postgraduate programs.

Preliminary Analyses

To assess levels of anxiety and perfectionism, the Multidimensional Perfectionism Scale (MPS; Frost et al., 1990) and the Trait version of the State-Trait Anxiety Inventory (STAI-T; Spielberger et al., 1983) were used. Both instruments have demonstrated strong internal consistency in past research (α = .80 for MPS; α = .89 for STAI-T). In the present study, internal consistency was also high (α = .875 for MPS; α = .874 for STAI-T).

A scatterplot showed a moderate positive linear relationship between total scores on the STAI-T and the MPS.

Normality was assessed using the Kolmogorov–Smirnov test. The total MPS scores were normally distributed (p = .200), while STAI-T scores were not (p = .003); therefore, Spearman’s correlation was used.

Gender Differences in Perfectionism and Anxiety

An independent samples t-test revealed that female students (M = 44.55, SD = 8.86) reported significantly higher anxiety than male students (M = 39.58, SD = 8.10), t(84) = 2.572, p = .012. The effect size was moderate (Cohen’s d = 0.58, 95% CI [0.13, 1.03]).

A second t-test found no significant difference in perfectionism scores between genders, t(84) = 0.172, p = .864. Female (M = 105.33, SD = 17.56) and male students (M = 104.71, SD = 12.65) showed similar perfectionism levels (Cohen’s d = 0.04, 95% CI [–0.40, 0.48]).

Correlation Analysis

A Spearman’s rank-order correlation indicated a moderate positive relationship between total perfectionism and anxiety scores, ρ(87) = .397, p < .001. Among subscales, Concern Over Mistakes (ρ = .471, p < .001) and Doubts About Actions (ρ = .492, p < .001) had the strongest correlations with anxiety, supporting the second hypothesis.

Multiple Regression

Before performing the regression analysis, key assumptions were evaluated. The data met the assumptions of linearity and homoscedasticity, as indicated by a random pattern in the residual plots. Multicollinearity assumption was also met, with tolerance values of .777 and VIF of 1.29 for both predictors. Although the dependent variable (STAI-T scores) did not follow a normal distribution (p = .003), the regression analysis proceeded, given that this method is generally considered robust to non-normality in samples of moderate size (N = 87; Field, 2018).

The overall regression model was statistically significant, F(2, 84) = 20.74, p < .001, and explained 33.1% of the variance in anxiety scores (R² = .331, Adjusted R² = .315). This suggests that maladaptive dimensions of perfectionism significantly predict trait anxiety. Both predictors contributed significantly to the model. Doubts About Actions significantly predicted anxiety (B = 3.66, β = .371, t = 3.67, p < .001). Concern Over Mistakes also significantly predicted anxiety (B = 3.64, β = .298, t = 2.94, p = .004), indicating a similar trend. These findings show that higher scores on maladaptive perfectionism traits, particularly doubt and fear of mistakes, are associated with greater anxiety in university students.

Discussion

Our results support the first hypothesis: individuals with higher levels of perfectionism reported greater trait anxiety. A moderate positive correlation was found between total scores on the Multidimensional Perfectionism Scale (MPS) and the State-Trait Anxiety Inventory – Trait Version (STAI-T), indicating that as perfectionistic traits increase, so do anxiety levels. Among the MPS subscales, Concern Over Mistakes and Doubts About Actions showed the strongest associations with trait anxiety, supporting our second hypothesis. These findings reinforce the idea that specific dimensions of maladaptive perfectionism are particularly linked to anxiety. The negative correlation between Organization and anxiety further validates the distinction between adaptive and maladaptive perfectionism.

Practical implications

Our findings have some important practical implications that can be applied for mental health support in educational settings. University counseling services could incorporate screenings for perfectionism traits – particularly Concern Over Mistakes and Doubts About Actions – as a part of early interventions for anxiety. Therapeutic strategies, for example Cognitive Behavioral Therapy (CBT) could be adjusted to help students reconsider perfectionistic thinking and reduce the fear of failure, thereby decreasing overall anxiety levels.

Theoretical implications

Our research contributes to the theoretical understanding of perfectionism by emphasizing its multidimensional nature and highlighting which dimensions are most psychologically harmful. It supports theories that distinguish between adaptive and maladaptive perfectionism. This research could help refine psychological models that predict emotional outcomes in young adults.

Policy implications. At the educational level, our findings could help adjust mental health policies in universities. For example, faculty could provide balanced feedback that emphasizes effort over flawlessness. University mental health programs could develop screening and psychoeducation about perfectionism, and teach student skills that help manage their perfectionistic concerns. Applying these changes to university programs could not only reduce anxiety, but also improve well-being and academic performance.

Limitations. Our study consisted of 87 students mostly from University of Nicosia, with the majority being undergraduate and female. This limits the generalizability of the findings to more diverse populations in terms of age, gender and educational background. Despite our sample size being defined by G*power analysis and is sufficient for detecting medium effects, it was still very small. Future studies should have larger and more diverse samples, which would be beneficial to increase external validity. The use of self-report measures introduces the risk of social desirability bias and subjective misreporting. Participants may have minimized or exaggerated their responses based on personal perceptions or expectations. The study’s design does not allow for conclusions about causality. It remains unclear whether perfectionism causes anxiety or whether anxiety influences perfectionistic tendencies. While the tools used in the study were validated and reliable, they measured perfectionism and anxiety as stable traits at just one moment in time. This means, they did not reflect how these experiences might change depending on the situation or context.

Conclusion. According to the study's findings, trait anxiety is more common among students who exhibit greater levels of maladaptive perfectionism. In particular, Concern Over Mistakes and Doubts About Actions were strongly linked to anxiety, while Organization – an adaptive trait – was not. These results emphasize how crucial it is to differentiate between maladaptive and adaptive perfectionism. These results suggest that recognizing and addressing perfectionistic thinking may help reduce anxiety in university students. Mental health programs could benefit from including support focused on perfectionism-related concerns. Although the study provides useful insights, future research with more diverse to learn more about the long-term interactions between these traits.

References:

1. Acar, Z., & Kaya, S. (2024). How cognitive avoidance and perfectionism predict anxiety in therapy-seeking adults. PsychNexus: Journal of Psychology and Behavioral Sciences, 3(10). https://doi.org/10.61838/kman.cp.psynexus.3.10
2. American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.; DSM-5-TR). https://doi.org/10.1176/appi.books.9780890425787
3. Benedetto, L., Macidonio, S., & Ingrassia, M. (2024). Well-being and perfectionism: Assessing the mediational role of self-compassion in emerging adults. European Journal of Investigation in Health, Psychology and Education, 14(5), 1383–1395. https://doi.org/10.3390/ejihpe14050091
4. Bills, E., Greene, D., Stackpole, R., & Egan, S. J. (2023). Perfectionism and eating disorders in children and adolescents: A systematic review and meta-analysis. Appetite, 187, 106586. https://doi.org/10.1016/j.appet.2023.106586
5. Damian, L. E., Stoeber, J., Negru-Subtirica, O., & Băban, A. (2016). On the development of perfectionism: The longitudinal role of academic achievement and academic efficacy. Journal of Personality, 85(4), 498–509. https://doi.org/10.1111/jopy.12261
6. Dimaggio, G., Lysaker, P. H., Calarco, T., Pedone, R., Marsigli, N., Riccardi, I., Sabatelli, B., Carcione, A., & Paviglianiti, A. (2015). Perfectionism and personality disorders as predictors of symptoms and interpersonal problems. American Journal of Psychotherapy, 69(3), 241–255. https://doi.org/10.1176/appi.psychotherapy.2015.69.3.317
7. Field, A. (2018). Discovering statistics using IBM SPSS statistics (5th ed.). SAGE Publications.
8. Flett, G. L., & Hewitt, P. L. (2002). Perfectionism and maladjustment: An overview of theoretical, definitional, and treatment issues. In G. L. Flett & P. L. Hewitt (Eds.), Perfectionism: Theory, research, and treatment (pp. 5–31). American Psychological Association. https://doi.org/10.1037/10458-001
9. Frost, R. O., Marten, P. A., Lahart, C., & Rosenblate, R. (1990). The dimensions of perfectionism. Cognitive Therapy and Research, 14(5), 449–468. https://doi.org/10.1007/BF01172967
10. Hong, W., & Ahmad, N. S. (2024). Body image dissatisfaction, depression and anxiety in a sample of college students. The Open Psychology Journal, 17, e18743501303541. https://doi.org/10.2174/0118743501303541240521104133
11. Ingram, R. E., & Luxton, D. D. (2005). Vulnerability-stress models. In B. L. Hankin & J. R. Z. Abela (Eds.), Development of psychopathology: A vulnerability-stress perspective (pp. 32–46). Sage Publications.
12. Khanam, Z. M., & Gautam, S. (2024). Examining the relationship between perfectionism, academic stress, and psychological well-being. International Journal of Indian Psychology, 12(2), 307–314. https://doi.org/10.25215/1202.440
13. Limburg, K., Watson, H. J., Hagger, M. S., & Egan, S. J. (2017). The relationship between perfectionism and psychopathology: A meta-analysis. Journal of Clinical Psychology, 73(10), 1301–1326. https://doi.org/10.1002/jclp.22435
14. McCambridge, J., de Bruin, M., & Witton, J. (2012). The effects of demand characteristics on research participant behaviours in non-laboratory settings: A systematic review. PLOS ONE, 7(6), e39116. https://doi.org/10.1371/journal.pone.0039116
15. Newman, B. N., Strickler, J. G., O'Brien, C., Lui, T., & Lynch, M. (2019). Deconstructing perfectionism in college students: Patterns of behavior, emotion, and cognition. Personality and Individual Differences, 145, 106–111. https://doi.org/10.1016/j.paid.2019.03.030
16. Oskouei, A. H., Zarchi, M. Z., Safarpour, F., et al. (2024). The impact of perfectionism on suicidal ideation among medical residents in Iran: The mediating role of psychological distress. BMC Psychiatry, 24, 664. https://doi.org/10.1186/s12888-024-06102-6
17. Patterson, H., Firebaugh, C., Zolnikov, T., Wardlow, R., Morgan, S., & Gordon, B. (2021). A systematic review on the psychological effects of perfectionism and accompanying treatment. Psychology, 12(1), 1–24. https://doi.org/10.4236/psych.2021.121001
18. Salomon, K., & Jin, A. B. (2013). Diathesis-stress model. In M. D. Gellman & J. R. Turner (Eds.), Encyclopedia of behavioral medicine. Springer. https://doi.org/10.1007/978-1-4419-1005-9_797
19. Singh, A., Anjankar, V. P., & Sapkale, B. (2023). Obsessive-Compulsive Disorder (OCD): A comprehensive review of diagnosis, comorbidities, and treatment approaches. Cureus, 15(11), e48960. https://doi.org/10.7759/cureus.48960
20. Smith, M. M., Sherry, S. B., Vidovic, V., Saklofske, D. H., & Stoeber, J. (2020). Why does perfectionism confer risk for depressive symptoms? A meta-analytic test of the mediating role of stress and social disconnection. Journal of Research in Personality, 86, 103954. https://doi.org/10.1016/j.jrp.2020.103954
21. Smith, M. M., Vidovic, V., Sherry, S. B., Stewart, S. H., & Saklofske, D. H. (2018). Are perfectionism dimensions risk factors for anxiety symptoms? A meta-analysis of 11 longitudinal studies. Anxiety, Stress, & Coping, 31(4), 379–395. https://doi.org/10.1080/10615806.2017.1384466
22. Spielberger, C. D. (1983). Manual for the State-Trait Anxiety Inventory STAI (Form Y). Consulting Psychologists Press.
23. Treasure, J., Duarte, T. A., & Schmidt, U. (2020). Eating disorders. The Lancet, 395(10227), 899–911. https://doi.org/10.1016/S0140-6736(20)30059-3
24. Weger, M., & Sandi, C. (2018). High anxiety trait: A vulnerable phenotype for stress-induced depression. Neuroscience & Biobehavioral Reviews, 87, 27–37. https://doi.org/10.1016/j.neubiorev.2018.01.012