Perfect Enough to Sleep? Perfectionism and Actigraphy-Determined Markers of Insomnia

Figures & data

Table 1. Overview of studies examining perfectionism and insomnia and/or sleep difficulties using subjective sleep measures.

Study	Sample	Scale used	Key findings
Akram et al. (2020)	624 community adults and students in the United Kingdom	FMPS	DA, PC and PE: Positive association with and predict insomnia but mediated by anxiety and dysfunctional beliefs. O: Negative association and predicts insomnia.
Akram et al. (2017)	39 adults with insomnia and 39 normal sleepers in the United Kingdom	FMPS HFMPS	CM and DA: Insomnia group score higher than normal sleepers. Predict insomnia but mediated by anxiety. PC: Insomnia group score higher than normal sleepers. Predict insomnia, but partially mediated by anxiety.
Akram et al. (2015)	76 community adults in the United Kingdom	FMPS HFMPS	DA and PC: Positive association with insomnia but mediated by depression and anxiety. Baseline insomnia predicts future DA but mediated by baseline anxiety and current insomnia. Baseline insomnia predicts future PC.
Andersson et al. (2005)	256 tinnitus patients in Sweden	FMPS	CM and PC: Positive association with ISI.
Azevedo et al. (2010)	870 university students in Portugal	HFMPS	SPP: Insomnia group score higher than good sleepers group score at T1 and T2. Baseline SPP predicts difficulties initiating sleep and difficulties maintaining sleep at T1 and T2.
Azevedo et al. (2009)	1163 university students in Portugal	HFMPS	HFMPS, SOP and SPP: Positive association with difficulties initiating sleep, difficulties maintaining sleep and sleep disturbance index.
Brand et al. (2015)	346 university students in Switzerland	FMPS	CM: Positive association with ISI, SOL and NOA but mediated by stress and emotional regulation. DA and PS: Positive association with ISI and NOA but mediated by stress and emotional regulation.
Jansson-Frojmark and Linton (2007)	1936 community adults in Sweden	FMPS: CM and PS only	CM: Positive association with pre-existing insomnia and future insomnia but mediated by emotional distress.
Lombardo et al. (2013)	819 community adults in Italy	FMPS	CM, DA, PC and O: Positive association with current and future insomnia.
Lundh et al. (1994)	383 community adults and 70 insomnia patients in Sweden	FMPS: Only CM, DA and PS	CM and DA: Positive association with sleeping problems.
Maia et al. (2011)	870 university students in Portugal	HFMPS	SOP: Inconsistent pattern found with small correlations. SPP: Positive association with difficulties initiating sleep and difficulties maintaining sleep across T1, T2 and T3.
Molnar et al. (2020)	335 university students in Canada 296 community adults in America	HFMPS	SOP: Positive associations with good sleep quality. SPP: Positive association with poor sleep quality.
Richardson and Gradisar (2020)	281 adolescents in Australia	Child Adolescent Perfectionism Scale	SOP: Positive association with insomnia but mediated by vulnerability to stress. SPP: Positive association with insomnia.
Schmidt et al. (2018)	180 university students in Switzerland	FMPS	CM and DA: Positive association with and predict insomnia severity but mediated by counterfactual processing. O: Negative association with and predicts insomnia severity but mediated by counterfactual processing.
Trudel-Fitzgerald et al. (2017)	853 cancer patients in Canada	FMPS	CM and DA: Positive association with insomnia in men. PC: Positive association with insomnia in women and men but mediated by arousability.
Vincent and Walker (2000)	32 community adults with insomnia and 26 as healthy controls in Canada	FMPS HFMPS	CM and DA: Clinical group score higher than healthy control group score. PC: Clinical group score higher than healthy control group score. Positive association with SOL in clinical group. PC: Positive association with sleep quality in healthy control group.

ISI, Insomnia Severity Index; TST, total sleep time; SOL, sleep onset latency; WASO, wake after sleep onset; NOA, number of awakenings; FMPS, Frost Multidimensional Perfectionism Scale; CM, Concern over Mistakes; DA, Doubts about Actions; PE, Parental Expectations; PC, Parental Criticism; O, Organisation; PS, Personal Standards; HFMPS, Hewitt-Flett Multidimensional Perfectionism Scale; SOP, Self-oriented Perfectionism; OOP, Other-oriented Perfectionism; SPP, Socially Prescribed Perfectionism.

Table 2. Mean scores and standard deviations for objective and subjective sleep measures.

	Objective		Subjective		Paired t-test		Effect size
	M	SD	M	SD	t	p	Cohen’s d
TST, mins	424.30	72.65	447.90	59.43	−2.58	.012*	−0.35 (small)
SOL, mins	7.36	8.23	22.97	21.74	−5.24	<.001**	−0.95 (large)
WASO, mins	49.02	34.01	18.65	22.69	5.50	<.001**	1.05 (large)
NOA, no.	1.25	1.48	1.43	0.97	−0.72	.474	−0.14 (negligible)
SE, %	87.52	9.50	91.49	7.45	−2.51	.015*	−0.46 (small)

TST, total sleep time; SOL, sleep onset latency; WASO, wake after sleep onset; NOA, number of awakenings; SE, sleep efficiency. *p < .05. **p < .01.

Table 3. Mean scores, standard deviations, and sample range for measures of perfectionism, depression, anxiety, and stress.

	M	SD	Sample range (Score range)
FMPS	86.93	19.69	41–141 (29–145)
Concern over Mistakes	26.92	8.18	11–45 (9–45)
Doubts about Actions	11.87	3.77	5–20 (4–20)
Parental Criticism	9.37	4.04	4–20 (4–20)
Parental Expectation	13.20	4.54	6–25 (5–25)
Organisation	24.58	3.43	15–30 (6–30)
Personal Standards	25.58	5.65	9–35 (7–35)
HFMPS	177.20	29.85	100–238 (45–315)
Self-oriented Perfectionism	72.30	14.90	33–105 (15–105)
Other-oriented Perfectionism	52.48	13.36	23–81 (15–105)
Socially Prescribed Perfectionism	52.47	13.37	28–105 (15–105)
Depression	4.37	4.74	0–21 (0–21)
Anxiety	3.35	3.57	0–18 (0–21)
Stress	6.47	4.75	0–19 (0–21)

FMPS, Frost Multidimensional Perfectionism Scale; HFMPS, Hewitt-Flett Multidimensional Perfectionism Scale.

Table 4. Correlations between log transformed subjective sleep measures and perfectionism.

n = 60	L1	2	3	4	5	6	7	8	9	10	11	12	13	14	15
1. TST #
2. logSOL	−.15*
3. logWASO	−.27	.50**
4. logNOA	−.04	.16	.68**
5. logitSE	.36**	−.87**	−.80**	−.31*
6. FMPS	−.08	.35**	.17	−.02	−.31*
7. CM	−.02	.34**	.11	.01	−.25	.88**
8. DA	−.09	.32*	−.02	−.17	−.21	.71**	.62**
9. PC	−.16	.15	.15	.12	−.18	.71**	.48**	.42**
10. PE	−.15	.04	.13	.00	−.12	.62**	.30*	.19	.72**
11. O	.03	.13	−.05	−.07	−.03	.09	.07	.08	−.16	.03
12. PS	.06	.37**	.22	−.04	−.35**	.74**	.62**	.44**	.20	.29*	.26*
13. HFMPS	−.07	.20	.14	.03	−.20	N.A.	N.A.	N.A.	N.A.	N.A.	N.A.	N.A.
14. SOP	.03	.30*	.13	−.03	−.26*	N.A.	N.A.	N.A.	N.A.	N.A.	N.A.	N.A.	.76**
15. OOP	−.01	−.14	.03	.11	.08	N.A.	N.A.	N.A.	N.A.	N.A.	N.A.	N.A.	.56**	.02
16. SPP	−.17	.25	.13	−.02	−.23	N.A.	N.A.	N.A.	N.A.	N.A.	N.A.	N.A.	.83**	.57**	.22

log, log-transformed; TST, total sleep time; SOL, sleep onset latency; WASO, wake after sleep onset; NOA, number of awakenings; SE, sleep efficiency; FMPS, Frost Multidimensional Perfectionism Scale; CM, Concern over Mistakes; DA, Doubts about Actions; PE, Parental Expectations; PC, Parental Criticism; O, Organisation; PS, Personal Standards; HFMPS, Hewitt-Flett Multidimensional Perfectionism Scale; SOP, Self-oriented Perfectionism; OOP, Other-oriented Perfectionism; SPP, Socially Prescribed Perfectionism, N.A., not available. *p < .05. **p < .01. # TST was the only sleep variable that was not log-transformed.

Table 5. Correlations between log transformed objective sleep measures and perfectionism.

n = 60	1	2	3	4	5	6	7	8	9	10	11	12	13	14	15
1. TST #
2. logSOL	−.36**
3. logWASO	−.46**	.57**
4. logNOA	.-.37**	.43**	0.80**
5. logitSE	.61**	−.32**	−.80**	−.74**
6. FMPS	.04	.23	.14	.07	−.16
7. CM	.13	.13	.11	.04	−.08	.88**
8. DA	.15	.03	.19	.05	−.07	.71**	.62**
9. PC	−.23	.15	.14	.09	−.19	.71**	.48**	.42**
10. PE	−.24	.28*	.13	.08	−.26*	.62**	.30*	.19	.72**
11. O	.09	.25	−.07	−.09	.16	.09	.07	.08	−.16	.03
12. PS	.21	.25	.07	.02	−.04	.74**	.62**	.44**	.20	.29*	.26*
13. HFMPS	.01	.23	.18	.02	−.20	N.A.	N.A.	N.A.	N.A.	N.A.	N.A.	N.A.
14. SOP	.13	.25	.12	.01	−.07	N.A.	N.A.	N.A.	N.A.	N.A.	N.A.	N.A.	.76**
15. OOP	−.01	.02	−.03	−.09	−.03	N.A.	N.A.	N.A.	N.A.	N.A.	N.A.	N.A.	.56**	.02
16. SPP	−.12	.21	.28	.12	−.33**	N.A.	N.A.	N.A.	N.A.	N.A.	N.A.	N.A.	.83**	.57**	.22

log, log-transformed; TST, total sleep time; SOL, sleep onset latency; WASO, wake after sleep onset; NOA, number of awakenings; SE, sleep efficiency; FMPS, Frost Multidimensional Perfectionism Scale; CM, Concern over Mistakes; DA, Doubts about Actions; PE, Parental Expectations; PC, Parental Criticism; O, Organisation; PS, Personal Standards; HFMPS, Hewitt-Flett Multidimensional Perfectionism Scale; SOP, Self-oriented Perfectionism; OOP, Other-oriented Perfectionism; SPP, Socially Prescribed Perfectionism, N.A., not available. *p < .05. **p < .01. # TST was the only sleep variable that was not log-transformed.

Table 6. Regression coefficients between objective sleep measures and perfectionism.

n = 60	TST #			logSOL			logWASO			logNOA			LogitSE
	β	CI	p	exp β	CI	p	exp β	CI	p	expβ	CI	p	expβ	CI	p
FMPS	0.06	−0.92–1.05	.90	1.31	0.96–1.79	.09	1.06	0.91–1.23	.44	1.06	0.70–1.59	.78	0.88	0.72–1.08	.23
CM	1.07	−1.32–3.45	.37	1.19	0.86–1.64	.29	1.04	0.89–1.20	.63	1.01	0.66–1.52	.98	0.95	0.78–1.17	.66
DA	2.39	−2.72–7.50	.35	1.02	0.74–1.40	.91	1.03	0.89–1.19	.70	1.03	0.68–1.55	.89	0.95	0.77–1.16	.59
PC	−4.30	−0.88–0.28	.07	1.19	0.87–1.63	.26	1.07	0.93–1.24	.33	1.13	0.76–1.69	.53	0.87	0.71–1.05	.15
PE	−4.18	−8.27–-0.10	.045*	1.39	1.03–1.89	.033*	1.06	0.92–1.23	.43	1.10	0.73–1.64	.65	0.82	0.67–0.99	.043*
O	1.04	−4.66–6.74	.72	1.32	0.97–1.80	.07	0.95	0.82–1.10	.50	0.84	0.56–1.26	.39	1.09	0.89–1.34	.40
PS	2.48	−0.84–5.81	.14	1.32	0.97–1.80	.07	1.03	0.89–1.19	.69	1.00	0.67–1.50	.99	0.95	0.78–1.16	.63
HFMPS	0.05	−0.61–0.71	.88	1.38	1.01–1.88	.043*	1.09	0.94–1.26	.27	1.00	0.66–1.52	.98	0.89	0.73–1.09	.25
SOP	0.50	−0.79–1.79	.44	1.32	0.97–1.80	.08	1.05	0.91–1.22	.48	0.98	0.65–1.47	.90	0.94	0.77–1.15	.53
OOP	0.21	−1.26–1.68	.78	0.10	−0.23–0.42	.55	0.98	0.85–1.14	.82	0.88	0.58–1.33	.53	1.03	0.84–1.27	.75
SPP	−0.62	−2.09–0.85	.40	1.36	1.00–1.87	.05	1.16	1.00–1.34	.05	1.18	0.78–1.79	.42	0.80	0.65–0.97	.027*

exp, standardized exponentiated regression coefficient, for example, a 1.00 standard deviation increase in PE leads to a ratio change of 1.39 or a 39%increase in logSOL, and a 1.00 standard deviation increase in HFMPS leads to a ratio change of 1.38 or a 38% increase in logSOL. log, log-transformed; TST, total sleep time; SOL, sleep onset latency; WASO, wake after sleep onset; NOA, number of awakenings; SE, sleep efficiency; FMPS, Frost Multidimensional Perfectionism Scale; CM, Concern over Mistakes; DA, Doubts about Actions; PE, Parental Expectations; PC, Parental Criticism; O, Organisation; PS, Personal Standards; HFMPS, Hewitt-Flett Multidimensional Perfectionism Scale; SOP, Self-oriented Perfectionism; OOP, Other-oriented Perfectionism; SPP, Socially Prescribed Perfectionism. *p < .05. # TST was the only sleep variable that was not log-transformed.

Table 7. Significant results from exponentiated regression coefficients of mediation analysis using stress as a mediator in the relationship between selected log transformed objective sleep measures and selected subscales of perfectionism (n = 60, simulations = 10,000).

Sleep measure	logitSE
perfectionism	Estimate	CI	P
Concern over Mistakes
- Average causal mediated effect	0.86	0.71–0.99	.036*
- Average direct effect	1.12	0.87–1.43	.40
- Total effect	0.95	0.77–1.20	.68
Doubts about Actions
- Average causal mediated effect	0.90	0.77–1.00	.042*
- Average direct effect	1.06	0.84–1.32	.61
- Total effect	0.95	0.76–1.19	.63

*p < .05. Only significant results presented above. For full results, see Table A9 in Appendix.

Akram, U., Gardani, M., Riemann, D., Akram, A., Allen, S. F., Lazuras, L., & Johann, A. F. (2020). Dysfunctional sleep-related cognition and anxiety mediate the relationship between multidimensional perfectionism and insomnia symptoms. Cognitive Processing, 21(1), 141–148. https://doi.org/10.1007/s10339-019-00937-8

 PubMed Web of Science ®Google Scholar

Akram, U., Ellis, J. G., Myachykov, A., Chapman, A. J., & Barclay, N. L. (2017). Anxiety mediates the relationship between multidimensional perfectionism and insomnia disorder. Personality & Individual Differences, 104, 82–86. https://doi.org/10.1016/j.paid.2016.07.042

 Web of Science ®Google Scholar

Akram, U., Ellis, J. G., & Barclay, N. L. (2015). Anxiety mediates the relationship between perfectionism and insomnia symptoms: A longitudinal study. Public Library of Science ONE, 10(10), e0138865. https://doi.org/10.1371/journal.pone.0138865

 Google Scholar

Andersson, G., Airikka, M.-L., Buhrman, M., & Kaldo, V. (2005). Dimensions of perfectionism and tinnitus distress. Psychology, Health and Medicine, 10(1), 78–87. https://doi.org/10.1080/13548500512331315389

 Google Scholar

Azevedo, M. H., Bos, S. C., Soares, M. J., Marques, M., Pereira, A. T., Maia, B., Gomes, A. A., & Macedo, A. (2010). Longitudinal study on perfectionism and sleep disturbance. The World Journal of Biological Psychiatry, 11(2 Pt 2), 476–485. https://doi.org/10.3109/15622970903304467

 PubMed Web of Science ®Google Scholar

Azevedo, M. H., Soares, M. J., Bos, S. C., Gomes, A. A., Maia, B., Marques, M., Pereira, A. T., & Macedo, A. (2009). Perfectionism and sleep disturbance. The World Journal of Biological Psychiatry, 10(3), 225–233. https://doi.org/10.1080/15622970701367930

 PubMed Web of Science ®Google Scholar

Brand, S., Kirov, R., Kalak, N., Gerber, M., Puhse, U., Lemola, S., Correll, C. U., Cortese, S., Meyer, T., & Holsboer-Trachsler, E. (2015). Perfectionism related to self-reported insomnia severity, but not when controlled for stress and emotion regulation. Neuropsychiatry Disease and Treatment, 11, 263–271. https://doi.org/10.2147/NDT.S74905

 PubMed Web of Science ®Google Scholar

Jansson-Frojmark, M., & Linton, S. J. (2007). Is perfectionism related to pre-existing and future insomnia? A prospective study. British Journal of Clinical Psychology, 46(1), 119–124. https://doi.org/10.1348/014466506X158824

 PubMedGoogle Scholar

Lombardo, C., Mallia, L., Battagliese, G., Grano, C., & Violani, C. (2013). Perfectionism mediates the relationship between insomnia and depressive symptoms. Sleep and Biological Rhythms, 11(2), 90–98. https://doi.org/10.1111/sbr.12009

 Web of Science ®Google Scholar

Lundh, L.-G., Broman, J.-E., Hetta, J., & Saboonchi, F. (1994). Perfectionism and Insomnia. Scandinavian Journal of Behavior Therapy, 23(1), 3–18. https://doi.org/10.1080/16506079409455949

 Google Scholar

Maia, B. R., Soares, M. J., Pereira, A. T., Marques, M., Bos, S. C., Gomes, A., Valente, J., Azevedo, M. H., & Macedo, A. (2011). Affective state dependence and trait stability of perfectionism in sleep disturbances. Revista Brasileira De Psiquiatria, 33(3), 252–260. https://doi.org/10.1590/S1516-44462011000300008

 PubMed Web of Science ®Google Scholar

Molnar, D. S., Janssen, W. F., & Sirois, F. M. (2020). Sleeping perfectly? Trait perfectionism, perceived stress, and sleep quality. Personality & Individual Differences, 167, 110244. https://doi.org/10.1016/j.paid.2020.110244

 Web of Science ®Google Scholar

Richardson, C., & Gradisar, M. (2020). Perfectionism and insomnia in adolescents: The role of vulnerability to stress and gender. Journal of Adolescence, 85(1), 70–79. https://doi.org/10.1016/j.adolescence.2020.10.003

 PubMedGoogle Scholar

Schmidt, R. E., Courvoisier, D. S., Cullati, S., Kraehenmann, R., & der Linden, M. V. (2018). Too imperfect to fall asleep: Perfectionism, pre-sleep counterfactual processing, and insomnia. Frontiers in Psychology, 9, 1288. https://doi.org/10.3389/fpsyg.2018.01288

 PubMed Web of Science ®Google Scholar

Trudel-Fitzgerald, C., Savard, J., Slim, L. M., Roy, R. C., Flett, G. L., Hewitt, P. L., & Ivers, H. (2017). The relationship of perfectionism with psychological symptoms in cancer patients and the contributing role of hyperarousability and coping. Psychology & Health, 32(4), 381–401. https://doi.org/10.1080/08870446.2016.1273354

 PubMed Web of Science ®Google Scholar

Vincent, N. K., & Walker, J. R. (2000). Perfectionism and chronic insomnia. Journal of Psychosomatic Research, 49(5), 349–354. https://doi.org/10.1016/S0022-3999(00)00175-6

 PubMed Web of Science ®Google Scholar