Maladaptive Perfectionism and the Impact of Fibromyalgia: A Serial Mediation Model Through Sleep Reactivity, Insomnia Severity, and Pain Catastrophizing
Keywords:
Maladaptive perfectionism, fibromyalgia impact, sleep reactivity, insomnia severity, pain catastrophizing, serial mediationAbstract
This study aimed to examine the association between maladaptive perfectionism and fibromyalgia impact and to test the serial mediating roles of sleep reactivity, insomnia severity, and pain catastrophizing. This cross-sectional, descriptive-correlational study included 300 adults with physician-diagnosed fibromyalgia residing in Canada. Participants were recruited from rheumatology and chronic pain clinics, community organizations, support groups, and online patient networks. Data were collected using the Discrepancy subscale of the Almost Perfect Scale–Revised, the Ford Insomnia Response to Stress Test, the Insomnia Severity Index, the Pain Catastrophizing Scale, and the Revised Fibromyalgia Impact Questionnaire. Pearson correlations and serial mediation analysis were conducted using IBM SPSS Statistics 29 and PROCESS Model 6. Age, gender, fibromyalgia duration, average pain intensity, and sleep-medication use were controlled. Indirect effects were tested with 10,000 bias-corrected bootstrap resamples. Maladaptive perfectionism significantly predicted sleep reactivity, insomnia severity, pain catastrophizing, and fibromyalgia impact. Sleep reactivity significantly predicted insomnia severity and pain catastrophizing, whereas insomnia severity significantly predicted pain catastrophizing and fibromyalgia impact. Pain catastrophizing was the strongest unique predictor of fibromyalgia impact. The complete serial indirect pathway from maladaptive perfectionism through sleep reactivity, insomnia severity, and pain catastrophizing to fibromyalgia impact was significant. All specific indirect effects were also significant, and the total indirect effect accounted for a substantial proportion of the overall association. The final model explained 69.6% of the variance in fibromyalgia impact. The remaining direct effect of maladaptive perfectionism was significant, indicating partial mediation. Maladaptive perfectionism may increase fibromyalgia burden through heightened stress-related sleep vulnerability, more severe insomnia, and stronger catastrophic interpretations of pain, supporting integrated interventions targeting perfectionistic self-evaluation, sleep disturbance, and pain-related cognition.
Downloads
References
Akram, U., Stevenson, J. C., Gardani, M., Allen, S., & Johann, A. F. (2023). Personality and Insomnia: A Systematic Review and Narrative Synthesis. Journal of Sleep Research, 32(6). https://doi.org/10.1111/jsr.14031
Ault, A., Wilkerson, A. K., McCauley, J. L., Muzzy, W., Mappin, G., Yonce, S., Barth, K. S., Brady, K. T., George, M. S., Wedin, S., Christon, L., Flanagan, J. C., Yates-Johnson, A., Tutek, J., Lin, T., Uhde, T. W., & Borckardt, J. J. (2024). Sleep, Pain Catastrophizing, and Pain Intensity in Treatment Seeking Adults With Opioid Use Disorder. The Clinical Journal of Pain, 41(2). https://doi.org/10.1097/ajp.0000000000001264
Baime, M., Satyavolu, P. U., Huhn, A. S., & Ellis, J. D. (2023). Pain Catastrophizing Moderates the Relationship Between Chronic Pain and Insomnia Severity in Persons With Opioid Use Disorder. Frontiers in Sleep, 2. https://doi.org/10.3389/frsle.2023.1111669
Baldi, E. M., Cerolini, S., Meneo, D., Baglioni, C., & Palagini, L. (2025). Insomnia Disorder: Gender Issues Over the Lifespan. Journal of Sleep Research, 34(5). https://doi.org/10.1111/jsr.70110
Brandelli, Y. N., Mackinnon, S. P., Chambers, C. T., Parker, J. A., Huber, A. M., Stinson, J., Johnson, S. A., & Wilson, J. P. (2024). Understanding the Role of Perfectionism in Contributing to Internalizing Symptoms in Youth With Juvenile Idiopathic Arthritis. Journal of Pediatric Psychology, 50(2), 175-186. https://doi.org/10.1093/jpepsy/jsae100
Chen, F., Mei, F., Jingjing, L., & Jiyang, P. (2022). Negative Perfectionism and Sleep Quality in Chinese International Students Under COVID-19 Epidemic: A Moderated Mediation. Frontiers in psychology, 13. https://doi.org/10.3389/fpsyg.2022.937816
Du, H. (2026). The Dual Impact of Perfectionism on Sleep Quality in Medical Students: A Mediation Analysis of Depression and Anxiety. https://doi.org/10.21203/rs.3.rs-9673905/v1
Foustoukos, T. L., Blanchard, M., & Hügle, T. (2024). Evidence-Based Self-Management Strategies for Fibromyalgia: Foundations for Digital Therapeutic Applications (Preprint). https://doi.org/10.2196/preprints.67523
Gordon, S., Brown, R., Hogan, M. K., & Menzies, V. (2022). Mindfulness as a Symptom Management Strategy for Fibromyalgia: An Integrative Review. Journal of Holistic Nursing, 41(2), 200-214. https://doi.org/10.1177/08980101221123833
Habibi, M., Vand, H. D. A., Yegaei, P. S., Hooman, F., Ahmadi, R., Baglioni, C., & Moradi, S. (2023). The Contribution of Transdiagnostic Vulnerability Factors in Patients With Chronic Insomnia. https://doi.org/10.21203/rs.3.rs-2241964/v2
Islam, Z., D’Silva, A., Raman, M., & Nasser, Y. (2022). The Role of Mind Body Interventions in the Treatment of Irritable Bowel Syndrome and Fibromyalgia. Frontiers in Psychiatry, 13. https://doi.org/10.3389/fpsyt.2022.1076763
Kachaner, A., Lemogne, C., Dave, J., Ranque, B., Broucker, T. d., & Meppiel, E. (2022). Somatic Symptom Disorder in Patients With Post-Covid-19 Neurological Symptoms: A Preliminary Report From the Somatic Study (Somatic Symptom Disorder Triggered by COVID-19). Journal of Neurology Neurosurgery & Psychiatry, 93(11), 1174-1180. https://doi.org/10.1136/jnnp-2021-327899
Kulshreshtha, P. (2023). Personality Construct as a Biomarker in Fibromyalgia: A Narrative Review From an Autonomic Rehabilitation Perspective. Journal of Back and Musculoskeletal Rehabilitation, 36(6), 1251-1260. https://doi.org/10.3233/bmr-220353
Mollica, A., DeDominicis, M., Silverberg, N. D., & Burke, M. J. (2025). Persisting Symptoms After Concussion and Functional Neurological Disorder: Points of Intersection. Seminars in Neurology, 46(02), 196-205. https://doi.org/10.1055/a-2752-8940
Montoro, C. I., & Galvez-Sánchez, C. M. (2022). The Mediating Role of Depression and Pain Catastrophizing in the Relationship Between Functional Capacity and Pain Intensity in Patients With Fibromyalgia. Behavioural neurology, 2022, 1-9. https://doi.org/10.1155/2022/9770047
Ohlsson, A., Engström, E., & Lilja, T. (2022). Psychological Predictors of Insomnia, Anxiety and Depression in University Students: Potential Prevention Targets. BJPsych Open, 8(3). https://doi.org/10.1192/bjo.2022.48
Ortiz, A. M. L., Peters, A. S., Webber, K. T., Butler, R. M., & Levinson, C. A. (2026). Eating Disorder Symptoms and Corresponding Evidence-Based Treatments: A Narrative Review. Journal of eating disorders, 14(1). https://doi.org/10.1186/s40337-025-01485-7
Pellegrini, L., Canfora, F., Ottaviani, G., D’Antonio, C., Rupel, K., Mignogna, M. D., Biasotto, M., Giudice, A., Musella, G., Caponio, V. C. A., Spagnuolo, G., Rengo, C., Pecoraro, G., Aria, M., D’Aniello, L., Albert, U., & Adamo, D. (2025). Obsessive-Compulsive Symptoms and Traits in Patients With Burning Mouth Syndrome: A Cross-Sectional Multicentric Analysis. Clinical Oral Investigations, 29(4). https://doi.org/10.1007/s00784-025-06293-6
Pistoia, F., Salfi, F., Saporito, G., Ornello, R., Frattale, I., D’Aurizio, G., Tempesta, D., Ferrara, M., & Sacco, S. (2022). Behavioral and Psychological Factors in Individuals With Migraine Without Psychiatric Comorbidities. The Journal of Headache and Pain, 23(1). https://doi.org/10.1186/s10194-022-01485-x
Rakhimov, A., Ong, J. C., Realo, A., & Tang, N. K. Y. (2022). Being Kind to Self Is Being Kind to Sleep? A Structural Equation Modelling Approach Evaluating the Direct and Indirect Associations of Self-Compassion With Sleep Quality, Emotional Distress and Mental Well-Being. Current Psychology, 42(16), 14092-14105. https://doi.org/10.1007/s12144-021-02661-z
Rezaei, P., Ilaghi, M., & Masoumian, N. (2024). The Triangle of Anxiety, Perfectionism, and Academic Procrastination: Exploring the Correlates in Medical and Dental Students. BMC Medical Education, 24(1). https://doi.org/10.1186/s12909-024-05145-3
Saravanan, A., & Reagan, L. (2021). A Biobehavioral Pain Hygiene Model: Narrative Review and Conceptualization. Topics in Pain Management, 36(12), 1-11. https://doi.org/10.1097/01.tpm.0000756300.54102.46
Selvanathan, J., Tang, N. K. Y., Peng, P., & Chung, F. (2021). Sleep and Pain: Relationship, Mechanisms, and Managing Sleep Disturbance in the Chronic Pain Population. International Anesthesiology Clinics, 60(2), 27-34. https://doi.org/10.1097/aia.0000000000000346
Stricker, J., Kröger, L., Küskens, A., Gieselmann, A., & Pietrowsky, R. (2022). No Perfect Sleep! A Systematic Review of the Link Between Multidimensional Perfectionism and Sleep Disturbance. Journal of Sleep Research, 31(5). https://doi.org/10.1111/jsr.13548
Tang, N. K. Y., Saconi, B., Jansson‐Fröjmark, M., Ong, J. C., & Carney, C. E. (2023). Cognitive Factors and Processes in Models of Insomnia: A Systematic Review. Journal of Sleep Research, 32(6). https://doi.org/10.1111/jsr.13923
Trouvin, A. P., Simunek, A., Coste, J., Medkour, T., Carvès, S., Bouhassira, D., & Perrot, S. (2022). Mechanisms of Chronic Pain in Inflammatory Rheumatism: The Role of Descending Modulation. Pain, 164(3), 605-612. https://doi.org/10.1097/j.pain.0000000000002745
Ünal‐Aydın, P., Arslan, A., & Aydın, O. (2022). Abstracts From the 1st Balkans Clinical Neuroscience Symposium. Epiphany, 15(1), 244. https://doi.org/10.21533/epiphany.v15i1.402
Xiong, X., Zhang, S.-Y., Zhang, J., Jiang, N., Zhang, L., Yang, H.-L., & Yue, Y. (2023). Exploring the Relationship Between Perfectionism and Pain in Patients With Temporomandibular Disorders: A Cross-Sectional Study. International Journal of Clinical Practice, 2023, 1-7. https://doi.org/10.1155/2023/2857115
Zhao, W., Someren, E. J. V., Xu, Z., Ren, Z., Tang, L., Li, C., & Lei, X. (2024). Identifying the Insomnia-Related Psychological Issues Associated With Hyperarousal: A Network Perspective. International Journal of Psychophysiology, 195, 112276. https://doi.org/10.1016/j.ijpsycho.2023.112276
Downloads
Additional Files
Publication Timeline
- Submitted
- Revised
- Accepted
