Athlete Perfectionism and Help Seeking

Do athletes with perfectionism seek help when they develop emotional problems? Longitudinal investigation of dimensions of perfectionism and help seeking in college athletes

Abstract

Objectives

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Young people are generally
reluctant to
seek mental health care, and perfectionism is one
of the factors that prevents help seeking. The purpose of this article is to
investigate whether perfectionistic athletes seek help when they develop
emotional and performance problems, and what types of help and support they
look for, if they do seek help.

Design and Method

Study 1 employed a
longitudinal design to test if perfectionistic athletes sought help, and 132
college athletes were asked to complete a questionnaire that included two forms
of perfectionism (self-oriented perfectionism and socially prescribed
perfectionism), help seeking, depression, stigma, and attitude toward seeking
help. Study 2 asked 109 college athletes what types of help and support they
would seek.

Results

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The results of Study 1 suggest
that, even after controlling for other factors that may affect help seeking,
self-oriented perfectionism was positively associated with help seeking for
both emotional and performance problems, while socially prescribed
perfectionism was negatively associated with help seeking only for emotional
problems. The results of Study 2 suggest that college athletes with self-oriented
perfectionism would ask their coach and teammates for emotional support and
problem solving support. Moreover, they think that seeking help may contribute
to a better relationship within the team. However, college athletes with
socially prescribed perfectionism would only ask friends and family for
information about mental health.

Conclusions

The present findings suggest
that some perfectionistic athletes seek help in order to cope with emotional
and performance problems.

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Keywords: Perfectionism; help seeking; athletes; stigma; longitudinal study.

Introduction

Barriers to help seeking in youth and athletes

A wide range of studies attests to young people’s reluctance to seek professional mental health care. For example, a school-based survey of 11,154 Norwegian youth aged 15–16 years reported that, even at the highest symptom levels for anxiety and depression, only a third had sought professional help. Similarly, the most recent national survey data for Australia show that only 29% of children and adolescents with a mental health problem had been in contact with a professional service of any type in a 12-month period (Andrews, Teesson, & Henderson, 1999). Gulliver, Griffiths, and Christensen (2010) reviewed perceived barriers to mental health help seeking in young people. The barriers firstly include poor mental health literacy, such as feeling unsure about where to seek help, not being able to distinguish between ‘real distress’ and ‘normal distress,’ and being uninformed about available services. Secondly, they identified attitudes and personal characteristics that may prevent them from seeking help, such as male gender, ethnicity, low emotional competence, negative attitudes to professional help-seeking, the belief that the problem would go away or could be solved without help, lack of confidence in the professional opinion of the specialist or doctor, a culture of self-reliance especially in rural areas, not wishing to admit to having a disorder, accessing help making it ‘real’, and not selecting GPs as a source of help. Following that, stigma including embarrassment, privacy and confidentiality concerns particularly amongst those living in a small town, and negative self-perceptions may discourage young people from seeking help. Finally, practical barriers such as lack of transport to access help, difficulty obtaining help, inadequate time, and financial cost could also be barriers to help seeking.

As elite athletes tend to fall within this high-risk age group, Gulliver,
Griffiths, and Christensen (2012) qualitatively investigated what young elite athletes
perceive as the barriers and facilitators to help seeking for common mental
health problems. Participants’ written and verbal data suggested that stigma
was the most important perceived barrier to seeking help for young elite
athletes. Other notable barriers were a lack of mental health literacy and
negative past experiences of help seeking. Facilitators to help seeking were
encouragement from others, having an established relationship with a provider,
pleasant previous interactions with providers, the positive attitudes of
others, especially their coach, and access to the Internet (Gulliver et al.,
2012).

The Multidimensional Nature of Perfectionism

Perfectionism is a personality trait characterized by striving for
flawlessness and setting exceedingly high standards of performance accompanied
by overly critical evaluations of one’s behaviour (Hewitt & Flett, 1991;
Frost, Marten, Lahart, & Rosenblate, 1990). Over the past 20 years,
research has produced converging evidence that perfectionism has different
aspects and is best conceptualized as a multidimensional characteristic (Enns
& Cox, 2002; Lo & Abbott, 2013). In particular, two main dimensions
have been differentiated: perfectionistic strivings,  i.e. setting high standards and a
self-oriented striving for perfection, and perfectionistic concerns, i.e. concerns
about making mistakes, feelings of discrepancy between one’s standards and
performance, and fears of negative evaluation and rejection by others if one
fails to be perfect (see Stoeber & Otto, 2006, for a review).

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The multidimensional nature of perfectionism and its linkages to both
maladaptive traits and negative outcomes, and less frequently, adaptive traits
and positive outcomes has generated much research during the past two decades.
Hewitt and Flett (1991) proposed three dimensions of perfectionism and
developed a self-report measure of the different components. Self-oriented
perfectionism characterizes those individuals who are assumed to create
excessively high standards for themselves and engage in intense self-criticism.
Socially prescribed perfectionism characterizes those individuals who perceive
that significant others are imposing excessively high standards on them and
that they must meet these standards in order to please others. Other-oriented
perfectionism characterizes those individuals who impose excessively high
standards on other individuals in their lives. A number of publications have
demonstrated a link between components of perfectionism and maladjustment. For
example, socially prescribed perfectionism has been linked to submissive
behaviour and shame-proneness, depression, diminished self-esteem, irrational
fears, maladaptive thinking patterns and coping, and other indices of
maladaptive symptomatology or maladjustment including suicide ideation (e.g.
Dunkley & Blankstein, 2000; Blankstein, Flett, Hewitt & Eng, 1993;
Flett, Hewitt, Blankstein & O’Brien, 1991; Hewitt & Flett, 1991; Wyatt
& Gilbert, 1998).

The Impact of Perfectionism
on The Treatment Process

There is also some
evidence that perfectionism may have an impact on outcome, being associated
with poorer prognosis and treatment drop-out (Bizeul, Sadowsky & Rigaud,
2001; Sutandar‐Pinnock,
Woodside, Carter, Olmsted & Kaplan, 2003), with OCPD traits including
perfectionism and rigidity found to be potential mediators of treatment outcome
(Crane, Roberts & Treasure, 2007). Although the means by which
perfectionism impacts outcome are not clear, it has been suggested that the all
or nothing thinking style and perceived failures associated with perfectionism
may make the setting of appropriate treatment goals difficult and that
perfectionistic traits may prevent the self-disclosure needed to establish a
strong therapeutic alliance (Goldner, Cockell & Srikameswaran, 2002). Some
support for this theory comes from a study conducted by Zuroff et al. (2000) regarding
the outcome of depression following treatment, where it was found that the
relationship between perfectionism and poorer treatment response was mediated
by the impact of perfectionism upon the therapeutic alliance.
Finally, Blatt and Zuroff (2005) found that higher levels of perfectionism at
both pre- and post-treatment predicted poorer ability to cope with life stress
18 months after treatment.

Moreover, perfectionism may affect individuals’ willingness to seek
treatment. Hewitt et al. (2003) maintain that perfectionists differ in terms of
their need to appear perfect to other people and not display or disclose
imperfections in public. Several studies support the notion that
perfectionistic individuals conceal negative personal information to maintain a
flawless appearance and avoid negative evaluation by others. For example, Frost
et al. (1995, 1997) found that perfectionistic individuals feared that others
would think negatively of them because of their mistakes, and therefore,
preferred to keep them secret. For perfectionists, the short-term benefit of
self-concealment appears to be the avoidance of evaluative threat, but
unfortunately, the long-term consequence of self-concealment may be higher
levels of psychological distress.

This unwillingness of
perfectionistic individuals to admit to others when they are having personal
difficulties may affect help seeking in
youth and athletes, because help seeking may be perceived, particularly
by athletes, as a powerful indication of weakness. Attitudes about seeking help from others are related to both perfectionism (Kelly & Achter,
1995) and self-concealment (Cepeda-Benito & Short, 1998; Hinson & Swanson, 1993). Mills
and Blankstein (2000) found that perfectionists exhibited a fear that others
would evaluate them negatively for poor academic performance and feared asking
for academic assistance. Regarding self-concealment and help-seeking attitudes,
Cepeda-Benito and Short (1998) found that high self-concealers were most likely
to avoid seeking needed psychological services. Finally, Hewitt, Flett, and Wekerle (2012) found that self-oriented
perfectionism is associated with internalized emotion-oriented coping responses
and self-reliant problem-solving, suggesting that perfectionists would keep the
problem to themselves rather than disclosing it to other people.

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Purpose
of this study

Flett and Hewitt (2014) point out that, if perfectionistic athletes are
indeed particularly susceptible to distress and tend to have difficulties
coping with stress, it is essential to study their willingness to seek help.
Those athletes who are high in perfectionistic self-presentation should be especially
unlikely to seek help if they are prone to self-stigma and endorse beliefs that
seeking help is an admission of being weak and imperfect. This issue is vitally
important to evaluate and the lack of help seeking points to the need for
proactive, preventive interventions. On the other hand, some perfectionists, at
least individuals with perfectionistic strivings, might seek help. A number of
studies have examined links between perfectionism and coping-strategy
utilization in sport and non-sport settings. In general, these studies have
found significant positive relationships between active, task-oriented, and
problem-oriented coping styles and subscales that measure sub-dimensions of
perfectionistic strivings (Dunkley, Blankstein, Halsall, Williams, &
Winkworth, 2000; Gaudreau & Antl, 2008), self-oriented perfectionism (Hill,
Hall, & Appleton, 2010; Kobori, Yoshie, Kudo, & Otsuki, 2011), and striving
for perfection (Stoeber & Childs, 2010; Stoeber & Rennert, 2008).
Moreover, self-oriented perfectionism is associated with adaptive social skills
(Flett, Hewitt, & DeRosa, 1996). These results suggest that individuals
with positive/adaptive forms of perfectionism can be good at seeking the help
and support of other people. However, it remains unknown as to what support perfectionistic
athletes seek and the way they want other people to help them. For example,
they may look for practical advice from their coach, want close friends to
listen to, or only want someone to do something with them for distraction,
without disclosing the detail of their problems.

So far, no studies have investigated the relationship between dimensions of
perfectionism and help seeking. The purpose of Study 1 was to investigate whether
perfectionism prevents athletes from seeking help. Regarding the problems they
seek help for, we included both emotional problems, and problems about athletic
performance. We hypothesized that only the facets of perfectionistic concerns,
not perfectionistic strivings, would prevent athletes from seeking help, even
after controlling for the stigma about mental health, attitudes toward
professional psychological help (e.g. how effective one thinks psychological
help is), and current level of depression, because these variables may affect
the motivations to seek help. Moreover, Study 1 employed a longitudinal design in
order that participants indicate whether they actually sought help over a
specific period of time (help seeking behaviour), as well as how likely they
would be to seek help (help seeking intention).

As athletes with perfectionistic strivings might seek help as an active
coping strategy, Study 2 explored further the way athletes utilize help and
support from other people, and its relationship to both perfectionistic
strivings and perfectionistic concerns. In other words, we examined what type
of help perfectionistic athletes may want from the other person. We also asked
athletes whether they see any secondary benefits of help seeking (i.e. benefits
other than resolving their problems). For example, perfectionistic athletes may
see seeking help as an opportunity to establish a trustful relationship with
other people, which can eventually enhance their performance. These
investigations will inform us of the person who can be the first contact when
athletes with perfectionism seek help, but also shed light on how we respond to
athletes with perfectionism when they seek help.

Study 1

Method

Design

            A longitudinal design was employed
to measure both help seeking intentions and help seeking behaviours. All the
measures except for Actual Help Seeking Questionnaire were administered to 132
participants. In 12 weeks, 96 participants completed the Actual Help Seeking
Questionnaire.

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Participants

At the end of a psychology lecture, college athletes
were asked to complete the questionnaire. A total of 132 college athletes were
recruited to participate in this study. The participants consisted of 48 men
and 84 women with a mean age of 18.22 years (SD=0.584), and 91% identified their
ethnicity as Japanese; the remaining 9% were Asian or Mixed. Their average practice
hours per week was 13.09 hours (SD=7.589), and average career history as an
athlete was 11.34 years (SD=3.684). They competed in different sports including
football, tennis, dancing, swimming, basketball, badminton, volleyball,
handball, lacross, gymnastics, kendo, aikido, table tennis, judo, softball,
baseball, rugby, and track and field.

Measures

Multidimensional Perfectionism Scale (MPS: Hewitt & Flett, 1991). In
order to measure the different facets of perfectionism traits, the Japanese version
of the MPS (Ohtani & Sakurai, 1995) was employed. This scale is a Japanese
translation of the MPS (Hewitt & Flett, 1991) that also consists of 3
dimensions (i.e. self-oriented perfectionism, other-oriented perfectionism, and
socially prescribed perfectionism). The psychometric properties of the Japanese
version of the MPS have been confirmed by Ohtani and Sakurai (1995), who
reported good construct validity, internal consistency (alpha = .65–.83), and
test-retest reliability (r = .61–.73). Items related to self-oriented
perfectionism and socially prescribed perfectionism from the Japanese version
of the MPS were administered. Participants rated these questions on a 7-point
Likert scale ranging from ‘disagree’ to ‘agree’.

             
Patient Health Questionnaire (PHQ-9) (Kroenke et al., 2001). The PHQ-9 was employed to
assess participant’s general wellbeing; it is a 9-item self-report
questionnaire originally measuring depressive symptoms. Items are scored on a
4-point scale from 0 (not at all) to 3 (nearly every day) with total scores
ranging from 0 to 27. The questions are based on the DSM-IV diagnostic
criteria, and thus, can provide both a diagnosis as well as a measurement of
depression severity (Kroenke & Spitzer, 2002). A cut off score of 10 or
greater has a sensitivity and specificity of 88% and a drop of at least 5
points is considered a clinically significant response (Kroenke & Spitzer,
2002). The internal consistency of the scale ranges from .86 to .89 (Kroenke et
al., 2001). The Japanese version (Inagaki et al.,
2013) was employed for this study.

Discrimination-Devaluation Scale (Link,
1987; Link, Cullen, Struening, Shrout, & Dohrenwend, 1989). The Japanese version of the D-D scale (Shimotsu et al.,
2006) was employed to measure public stigma. The D-D scale asks people how much
they agree with each of 12 statements that begin with ‘Most people believe . .
.’, ‘Most people think . . . ’, or ‘Most people would . . .’ followed by a
stereotype, example of discrimination, or the opposite (an accepting view or behaviour).
The original D-D scale refers to a ‘patient with mental health problems’, a ‘former
patient with mental health problem’, or a person ‘who has been hospitalized for
mental illness’. We adapted the wording to refer instead to ‘a person who has
received mental health treatment’ because our objective was to measure
perceived stigma regarding a broader concept of mental health treatment (rather
than institutional treatment for severe mental illness per se). As in the
original D-D scale, the answer choices were on a 6-point Likert scale from
strongly agree to strongly disagree. As in the original use of the scale, we
constructed an index of perceived stigma by coding each response as 0, 1, 2, 3,
4, or 5 (with higher numbers referring to answers indicating higher perceived
stigma) and calculating the average across the 12 items for each individual.

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            Attitude
toward Seeking Professional Psychological Help-Short Scale (ATSPPH-S: Fischer & Farina, 1995). The Attitude Towards Seeking Professional Psychological
Help-Short Scale (ATSPPH-S) (Fischer & Farina, 1995) measures willingness
to seek help from mental health professionals when psychological problems are
encountered in general. It is a 10-item short scale based on the original
29-item version developed by Fischer and Turner (1970). Items on the scale
include ‘I would want to get psychological help if I were worried or upset for
a long period of time’. Responses are on a 5-point scale ranging from ‘strongly
disagree (1)’ to ‘strongly agree (5)’. High scores indicate more positive
attitude towards seeking professional psychological help. Fischer and Farina
(1995) report an internal coefficient alpha of .84 and a test-retest
reliability of .80 over one month. They also report significant point biserial
correlations between individuals’ scores on the ATSPPH-S and psychological
help-seeking behaviour, an indication of a good construct validity. Elhai,
Schweinle, and Anderson (2008) also reported an internal consistency of .87 for
the scale, and a moderate correlation with the mental health care utilization
scale. The Japanese version of the ATSPPH-S was employed for this study
(Takamura, Oshima, Yoshida & Motonaga, 2008).

General Help-Seeking Questionnaire (GHSQ; Wilson, Deane, Ciarroch & Rickwood,
2005). GHSQ
assesses future help-seeking intentions. The athlete’s intentions to seek help were measured by listing a number of potential help
sources and asking participants to indicate how likely it is that they would
seek help from that source for (1) emotional and personal
problems, and (2) problems with athletic performance, on a 7-point
scale ranging from (1) extremely unlikely to seek help to (7) extremely likely
to seek help. In this study, the potential
help sources included the coach, teammates or supporting staff, partner,
friends, family, college counsellor, physicians, and mental health
professionals. These sources were grouped into three higher categories: ‘Athletic
Networks’ (average of coach and teammates or supporting staff), ‘Social Networks’
(average of partner, friends, and family), and ‘Professionals’ (average of college
counsellor, physicians, and mental health professionals).

Actual Help-Seeking Questionnaire (AHSQ;
Rickwood & Braithwaite, 1994). The
AHSQ was derived from an earlier measure used by Rickwood and Braithwaite
(1994) and developed to measure recent actual help-seeking behaviour. Listing
the same sources of help as the GHSQ, participants indicate, over the past 12
weeks, whether they sought help from that source for (1) emotional and interpersonal problems, and (2)
problems with athletic performance, by choosing either ‘yes’ or ‘no’. These
sources were grouped into three higher categories: ‘Athletic Networks’, ‘Social
Networks’, and ‘Professionals’. For computing the score, if the participant
sought help from one or more sources in the category, the score of the category
was ‘1’, whereas if the participant did not seek help from any sources, the
score of the category was ‘0’.

Results

Descriptive statistics

Table 1
presents means and standard deviations of standard
measures and help seeking intentions from Athletic Networks, Social Networks,
and Professionals, for emotional and interpersonal problems, and performance problems. Scores on help seeking intentions suggest that
athletes would seek help for emotional problems from social networks more than
athletic networks and professionals, and seek help for performance problems
from athletic networks more than social networks and professionals.

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Tables 1 and 2

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Table 2 presents the
number and percentage of athletes who actually sought help for emotional and personal
problems and performance problems from any source(s) in each category (Athletic
Network, Social Networks, and Professionals). Scores on help seeking behaviours
suggest that athletes sought help for emotional problems from social networks
more than athletic networks, and sought help for performance problems from
athletic networks more than social networks. However, few athletes sought help
from professionals for both problems.

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Hierarchical and logistic regression analysis

Tables 3 and 4 are the result of hierarchical
regression analyses that tested whether perfectionism affects help seeking
intentions after controlling for the current level of depression, stigma
related to mental health, and attitude toward seeking professional
psychological help.

The analysis of
factors that predict help seeking intentions for emotional and interpersonal
problems (Table 2) revealed that positive attitude towards seeking professional
psychological help predicted help seeking intentions not only from
professionals but also from athletic and social networks. Self-oriented
perfectionism positively predicted help seeking from athletic and social
networks, but socially prescribed perfectionism negatively predicted help
seeking from athletic and social networks. Help seeking from professionals was
not predicted by perfectionism.

The analysis of factors that predict help seeking intentions
for performance problems (Table 4) revealed that positive attitude towards seeking
professional psychological help predicted help seeking intentions only from
social networks. Self-oriented perfectionism positively predicted help seeking
from athletic and social networks, but social prescribed perfectionism did not
predict help seeking from any resources.

The analysis of
factors that predict help seeking behaviours for emotional and interpersonal
problems (Table 5) revealed that positive attitude towards seeking professional
psychological help predicted help seeking behaviours from social networks. The
analysis of factors that predict help seeking behaviours for performance problems
(Table 6) revealed that self-oriented perfectionism positively predicted help
seeking behaviours from athletic networks. Help seeking behaviours from professionals
for both problems were not analysed due to the small number of participants who
sought help.

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Tables 3-6

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Study 2

Method

Participants

The sample consisted of 119 Japanese college athletes
(women, n=34; men, n=85), majoring in sport and exercise studies at the
University of Tsukuba, Japan. The mean age of participants was 18.40 (SD=1.145)
years, the mean hours of training per week was 17.39 hours (SD=7.116), and the mean
years in training was 8.71 years (SD=3.887).

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Measures

Multidimensional
Perfectionism Scale (MPS: Hewitt & Flett, 1991). The
same scale was used as Study 1.

Help
Seeking Utilization Questionnaire. This questionnaire was
developed specifically for this study. Participants were asked what kind of
help and support they would look for if they seek help for emotional and
interpersonal problems from athletic networks (coaches and teammates) and from
social networks (partner, friends, and family). The types of support were categorized
according to the broad classification of coping strategies, which include the individual’s attempts to (a) deal with
resultant emotions, (b) approach or alter the task/problem, and (c) avoid/disengage
from the stressor entirely (see Nicholls & Polman, 2007). Participants were
asked to rate the following items from strongly disagree (1) to strongly agree
(7).

• Emotional Support: ‘I would
  seek emotional support (e.g. being listened to, receiving empathy, listening to
  other people’s experiences) by talking my problems in detail’
• Problem-Solving Support: ‘I
  would seek support for problem solving (e.g. asking for advice about what to
  do, asking the person to resolve interpersonal problems) by talking my problems
  in detail’
• Information Seeking: ‘I would
  seek information about mental health such as where to find mental health
  professionals’
• Distraction Seeking: ‘I would
  ask the person to have a chat or to do something together to freshen up’

In addition, participants were
asked if they see any secondary benefits of help seeking from athletic networks
(coaches and teammates) and from social networks (partner, friends, and family),
apart from solving emotional and interpersonal problems. They were asked to
rate the following items from strongly disagree (1) to strongly agree (7).

• Relationship Building: ‘I can develop
  a more trustful relationship with a person by seeking help for emotional and
  personal problems’
• Performance Enhancement: ‘I
  can improve my performance by seeking help for emotional and personal problems’
• Participants were also asked
  to briefly write down their ideas of any other benefits of seeking help for
  emotional and personal problems

Results

Table 7 presents the means and
standard deviations of the perfectionism scales and the type of help athletes
seek from both athletic and social networks, and potential benefits of seeking
help from these networks. The score for Information Seeking was lower than for other
types of help, and participants moderately agreed that seeking help has
secondary benefits. Self-oriented perfectionism was correlated to two types of
help sought from Athletic Networks, while socially prescribed perfectionism was
correlated only to Information Seeking from Social Network. Self-oriented
perfectionism was positively correlated with secondary benefits of seeking
help, while socially prescribed perfectionism was negatively correlated to one
of the potential benefits of seeking help from Athletic Network.

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Table 7

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Some participants wrote down
their comments about other secondary benefits of seeking help. The benefits of
seeking help from Athletic Network include:

‘It gives you a sense of
comfort that somebody is on your side’

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‘The teammate may also
tell you his or her problems’

‘The person will swiftly
notice when I am starting to develop a similar condition again’

‘The team can develop
better communication between members’

 ‘As people understand me more, they may discover
a position that suits me more‘

The benefits of seeking help
from Social Network include:

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‘The person thinks that
I am strong enough to disclose my weaknesses’

 ‘You can re-discover the good relationships
you have outside the team’

‘It may help the person to seek help from you so
that you can support each other’

General Discussion

The purpose of this article was to investigate whether perfectionistic
athletes seek help when they have emotional and performance problems, and what
types of help and support they look for, if they do seek help. Study 1
hypothesized that only the facets of perfectionistic concerns, not
perfectionistic strivings, would prevent athletes from seeking help even after
controlling for the stigma about mental health, attitudes toward professional
psychological help (e.g. how effective one thinks psychological help is), and
current level of depression. The analyses of help seeking intentions (how
likely they would seek help if they have problems) showed that self-oriented
perfectionism and socially prescribed perfectionism have different patterns of
relationships for help seeking intentions. While self-oriented perfectionism is
positively associated with help seeking intentions for both emotional and
performance problems from both athletic and social networks, socially
prescribed perfectionism is negatively associated with help seeking intentions
only for emotional problems both from athletic and social networks. Only the attitude
towards seeking professional psychological help but neither type of perfectionism
was associated with help seeking from professionals. The analyses of help
seeking behaviour (whether they actually sought help over the past 12 weeks) revealed
that self-oriented perfectionism was positively associated with help seeking
behaviours only for performance problems from athletic networks, but socially
prescribed perfectionism was not associated with any help seeking behaviours. Study
2 then explored what kind of help and support athletes with perfectionism would
seek. The results suggest that self-oriented perfectionism is associated with
two types of help (emotional support and problem solving support) from athletic
networks, while socially prescribed perfectionism is associated only with
information seeking from social network. Moreover, self-oriented perfectionism
is positively associated with the secondary benefits of seeking help such as
relationship building, while socially prescribed perfectionism is negatively
associated with such secondary benefits.

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            These findings elucidate some important theoretical
implications for perfectionism and help seeking in athletes. Firstly, our
findings consistently suggest that college athletes with self-oriented
perfectionism would seek help from informal sources such as their coach, teammates,
family, and friends. This is consistent with the finding that ‘healthy’
perfectionists view teammates as important sources of support and motivation
(Gotwals, Spencer, & Cavaliere, 2014). It is also suggested that these
athletes look for both emotional support and problem solving support when they seek
help, and they may think that seeking help can contribute to building a more
trustful relationship with a person. Flett
et al. (1996) found that self-oriented perfectionism was associated with emotional-sensitivity
and social expressiveness as measured by the Social Skills Inventory (Riggio,
1986), suggesting that individuals with such perfectionism have a perceived
ability to decode social messages and engage others in conversation. This
perceived skill may help athletes with self-oriented perfectionism to
effectively seek help and support from other people. These results contrast
with the assumption of Hewitt et al. (2003) that perfectionists try to look
perfect and flawless, and conceal their mistakes and weaknesses. For college
athletes with self-oriented perfectionism, it would be more important to
achieve their goals (e.g. winning the match) with help and support from other
people, rather than worrying too much about what they think of them if they
disclose their problems. Alternatively, they may have good interpersonal skills
that allows them to keep other people on their side, as suggested by Flett et
al. (1996).

            On the other hand, college athletes with socially
prescribed perfectionism may hesitate to seek help from those sources when they
develop emotional problems. They may seek relevant information (e.g. where to
find mental health professionals) when they seek help from family and friends,
and would not think that seeking help can contribute to building more
trustful relationships with their coach and teammates. These findings are consistent
with Gotwals et al. (2014), who found that
some ‘unhealthy’ perfectionists felt significant pressure to perform to avoid criticism
and angry reactions from the coach. They also felt pressure in not wanting to let
the teammates down. This may be why some perfectionists try to conceal their
mistakes and weaknesses (Hewitt et al., 2003), which is a possible mediator in
the relationship between perfectionism and distress (Kawamura and Frost, 2004).
Gulliver et al. (2012) discovered that athletes would be worried about others
finding out if they were seeking help for a mental health problem, because their
coach and teammates would think they were not coping effectively or were ‘weak’.
This may explain the present finding that college athletes with socially
prescribed perfectionism would not seek help when they develop emotional
problems, and they would not think that seeking help could contribute to
relationship building with the coach and teammates.

Clinical implications, limitations, and future
directions

Our findings also have
practical or clinical implications for the facilitation of athletes’ help
seeking. Both perfectionistic strivings and concerns do
not affect athletes’ help seeking from formal sources such as mental health
professionals when they develop emotional problems, and only attitudes toward
professional psychological help (e.g. how effective one thinks psychological
help is) can affect such help seeking. This is consistent with the view that
athletes do not believe that a general practitioner was an appropriate source
for seeking help for mental health problems (Gulliver et al., 2012; Boyd,
Francis, Aisbett, Newnham, Sewell, Dawes, & Nurse, 2007; Biddle, Donovan,
Gunnell, & Sharp, 2006). Athletes may not view mental health professionals
as a good source of help when they have developed emotional problems as a
result of performance problems. Alternatively, they may believe such
professionals would not understand the nature of interpersonal relationship in
sports (e.g. the coach-athlete relationship), although they suffer because of
such relationships. Thus, in order to facilitate help seeking, it would be
important to provide relevant psychoeducation to athletes at an early stage in
their career, such as how mental health professionals help athletes’ emotional
and interpersonal problems, as well as how effective the psychological therapies
are and where to find the relevant professionals.

While few adolescents
seek professional psychological help, most will seek help from a variety of
other sources, such as family members, friends, and teachers (Boldero &
Fallon, 1995; Offer, Howard, Schonert, & Ostrov, 1991). Our findings also suggest that college athletes would
seek help from a range of sources such as the coach, teammates, family, and
friends. However, college athletes with socially prescribed perfectionism may
hesitate to seek help for emotional problems from such sources. The comments that
participants provided in Study 2 may help such athletes to understand the
positive aspects of help seeking, such as (1) enhancing relationships with
other people, (2) giving opportunities for other people to tell their problems
to you in order that you support each other, and (3) helping other people to
notice when you develop similar problems again. This can be surprising as well
as helpful to those with socially prescribed perfectionism, who may fear
criticism and rejection if they disclose their problems.

However, such athletes may not know ‘how to start’ help seeking, even if
they understand that seeking help does not necessarily result in criticism and
rejection. Our clinical experiences suggest that athletes with negative
perfectionism are likely to keep emotional problems to themselves until they
can no longer practice and somebody else notices it. Moreover, most of them do
not know what to do when they can no longer practice. Thus, coaches or other
staff may need to help them to identify the person who is the easiest to seek
help from, and what kind of help and support they would like, in order that
they can start help seeking before the problems become too difficult to manage.
The coaches and staff can also stipulate a procedure for athletes who have developed
emotional problems that need support from mental health professionals. For
example, athletes may want to know who to report to first, the forms to fill in
order that they know what to report, where to find the mental health
professionals that other teammates have sought help from, and how often they
need to give an update on their condition to the relevant staff. This will help
the athletes to stop worrying about what to do, but also enhance their
awareness of mental health issues and services.

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            The present study has some limitations. First, the study
investigated college athletes. Consequently, future studies need to explore if
the present findings generalize to professional athletes and youth athletes who
may have different problems and different people who they seek help from. For
example, one of our clients (semi-professional athlete) had trouble with her
coach, and she sought help from her line manager at work, who resolved the
interpersonal problem. Further, the majority of the participants was Asian, and
cross-cultural differences might have affected the result. A survey by the
National Institute of Mental Health (Matsuoka, Breaux, & Ryujin, 1997)
reported that for all types of services (e.g. inpatients or outpatients etc.)
across all types of facilities (e.g. hospitals psychiatric services, mental
clinics, community services, etc.), Asian American/Pacific Islanders are much
less likely than their Euro-American counterparts to make use of mental health
services. A variety of research studies have examined the beliefs of Asians
toward mental illness. Following that, this study employed a longitudinal
design, but followed up the participants only for 12 weeks. Hence, future
studies need to include participants with other ethnic backgrounds, and employ
a longer follow-up period. Finally, it remains unknown what kind of intervention
can effectively facilitate athletes’ help seeking. One study has conducted a
randomized controlled trial of an Internet-based mental health help seeking
intervention for young elite athletes (Gulliver et al., 2012). Their results
suggest that brief mental health literacy and destigmatization improves
knowledge and may decrease stigma but does not increase help-seeking. The
interventions consisted of a mental health literacy and destigmatization
condition, a feedback condition providing symptom levels, and a minimal content
condition comprising a list of help-seeking resources, compared with a control
condition (Gulliver et al., 2012). Thus, future interventions may need to
include psychoeducation about how to start help seeking, and how to modify
negative perfectionism, which can prevent athletes from seeking help.

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Tables

Table 1. Means and standard deviations of standard measures, and help seeking intentions for emotional and interpersonal problems, and performance problems

Table 2. Proportion of athletes who sought help from any sources in each category

Table 3. Hierarchical regression analysis for help seeking intention for emotional and interpersonal problems

Table 4. Hierarchical regression analysis for help seeking intention for performance problems

Table 5. Logistic regression analysis of help seeking behaviours for emotional and interpersonal problems, predicted by demographics, depression, stigma, attitude towards seeking professional psychological help, and perfectionism with the block-entry model.

Table 6. Logistic regression analysis of help seeking behaviours for performance problems, predicted by demographics, depression, stigma, attitude towards seeking professional psychological help, and perfectionism with the block-entry model.

Table 7. Means and standard deviations of multidimensional perfectionism scales, help seeking utilization questionnaire, and their interrelationships.

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