Kaylee Fisher, Nancy M Bauman, Pamela A Mudd, Courtney Long, Hengameh K Behzadpour, Lilia Mucka Andrew
This pediatric VCD cohort demonstrated a distinct perfectionism profile, with over half of subjects exhibiting clinically elevated perfectionism compared to age- and gender-matched normative data. These findings support the use of psychometric profiling to guide individualized treatment strategies, with attention to underlying perfectionistic traits and suggest a potential shift in management toward addressing internal cognitive frameworks alongside external stressors to improve long-term outcomes.
IMPORTANCE: Pediatric Vocal Cord Dyskinesia (VCD) is frequently diagnosed in high-achieving youth. However, perfectionism traits in this population remain unquantified.
OBJECTIVE: We sought to determine if our VCD population demonstrates high levels of perfectionism and to examine the relationship between perfectionism and clinical and demographic variables.
DESIGN: Setting, and Participants: Prospective observational cohort study conducted from January 2022 to July 2025 at a tertiary care multidisciplinary pediatric VCD clinic. Participants included 40 consecutive patients diagnosed with VCD.
MAIN OUTCOME MEASURES: Perfectionism was measured using the Child and Adolescent Perfectionism Scale (CAPS), with domains of self-oriented perfectionism (SOP) and socially prescribed perfectionism (SPP). Z-scores were generated using age- and gender-matched normative data and considered elevated if Z ≥ 1 standard deviation above normative means. Secondary measures included demographics and clinical and diagnostic characteristics.
RESULTS: Subjects had a mean age of 13.8 years (SD = 2.9), and 75% were female. The median SOP Z-score was 0.88 (interquartile range [IQR] 0.06 to 1.69), and the median SPP Z-score was -0.54 (IQR -1.16 to 0.37). Elevated SOP (Z ≥ 1) was present in 50% of patients, and 7.5% demonstrated elevated SPP. Overall, 52.5% of patients exhibited elevation in at least one perfectionism domain. Elevated SOP was associated with diagnostic delays and lower emergency room utilization (p < .05).
CONCLUSIONS AND RELEVANCE: This pediatric VCD cohort demonstrated a distinct perfectionism profile, with over half of subjects exhibiting clinically elevated perfectionism compared to age- and gender-matched normative data. These findings support the use of psychometric profiling to guide individualized treatment strategies, with attention to underlying perfectionistic traits and suggest a potential shift in management toward addressing internal cognitive frameworks alongside external stressors to improve long-term outcomes.