研究背景：在乳癌病人照護中，提升病人生活品質是重要的目標，而性格特質是能夠預測生活品質的關鍵因素之一。根據理論，完美主義特質對於癌症等慢性疾病而言，是影響疾病適應的風險因子，可能藉由不良的人際互動影響身心健康。完美主義可分為自我導向型、社會規定型及他人導向型三向度，過去研究認為此三向度對人際適應與健康的影響有所差異，然而目前針對癌症病人的相關研究仍相當有限。因此，本研究期望能探索乳癌病人的完美主義三向度如何預測癌症寂寞感與生活品質，以及癌症寂寞感在此路徑中的中介效果。
研究方法：本研究採橫斷式調查，以113位術後六個月內的乳癌病人為對象，使用短版多向度完美主義量表（Multidimensional Perfectionism Scale-Short Form; HF-MPS-SF）、癌症寂寞感量表（Cancer Loneliness Scale; CLS）以及EORTC癌症生活品質核心問卷（QLQ-C30）與乳癌生活品質問卷（QLQ-BR23）進行評估，並使用路徑分析檢驗多向度完美主義、癌症寂寞感與生活品質的關係。
研究結果：路徑分析顯示自我導向型完美主義可透過癌症寂寞感正向預測生活品質，社會規定型完美主義可透過癌症寂寞感負向預測生活品質，他人導向型完美主義則無顯著預測效果。不論是自我導向型或社會規定型完美主義，對生活品質的預測皆受到癌症寂寞感的完全中介。
討論與結論：完美主義中的社會規定型向度是預測乳癌病人生活品質的重要風險因子，且癌症寂寞感是其中的關鍵機制，自我導向型則具備部分適應性。當病人過度擔憂外在評價，自覺必須在他人面前表現完美，將使其在面對乳癌與治療的挑戰時，較容易感到與他人疏離、缺乏所需的社會支持，並且有較低的生活品質。醫療團隊可考慮在診斷初期針對社會規定型完美主義進行預防性篩檢，將高風險病人轉介病友團體或臨床心理照護資源，以提升病人生活品質。

Background: While optimizing quality of life (QoL) has become a core priority in breast cancer care, specific personality dispositions serve as critical indicators of patient well-being. Perfectionism has been theorized as a risk factor for illness adjustment in chronic diseases such as cancer, potentially affecting physical and psychosocial health through maladaptive interpersonal functioning. Perfectionism comprises three dimensions — self-oriented perfectionism (SOP), socially prescribed perfectionism (SPP), and other-oriented perfectionism (OOP) — which are thought to differ in their effects on interpersonal adjustment and health outcomes. However, empirical research on perfectionism in cancer populations remains limited. This study aimed to examine how the three dimensions of perfectionism predict cancer loneliness and QoL in breast cancer patients, and to investigate the mediating role of cancer loneliness in these pathways.
Methods: A cross-sectional design was conducted among 113 breast cancer patients within six months post-surgery. Participants were assessed using the Hewitt-Flett Multidimensional Perfectionism Scale-Short Form (HF-MPS-SF), the Cancer Loneliness Scale (CLS), the EORTC Quality of Life Core Questionnaire (QLQ-C30), and the Breast Cancer Module (QLQ-BR23). Path analysis was conducted to examine the relationships among multidimensional perfectionism, cancer loneliness, and quality of life.
Results: Path analysis revealed that SOP positively predicted quality of life through cancer loneliness, while SPP negatively predicted quality of life through cancer loneliness. OOP showed no significant predictive effects. Cancer loneliness fully mediated the relationships between both SOP and SPP on quality of life.
Discussion: SPP emerged as a significant risk factor for quality of life in breast cancer patients, with cancer loneliness serving as the key mediating mechanism, while SOP demonstrated partial adaptiveness. When patients are overly concerned about external evaluation and feel compelled to appear perfect in front of others, they are more likely to experience social disconnection and insufficient social support when facing the challenges of breast cancer and its treatment, resulting in poorer quality of life. Healthcare teams are encouraged to implement proactive screening for SPP upon diagnosis, referring high-risk patients to peer support groups or clinical psychology services to improve quality of life outcomes.

吳娮翎（2026年4月20日）。新聞挖挖哇｜30歲乳癌人生無敵了！資深營養師10年觀察「完美主義」會罹癌？癌症前兆被忽略，乳癌原因跟情緒有關？大病之後的人生轉變！20260224。OOPSWU。https://oopswu.com/2026/04/20/%E6%96%B0%E8%81%9E%E6%8C%96%E6%8C%96%E5%93%87%EF%BD%9C30%E6%AD%B2%E4%B9%B3%E7%99%8C%E4%BA%BA%E7%94%9F%E7%84%A1%E6%95%B5%E4%BA%86%EF%BC%81%E8%B3%87%E6%B7%B1%E7%87%9F%E9%A4%8A%E5%B8%AB10%E5%B9%B4/
李玥妡（2025）。自我導向型及社會規定型完美主義與不同心理健康之關聯--以目標導向為中介。未出版之碩士論文，國立中正大學，心理學系臨床心理學研究所，嘉義縣。
岩滝宙夢（2021）。探討英語為外語學習者之完美主義、寫作焦慮與寫作表現間的關係。未出版之碩士論文，國立臺灣師範大學，英語學系，臺北市。
楊國樞（2004）。華人自我的理論分析與實徵研究：社會取向與個人取向的觀點。本土心理學研究，22，11-80。
臺灣癌症登記中心（2025）。癌症五年相對存活率（僅含侵襲癌）。取自：https://twcr.tw/?page_id=1804
衛生福利部國民健康署（2024）。中華民國111年癌症登記報告。取自：https://www.hpa.gov.tw/Pages/List.aspx?nodeid=269
鄭斐文（2023）。做乳房：醫療論述與乳癌病患的身體經驗。人文及社會科學集刊，35(4)，715-757。
羅家玲、吳秀碧（2015）。團體諮商歷程中乳癌患者對疾病經驗解釋之研究。臺灣諮商心理學報，3(1)，53-77。
Aaronson, N. K., Ahmedzai, S., Bergman, B., Bullinger, M., Cull, A., Duez, N. J., Filiberti, A., Flechtner, H., Fleishman, S. B., de Haes, J. C., Kaasa, S., Klee, M. C., Osoba, D., Razavi, D., Rofe, P. B., Schraub, S., Sneeuw, K. C., Sullivan, M., & Takeda, F. (1993). The European Organisation for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. Journal of the National Cancer Institute, 85(5), 365-376.
Adams, R. N., Mosher, C. E., Abonour, R., Robertson, M. J., Champion, V. L., & Kroenke, K. (2016). Cognitive and situational precipitants of cancer patients’ loneliness: A qualitative analysis. Oncology Nursing Forum, 43(2), 156–163.
Adams, R. N., Mosher, C. E., Rand, K. L., Hirsh, A. T., Monahan, P. O., Abonour, R., & Kroenke, K. (2017). The cancer loneliness scale and cancer-related negative social expectations scale: development and validation. Quality of Life Research, 26(7), 1901-1913.
Adams, R. N., Mosher, C. E., Winger, J. G., Abonour, R., & Kroenke, K. (2018). Cancer-related loneliness mediates the relationships between social constraints and symptoms among cancer patients. Journal of behavioral medicine, 41(2), 243-252.
Banville, C., Massicotte, V., Caplette-Gingras, A., Langlois, F., Gouin, J.-P., Flett, G., Molnar, D. S., Lemieux, J., & Savard, J. (2024). A qualitative study of perfectionism among self-identified perfectionist women with nonmetastatic breast cancer. Journal of Psychosocial Oncology Research and Practice, 6(1), e122.
Barnett, M. D., Moore, J. M., & Edzards, S. M. (2020). Body image satisfaction and loneliness among young adult and older adult age cohorts. Archives of gerontology and geriatrics, 89, 104088.
Baumeister, R. F., & Leary, M. R. (1995). The Need to Belong: Desire for Interpersonal Attachments as a Fundamental Human Motivation. Psychological Bulletin, 117(3), 497-529.
Beutel, M. E., Klein, E. M., Brähler, E., Reiner, I., Jünger, C., Michal, M., ... & Tibubos, A. N. (2017). Loneliness in the general population: prevalence, determinants and relations to mental health. BMC psychiatry, 17(1), 97.
Blom, M., Guicherit, O. R., & Hoogwegt, M. T. (2023). Perfectionism, intolerance of uncertainty and coping in relation to fear of cancer recurrence in breast cancer patients. Psycho‐oncology, 32(4), 581-588.
Bloom, J. R., Stewart, S. L., Chang, S., & Banks, P. J. (2004). Then and now: quality of life of young breast cancer survivors. Psycho‐Oncology: Journal of the Psychological, Social and Behavioral Dimensions of Cancer, 13(3), 147-160.
Birch, H. A., Riby, L. M., & McGann, D. (2019). Perfectionism and PERMA: The benefits of other-oriented perfectionism. International Journal of Wellbeing, 9(1), 20-42.
Boehlen, F. H., Maatouk, I., Friederich, H. C., Schoettker, B., Brenner, H., & Wild, B. (2022). Loneliness as a gender-specific predictor of physical and mental health-related quality of life in older adults. Quality of life research : an international journal of quality of life aspects of treatment, care and rehabilitation, 31(7), 2023–2033.
Burns, D. D. (1980). The perfectionist’s script for self-defeat. Psychology today, 14(6), 34-52.
Cacioppo, S., Grippo, A. J., London, S., Goossens, L., & Cacioppo, J. T. (2015). Loneliness: Clinical import and interventions. Perspectives on psychological science, 10(2), 238-249.
Caffo, O., Amichetti, M., Ferro, A., Lucenti, A., Valduga, F., & Galligioni, E. (2003). Pain and quality of life after surgery for breast cancer. Breast cancer research and treatment, 80(1), 39-48.
Cella, D. F. (1994). Quality of life: concepts and definition. Journal of pain and symptom management, 9(3), 186-192.
Chen, S., Saklofske, D. H., Flett, G. L., & Hewitt, P. L. (2024). Assessing and evaluating the perfectionism social disconnection model: Social support, loneliness, and distress among undergraduate, law, and medical students. Journal of Psychoeducational Assessment, 42(6), 743-767.
Chie, W. C., Chang, K. J., Huang, C. S., & Kuo, W. H. (2003). Quality of life of breast cancer patients in Taiwan: validation of the Taiwan Chinese version of the EORTC QLQ‐C30 and EORTC QLQ‐BR23. Psycho‐Oncology: Journal of the Psychological, Social and Behavioral Dimensions of Cancer, 12(7), 729-735.
Curran, P. J., West, S. G., & Finch, J. F. (1996). The robustness of test statistics to nonnormality and specification error in confirmatory factor analysis. Psychological methods, 1(1), 16.
Deckx, L., van den Akker, M., & Buntinx, F. (2014). Risk factors for loneliness in patients with cancer: a systematic literature review and meta-analysis. European Journal of Oncology Nursing, 18(5), 466-477.
Demir, A., & Fişiloĝlu, H. (1999). Loneliness and marital adjustment of Turkish couples. The Journal of Psychology, 133(2), 230-240.
Denford, S., Harcourt, D., Rubin, L., & Pusic, A. (2011). Understanding normality: a qualitative analysis of breast cancer patients concepts of normality after mastectomy and reconstructive surgery. Psycho‐oncology, 20(5), 553-558.
DeVellis, R. F., & Thorpe, C. T. (2021). Scale development: Theory and applications. Sage publications.
Emilee, G., Ussher, J. M., & Perz, J. (2010). Sexuality after breast cancer: a review. Maturitas, 66(4), 397-407.
Fathima, Z., & Nambiar, D. (2025). From Perfect to Alone: Examining the Connection Between Perfectionism and Loneliness Among Gen Z. International Journal of Indian Psychȯlogy, 13(1).
Fayers, P. M., Aaronson, N. K., Bjordal, K., Groenvold, M., Curran, D., & Bottomley, A. (2001). The EORTC QLQ-C30 scoring manual (3rd ed.). European Organisation for Research and Treatment of Cancer.
Ferlay J, Ervik M, Lam F, Laversanne M, Colombet M, Mery L, Piñeros M, Znaor A, Soerjomataram I, Bray F (2024). Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer. Available from: https://gco.iarc.who.int/today
Flett, G. L., & Hewitt, P. L. (2015). Managing perfectionism and the excessive striving that undermines flourishing Implications for leading the perfect life. In Flourishing in life, work and careers (pp. 45-66). Edward Elgar Publishing.
Flett, G. L., Sawatzky, D. L., & Hewitt, P. L. (1995). Dimensions of perfectionism and goal commitment: A further comparison of two perfectionism measures. Journal of Psychopathology and Behavioral Assessment, 17(2), 111-124.
Frost, R. O., Heimberg, R. G., Holt, C. S., Mattia, J. I., & Neubauer, A. L. (1993). A comparison of two measures of perfectionism. Personality and individual differences, 14(1), 119-126.
Frost, R. O., Marten, P., Lahart, C., & Rosenblate, R. (1990). The dimensions of perfectionism. Cognitive therapy and research, 14(5), 449-468.
Garner, D. M., Olmstead, M. P., & Polivy, J. (1983). Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. International journal of eating disorders, 2(2), 15-34.
Hamachek, D. E. (1992). Encounters with the self. Harcourt Brace Jovanovich.
Hashemi, S. M., Rafiemanesh, H., Aghamohammadi, T., Badakhsh, M., Amirshahi, M., Sari, M., Behnamfar, N., & Roudini, K. (2020). Prevalence of anxiety among breast cancer patients: a systematic review and meta-analysis. Breast cancer, 27(2), 166–178.
Hawkley, L. C., & Cacioppo, J. T. (2010). Loneliness matters: A theoretical and empirical review of consequences and mechanisms. Annals of behavioral medicine, 40(2), 218-227.
Heidary, Z., Ghaemi, M., Hossein Rashidi, B., Kohandel Gargari, O., & Montazeri, A. (2023). Quality of life in breast cancer patients: a systematic review of the qualitative studies. Cancer Control, 30, 1-10.
Heinrich, L. M., & Gullone, E. (2006). The clinical significance of loneliness: A literature review. Clinical psychology review, 26(6), 695-718.
Hewitt, P. L., & Flett, G. L. (1991). Dimensions of perfectionism in unipolar depression. Journal of abnormal psychology, 100(1), 98.
Hewitt, P. L., & Flett, G. L. (2002). Perfectionism and stress processes in psychopathology. In Perfectionism Theory, research, and treatment. (pp. 255–284). American Psychological Association.
Hewitt, P. L., Flett, G. L., & Mikail, S. F. (1995). Perfectionism and relationship adjustment in pain patients and their spouses. Journal of Family Psychology, 9(3), 335.
Hewitt, P. L., Flett, G. L., Sherry, S. B., & Caelian, C. (2006). Trait Perfectionism Dimensions and Suicidal Behavior. In T. E. Ellis (Ed.), Cognition and suicide: Theory, research, and therapy (pp. 215–235). American Psychological Association.
Hewitt, P. L., Habke, A. M., Lee-Baggley, D. L., Sherry, S. B., & Flett, G. L. (2008). The impact of perfectionistic self-presentation on the cognitive, affective, and physiological experience of a clinical interview. Psychiatry, 71(2), 93-122.
Hewitt, P. L., Smith, M. M., Deng, X., Chen, C., Ko, A., Flett, G. L., & Paterson, R. J. (2020). The perniciousness of perfectionism in group therapy for depression: A test of the perfectionism social disconnection model. Psychotherapy, 57(2), 206.
Horowitz, L. M., French, R. D. S., & Anderson, C. A. (1982). The prototype of a lonely person. Loneliness: A sourcebook of current theory, research, and therapy, 183-205.
Irvine, D., Brown, B., Crooks, D., Roberts, J., & Browne, G. (1991). Psychosocial adjustment in women with breast cancer. Cancer, 67(4), 1097-1117.
Jaremka, L. M., Andridge, R. R., Fagundes, C. P., Alfano, C. M., Povoski, S. P., Lipari, A. M., Agnese, D. M., Arnold, M. W., Farrar, W. B., Yee, L. D., Carson, W. E. III, Bekaii-Saab, T., Martin, E. W., Jr., Schmidt, C. R., & Kiecolt-Glaser, J. K. (2014). Pain, depression, and fatigue: Loneliness as a longitudinal risk factor. Health Psychology, 33(9), 948–957.
Kootstra, J., Hoekstra-Weebers, J. E., Rietman, H., de Vries, J., Baas, P., Geertzen, J. H., & Hoekstra, H. J. (2008). Quality of life after sentinel lymph node biopsy or axillary lymph node dissection in stage I/II breast cancer patients: a prospective longitudinal study. Annals of surgical oncology, 15(9), 2533-2541.
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.
Liu, X., Chen, C., Wu, Q., Ji, Q., & Zhu, P. (2022). Dilemma: disclosure experience among young female breast cancer survivors in China. Journal of Adolescent and Young Adult Oncology, 11(5), 486-492.
Lovelace, D. L., McDaniel, L. R., & Golden, D. (2019). Long‐term effects of breast cancer surgery, treatment, and survivor care. Journal of midwifery & women's health, 64(6), 713-724.
Manne, K. (2017). Down girl: The logic of misogyny. Oxford University Press.
Mokhtari-Hessari, P., & Montazeri, A. (2020). Health-related quality of life in breast cancer patients: review of reviews from 2008 to 2018. Health and quality of life outcomes, 18(1), 338.
Molnar, D. S., Reker, D. L., Culp, N. A., Sadava, S. W., & DeCourville, N. H. (2006). A mediated model of perfectionism, affect, and physical health. Journal of Research in Personality, 40(5), 482-500.
Molnar, D. S., Sadava, S. W., Flett, G. L., & Colautti, J. (2012). Perfectionism and health: A mediational analysis of the roles of stress, social support and health-related behaviours. Psychology & Health, 27(7), 846-864.
Molnar, D. S., Sirois, F. M., & Methot-Jones, T. (2016). Trying to be perfect in an imperfect world: Examining the role of perfectionism in the context of chronic illness. In Perfectionism, health, and well-being (pp. 69-99). Cham: Springer International Publishing.
Montazeri, A. (2008). Health-related quality of life in breast cancer patients: a bibliographic review of the literature from 1974 to 2007. Journal of experimental & clinical cancer research, 27(1), 32.
Mullen, B., Atkins, J. L., Champion, D. S., Edwards, C., Hardy, D., Story, J. E., & Vanderklok, M. (1985). The false consensus effect: A meta-analysis of 115 hypothesis tests. Journal of Experimental Social Psychology, 21(3), 262-283.
Park, C., Majeed, A., Gill, H., Tamura, J., Ho, R. C., Mansur, R. B., Nasri, F., Lee, Y., Rosenblat, J. D., Wong, E., & McIntyre, R. S. (2020). The Effect of Loneliness on Distinct Health Outcomes: A Comprehensive Review and Meta-Analysis. Psychiatry research, 294, 113514.
Parton, C. M., Ussher, J. M., & Perz, J. (2016). Women’s construction of embodiment and the abject sexual body after cancer. Qualitative Health Research, 26(4), 490-503.
Penberthy, J. K., Stewart, A. L., Centeno, C. F., & Penberthy, D. R. (2023). Psychological Aspects of Breast Cancer. The Psychiatric clinics of North America, 46(3), 551-570.
Perlman, D., & Peplau, L. A. (1982). Theoretical approaches to loneliness. Loneliness: A sourcebook of current theory, research and therapy, 36, 123-34.
Pilevarzadeh, M., Amirshahi, M., Afsargharehbagh, R., Rafiemanesh, H., Hashemi, S. M., & Balouchi, A. (2019). Global prevalence of depression among breast cancer patients: a systematic review and meta-analysis. Breast cancer research and treatment, 176(3), 519-533.
Rnic, K., Hewitt, P. L., Chen, C., Flett, G. L., Jopling, E., & LeMoult, J. (2021). Examining the link between multidimensional perfectionism and depression: A longitudinal study of the intervening effects of social disconnection. Journal of Social and Clinical Psychology, 40(4), 277-303.
Rosedale, M. (2009, March). Survivor loneliness of women following breast cancer. In Oncology nursing forum (Vol. 36, No. 2).
Rubenstein, C., & Shaver, P. (1982). The experience of loneliness. Loneliness: A sourcebook of current theory, research and therapy, 206-223.
Segrin, C., Badger, T. A., & Sikorskii, A. (2019). A dyadic analysis of loneliness and health-related quality of life in Latinas with breast cancer and their informal caregivers. Journal of Psychosocial Oncology, 37(2), 213-227.
Shapiro, S. L., Lopez, A. M., Schwartz, G. E., Bootzin, R., Figueredo, A. J., Braden, C. J., & Kurker, S. F. (2001). Quality of life and breast cancer: relationship to psychosocial variables. Journal of clinical psychology, 57(4), 501-519.
Sheftel, M. G., Margolis, R., & Verdery, A. M. (2024). Life events and loneliness transitions among middle-aged and older adults around the world. The Journals of Gerontology: Series B, 79(1), gbad149.
Sherry, S. B., Law, A., Hewitt, P. L., Flett, G. L., & Besser, A. (2008). Social support as a mediator of the relationship between perfectionism and depression: A preliminary test of the social disconnection model. Personality and Individual Differences, 45(5), 339-344.
Sherry, S. B., Mackinnon, S. P., & Gautreau, C. M. (2016). Perfectionists do not play nicely with others: Expanding the social disconnection model. In Perfectionism, health, and well-being (pp. 225-243). Cham: Springer International Publishing.
Sirois, F. M., & Molnar, D. S. (2016). Conceptualizations of perfectionism, health, and well-being: An introductory overview. In Perfectionism, health, and well-being (pp. 69-99). Cham: Springer International Publishing.
Sirois, F. M., & Molnar, D. S. (2017). Perfectionistic strivings and concerns are differentially associated with self-rated health beyond negative affect. Journal of Research in Personality, 70, 73-83.
Slaney, R. B., Rice, K. G., Mobley, M., Trippi, J., & Ashby, J. S. (2001). The Revised Almost Perfect Scale. Measurement and Evaluation in Counseling and Development, 34(3), 130–145.
Stoeber, J. (2018). Comparing two short forms of the Hewitt–Flett multidimensional perfectionism scale. Assessment, 25(5), 578-588.
Stoeber, J., & Otto, K. (2006). Positive conceptions of perfectionism: Approaches, evidence, challenges. Personality and social psychology review, 10(4), 295-319.
Tiedtke, C., de Rijk, A., Dierckx de Casterlé, B., Christiaens, M. R., & Donceel, P. (2010). Experiences and concerns about ‘returning to work’for women breast cancer survivors: a literature review. Psycho‐oncology, 19(7), 677-683.
Tran, T. X. M., Jung, S. Y., Lee, E. G., Cho, H., Cho, J., Lee, E., Chang, Y. J., & Cho, H. (2023). Long-term trajectory of postoperative health-related quality of life in young breast cancer patients: a 15-year follow-up study. Journal of cancer survivorship : research and practice, 17(5), 1416–1426.
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.
Waks, A. G., & Winer, E. P. (2019). Breast cancer treatment: a review. Jama, 321(3), 288-300.
Walsh, S. R., Manuel, J. C., & Avis, N. E. (2005). The impact of breast cancer on younger women's relationships with their partner and children. Families, Systems, & Health, 23(1), 80-93.
Weiss, R. (1973). Loneliness: The experience of emotional and social isolation. The MIT press.
Wintraecken, V. M., Vulik, S., de Wild, S., Dirksen, C., Koppert, L. B., de Vries, J., & Smidt, M. L. (2022). A descriptive systematic review of the relationship between personality traits and quality of life of women with non-metastatic breast cancer. BMC cancer, 22(1), 426.
Wortman, C. B. (1984). Social support and the cancer patient. Conceptual and methodologic issues. Cancer, 53(10 Suppl), 2339-2362.
Yovani, M. C., & Rumondor, P. C. (2021). Perfectionistic concerns, other-oriented perfectionism and marital satisfaction. Jurnal Ecopsy, 8(2), 119-128.