Perfectionism

When most people think of perfectionism, they think of striving at any and all costs to achieve a wanted result. In fact, psychologists have shown that perfectionism has multiple components, some of which are adaptive (and even desirable) while others are actually more problematic (because they get in the way of goals or can lead individuals to feel frustrated by failures). Lots of research has confirmed the positive and negative components to perfectionism.

Positive aspects of perfectionism

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The positive aspects to perfectionism include things like setting high standards for achievement (for oneself or for others), organizational skills and neatness. Almost by definition, successful individuals are required to believe they can achieve their goals, and to have the high standards and work ethic necessary in order to achieve their goals. Having a positive support group and the skills necessary to achieve the standard can be helpful in achieving and expecting high standards to continue as well. Organizational skills can be helpful in achieving standards as well since they help people map out and test success strategies which can favour optimal results. Think of an Olympic athlete who has the expectation to succeed, puts in the time and sacrifice necessary to practice, and has the backing of coaches, sponsors, friends and family to find the winning formula. The positive aspects of perfectionism, when properly channeled, are indeed wonderful things.

Negative aspects of perfectionism: Clinical perfectionism

The negative aspects of perfectionism are perhaps less obvious. They are the “dark side” of perfectionism and the result (and maybe even the cause) of failing to achieve the desired goal: doubting one’s performance, concern over one’s mistakes, self-criticism (or criticism from loved ones) for not meeting a standard, or the individual (or their loved ones) having and maintaining unrealistic standards. These aspects of perfectionism are “dark” in that they usually lessen the chances of succeeding in the future, and because they cause considerable emotional distress and discomfort in the individual and in their support group. So it is no surprise that there is also a considerable amount of scientific research that shows that the negative side of perfectionism (called clinical perfectionism) is a risk factor for developing psychological problems.

Depression and mood swings

Clinical perfectionism can contribute to, and maintain, depression and mood swings. Clinical perfectionism is higher in individuals with depression compared with non-depressed people, and perfectionism levels are related to the severity of depression symptoms. In non-depressed individuals, clinical perfectionism has been found to predict development and worsening of depressive symptoms over a 4-month period. Also, higher clinical perfectionism scores predict poorer long-term treatment response for depressed individuals, suggesting clinical perfectionism serves to maintain depression. There is also evidence that clinical perfectionism is a vulnerability factor for mood swings in bipolar disorder and among people with self-harming behaviours. Several research papers have shown that clinical perfectionism has a strong association with self-injurious behaviours, suicidal ideation and suicidal behaviours.

Anxiety

Clinical perfectionism has a strong association with anxiety. For example, clinical perfectionism (especially doubting one’s actions and concerns over mistakes) has been linked to obsessions and compulsions in Obsessive-Compulsive Disorder. There is evidence that individuals with OCD (vs those with no OCD) have significantly higher clinical perfectionism. It has been shown that clinical perfectionism interferes with OCD treatment meaning it maintains symptoms in OCD. Several studies have found that individuals with panic attacks (vs. those who don’t) have higher clinical perfectionism. In Social Phobia (also called Social Anxiety Disorder), the leading cognitive-behavioural theory is that clinical perfectionism serves to prime socially anxious individuals to expect negative social interactions. This idea comes from the finding that, in clinical samples, socially anxious individuals (compared with those who are not socially anxious) have significantly higher levels of clinical perfectionism (especially in regards to others’ expectations of them). One treatment study of Social Phobia has found that Cognitive-Behavioural Therapy significantly improved negative perfectionism scores, and that those who did not respond to the therapy had significantly higher perfectionism at the start of treatment. This suggests that perfectionism needs to be targeted directly in Social Phobia, as higher levels of perfectionism were associated with not responding to CBT for social anxiety.

Eating Disorders

A number of studies show that clinical perfectionism increases and maintains eating disorder symptoms. Individuals with anorexia nervosa (AN) and bulimia nervosa (BN) have significantly higher perfectionism than healthy individuals. Clinical perfectionism in childhood is associated with later development of an eating disorder and individuals who have recovered from an eating disorder continue to show elevated perfectionism compared to controls.

Why is clinical perfectionism a problem?

Clinical perfectionism reduces the positive benefits of cognitive-behavioural therapies for different disorders. Studies suggest that clinical perfectionism might interfere with the patient’s ability to cope with stress after treatment, it may negatively affect the therapeutic alliance, or it may reduce the quality of social networks that help patients recover from their problem.

Treatment interventions helpful for clinical perfectionism

Clinical perfectionism can be assessed by asking about the degree to which people base their sense of self-worth on striving and achievement. If the person judges their self-worth predominately on how well they achieve their personal standards, then it is important to further assess for the maintaining factors of clinical perfectionism. This involves asking what in which areas of the person’s life they have high standards, and evaluating the impact that striving has on their life. The next step is to look at their reaction to failure to meet a goal, whether they feel satisfied after reaching a goal, and if they re-set their standards higher after meeting a goal or avoid trying to meet a goal because of fear of failure (i.e., procrastination). Possible thought biases can be assessed by determining exaggerated rules for achievement, and how the person reacts to breaking a rule. Examples to determine whether they discount their successes and notice their failures can be looked at. To assess self-criticism, a recent example of the person’s thoughts when they made a mistake is explored. Counter-productive behaviours are assessed through asking what the person avoids or delays in regards to performance, how they compare their performance to others, and if they seek reassurance from others about their performance. This information is used to guide the development of an individualised solution to reduce the thought biases and is based on the person’s own examples.

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