The 3 Destructive Features of Clinical Perfectionism

We have all at some point observed perfectionism, in others or perhaps in ourselves; high exacting standards and disappointment when they aren't met. Perfectionism is multidimensional, meaning it has different flavors: It can apply to work, academic performance, hobbies, parenting (e.g. wanting to be the perfect parent), relationships, expectations of others (expecting high standards from friends, family, colleagues) and also how people view themselves and engage in social situations (e.g. needing to say the right thing and come across brilliantly). Perfectionism can be adaptive and maladaptive: In adaptive perfectionism, achievements are strived for with intense effort but without harsh self-criticism. Maladaptive perfectionism in comparison is characterised by high standards accompanied by extreme self-critical evaluations when standards aren't met. In maladaptive perfectionism, perfectionism is destructive and extreme causing high levels of distress and impairment termed clinical perfectionism. Clinical perfectionism has been found to be a core process in suicide risk, anxiety disorders, depression and eating disorders.


Common features in Clinical Perfectionism:


1. The setting of personally demanding excessive high standards despite negative consequences. Perfectionists strive for extremely high standards despite the detrimental impact that doing so might cause. This for example may mean pursuing tasks despite exhaustion, stress, physical pain and disruption to other areas of life such as leisure and relationships. The striving of perfectionists is so unrelenting that once a task is complete, or goal met, another will follow with merciless pursuit. Perfectionists respond to failure to meet their standards with self-criticism and when they do meet their standards, they will perceive the standard as insufficiently challenging.


2. Overly critical self judgement Perfectionists base their self-worth on their ability to perform to and achieve their high standards. When they fall short, their value is diminished. There may be comparisons to others and harsh punishments that are imposed alongside absolute self beliefs, such as "I am a failure", "I'm not good enough", "I am useless". Brené Brown writes that "where perfectionism exists shame is always lurking". Overly critical self judgement negatively erodes perfectionists self-esteem and confidence. As well as being detrimental to well-being, excessive self-criticism can prevent individuals from taking risks, asserting their opinions and believing in their abilities.


3. Concern over the possibility of making mistakes Because of a fear of making mistakes, perfectionists often experience high levels of worry. Perfectionists assume that making mistakes will mean adverse consequences such as failure, humiliation: or that mistakes are a sign of weakness and incompetence. To protect themselves perfectionists engage in safety behaviours as a guard to perceived threats. A perfectionist might for example check their work multiple times and for hours to ensure that what they produce is error free. Whilst safety behaviours tend to feel useful in the short-term, in the long-term they serve to maintain unhelpful beliefs and ways of coping. A destructive vicious cycle is fueled by perfectionists fear of making mistakes.


Cognitive Behavioural Therapy (CBT) and Perfectionism:


Cognitive Behavioural Therapy has been found to help address the damaging aspects of clinical perfectionism. CBT isn't necessarily about changing a person and "getting rid of" all of their perfectionist ways, but rather collaboratively working together to bring their standards to a level that is no longer detrimental and causing harm. Approaches include addressing cognition's or thoughts that fuel maladaptive perfectionism, (such as "all or nothing thinking") and learning to notice the positive. Behavioural techniques include directly addressing procrastination (a common by-product of perfectionism), prevention of safety behaviours, prioritising and problem solving. Third-wave CBT approaches such as Mindfulness, Compassion Focused Therapy (CFT) and Acceptance and Commitment Therapy (ACT) encourage viewing thoughts, feelings and emotions without judgement, and with acceptance, humanity and kindness. This is in contrast to over-analysing, judging and avoiding which tends to characterise clinical perfectionism. Recent research has found that self-compassion can moderate or weaken the relationship between maladaptive perfectionism and depression in a sample of adolescents and adults. Whilst the common features of clinical perfectionism can be destructive, there are ways of creating change and moving towards adaptive standards and away from the fraught nature of clinical perfectionism.







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© 2020 by Ruth Parchment CBT Cambridge