Perfectionism and Anxiety: The Problem With Trying to Be Perfect

Perfectionists are more likely to experience anxiety and have a higher risk of suicide.

being-perfect-can-be-deadly.jpg
Photo: Getty Images

Maybe you have a friend or loved one obsessed with perfection, say, the one who's always working—utterly terrified of letting the boss down—or the mom who won't let anyone help around the house because no one else does it "right." Or perhaps you're the perfectionist in your life?

People tend to hold up perfectionism as a sign of being a high achiever. But that perception doesn't account for how anxiety-provoking it can be to meet such impossibly high standards.

"Perfectionists have an all-or-nothing mindset that's propelled by a crippling fear of failure," said Elizabeth Lombardo, PhD, a clinical psychologist and author of Better Than Perfect: 7 Strategies to Crush Your Inner Critic and Create a Life You Love. "They also have what's called conditional self-worth. They think 'I am only a good person if I can achieve these things.'" Since true perfection is impossible, "you can see how someone with that mindset could get to a dark place," Lombardo told Health.

What is Perfectionism, Anyway?

Perfectionism, according to the American Psychological Association, is "the tendency to demand of others or of oneself an extremely high or even flawless level of performance, in excess of what is required by the situation."¹

In other words, it's considered a personality trait, not a mental disorder.

According to a 2020 review in the International Journal of Medical Education, perfectionism can be either positive ("adaptive") or negative ("maladaptive"). Some people who strive for perfectionism still allow themselves to make a mistake now and then. Others, though, are "driven by a fear of failure," and they're more likely to experience anxiety, depression, and other "detrimental health effects."²

Perfectionism and Anxiety

There's long been an association between perfectionistic tendencies and anxiety. Perfectionism is elevated in anxiety disorders, note the authors of a 2011 paper in Clinical Psychology Review.³ That includes generalized anxiety, social anxiety, panic, and post-traumatic stress disorder (PTSD).

For people with social anxiety disorder, fear of being judged by others can drive excessive, perfection-seeking behaviors, per the Anxiety & Depression Association of America (ADAA). As a result, social encounters can be exhausting, stressful, and not very authentic. Worries about meeting very high standards can prevent people from being themselves.⁴

One small study found perfectionism to be a significant predictor of pathological worry, a defining characteristic of generalized anxiety disorder (GAD). The authors of the 2014 study, published in BMC Psychiatry, say the findings highlight the need for mental health professionals to ask people with GAD symptoms about their perfectionism.⁵

The Dangers of Perfectionism

Some research suggests the frequency of a person's perfectionistic thoughts can impact anxiety symptoms.

A 2021 study published in Cognitive Behaviour Therapy asked 356 adults who had been diagnosed with anxiety or an anxiety-related disorder to complete a self-report questionnaire about their perfectionistic thoughts. The questionnaire included statements such as: "I have to be the best," "No matter how much I do, it's never enough," and "My work should be flawless." Overall, researchers found that people who experienced more frequent perfectionistic thoughts were more likely to report severe symptoms of GAD and PTSD, according to their report.⁶

There's also some evidence that perfectionism may be a factor in suicidal behavior. Not only do perfectionists struggle with the pressure to be perfect, they may also face a higher risk of dying by suicide, per a 2014 analysis in the Review of General Psychology.⁷

Separately, a 2020 study of adult psychiatric outpatients suggests that fear of humiliation, a trait of people with perfectionistic tendencies, may be related to suicidal behavior. Reporting in the International Journal of Environmental Research and Public Health, the authors note that perfectionists are more self-critical and more likely to feel humiliated if things don't go as planned.⁸

Strategies for Coping

So how can you help a perfectionist in your life, or yourself, deal with anxious thoughts and perfectionistic behaviors? Here are some ideas from Lombardo.

Don't Say, 'It Doesn't Have to Be Perfect'

"It doesn't have to be perfect" is the worst thing you can say to a perfectionist, Lombardo explained. Instead, highlight their strengths and what you like about them. For example, if your perfectionist sister is struggling with a work screw-up, focus on how you're proud of her no matter what, rather than telling her to stop expecting perfection.

Get Rid of 'Should'

Perfectionists are often obsessed with the word "should." If you find yourself focus on how things "should" be, try reframing the issue. For example, if you're stressed about a party you're planning focus on what you want from the party (to have a good time) versus trying to prevent every possible thing that could go wrong.

Find Workable Solutions

Fear of failure is a common concern for perfectionists. If they can't do it perfectly, why do it at all? Your friend might say, "I tried going to the gym, but I never had time so I just can't work out." Help them see that their problems don't have to be either or issues by offering middle ground solutions. Maybe they can't find a full hour to work out, but can sneak in a few stretches between meetings, or a long walk over the weekend.

Seek Help

If you're experiencing suicidal thoughts, there's no need to go it alone. The National Suicide Prevention Hotline offers free and confidential support to people in emotional distress or suicidal crisis.¹² Help is also available to loved ones seeking resources. Call 1-800-273-8255 (TALK).

Sources

  1. American Psychological Association. APA Dictionary of Psychology.
  2. Thomas M, Bigatti S. Perfectionism, impostor phenomenon, and mental health in Medicine: A Literature Review. International Journal of Medical Education. 2020;11:201-213. doi:10.5116/ijme.5f54.c8f8
  3. Egan SJ, Wade TD, Shafran R. Perfectionism as a transdiagnostic process: a clinical review. Clinical Psychology Review. 2011 Mar;31(2):203-12. doi: 10.1016/j.cpr.2010.04.009.
  4. Anxiety & Depression Association of America. Society Anxiety: Imperfect Is the New Perfect.
  5. Handley AK, Egan SJ, Kane RT, Rees CS. The relationships between perfectionism, pathological worry and generalised anxiety disorder. BMC Psychiatry. 2014;14:98. Published 2014 Apr 2. doi:10.1186/1471-244X-14-98
  6. Tyler J, Mu W, McCann J, Belli G, Asnaani A. The unique contribution of perfectionistic cognitions to anxiety disorder symptoms in a treatment-seeking sample. Cognitive Behaviour Therapy. 2021 Mar;50(2):121-137. doi: 10.1080/16506073.2020.1798497
  7. Flett GL, Hewitt PL, Heisel MJ. The Destructiveness of Perfectionism Revisited: Implications for the Assessment of Suicide Risk and the Prevention of Suicide. Review of General Psychology. 2014;18(3):156-172. doi:10.1037/gpr0000011
  8. Pia T, Galynker I, Schuck A, Sinclair C, Ying G, Calati R. Perfectionism and Prospective Near-Term Suicidal Thoughts and Behaviors: The Mediation of Fear of Humiliation and Suicide Crisis Syndrome. International Journal of Environmental Research and Public Health. 2020;17(4):1424. Published 2020 Feb 22. doi:10.3390/ijerph17041424
Was this page helpful?
Related Articles