Perfectionism is a personality trait characterized by striving for flawlessness and setting extremely high performance standards, often accompanied by overly critical self-evaluations and concerns about how others evaluate oneself. Perfectionism has aspects that could be considered healthy, like having high personal standards and striving for excellence. But it also has aspects that could be considered unhealthy, like unrealistic expectations, excessive self-criticism, and being unable to feel satisfied because of unachievable goals. Researchers have been trying to determine if perfectionism should be considered a mental illness.
What is perfectionism?
Perfectionism involves setting unrealistic, unattainable goals accompanied by overly critical self-evaluations.[1] Perfectionists have a strong desire to avoid failure and aim to be perfect in endeavors. This involves black-and-white thinking where outcomes are seen as either perfect or unacceptable failures. Perfectionists will persist at tasks long after others have ceased and are intensely competitive. Socially prescribed perfectionists believe that other people hold unrealistic standards for them that they try to attain, while self-oriented perfectionists set unrealistic high standards for themselves. Some main characteristics of perfectionism include:[2]
– Black-and-white thinking – Things are either perfect or failures.
– Focusing too much on flaws – Perfectionists focus more on what’s wrong than strengths and achievements.
– Harsh self-criticism – Extremely critical toward oneself when goals aren’t met.
– Avoidance of failure – Going to extremes to avoid failure or mistakes.
– Setting unrealistic standards – Standards and expectations for oneself are unattainable.
– Feeling like nothing is ever good enough – Feeling unsatisfied even with great achievements.
Is perfectionism a mental disorder?
The classification of perfectionism as a mental disorder is controversial in psychology. Perfectionism is not included as a mental disorder in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), which is published by the American Psychiatric Association and provides the main diagnostic reference on mental health disorders.[3] However, some psychologists argue perfectionism should be considered a disorder because it can cause significant dysfunction and distress when taken to an extreme level.
Arguments that perfectionism is a mental illness
Here are some key arguments that perfectionism should be considered a mental disorder:[4]
– Perfectionism is associated with multiple types of psychopathology when severe. Research shows perfectionism is correlated with increased anxiety, depression, obsessive-compulsive disorder, eating disorders, and even suicide risk when perfectionistic tendencies become extreme.
– Perfectionism can significantly disrupt life functioning. Severe perfectionism can impair social relationships, academic and work performance, and the ability to complete day-to-day tasks.
– Perfectionism often requires clinical treatment to resolve. People severely affected by perfectionism often require psychotherapy and psychiatric treatment to manage their symptoms and underlying issues related to their perfectionism.
– Perfectionism has cognitive and behavioral components resembling other disorders. Like other disorders, perfectionism has distorted, unrealistic thinking patterns as well as ritualistic behaviors centered around unattainable goals.
Arguments against classifying perfectionism as a mental illness
Here are some reasons why perfectionism is not considered a diagnosable mental illness:[5]
– Perfectionism exists on a spectrum. Perfectionistic traits occur normally in the general population. Only perfectionism at the extreme end of the spectrum causes dysfunction.
– Perfectionism often does not occur alone. It typically accompanies or overlaps with other mental illnesses like anxiety disorders and obsessive-compulsive disorder.
– Perfectionism can have positive effects. Some elements like setting high standards and being organized can be adaptive in moderation. There are healthy adaptive perfectionists.
– Difficulty establishing clear diagnostic criteria. Perfectionism manifests in different ways, making it hard to establish standardized diagnostic criteria.
– Not enough data on effective treatments. More research is needed on treatments specifically targeting perfectionism to determine if it warrants being classified as its own disorder.
Is perfectionism an official DSM-5 diagnosis?
No, perfectionism is not an official diagnosis in the DSM-5. The DSM-5 is viewed as the main authority on the classification of mental disorders. Perfectionism is not included as a standalone mental disorder in this diagnostic manual for the following reasons:[6]
– Perfectionism overlaps with other disorders’ criteria. Perfectionism often occurs alongside other DSM-5 diagnoses like OCD and depression.
– Lack of distinguishing characteristics from other disorders. Perfectionism does not have enough unique, defining features to differentiate it from related conditions.
– Spectrum of severity. Perfectionism ranges from adaptive traits to maladaptive symptoms, making categorical diagnosis difficult.
– Poor delineation from normal behavior. It is hard to delineate normal perfectionistic traits seen in many people from pathological perfectionism.
– No agreed upon diagnostic criteria. Researchers have not established standardized diagnostic criteria that define clinical perfectionism.
So perfectionism is not an official DSM-5 diagnosis. However, the DSM-5 does recognize that maladaptive perfectionism is a contributing factor to other mental illnesses.
Is perfectionism a symptom of other mental illnesses?
Yes, perfectionism is recognized in the DSM-5 and by mental health experts as a symptom and contributing factor of other mental illnesses, rather than a standalone disorder. Some key ways perfectionism manifests as a symptom of other diagnoses:[7]
Obsessive Compulsive Disorder (OCD)
– Perfectionism is a major symptom of OCD, related to the disorder’s compulsions and obsessions. OCD patients may fixate on perfectionism related to order, arrangements, and exactness.
Eating disorders
– Those with eating disorders often display perfectionism surrounding their appearance, diet, exercise regime, and other factors tied to reaching an unrealistic “perfect” standard.
Depression
– Perfectionists struggling with depression may feel nothing they do is good enough and that they inevitably fail to meet their own perfect standards.
Social anxiety
– Socially anxious perfectionists may believe they can never behave flawlessly in social situations up to their exaggerated standards.
Suicidal ideation
– Perfectionists may experience suicidal thoughts if they feel profound hopelessness about achieving their perfect standards.
So while not an official diagnosis itself, perfectionism is a recognized part of many diagnosable mental illnesses.
How is perfectionism assessed and measured?
There are two main methods researchers use to assess perfectionism:[8]
Perfectionism scales
The most common way perfectionism is measured is through standardized perfectionism rating scales and questionnaires. Some examples:
– Frost Multidimensional Perfectionism Scale (FMPS) – Assesses perfectionism on factors like concern over mistakes, high standards, doubting actions, parental expectations, and organization.
– Hewitt Multidimensional Perfectionism Scale – Measures self-oriented, socially prescribed, and other-oriented perfectionism.
– Clinical Perfectionism Questionnaire – Assesses perfectionism associated with clinical issues and disorders.
Structured interviews
Clinical interviews by a psychologist may also be used to systematically assess perfectionism. The interviewer will ask about symptoms, impairment, and other diagnostic criteria. Examples of perfectionism interview schedules:
– Perfectionism Interview – Assesses perfectionism dimensions including concerns over mistakes, need for approval, rumination, and perceived parental pressure.
– Structured Clinical Interview for DSM Disorders (SCID) – Can include supplemental questions on perfectionism for research purposes.
In addition to these measurements, clinicians may also assess perfectionism based on how much it interferes with a person’s functioning and quality of life.
What are common perfectionism scale scores?
The level of perfectionism revealed by common rating scales can be interpreted via the following general score ranges:[9]
| Perfectionism Scale | Low Score | Moderate Score | High Score |
|---|---|---|---|
| Frost Multidimensional Perfectionism Scale (FMPS) | Less than 150 | 150-200 | Over 200 |
| Hewitt Multidimensional Perfectionism Scale | Less than 80 | 80-105 | Over 105 |
| Clinical Perfectionism Questionnaire | Less than 20 | 20-25 | Over 25 |
Higher scores indicate greater degrees of perfectionism that could require treatment.
What disorders are associated with perfectionism?
Research indicates perfectionism commonly occurs in the following mental health conditions:
Obsessive-compulsive disorder (OCD)
OCD has a high rate of co-occurrence with perfectionism, with 25-35% of those with OCD reporting perfectionism.[10] Perfectionism in OCD includes fixations on symmetry, exactness, and order.
Eating disorders
35% to 57% of those with eating disorders like anorexia nervosa and bulimia nervosa display perfectionism related to their body image and weight.[11]
Depression
Perfectionism overlaps with symptoms of self-criticism, guilt, and hopelessness in major depressive disorder.[12] Up to 70% of people with depression exhibit perfectionism.
Anxiety disorders
Perfectionism is linked to generalized anxiety disorder, social anxiety, and panic disorder due to unrealistic standards causing distress.[13]
Suicide risk
Perfectionism combined with hopelessness increases the risk for suicide in the context of depression.[14]
Personality disorders
Perfectionism is a key trait associated with obsessive-compulsive personality disorder and avoidant personality disorder.[15]
So perfectionism commonly accompanies many psychological disorders and suicidal behaviors. However, it remains unclear whether it is simply a symptom or contributing causative factor.
What are the dimensions of perfectionism?
Researchers who study perfectionism have identified dimensions that provide further insight into its characteristics and types. Some main dimensions of perfectionism include:[16]
– Self-oriented vs. socially prescribed – Perfectionism directed toward one’s own performance vs. perfectionism driven by perceived expectations of others.
– Positive striving vs. maladaptive evaluation – Pursuing excellence vs. overly critical evaluations.
– Adaptive vs. maladaptive – Healthy high standards vs. unrealistic standards causing distress.
– Hypercriticalness – Harshly judging oneself for not meeting standards.
– Need for approval – Basing self-worth on achieving perfection.
– Rumination – Dwelling on imperfections and mistakes.
– Perceived parental pressure – Believing parents imposed high expectations.
– Organization – Preference for order and neatness.
These dimensions capture the range of perfectionism characteristics observed in research and clinical practice.
Is perfectionism a personality trait or disorder?
Perfectionism exists on a continuum between normal human behavior and clinical issues.[17] Many experts view perfectionism as best described as a dimensional personality trait rather than a distinct disorder. Reasons perfectionism is often seen as a personality trait:
– It is continuously distributed in the general population rather than categorical.
– It involves a stable pattern of thinking and behaving.
– It has adaptive forms that do not necessarily cause impairment.
– It is made up of emotional, cognitive, and behavioral components.
At the same time, perfectionism can become maladaptive and symptomatic of an underlying mental disorder when taken to an extreme. But overall, it is often viewed as an overdeveloped personality trait rather than a distinct clinical condition. Describing it dimensionally captures its variability and shades of grey.
What causes perfectionism?
The development of perfectionism likely involves a complex interaction of multiple factors, including:[18]
– Genetics and biology – Perfectionistic traits may have an innate, hereditary basis tied to personality and temperament.
– Parenting – Having overly critical parents or parents that model perfectionism frequently plays a role.
– Childhood experiences – Adverse childhood events like abuse could contribute to perfectionism.
– Culture and societal factors – Cultures or environments rewarding excellence may foster perfectionism to an extreme.
– Underlying mental health issues – Perfectionism often accompanies or is a symptom of conditions like OCD and depression.
– Personality – Certain personality traits like neuroticism contribute to perfectionistic tendencies.
– Thinking patterns – Black-and-white thinking and cognitive distortions underscore perfectionism.
So the development of perfectionism likely stems from a mix of biological, familial, cultural, psychological, and socialization influences over time.
How is perfectionism treated?
When perfectionism becomes problematic and accompanies mental health disorders, psychotherapy is the main treatment approach. Some key techniques therapists use to address perfectionism are:[19]
– Cognitive-behavioral therapy (CBT) – CBT focuses on changing thought patterns and behaviors that underlie perfectionism through strategies like cognitive restructuring and exposure therapy.
– Mindfulness-based approaches – Mindfulness practices help perfectionists accept themselves and let go of self-judgment.
– Acceptance and commitment therapy (ACT) – ACT centers on accepting inability to be perfect and committing to a values-based life.
– Relational therapy – This addresses interpersonal patterns, like perceived parental pressure, that impact perfectionism.
– Support groups – Group therapy provides support and reality testing around perfectionism.
Medications like antidepressants may also be used to treat accompanying issues like depression. Treatment focuses on shifting rigid thinking patterns, improving self-acceptance, and reducing distress over imperfections.
Tips for managing perfectionism
Here are some key tips that can help in managing perfectionism:[20]
– Identify triggers for perfectionism and self-criticism. Increase awareness of situations that activate perfectionistic thinking.
– Challenge distorted thoughts. Ask yourself if perfectionistic thoughts are rational or rooted in reality.
– Emphasize progress over perfection. Focus on growth and improvement rather than flawless end results.
– Allow yourself to make mistakes. Mistakes and failures are part of being human.
– Recognize areas where perfectionism does not matter. Consider which tasks require high standards vs. those that do not.
– Ask if expectations would be realistic for others. Hold yourself to standards you would hold others to.
– Reward efforts and progress. Praise your process and hard work, not just perfect outcomes.
– Focus on self-care. Make taking care of your health and wellbeing a priority over unattainable goals.
– Seek social support. Spending time with supportive friends and family helps provide reality testing.
– Consider professional help if needed. Therapy can change harmful thought and behavior patterns underlying perfectionism.
Learning to replace perfectionistic thinking with more flexible, self-compassionate thoughts takes practice but can reduce distress. Support, reality-testing, and cognitive-behavioral skills help in managing problematic perfectionism.
Conclusion
In summary, perfectionism is not officially classified as its own mental disorder, but maladaptive perfectionism is recognized as a contributing problem to many psychiatric conditions. Perfectionism exists on a spectrum between normal behavior and psychological issues. In its extreme, unhealthy form, perfectionism can significantly disrupt functioning and requires treatment. But perfectionism also has adaptive forms that do not necessarily cause impairment. Classifying perfectionism remains controversial, as it involves traits present to some degree in many people and often accompanies other disorders like OCD and depression. While not an official diagnosis itself, perfectionism is an important psychological construct. Understanding when it ventures into the realm of causing distress can help address it through targeted treatment.