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Clinical Perfectionism: What It Is and What It Definitely Is Not

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I’m really overthinking this. I get nervous when I write articles because I want them to be perfect, but not in the way someone with a perfectionist streak may spend some extra time on it and be really thorough until they were happy with it. No, I could spend hours on one small task, make it absolutely flawless and never be satisfied. I always feel like I could have and should have done better. Why? I fall into a different category of perfectionism – clinical perfectionism.

So what is clinical perfectionism? 

According to Shafran, Cooper, and Fairburn in their 2002 article, Clinical perfectionism: a cognitive-behavioural analysis, clinical perfectionism involves overdependence of self-evaluation on the pursuit of demanding, self-imposed standards even if there are adverse consequences. Nothing is worth risking failure. The dimensions of perfectionism, a 1990 study by Frost, Marten, Lahart, and Rosenblate, describes how people who live with clinical perfectionism like me are known to set sky-high standards paired with extremely critical evaluations of themselves. And, in his 1980 article, The perfectionist’s script for self-defeat, David D. Burns details the all-or-nothing frame of mind of someone living with clinical perfectionism and also suggests that all of the effort for excellence is ultimately self-defeating. The authors of Clinical perfectionism: a cognitive-behavioural analysis also describe how someone with clinical perfectionism may routinely feel as though they should do better, even when a task is completed successfully. For me, the pursuit of excellence is more of an excuse to cover up the fact that excellence isn’t what clinical perfectionism is all about.

Here’s what clinical perfectionism is not. 

Unlike a perfectionistic streak, clinical perfectionism isn’t really about striving for excellence and success. In their article, New Frontiers in the Treatment of Perfectionism, Shafran, Coughtrey, and Kothari suggest it’s actually about striving to prevent failure at all costs. As someone living with clinical perfectionism, I can assure you that it is not a helpful frame of mind. It is constantly getting in my way and holding me back. It slows me down because I will triple check things even when I know that it’s correct. Sometimes it keeps me from even beginning projects because I am so terrified of failure. And even when a task is done perfectly, there is no satisfaction. I will always find a way to criticize myself. Clinical perfectionism is also not healthy. In fact, in Clinical perfectionism: a cognitive-behavioural analysis, the authors go on to detail how, because of its impact on mental health, it’s even been referred to as “neurotic” and “dysfunctional” perfectionism in some academic texts. Though they do go on to note that clinical perfectionism is not a mental illness on its own, it has been identified as a risk factor for eating disorders and can complicate and even interfere with the treatment of those and other mental health conditions.

There are similarities between “normal” perfectionism and clinical perfectionism. 

It’s true that both kinds of perfectionism can drive people to work hard. Both involve setting high standards. And people with both types of perfectionism can be extremely detail-oriented in completing projects and tasks. They can even both lead to successful completion of projects.

But typical perfectionism and clinical perfectionism are still very different. 

Someone who has a perfectionistic streak may strive for perfection and feel proud of their accomplishments. But many people living with clinical perfectionism work hard because they do not give themselves another option. There is no joy in success. There is no pride. It’s do or die and never good enough. It’s one thing to be thorough and double-check your work. It’s another kind of thorough when I weigh a package to be mailed at work, write the weight down, but still anxiously go back and weigh it again “just to be safe.” By that, I mean to prevent what, to me, would be a catastrophic mistake– making an error in postage. I know that even if I did get it wrong, it’s an easy fix, but the fear of failure of any kind can be overwhelming. And even minor failures like that will haunt me.

My obsession with preventing mistakes is so bad that it’s even causing problems at work. I’m not productive enough, and with every dysfunctional thought and fear of failure that runs through my head, my anxiety level goes as high as my unachievable standards. The standards that typical perfectionistic people set for themselves are often flexible. So you didn’t get an A+, but you still got an A-. That’s still pretty good! For many people living with clinical perfectionism, even an A+ will never be good enough. And according to the article, Clinical perfectionism: a cognitive-behavioural analysis, when someone living from clinical perfectionism does actually meet their standards, they often re-evaluate their standards as not being demanding enough.

Clinical perfectionism has integrated itself into every part of my life. 

It’s warped my perception of myself and my value as a person. I sabotage myself when I start to feel proud of myself. My brain always manages to find a way I could have done something better. I’m also a master at finding flaws. I’ll even convince myself that people were not sincere in their praise of me. It’s maladaptive and so deeply ingrained in me that it plays a role in each of my mental health disorders. Sometimes I even criticize myself for not being “good enough” at having mental illnesses, and that construct changes. Sometimes I feel like I don’t have enough or severe enough symptoms, and at other points I feel I’m not “good enough” because I have too many symptoms and my medication dosages are too high. There is no winning with clinical perfectionism.

But there is some good news. 

While I have accomplished a great deal in life because I push myself so hard, I don’t care about that. It wasn’t worth what I put myself through to attain it. What I’m excited about is that treatment for clinical perfectionism is possible, and I’m even making progress on my own clinical perfectionism in therapy. It’s painfully slow, but after a lifetime of living with this, I will take every tiny win. Right now, I’m able to force myself to skip the triple and quadruple checks on the weight of those packages and other tasks at work. I’ve hung my toes over the edge of my comfort zone. And as truly terrifying and anxiety inducing as it is, I’m kind of feeling slightly proud of myself. I’ve got a long road ahead of me to really understand it and tackle its source, but, for the first time, I’m feeling kind of hopeful.


Photo courtesy of Getty Images

Originally published: January 7, 2021
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