Perfectionism: the root cause of unhappiness?

I recently attended a seminar put on by a leading researcher in the field of perfectionism, Dr. Simon B. Sherry. This was in hopes to offer some help to the many patients that come through my door struggling with the un-achievable… perfection.

I have had patients come in with extreme stress symptoms caused by their unwillingness for anything but perfection. I’ve seen many patients come into follow up visits, neglecting to recognize the many accomplishments they’ve had, feeling a sense of failure with their protocols and diets because they weren’t able to complete them perfectly. Then there are those who give up or procrastinate, because if it’s not perfect, it’s not worth doing. The dread and guilt that ensue from the perfectionists cycle leads to self defeat, and potentially mood disorders.

Conscientiousness vs. perfectionism.

Do we have to be imperfect to be perfectly happy? Not necessarily, when attention is placed on the process and not the end goal, more contentment ensues. As Emerson said “ Life is a journey, not a destination”. This is the difference between conscientiousness and perfectionism.

Perfectionism is not to be confused with conscientiousness, which is a healthy drive to be competent, self-disciplined, achievement-striving, dutiful and deliberate. A high amount of conscientiousness decreases risk of suicide, self-harm, mortality, disordered eating, depression and stress. It’s also associated with higher marital satisfaction, self-compassion and productivity. Perfectionism does exactly the opposite.

What “causes” perfectionism?

On the biological side, those with perfectionism have an increased Error Related Negativity. What this means is that when making an error, say during a task, the brain shows greater negative activity on electrodes than with non-perfectionists. This is related to the motivational significance of the task, or the emotional reaction to making the error. In short, people with perfectionism are harder on themselves. This may be related to an error in dopamine signalling which will cause one to “feel” the events have gone worse than what’s expected. One particular genetic polymorphism, COMT Val158Met, may be at the root of this experience as those with this SNP have trouble regulating dopamine and have higher Error Related Negativity scores as well. We can test for this gene at the clinic, and those who are positive can do specific supplementation to help with dopamine regulation. Nutrigenomics is the treatment of genetic polymorphisms with diet and supplementation, and it can potentially play a role in treating perfectionism.

On the psychological side, several personality traits such as neuroticism give rise to higher degrees of perfectionism. Depression, with it’s apathy, will create decreased motivation, impeding goal striving. Giftedness fosters higher praise and pressure, those who are gifted will seldom evaluate themselves and others via normal standards.

On the social side, there are particular subcultures such as competitive sports or arts which encourage perfectionism. Insecure attachment and fear of abandonment can lead to one striving to maintain acceptance from others by being perfect. And of course, parenting style and high expectations will also play a role in creating perfectionism in an individual.

Perfectionist tend to have problems with self-definition including low and unstable self-esteem. A satisfied perfectionist is referred to by Dr. Sherry as a shooting star - something that is rarely seen and unlikely to last for long. Most perfectionists will suffer with dissatisfaction. As such their perceptions of relationships tend to be skewed towards seeing others as disappointed in them. Their stress levels will also be higher: expecting the worst causes the stress response to last longer at a higher intensity.

Are you a perfectionist?

In Dr. Sherry’s lecture he identified several key characteristics perfectionists display. Take a read through the following statements and underline those you identify with. This is not an exhaustive list, but should give you a good idea if perfectionism may be playing a role in your wellbeing:

Perfectionists have a hard time playing nicely with others, they don’t appreciate the impact of their behaviour on others.
Perfectionists are often so paralyzed with fear of not achieving their perfectionist aspirations that they will act imperfectly, such as procrastinating. This can be painful as it’s the opposite of the perfect person they want to be
Perfectionists don’t always set high goals due to defensiveness. They often fail to follow through on goals of any sort.
Perfectionists have extreme cognitive distortions such as all-or-nothing thinking, catastrophizing, mind reading, emotional reasoning and if/then contingencies. It’s hard for them to challenge their beliefs.
Perfectionists who experience behaviours such as repeated checking, avoiding mistakes, and over striving may limit their life experiences missing chances for personal growth, social relations and meaning.
Perfectionists unleash a torrent of self-criticism following a perceived mistake.
Perfectionists have a low frequency of rewards in their lives. Pleasurable, meaningful and reinforcing activities are few and far between.
Perfectionists avoid recreation and relationships in their ceaseless pursuit of perfection. Avoidance creates a space and place for self-criticism, guilt and anxiety.
Perfectionists are prone to unconstructive, repetitive thoughts such as brooding and ruminating, .
Perfectionists are so hypercritical and unforgiving towards themselves it makes it hard to accept their experiences.
Perfectionists have rigid beliefs of how things should and must be that they are at war with reality.
Perfectionists often believe their self-criticism is motivating and helpful, but it’s probably the most destructive aspect of perfectionism.

From these points above, the suggestion that perfectionists are hard on themselves is quite apparent. In fact, perfectionists are so good at attacking themselves, their lateral prefrontal cortex becomes over developed. This is the area of the brain involved with executive function, the ability to differentiate between conflicting thoughts. When a perfectionist learns to be more compassionate it increases the development a different pathway the insula, which fosters inner support and warmth as well as interpersonal experience.

Treating Perfectionism

It seems perfectionistic traits interfere with treatment of other psychiatric disorders. Take depression for example, where perfectionistic traits increase relapse after treatment with medications. Self termination of treatment increases even after CBT and interpersonal psychotherapy among perfectionists. Most perfectionists will feel controlled motivation, which is when their goals are driven by the feeling of guilt if they didn’t complete a task or the fear of another being upset with them if they didn’t complete the task. Many perfectionists feel greatly misunderstood, so much that just understanding the why’s and how’s during assessment can help them with their distress.

The following are just a sample of at home activities you may want to try at home to address perfectionism. If you believe you may be suffering with a high degree of perfectionism please consider seeing a qualified therapist to help you deepen your path of self discovery and healing. At the clinic, testing for genes associated with perfectionism and mental health is another useful tool to guide proper diet and supplementation therapy.

Treatment of Perfectionism can be broken into 3 areas:

INTERPERSONAL: Social connectedness

Journal Exercise answer the following questions:
Self Definition: Who am I? (Try to develop a realistic, independent, positive, integrated, stable and mature self-identity)
Relatedness: How do I relate to others? (Try to develop the capacity for stable, mature, satisfying and reciprocal interpersonal relationships)
How have other responded to your perfectionism?
Is someone, perhaps unwittingly, reinforcing your perfectionistic behaviour?

BEHAVIOURAL: Pattern-breaking

Have a sense of play. Your beliefs are not facts, they are assumptions which need to be questioned. Get out there and try something new, fresh and intimidating. Either debunk or confirm your beliefs. Exposing yourself to your fears fosters resilience and increases tolerance.
Activity monitoring: activity, mood, pleasure. Try to established more activities associated with positive mood and a regular routine & daily structure. Choose activities patient used to enjoy, what activities their values would match up with. Follow a plan not your mood. Activity breeds activity. Actions speak louder than moods
SMART goal setting: Specific, Measurable, Achievable, Realistic, Timely.
Goals help to foster a sense of direction and help prioritize. They can be motivating by offering a sense of incentive. Goals are much more than an ends to a means, even if you don’t succeed at your goal it carves a path to propel you in life.
Write down your goals: Three for each the short term (next 3 months), medium term (next year) and long term (next 5 years).

COGNITIVE: Compassionate acceptance

Mindfulness: This is intentionally bringing non-judgemental to you present moment with willingness, curiosity, and acceptance of what is. Cognitions do not necessarily need to be challenged, merely responded to differently. Thoughts are only mental events, they are not facts and we are not truths. Do one thing at a time.
Visualization: Picture your thoughts as leaves floating down a river, they come and pass. at times the river is raging and you may be tempted to jump in a float along with those thoughts. If this happens, that’s ok, but make your way back to the shore as a passive onlooker once you’re aware of drifting.
Consider joining a meditation group or starting a daily meditation practice.

Acceptance: This is a willingness to experience a wide range of unwanted/unpleasant internal phenomena without trying to avoid, escape or terminate them. Fostering non-judgement towards the self, others, and the world. Moving from absolute beliefs to flexible preferences.

Visualization: When a tough emotion, situation or decision comes up picture yourself jumping into it from a height. This is symbolic of willingness to let go an experience life without control. Controlling would be slowly stepping down and never fully committing.

Compassion: This is self kindness.

Journal: Write down supportive statements, repeat self statements out loud several times daily.
Visualization: Visualize yourself walking hand in hand with yourself as a child. That vulnerable inner child will always be a part of you, and needs nourishment.

Books on the subject

Perfectionism: Theory, Research and Treatment by Flett & Hewitt 2002

Overcoming Perfectionism by Shafran, Egan & Wade

When Perfect isn’t good enough by Antony and Swinson

Resources

Lecture “Nobody’s perfect: Understanding, assessing and treating perfectionism and related problems” Simon B. Sherry, Ph.D. 2014

Pathway to disordered eating encompasses self critical perfectionism and genetic variations in DAT1 and COMT. Kyra Sarner et al.