This guide explains what perfectionism is, how it can be both healthy and unhealthy, and the impact it can have on wellbeing. It looks at ‘unhealthy perfectionism’ – how to spot it and advice on how to develop effective interventions.
This resource is based on work conducted by Prof. Roz Shafran in collaboration with Prof. Tracey Wade and Dr Sarah Egan.
What is the distinction between such perfectionism and ‘healthy striving for excellence’?
People with a healthy striving for excellence have very high standards but the standards are potentially achievable; when they do not reach their goals, people with healthy striving for excellence are able to stand back and reflect objectively on their mistakes so that they can learn from them.
They are able to tolerate uncertainty and don’t react to their failure with intense self-criticism.
People with unhealthy perfectionism often have the same very high standards but the standards are not realistic or only attainable with significant negative consequences; such people react to mistakes in an extreme and highly self-critical manner and are very uncomfortable with uncertainty.
The self-esteem of such perfectionists is almost exclusively dependent on striving and achievement but they constantly perceive themselves to have failed and live in fear of such failure and what it means for them.
It is not always easy to detect this unhealthy perfectionism and very often people themselves do not consider it to be a problem. Instead, it can cause difficulties for those around them.
The area in which the perfectionism is expressed is also very important.
Unhealthy perfectionism applied in the domain of work may lead to someone being labelled as a ‘workaholic’ but the same type of perfectionism applied in the domain of dieting and weight loss may lead to an eating disorder.
Typically such perfectionism is applied across many areas of life and can cause multiple difficulties.
We know that perfectionism of this sort is associated with depression as well as other difficulties such as eating disorders, anxiety, chronic fatigue syndrome, obsessive compulsive disorder and low self-esteem.
Unlike depression, ‘perfectionism’ is not a diagnosis and it can sometimes be difficult for an outsider to spot.
What is the distinction between such perfectionism and ‘healthy striving for excellence’?
There are other types of perfectionism that might also be posing a problem such as having high standards for other people and constantly feeling let down. Similarly, some people erroneously believe that other people have high standards for them and that theyfeel they are constantly letting other people down. In some cases, people are focused on the need to appear perfect and in others their perfectionism may predominantly be focused in an area such as sport or religion.
Until relatively recently, no treatment for perfectionism had been developed, partly due to the suggestion that perfectionism was an unchangeable personality characteristic.
However, in 2002 the Oxford Centre for Eating Disorders proposed a cognitive- behavioural approach to perfectionism (Shafran, Cooper & Fairburn, 2002).
Although it was controversial, it paved the way for research and multiple studies have now shown that the treatment based on this approach is effective both in terms of reducing perfectionism but also with respect to the impact that the treatment has on other difficulties such as depression and anxiety.
The treatment can be delivered individually, in groups, using a self-help book or over the internet. Some of the key treatment strategies are:
We have come a long way in our understanding of perfectionism and in developing interventions that work.
However, there remains a great deal of work to do so that we can help people with a wide variety of forms of perfectionism and to see whether the interventions work for children and young people. We also need to make sure that people can access the treatments that they need in a timely way. I am hopeful that such ambition reflects healthy striving for excellence and an achievable goal, but only time will tell...
