The Dark Side of Perfectionism Revealed

Perfectionists, by definition, strive for the best, trying to ace exams, be meticulous at their jobs, and raise perfect children. So one might assume this drive for the ideal translates over to their health as well, with perfectionist being models for physical and mental well-being.

But new research is revealing the trait can bring both profits and perils.

Though perfection is an impossible goal, striving for it can be a boon for one's health, causing one to stick to exercise programs to a tee, say, or follow a strict regimen for treating chronic illnesses like type 2 diabetes. But the same lofty goals can mean added mental pressure when mistakes are made and the resistance to asking for help from others in fear of revealing one's true, imperfect self.

In fact studies show the personality trait of perfectionism is linked to poor physical health and an increased risk of death.

Researchers are just beginning to tease apart this complex trait and its relation to health.     

"Perfectionism is a virtue to be extolled definitely," said Prem Fry, a psychology professor at Trinity Western University in Canada. "But beyond a certain threshold, it backfires and becomes an impediment," she said. [Related: Perfectionists at Risk for Postpartum Depression]

Fry and several of her colleagues recently spoke at a symposium on perfectionism and health at the Association for Psychological Science convention in Boston.

What is perfectionism?

While some might aim to be perfect in certain areas of their life — such as an athlete who must stick to a grueling workout schedule — true perfectionism comes in a generalized form.

"You should want to be perfect across a variety of aspects of your life," said Gordon Flett, a psychology professor at York University in Canada.

"It's natural to be perfectionistic in the thing that matters the most, like your job — if you're a surgeon, there's no room for error," Flett said. "[But] you don’t want that same person to be going home and using those same standards to evaluate family members, which causes stress," he said. "It has to generalize."

Perfectionism tends to have two components: a positive side, including things like setting high standards for themselves; and a negative side, which involves more deleterious factors, such as having doubts and concerns over mistakes and feeling pressure from others to be perfect.

Some scientists have argued a subset of these high-achievers can be classified as "positive perfectionists," those who reap the benefits of perfectionism without falling victim to its ills. However, others say that while perfectionism might seem to be advantageous in certain situations, it always has a dark side that inevitably rears its head. For instance, a perfectionist might seem fine under normal circumstances, but lose control under stress.  

While the existence of "positive perfectionists" is still debated, there's no doubt the trait can be quite counterproductive in some cases.

"That, in essence is the paradox of perfectionism, that certain people have extraordinarily high standards, but objectively can often look very dysfunctional in terms of their daily functioning, their physical health, their achievement," said Patricia DiBartolo, a psychology professor at Smith College, in Northampton, Mass. "They flunk out of college, and the reason why is they're so perfectionistic they can't actually achieve any goal; as you begin the process, it's just impossible."

Perfectionism and lifespan

Compared with the number of studies looking at perfectionism's impact on mental health, relatively few have examined the condition's toll on physical health. Some earlier work has linked the trait with various ailments, including migraines, chronic pain and asthma.

Fry and her colleagues recently looked at the relationship between perfectionism and overall risk of death. The study followed 450 adults aged 65 and older for 6.5 years. The participants completed an initial questionnaire to assess their level of perfectionism and other personality traits.

Those with high perfectionism scores, meaning they placed high expectations on themselves to be perfect, had a 51-percent increased risk of death compared to those with low scores.

The researchers suspect high levels of stress and anxiety, which are known to be linked with perfectionism, might contribute to the decrease in lifespan.

Next, they reasoned that if perfectionism showed this association in a normal population, it might have an even greater impact on those with a chronic disease, which would put their bodies under even more stress.

But after following 385 patients with type 2 diabetes for 6.5 years, the researchers actually saw the opposite effect. Those with high perfectionism scores had a 26-percent lower risk of death than those with low scores.

The results suggest that in certain situations, perfectionism can have advantages. With type 2 diabetes, scrupulous attention to blood sugar levels and strict adherence to dietary rules can have payoffs in terms of reducing disease severity, the researchers suspect.

"[Perfectionists] are very self-critical, they are not satisfied ever with their performance," Fry said.

"In this particular study on diabetes, those kinds of perfectionistic attitudes, normally we would regard them to be dysfunctional attitudes, but in the case of the diabetic sample, they turned out to be very positive traits," she said. "These individuals were highly self-critical, they worked harder than the average person to adhere to the instructions of the physician or the attending doctor in staying with all the do's and dont's of diabetic diet constraints."

"So they ended up taking better care of themselves through self-management than people who were sort of more easygoing and lax," she said.

Who expects perfection?

Some studies suggest the role of perfectionism on health might depend on who’s imposing the high standards.

In 2006, Danielle Molnar, of Brock University in Canada, examined the perfectionism-health link in nearly 500 Canadian adults between the ages of 24 and 35.

The study assessed participants for three different dimensions of perfectionism: self-oriented perfectionism, in which individuals impose high standards on themselves; socially prescribed perfectionism, where individuals feel others expect them to be perfect; and other-oriented, in which individuals place high standards on others.

People experience these perfectionist traits to varying degrees. One person might score high on all three, or they might fall into one extreme or another such as self-oriented perfectionism.

The researchers found socially prescribed perfectionism was associated with poorer physical health, which in this case meant individuals experienced more symptoms of health problems, had more doctors visits, took more days off work, and gave themselves low scores when asked to rate their health.

On the other hand, self-oriented perfectionism was associated with better physical health.

So what’s behind this relationship?

One factor could be the degree to which people feel happy or sad, known in psychology as positive or negative affect. The 2006 paper showed general negative feelings, including feeling anxious and upset, could partially explain the relationship they saw between socially prescribed perfectionism and poorer health. And feelings of happiness explained self-oriented perfection's link with better health.

However, the pathway that connects perfectionism to health is likely more complex.

For instance, in more recent research, Molnar found self-imposed perfectionism conferred pros and cons with regard to health that canceled each other out.

"On one hand it was related to higher levels of stress in students, which was related to lower levels of health," Molnar said. "On the other hand it had a protective factor, because it was also related to lower levels of high risk behavior," which includes things such as smoking and drinking.

"You really have to look at the mechanism, not just looking at how perfectionism is directly related to health, but what pathways link it to health?" Molnar said. "Unless you look at the mechanism, a lot of the time [the effect] washes itself out because it will have opposing relationships."

Other factors

Those who feel others expect them to be perfect might also experience declines in health as a result of distancing themselves from other people, and any support from friends and family.

"We know social support is a huge indicator of physical health. If you tend to have strong bonds with people, good family life, good friendships, you tend to be healthier," Molnar said. "And we know socially prescribed perfectionists, they tend to have this sense of disconnection with other people, so it would make sense that one of the ways they would experience poorer health is because of this sense of social disconnection from others."

Even if others reach out to help, socially prescribed perfectionists may view the kind actions as critical.

"Even when the levels of received support, so the support they're actually getting, is the same, there's been some work showing that perfectionists will actually appraise it differently," Molnar said. "They don’t see it as nurturing and supportive, but that people are being critical of them, and they're interfering, they're perceiving that people aren’t there for them," she said.

Other perfectionists might hold off on asking for help altogether, because they don't want to let on that there's anything wrong, or that they're imperfect in some way.

"If you have to ask someone for help, well that means you're flawed, that means you're weak, right? And so I think there's also that presentation of not wanting to seem like you need help from others," said Fuschia Sirois, of the University of Windsor in Canada.

Poor health could also be the result of perfectionists leaving little time to care for themselves, while spending every minute striving for perfection, Sirois said.

Future work

More work is needed to untangle the intricate relationship between perfectionism and health.

For instance, few studies have examined perfectionism in older adults, which might be due to the incorrect notion that perfectionism eases with age, Fry said.

"We've gone along with the misconception that if people are perfectionistic in their earlier stages of life, that in late life their perfectionism sort of automatically tapers off, but it doesn’t tapper off," she said.

Perfectionism in the elderly is of particular concern because, although they still have the same high expectations, they are unable to perform as well, which could ultimately lead to greater depression and anxiety, Fry said.

Researchers should also focus on understanding exactly why perfectionism is associated with poorer health or better health, depending on the situation.

"Without knowing the whys we can't intervene, we can't help these people," Molnar said. "These people are walking around with incredibly unrealistic expectations … they're not just striving for excellence, they're striving for absolute perfection, which of course is impossible. So they're setting themselves up for more failure experiences," she said.

"We have to start understanding what's going on in the middle so how can we help these people."

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