Several of my patients commented on a recent article in the Health Section of the New York Times that dealt with perfectionism (“Unhappy? Self-critical? Maybe You’re Just a Perfectionist”, December 4, 2007). They’d homed in on the article because it was about the issue that had brought them into treatment with me.

A problem that has many faces

These people suffered from a variety of symptoms- anxiety, depression, problems in careers and relationships, eating disorders – that appeared to be unrelated. But it became clear that they were united by a common factor. Each person was plagued by all sorts of “never good enough” tendencies. As different as they appeared, each struggled with the problem of perfectionism.

Perfectionism is tricky. Efforts to pin it down have been, well, less than perfect. Many questions remain.

What is it?

Perfectionism is a propensity for being displeased with anything that is not perfect or does not meet extremely high standards. It is self-oriented (setting high standards for yourself), socially prescribed (thinking other people are setting high standards for you), and other-oriented (having high expectations of other people).

Where does it come from?

There is disagreement as to what causes perfectionism to develop. There are researchers who see a possible genetic component that may run in families. Others propose that it is a coping mechanism that develops to help people who have been rejected in the past to assert themselves socially, and to maintain some sense of control over a threatening environment.

Is it always a bad thing?

Again, there is disagreement. Some research suggests that perfectionism comes in two forms. A “neurotic” form characterized by excessively high standards and driven by a fear of failure, and a “normal” form characterized by more reasonable standards and some sense of satisfaction.

Other research differentiates between the desire to be perfect and the desire to do well and contends that the former is inevitably accompanied by excessive stress, frustration, and loss of reality testing.

As the NYT article pointed out, “…being a good editor or surgeon depends on not making mistakes…It’s when it generalizes to other areas of life, home life, appearance, hobbies, that you begin to see real problems.”

Perfectionism v. excellence.

Many perfectionists are successful, high-achieving professionals. They usually don’t want to give that up. They are also frequently exhausted and exhausting. That needs to go. Treatment involves separating and preserving the parts of their behavior that are beneficial. The parts that are problematic can then be addressed and diminished or resolved.