BY: CHERI A. LEVINSON, M.A.

Date: May 11, 2015

I first encountered clinical perfectionism while working with a young man at an anxiety clinic who had recently dropped out of graduate school. He was a previously high functioning individual who had to drop out of school because he was spending hours upon hours on his class assignments. If only he could make his work ‘perfect’.

After this, I started noticing perfectionism everywhere. Social interactions that were avoided because of worries that the ‘wrong thing’ might be said. Hours spent making beds without any wrinkles. Test scores that could be no less than 101%. Calories that had to be counted and recorded in a very precise manner. These behaviors were prevalent; and they were causing problems. It turns out that there is a name for this phenomenon. “Clinical perfectionism” is a term that is used when perfectionism becomes impairing.

What does the literature say about clinical perfectionism? First, there are lots of different types of perfectionism and lots of different definitions. There are two types of perfectionism in particular that seem to be especially impairing.

The first type is what we call “concern over mistakes.” What this means, is that you might be so afraid of making a mistake that this fear gets in the way of your life. Thinking back to my first perfectionistic client, he was so fearful of making a mistake on his school work that he was afraid to turn it in. He would spend hours and hours scouring his work to make sure there were no mistakes.

The second type of perfectionism is “excessively high standards.” In some ways having high standards can be adaptive, it pushes you to try and achieve higher and higher goals. But when these goals become too high or demanding, this can become problematic. Imagine spending hours upon hours exercising, trying to push yourself to exercise just a little bit longer, perhaps ignoring signals from your body that you have gone too far.

Does this apply to eating disorders? Yes! The research shows that perfectionism is transdiagnostic. This means that perfectionism shows up in individuals diagnosed with eating disorders, anxiety disorders, obsessive compulsive disorder, depression etc. We also know that perfectionism is a maintaining factor for these disorders and can impede progress in treatment.

Most people with eating disorders don’t just have an eating disorder, they also have anxiety, depression, or other problems. The Good News: Treating perfectionism might help with the eating disorder, but it might also help with the co-occurring anxiety and depression. Recently, Handley and colleagues published their findings on a randomized control trial of cognitive behavioral therapy for perfectionism. They found that treating perfectionism not only reduced perfectionism, but it also reduced symptoms of depression, eating disorders, social anxiety, and worry.

The UNC Center of Excellence for Eating Disorders recently started a perfectionism group on our inpatient unit where we address perfectionistic thoughts and behaviors. Patients start by identifying areas in their lives where they are particularly perfectionistic and end by completing behavioral experiments. Behavioral experiments are opportunities to practice challenging perfectionistic behaviors. For example, it might mean leaving that bed wrinkly or making a purposeful mistake in a social interaction. It could mean dropping your change in the cafeteria or making a punctuation mistake in your homework

In the end, we want our patients to learn that it is okay not to be perfect

Handley, A. K., Egan, S. J., Kane, R. T., & Rees, C. S. (2015). A randomised controlled trial of group cognitive behavioural therapy for perfectionism. Behaviour Research and Therapy, 68, 37-47.