Harvard Mental Health Letter | November 2007

The perils of perfectionism

Often evident at the holidays, this personality trait has a dark side.

References for "The perils of perfectionism"

November marks the start of both the holiday season and what could also be called the perfectionist season. Although holiday celebrations vary, conditions are perfect for one personality trait to emerge forcefully: The desire for everything to be perfect — serving the perfect meal, hosting the perfect family gathering, or showing off the perfect children.

Perfectionism can be exhausting. In extreme forms, it may also be hazardous to mental health.

Various studies over the years have linked perfectionism to obsessive-compulsive disorder, obsessive-compulsive personality disorder, mood disorders (such as anxiety and depression), eating disorders (such as anorexia and bulimia), body dysmorphic disorder, and an interest in cosmetic surgery. Perfectionism has also been investigated — but subsequently dismissed — as a cause of insomnia and irritable bowel syndrome.

A study suggests that perfectionism may at times arise in reaction to indirect aggression, a largely female type of social bullying that can leave its victims emotionally battered and bruised, rather than physically bloodied.

Exploring perfectionism

Efforts to pin down perfectionism over the years have been, well, less than perfect. The debate continues about how best to define this personality trait and whether it is always a detriment to mental health or might sometimes be a benefit.

Two perfectionism scales are used extensively today. The Frost Multidimensional Perfectionism Scale assesses six specific aspects of perfectionism: concern over mistakes, personal standards, parental criticism, parental expectations, doubts about actions, and organization. The Hewitt and Flett Multidimensional Perfectionism Scale, in contrast, measures three personal and social traits: self-oriented perfectionism (setting high standards for yourself), socially prescribed perfectionism (thinking other people are setting high expectations for you), and other-oriented perfectionism (having high expectations of other people).

In 1978, Dr. Don Hamachek first suggested that perfectionism could come in two forms — the “neurotic” one characterized by excessively high standards and driven by a fear of failure, and the “normal” version characterized by more reasonable standards and a feeling of satisfaction. When it comes to the research, though, scientists have overwhelmingly focused on the detrimental aspects of perfectionism.

One glaring example: eating disorders. Researchers reviewed 55 papers on eating disorders and perfectionism that were published between 1990 and 2005. Most studies suggested that eating disorders (especially anorexia) tend to develop in people who are perfectionist by nature and that the perfectionism endures even after recovery.

It remains unclear what causes perfectionism to develop in the first place. Some evidence suggests that, like perfect skin and teeth, perfectionism seems to run in families, and so may have a genetic component. Another view is that perfectionism is a response to environmental pressures and needs to be understood in a social context.

Investigating indirect aggression

A study published in 2007 in Aggressive Behavior supports the idea that perfectionism may develop in a social context and suggests an unexpected trigger: indirect aggression. This type of aggression involves socially manipulative behaviors such as talking behind someone’s back, giving someone the “silent treatment,” divulging secrets, and being nice to someone in private but mean in public. Females tend to engage in indirect aggression more often than males, with the theory being that this reflects the fact that girls and women are not encouraged to be overtly aggressive and so must express such tendencies in covert ways.

To find out whether experiencing indirect aggression might be linked to long-term perfectionism, researchers at McMaster University asked two groups of college-age women to fill out surveys to determine what types of verbal abuse, physical abuse, and indirect aggression they had experienced in grades 3 through 12. They also asked the women to answer questions to gauge whether they were perfectionists.

The researchers found that the women who recalled experiencing indirect aggression in childhood were more likely to become perfectionists by the time they reached college. Verbal and physical abuse had no impact.

The authors acknowledge that the study’s retrospective nature may have biased its findings, in that those women who were perfectionistic might be more likely than others to recall past events in a negative way. Even so, the authors propose that this study provides further evidence that perfectionism may develop as a coping mechanism that helps people who have felt rejected in the past to assert themselves socially, and to maintain some sense of control over a threatening environment.

Bardone-Cone AM, et al. “Perfectionism and Eating Disorders: Current Status and Future Directions,” Clinical Psychology Review (April 2007): Vol. 27, No. 3, pp. 384–405.

Miller JL, et al. “Relation Between Childhood Peer Victimization and Adult Perfectionism: Are Victims of Indirect Aggression More Perfectionistic?” Aggressive Behavior (May–June 2007): Vol. 33, No. 3, pp. 230–41.

For more references, please see www.health.harvard.edu/mentalextra.