Perfectionism

It is June in Dhanmondi, mango season, and the power has gone for the second time this evening. Ehsan, 17, is revising A-level maths by torchlight, a mock paper marked 98 beside him. His Nanu, fanning herself with a hand fan, is delighted. “Ninety-eight. In our time, if you passed, the whole para got mishti.” His little sister looks under the bed. “Bhaiya, I’m searching for the two missing marks.”

Ehsan does not laugh. “Ninety-eight isn’t a hundred.” His mother, Mitali, has noticed things the mark sheet does not show. He rewrites his notes until two or three in the morning, erases until the paper tears, and has stopped going to football because he missed a practice and “can’t go back behind”. When he makes a small mistake he goes very quiet, then very angry. She wonders whether she and his father pushed too hard, and then wonders whether wondering that is pushing too.

An illustration drawn from common experience. The people are invented; the pattern is not.

Understanding perfectionism

Perfectionism is a personality trait, not a diagnosis. Researchers describe two sides: perfectionistic strivings, which are very high personal standards, and perfectionistic concerns, which are fear of mistakes, harsh self-criticism and the sense that others expect perfection. Both sides have been linked with mental health problems. Perfectionism is described as transdiagnostic, which means it shows up across several conditions, including depression, anxiety disorders, obsessive compulsive disorder (OCD) and eating disorders. When rewriting must continue until something feels exactly right, a psychiatrist will also ask about OCD.

How common it is

There is no single prevalence figure, because perfectionism is measured on a scale rather than diagnosed. A meta-analysis of 164 samples of 41,641 college students in the United States, Canada and Britain found that all three measured forms of perfectionism rose steadily between 1989 and 2016; the largest rise was in the sense that others demand perfection. A separate meta-analysis of 284 studies found both dimensions of perfectionism associated with various forms of psychopathology, across outcomes that included depression, anxiety, OCD, eating disorders, self-harm and suicidal thinking. We did not find comparable figures for young people in Bangladesh.

Signs worth noticing

• Redoing work many times, or staying up late to make it perfect
• Distress or anger over small mistakes
• Avoiding tasks or activities where success is not certain
• Harsh self-talk, and difficulty accepting praise
• Headaches, poor sleep or skipped meals around exams
• Low mood or worry that continues after good results

How care helps

A psychiatrist assesses for depression, anxiety, OCD and eating disorders and treats any that are present. For perfectionism itself, a meta-analysis of 15 randomised trials with 912 participants, average age 23, found that CBT for perfectionism, given face to face or as self-help, reduced perfectionism and also symptoms of depression, anxiety and eating disorders. The work includes testing what really happens when a task is done well rather than perfectly, setting time limits, and treating mistakes as information. Parents can help by praising effort and process, keeping comparisons with cousins out of the conversation, and showing that their love does not depend on the mark.

What getting better can look like

Ehsan’s week might hold notes written once, a lamp switched off by midnight, football on Friday afternoons, and a 91 in the next mock that he shrugs at and then goes to eat a mango.

Common questions about perfectionism

Is perfectionism a mental illness?

No. Perfectionism is a personality trait, not a diagnosis. But a large meta-analysis found it is linked with several mental health conditions, including depression, anxiety, OCD and eating disorders. When it causes distress or gets in the way of life, it can be treated with CBT.

How can parents help a perfectionist teenager?

Praise effort, strategies and progress rather than only marks, and avoid comparisons with siblings or cousins. Notice signs such as staying up late to redo work, anger over small mistakes or avoiding activities, and talk about them calmly. If these signs persist or come with low mood or anxiety, a doctor can assess what is going on.

When to see a psychiatrist

If perfectionism is costing sleep, meals, friendships or joy, or if a young person seems hopeless after results, it is time for an assessment. If there is any talk of self-harm or suicide, call 999 or go to the nearest emergency department.

Care here is personal: built around your history, your health and what you want to change, and reviewed with you as it goes.

Sources

• Limburg et al., Journal of Clinical Psychology, 2017 (PMID 28026869)
• Curran and Hill, Psychological Bulletin, 2019 (PMID 29283599)
• Galloway et al., Cognitive Behaviour Therapy, 2022 (PMID 34346282)