Several years ago, I had a therapist who called herself “a recovering perfectionist.” While I thought that was clever, it wasn’t really something that I personally wanted to strive for. Sure, perfectionism can be hugely problematic and maladaptive… but I think that on many levels, perfectionism is okay. In the “real world,” perfectionism has a positive connotation, but in treatment, it kind of gets a bad rap.
A recent article was published on “Psychological inflexibility and symptom expression in anorexia nervosa.” It makes a lot of interesting points on controlling the bodily experience, using verbal rules to deal with fears, maladaptive social scripts, etc, but what really interested me was the distinction between psychological inflexibility and perfectionism.
Definition of pyschological inflexibility (according to the journal article):
The inability to behave flexibly in the presence of difficult thoughts, feelings, and bodily sensations.
Definition of perfectionism (acording to wikipedia):
The unitary combination of a desire to be perfect, a fear of imperfection, and an emotional conviction that perfection (not “near-perfection”) is the only route to personal acceptance by others. The difference [between perfectionism and striving for excellence] is in the meaning given to mistakes. Those who strive, however intently, for excellence can simply take mistakes (imperfections) as inducements to further learning and work. Perfectionists take mistakes as signs of personal defects that make them less acceptable. Anxiety over potential failure is the reason perfectionism is felt as a burden.
I think this is a great distinction for several reasons:
- “psychological inflexibility” encompasses more than just perfectionistic tendencies
- the word “inflexibility” suggests something problematic
- perfectionism is not necessarily a bad thing
- perfectionism is a personality trait, which may not change even if someone does completely recover from their eating disorder
By examining psychological inflexibility rather than perfectionism, the study was able to separate perfectionistic thoughts from actions/consequences. Meaning, you can still have perfectionistic thoughts without reacting to them negatively. This lead to several great findings:
“Although the frequency of perfectionistic cognitions did not change, adolescents’ reported decreased distress in response to those thoughts. Importantly, decreased distress was associated with reductions in dietary restraint and lower global scores on a structured interview of eating disorder symptoms when baseline levels of symptoms were controlled. This is consistent with studies of adults with AN that have reported greated acceptance of negative thoughts and feelings about weight and shape corresponded with ED symptom improvement in the absence of any significant change in the content or frequency of the thoughts and feelings themselves.”
and then
“Lower levels of psychological flexibility distinguish individuals with full syndrome AN from those who are weight restored and health controls, while the ability to engage flexibly with distressing throughts and feelings is associated with AN symptom remission across treatment. Perfectionism and related cognitions which have long been desribed as part of the phenomenology of AN, do not change in frequency but in impact as a result of successful intervention, suggesting how individuals with AN relate to these thoughts may be of prime importance.”
Maybe one of the goals of treatment, then, is not to eliminate perfectionistic tendencies, but to change your reactions to them. Distress tolerance. “It’s not perfect, but I can deal with that.” I don’t think it’s really the perfectionism that’s the problem, so much as the interpretation/internalization of what a mistake (or being out of control, or uncomfortable emotions, etc.) means.
8 comments
Michael says:
May 6, 2011
Thank you so much for the provocative article. However, I’m not entirely compfortable with the definition of perfectionism, that perfection “is the only route to personal acceptance by others.” I believe that perfectionism can be more about personal accpetance as opposed to acceptance by others. Of course, the personal ideals of being perfect can embedded earlier in life by others (such as a parent, teacher or clergy member) but who are who no longer have an active influence on the perfectionist’s life. Regardless, the perfectionist seldom, if ever, feels the satisfaction of a job well done or completed to perfection…even when recognized by others. Rather, they might find ways to question the results or see the opinions of others as flawed. So to your excellent point about accepting imperfection-it is more about accepting oneself. If the perfectionist is looking to others for acceptance, they will continue to be looking in the wrong place.
greythinking says:
May 7, 2011
Michael,
You are absolutely right — I agree that perfectionism is largely about personal acceptance. I actually found it really difficult to define perfectionism (or find a definition that I full agreed with).
In regards to your second point… sometimes I think it takes having people you care about tell you repeatedly that you did a good job, you are enough, you don’t have to be perfect, etc., for you to start to internalize it. Or, even better, show you that you can be okay, even when you screw up. Treatment really provided this for me. I could have a bad day, not follow my meal plan, and say all the wrong things… and they still cared. It took this external approval for me to be able to freak out less about being a disappointment.
You make great points!
grey
Michael says:
May 12, 2011
Grey, I really appreciate your feedback (and this entire site). For perspective, I am a proud parent of a perfectionist with an ED. I love your reply to my second point, it’s reaffirming and encourages me that that persistance will pay off.
Jess says:
May 6, 2011
I love that the study sorts out psychological inflexibility from perfectionism. I agree that perfectionism is not an inherently bad thing, but the reaction to finding one’s work imperfect can be. I myself struggle with perfectionism, but it’s not so much the striving to do better and be better that’s an issue — it’s my reaction when I found out that I am not, in fact, perfect. Teaching distress tolerance would seem to be key — probably why so many treatment centers love DBT, eh?
greythinking says:
May 7, 2011
Jess,
That’s interesting about realizing you’re not perfect. I have a question for you, then — do you keep striving for perfectionism because you feel it is possible for you to be perfect?
For me, I think perfectionism is actually about avoidance, as funny as that probably sounds. I want to avoid screwing up, avoid disappointing others, avoid uncomfortable feelings, avoid making other people feel negatively, etc. But then again, I could probably chalk most things up to avoidance.
Glad to have you reading
grey
is less about being perfect and more about not screwing up. Ac
Jess says:
May 9, 2011
I think when I was still in school, “perfection” was an attainable thing – there were, in fact, a perfect scores on tests, papers, etc. But you’re right, in the real world, we are rarely evaluated on such a scale, making “perfection” a less reasonable pursuit. I’ve noticed that in my acceptance of never being able to be perfect, I’ve switched to a need to be “the best” — the best daughter, the best friend, the best sister, the best patient, the best anorexic, the best depressive, whatever.
greythinking says:
May 14, 2011
Jess,
The best depressive? I’m not going to fight you for that title
BL says:
May 8, 2011
As much as I love CBT, this article highlights why I think DBT and other therapies like ACT (acceptance and commitment therapy) are probably better for me and maybe other eating disorder patients. Just like you said in one of your comments, I think that rather than being a perfectionist per se, it is more that I am afraid of failure. I don’t want to be perfect and I don’t expect to be perfect, but I also have these unrealistic expectations for myself with regards to what I need to do in order to not fail. I also care way too much about what others think of me, and am always worried about whether or not I am making the “right” decision. I have tried restructuring those thoughts, but unfortunately, most of them simply can’t be restructured. For example, there is just no way to know what others are thinking about me or my decisions (I could ask them, but that would still require a leap of faith on my part that they are telling the truth), so the key is to learn to deal with that uncertainty.
I think a lot of distress with negative thoughts is also self-imposed. For example, beating one’s self up with “I shouldn’t be thinking that” or “I shouldn’t be feeling that way.” Rather than sitting there thought restructering those should statements, I find that it is more helpful to just try and “let them go”…otherwise I just keep having more should statements with regards to the original should statements!