CBT Therapy for Perfectionism. 

 

What is Clinical Perfectionism? 

 

• Perfectionism is a personality trait which is characterised by the setting of exceedingly high expectations and standards while being overly critical of evaluating both your own behaviours as well as others (https://www.sciencedirect.com/science/article/abs/pii/S0191886920300362#preview-section-references ). It can become extremely maladaptive and contributes to several disorders including anxiety, depression, obsessive compulsive disorder, eating disorders. Perfectionism can become extremely intrusive to ones life, interfering with daily functioning and general well-being. 

 

• Maladaptive perfectionism falls into three major categories according to Hewitt and Flett (https://psycnet.apa.org/record/1991-17214-001 ): 

 

• Self-Oriented Perfectionism 

• Socially Prescribed Perfectionism  

• Other-Oriented Perfectionism 

 

 

1. Self-Oriented Perfectionism is characterised by the beliefs that striving for perfection and being ‘perfect’ are extremely important. It is associated with setting extremely high standards (Stoeber, J., Feast, A. R., & Hayward, J. A. (2009). Self-oriented and socially prescribed perfectionism: Differential relationships with intrinsic and extrinsic motivation and test anxiety. Personality and individual differences, 47(5), 423-428. ).  

 

Self-Oriented Perfectionism is seen as a double edged sword because there are associations with positive characteristics such as conscientiousness and trait emotional intelligence and can lead to positive ambitions and goals. However maladaptive self-oriented perfectionism contributes to longitudinal issues such as depression due to its excessively high expectations. (https://cruxpsychology.ca/wp-content/uploads/2018/07/Smithetal.2017.349-369.pdf ) 

 

1. Social Prescribed Perfectionism is comprised of the belief that others have exceptionally high standards for themselves and an inherent need to meet the high standards of others. This form of perfectionism is overwhelmingly associated with psychological distress and the development of depression.  

 

1. Other-Oriented Perfectionism is the desire for others to meet your own high expectations and negatively effects your mood if they fall short. One cannot comprehend why someone would not strive for the expectations you may have for yourself. This form of perfectionism shows a relationship with a narcissistic personality.   

 

 

Perfectionism as a Symptom of Mental Health Disorders 

 

Is perfectionism linked to my Anxiety? 

 

• According to a meta analysis produced by the Journal of Clinical Psychology, individuals with anxiety are shown to display more perfectionistic traits. Perfectionist see the world through the lense of extreme high expectations and when expectations aren’t met this can lead to waves of anxiety often leading to constant dwelling on their ‘mistakes’ which only reinforces anxiety symptoms. This can be present across all forms of perfectionism but is most prominent in self-orientated perfectionism. Symptoms can be: 

 

• Difficulty concentrating  

• Racing Thoughts  

• Sleep issues 

• Appetite changes  

• Resltless nights  

• Rapid heart rate/breathing  

• Obsessions over certain things  

• Feelings of panic or dread 

 

• Anxiety-Perfectionism cycle can contribute to what feels like an endless loop of low self-esteem.  

 

1. Setting unattainably high standards 

 

 The inherent need to strive for perfection stimulates the decision of achieving goals that from an outsiders perspective are impossible to achieve.  

 

1. Persistent self-evaluating 

 

When the expectations are inevitably unmet, the individual will subject themslef to relentless self evaluation resulting in feelings of self-worth and doubt. 

 

1. Induced anxiety 

 

 These growing feelings of self-doubt result in a cascade of anxiety symptoms centred around making errors and facing judgment from others. 

 

1. Avoidance and Procrastination  

 

The result of these anxiety symptoms often result in behaviours designed to alleviate symptoms, such as procrastination. While these provide momentary relief, they only strengthen the individuals desire to achieve their exceedingly high goals. 

 

1. Reinforced Cycle  

 

With the strengthened desire to achieve high goals, this stimulates the restart of this loop where perfectionism exacerbates anxiety which then promotes further perfectionism and so forth.  

 

(https://mpowerminds.com/blog/the-link-between-anxiety-and-perfectionism-how-to-break-the-cycle#:~:text=Those%20with%20perfectionist%20inclinations%20are,an%20unending%20cycle%20of%20anxiety. ) 

 

 

The Link between Perfectionism and Depression 

 

While adaptive and healthy perfectionism can lead to great accomplishments, maladaptive perfectionism with individuals who constantly cast doubt on themselves for underachieving are shown to be vulnerable to depression, often being unable to change the way they are thinking, only reinforcing depressive symptoms. 

 

Depression arouses in perfectionist individuals based on their self-worth being evaluated on how successful they are/have been. This implies that self-worth is contingent on whether goals are achieved. As well as this, perfectionists are found to ruminate on their errors (https://link.springer.com/article/10.1007/s10608-007-9173-7 ) resulting in negative emotions which persist for long periods of time, creating an environment that contributes towards depressive symptoms (https://pmc.ncbi.nlm.nih.gov/articles/PMC3169326/ ). 

 

 

Perfectionism and OCD 

 

OCD is a disorder characterised by unwanted thoughts and repetitive behaviours and is commonly linked with perfectionism (https://pubmed.ncbi.nlm.nih.gov/24872829/ ). This subtype of OCD can also be known as ‘just right’ OCD and is associated with powerful compulsions for things to be done perfectly and correctly, leading to excessive checking behaviours and induced anxiety. Patients with OCD are shown to exhibit high levels of concern over mistakes and doubts over actions (https://www.sciencedirect.com/science/article/pii/S0005796796001088 ) 

 

Perfectionism in OCD is concentrated on the intensity of ones checking behaviours. These checking behaviours will intensify when ones feels they lack certainty over a specific action such as locking the front door resulting in excessively checking whether the door is locked to a point of perfect certainty. This excessive uncertainty can reinforce the idea that one is not perfect which can intensify the feelings of inadequacy and ultimately worsen further checking behaviours (https://www.verywellmind.com/ocd-and-perfectionism-2510483 ) 

 

 

Perfectionism in Eating Disorders  

 

Perfectionism is a significant driving force towards the development and maintenance of eating disorders. It drives individuals to achieve an unattainable standard of perfection as is highly prevalent amongst all eating disorders (anorexia nervosa, binge eating, bulimia nervosa). Perfectionism will convince individuals that there is a ‘perfect’ way to exercise and eat and will induce behaviours which will are targeted towards this unattainable reality. In individuals with eating disorders, the notion of fear of failure is expressed through fear of gaining weight and/or overeating which results in intense negative evaluation which only reinforces the perfectionistic attitudes and therefore maintaining the eating disorder (https://www.sciencedirect.com/science/article/abs/pii/S0005796702000888 ).  

 

Symptoms of an individual who suffers from an eating disorder and perfectionism can include: 

 

• Strict food rules  

• Excessive exercise 

• Black and white thinking  

• Fear of weight gain  

• Self-criticism  

• Control issues  

(https://eatingdisordersolutions.com/the-link-between-perfectionism-and-eating-disorders/ )  

 

 

How Can CBT treat my Perfectionism  

 

CBT is form of psychotherapy designed to restructure the thoughts and emotions one has to specific circumstances, ultimately altering their behavioural responses. It is a common practise for treating a wide variety of disorders, many of which include perfectionism subtypes. As perfectionism is pervasive pattern of preoccupation to toward perfection and high expectations, resulting in high levels of self-evaluation in response to expectations being met or not, CBT is proven to be effective in altering thought patterns that contribute toward this.  

 

Through methods of cognitive restructuring as a part of the CBT process, therapist can identify, highlight and eliminate the perfectionist thoughts and impulses. Cognitive restructuring is a series of conversations that aim to identify and challenge these self-critical thoughts, replacing them with more rational ones that allow for imperfection and mistakes. This aims to reframe thoughts to be less harmful, reducing any further anxiety.  

 

In conjunction with exposure response prevention (ERP), responses to perfectionistic thoughts can be altered. ERP is a form of CBT that induces scenarios which stimulate perfectionistic thoughts and aims to prevent any instinctive compulsions that might be triggered by these perfectionistic thoughts. With the guidance of a therapist, these exercises can help eliminate uncomfortable feelings, break compulsions and learn that not acting on these compulsions is okay.