Study finds perfectionists at higher risk for an array of problems

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Karen Kain, Canadian prima ballerina, confessed in her autobiography that out of some 10,000 performances during her career, there were only seven or eight with which she was truly satisfied.

Gen. Douglas MacArthur, the American commander during World War II, loathed admitting defeat and once uttered during battle, "We are not retreating — we are advancing in another direction."

Martha Stewart, the notoriously demanding lifestyle maven-cum-felon, once threatened to dump her Merrill Lynch stockbroker because she didn't like the firm's telephone hold music.

Kain. MacArthur. Stewart. Perfectionists all.

Perfectionism is the need to be — or to appear — perfect. Perfectionists are persistent, detailed and organized high achievers. Perfectionists vary in their behaviors: Some strive to conceal their imperfections; others attempt to project an image of perfection. But all perfectionists have in common extremely high standards for themselves or for others.

Researchers are split on whether perfectionism has only negative aspects; some argue it could be a virtue that propels people to excellence. Yet convincing data link certain forms of perfectionism to a host of emotional, physical and relationship problems, including propensity to depression, eating disorders, marital discord and even suicide.

According to the prevailing definition, perfectionists are people who not only hold unrealistically high standards but also judge themselves or others as always falling short.

"The thing about perfectionists is that they don't ever experience satisfaction," said Paul Hewitt, professor of psychology at the University of British Columbia and one of the leading researchers on perfectionism. "Nothing is ever good enough."

Hewitt had a patient who was a classic case: A graduate student set out to earn an A-plus in a particular course, only to become distressed and morose when he succeeded.

"He said that if he was really, truly smart, he wouldn't have had to study so hard," Hewitt recalled.

Perfectionism's many faces

Hewitt and his co-researchers have identified three types of perfectionists. Self-oriented perfectionists expect perfection of themselves. Other-oriented perfectionists demand perfection from other people. And socially prescribed perfectionists think others expect perfection from them.

Hewitt helped to develop a 45-question test, called the Multidimensional Perfectionism Scale, to measure the three different facets. He contends that all three types of perfectionism are maladaptive — that is, nothing about them is beneficial.

Some studies have shown that self-oriented perfectionists, such as the ballerina Kain, score higher on exams and get better grades than nonperfectionists, even when adjusted for IQ levels. But Hewitt says such accomplishments come with a price. For instance, all three types of perfectionists tend to experience greater personal dissatisfaction despite their accomplishments. The correlation between self-oriented perfectionism and another potential consequence, depression, is inconclusive. However, Hewitt maintains that perfectionistic tendencies create a vulnerability that could push a person into depression if something were to trigger it.

Socially prescribed perfectionism, the belief that others have exaggerated expectations of a person, is the type most closely linked to suicide. A 1992 study by Hewitt and two co-authors examined the records of psychiatric inpatients and outpatients and found that socially prescribed perfectionists were significantly more at risk for suicide. Such patients not only made more attempts but also were more likely to succeed in killing themselves, indicating the seriousness of their intent, Hewitt said.

In 1993, a group of Israeli researchers published the results of psychological autopsies on 43 suicides by male soldiers during compulsory military service. The victims were all between 18 and 21 years old.

Examination of their military records and interviews with those who knew them implicated intense perfectionism as a key trigger for 28 percent of the soldiers. These suicides stemmed in part from the victims' perception of "humiliation or insult or a failure to live up to his own or others' expectations" during their service. The study appeared in the Archives of General Psychiatry.

Other-oriented perfectionism, a form Martha Stewart is said to exhibit, can involve exceedingly high expectations by parents of their children or extreme criticism of a spouse or significant other. This type is associated with low marital happiness — particularly on the part of the besieged partner — and other relationship difficulties.

Spotting perfectionists

In addition to identifying the three types of perfectionists, Hewitt and his co-researchers say perfectionists reveal themselves in three distinct ways.

The first, a "self-promotion" style, involves attempts to impress others by bragging or displaying one's perfection. Self-promoters care deeply about appearing in control, about displaying perfect social graces and are meticulous about their looks. Politicians and most of the cast of television's "The Apprentice" could fit this mold.

This type is easy to spot because "they irritate people," said Gordon Flett, professor of psychology at York University in Toronto and Hewitt's long-time collaborator.

Self promoters are more prone to eating disorders such as anorexia. Flett said he and his colleagues are planning a simple, but novel, experiment to test for this trait: asking female subjects to be photographed without makeup.

"We predict that they're going to be very anxious. Especially if we tell them the photos will be evaluated," Flett said.

A second way that perfectionists reveal themselves is by shunning situations that could display their imperfection. They avoid making mistakes in public and hate letting people know about their failures. For example, they likely will turn down a golf invitation from the boss if they play poorly.

Flett said such tendencies are obvious even in young children.

"Teachers know that perfectionistic kids only try things they're good at," he said.

Perfectionists who practice such avoidance tend to form few relationships.

The third type of presentation is a person who keeps problems to himself, won't admit failure to others and conceals how hard he works on things. Gen. MacArthur's inability to concede defeat is one example. Another is the spouse who might have had a screw-up on the job but, when asked about his day at work, replies, "it was fine."

This person may have more relationships than those who evade situations but not deeply intimate relationships.

Origins of perfectionism

Perfectionism is not officially recognized as a psychiatric disorder in the Diagnostic and Statistical Manual, the reference most commonly used in the United States for diagnosing mental disorders.

But Flett argues that extreme forms of it should be considered an illness — similar to narcissism, obsessive compulsiveness, dependent-personality disorder and other personality disorders listed in the manual. To qualify perfectionism as a clinical disorder, researchers would need to show that it stems from behavioral, psychological or biological dysfunction and that it causes distress or disability, among other things.

A 1994 experiment with 30 preschoolers at a computer camp in Toronto showed that even 4- and 5-year-olds possess marked traits for perfectionism. Interviewers asked the children five questions tapping perfectionism levels ("How would you like to be perfect?"). Then they gave the kids a computer task that was rigged to not work. The highly perfectionistic children showed signs of more extreme distress, such as elevated anger and anxiety, Flett said.

Hewitt said preliminary research indicates a possible genetic factor to perfectionism. Children of perfectionists tend to grow up to be perfectionists themselves, although Hewitt said much more study is needed to confirm this.

Hewitt is emphatic that perfectionism is never a good thing. He disagrees with an emerging view from other researchers that perfectionism may lead to positive results, such as higher self esteem or better grades.

But others disagree: "Is relentless pursuit of perfection bad? How about making a really, really good car?" said Ken Rice, an associate professor of psychology at the University of Florida. "I don't see anything really wrong with people trying to be at the top of their game."

Rice agrees with Edward Chang of the University of Michigan, who argues that research by Hewitt and others have unfairly given perfectionism a bad name.

Chang, a Korean-American associate professor of psychology, says cultural differences about perfectionism and striving have especially been overlooked. For instance, Asian Americans show greater levels of perfectionism than whites, Chang said. Yet Asian Americans are no more prone to considering suicide, which, Chang said, demonstrates that perfectionism is not as maladaptive for them.

"For some people, perfectionism will represent something bad and pathological. For other people, perfectionism will represent something good and inspiring, said Chang, who is writing a book called, "Positive and Negative Perfectionism."

Hewitt dismisses such views as differences over semantics.

The so-called healthy perfectionists, in fact, are something else, Hewitt says.

"I wouldn't call them perfectionists. I'd call them high achievers. There are no positive aspects to perfectionism."

Kyung Song: 206-464-2423 or

Are you a perfectionist?

Canadian researchers have developed a 45-item questionnaire to identify the three types of perfectionists. Here are some sample questions.

Self-oriented perfectionism

Yes answers indicate that you have unrealistic standards and perfectionistic expectations of yourself.

I demand nothing less than perfection of myself.

Yes No

I strive to be as perfect as I can be.

Yes No

Other-oriented perfectionism

Yes answers indicate that you hold other people to unrealistically high standards.

I cannot stand to see people close to me make mistakes.

Yes No

If I ask someone to do something, I expect it to be done flawlessly.

Yes No

Socially prescribed perfectionism

Yes answers indicate that you believe that others expect you to be perfect.

People expect nothing less than perfection from me.

Yes No

The better I do, the better I am expected to do.

Yes No

Research Version 1998, 2003, Multi-Health Systems Inc. All rights reserved.

Loosening perfectionism's grip

Perfectionism is not officially recognized as a psychiatric disorder and thus has no standard treatments. But these common-sense tips could help curb perfectionistic tendencies.

Is it really that bad? Getting a B+ or a C or even a D instead of an A does not have to equal doom. Do a reality check: Does the event justify your reaction?

Check the evidence. If you think others are smarter, prettier, happier or better than you, who are you comparing yourself against? Are you judging yourself against reasonable standards? Is a comparison even necessary?

Relax the tyranny of the "shoulds." Avoid thinking in terms of "should" and "ought." Few things in life are absolute: You should not kill others. You should not harm children. But instead of saying, "I should run five miles," say, "I would prefer to run five miles, but my self worth does not depend on it."

Forgive yourself. Humans are not perfect beings. If you grant that to those you love, don't hold yourself to higher standards.

Lighten up. Set your sights just a bit lower and see how you like it. If you practice the piano for an hour every day, try taking a day off. Or play for 45 minutes one day instead of a full hour. Drop the all-or-all approach to life.

Source: Ken Rice, associate professor of psychology at University of Florida.