The perils of perfectionism

I have a neighbor who prides himself on having the perfect lawn. He spends hours each week tending, mowing, and weed-whacking his yard. I get tired just watching him.

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.

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.

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.

A study published in 2007 in the journal 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.

Like many other things in life, perfectionism is fine in small doses. As this study suggests, it may even provide a coping mechanism. But when perfectionist thinking predominates, it may lead to anxiety, depression, and other mental health problems.

Are you a perfectionist? Do you know someone who is? What steps may help to keep perfectionist thoughts from taking control of your life?

Dr. Michael Miller has been on staff of the Beth Israel Deaconess Medical Center, a large teaching hospital in Boston, for more than 25 years. He is also an Assistant Professor of Psychiatry at Harvard Medical School.

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