Evidence-Based Reviews

When does conscientiousness become perfectionism?

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Traits, self-presentation styles, and cognitions suggest a persistent psychopathology.


 

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Mr. C is a 50-year-old professional writer who recently made a serious suicide attempt. At his initial session, Mr. C was hesitant to discuss his situation and reason for attending. He did, however, bring a copy of his résumé so the therapist could “get to know him quickly.”

He said he had been depressed for a long time, especially since he found an error in one of his published works. His confidence and writing abilities seemed to decline after this discovery, his career took a downturn, and ultimately he was fired from his position. He described often being at odds with his supervisors at work, whom he saw as critical and condescending. He was mortified by his job loss and did not inform his wife or friends of his firing.

Mr. C had always been a bit of a loner, and after losing his job he further distanced himself from others. He began drinking heavily to avoid the pain of “letting everyone down.” His wife, family, and friends were shocked at the suicide attempt and expressed dismay that Mr. C had not confided in anyone.

Mr. C describes himself as being perfectionistic throughout his life and never being quite good enough in any of his pursuits. This leads to self-recriminations and persistent feelings of shame.

Far from being a positive attribute, perfectionism is a neurotic personality style that can result in serious psychopathology, including relationship problems, depression, anorexia nervosa, and suicide. Determining a patient’s perfectionistic traits is essential when evaluating those who seek treatment specifically for this distressing behavior as well as patients in treatment for other issues who may have a perfectionistic personality. Accurately assessing perfectionism can help you predict and forestall noncompliance, assess suicide risk, determine appropriate treatment and identify circumstances under which a patient might be particularly vulnerable to relapse.

This article describes:

  • 3 traits of perfectionism
  • 3 dimensions of perfectionistic self-presentation
  • perfectionistic cognitions
  • useful self-report tools for clinical practice
  • effective treatments.

Characteristics of perfectionism

Although perfectionism initially was viewed as self-related cognitions, recent models suggest it incorporates intrapersonal and interpersonal dimensions.1 A person with perfectionism has a marked need for absolute perfection for the self and/or others in many—if not all—pursuits that is strongly rooted in his or her intrapersonal and interpersonal worlds. Other characteristics of perfectionism include:

  • equating self-worth or esteem with performance
  • self-punishment in failure and a lack of satisfaction in success
  • maintaining and needing to strive for unrealistic expectations
  • unrealistic criteria for success and broad criteria for failure.
Some clinicians have suggested that perfectionism may be adaptive,2 but “adaptive perfectionism” is more likely a reflection of conscientiousness or achievement striving (Table 1). Although perfectionism can involve rumination, it is much broader than simply having an obsessional cognitive style.

We define perfectionism as a neurotic personality style involving perfectionist traits, self-presentation styles, and cognitions that is a core vulnerability factor for a variety of psychological, physical, achievement, and relationship problems (Table 2).1,3

3 traits. Three traits of perfectionism reflect the desire for the self or others to be perfect:

  • self-oriented perfectionism—a requirement for the self to be perfect
  • other-oriented perfectionism—a requirement for others to be perfect
  • socially prescribed perfectionism—a perception that others require perfection of oneself.
Each of these traits is associated with different Axis I and Axis II disorders, which we outline below.4 In addition to these traits, perfectionism includes interpersonal and intrapersonal expressions.

3 self-presentational dimensions. The interpersonal expression of perfectionism is perfectionistic self-presentation. In our model, the 3 facets of perfectionistic self-presentation are:

  • perfectionistic self-promotion—overt displays and statements of one’s supposed “perfection”
  • nondisplay of imperfections—hiding any imperfections
  • nondisclosure of imperfections—avoiding disclosure or discussion of any imperfection.3
Perfectionistic cognitions. The intrapersonal expression of perfectionism is perfectionistic information processing and ruminative thoughts regarding the need for perfection for the self or others.5 This state component reflects the self-related inner dialogue of the patient’s requirement for perfection, recriminations, etc. Perfectionistic cognitions are associated with state levels of distress and symptom severity.

Table 1

How perfectionism differs from conscientiousness

PerfectionismAchievement striving/conscientiousness
Receives no satisfaction from any performanceExperiences satisfaction with good performance
Experiences no rewards from any performanceRewards self or others for good performance
Maintains expectations in the face of failureAlters expectations in the face of failure
Is motivated by fear of failureIs motivated by desire for success
Shows poor organizationIs organized
Focuses on flaws as indication of self-worthFocuses less on flaws

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