Perfectionism · Kitchener, Waterloo & Cambridge
Perfectionism is more than high standards. It is standards so demanding that your sense of worth depends on meeting them, pursued even when the cost is plain. It is not a diagnosis, but it runs through depression, anxiety, obsessive-compulsive disorder and eating disorders. In 15 randomized trials, cognitive behavioural therapy aimed at perfectionism reduced it by the end of treatment; how well that holds afterwards is still argued over. At CARESPACE this is counselling work, and the first visit is with a Registered Psychotherapist or a Registered Social Worker.
What perfectionism is
One clinical description, from Western Australia’s Centre for Clinical Interventions, has three parts: relentless striving for extremely high standards, for yourself or for others, that are personally demanding; judging your worth largely by your ability to reach them; and carrying on in spite of the cost. Researchers use “clinical perfectionism” for the core of it: self-worth that depends on striving, whatever the consequences.
High standards are not the problem. The aim of treatment is to pursue healthy high standards in place of unrelenting ones that damage your life. That is also where perfectionism parts from its neighbours. Low self-esteem is a poor opinion of yourself across the board; in perfectionism, your opinion of yourself rises and falls with your results. Imposter syndrome is being unable to credit success you have already earned.
Three kinds, and two sides
Paul Hewitt and Gordon Flett, psychologists at the University of British Columbia and York University, described three forms in 1991, and researchers still use them:
- Self-oriented. You attach irrational importance to being perfect and hold unrealistic expectations of yourself.
- Socially prescribed. You believe the people around you are excessively demanding and judge you harshly.
- Other-oriented. You hold others to unrealistic standards and are critical when they fall short.
Much research now sorts perfectionism another way, into two sides. Perfectionistic strivings are the reaching for high standards. Perfectionistic concerns are the negative reactions to mistakes and the fear of being judged. Concerns are the side most consistently tied to distress.
How it shows up
- Relentless striving for extremely high standards
- Harsh self-criticism when you fall short
- Strong negative reactions to your own mistakes
- Doubts about whether you have done something properly
- Fear of being judged by others
- Putting off starting a task for fear of not doing it perfectly
- Pushing on despite what it is costing you
Is it becoming more common?
Among students, it appears so. A 2019 analysis combined 164 samples, 41,641 college and university students in the United States, Canada and the United Kingdom, who had filled in the same perfectionism questionnaire between 1989 and 2016. All three forms rose, and socially prescribed perfectionism rose twice as much as the other two. The authors speculate that this may be because young people now face more competitive environments, more unrealistic expectations and more anxious and controlling parents than earlier generations did. In a region with two universities, a college and plenty of rep sport, there is no shortage of places to be ranked. The study compared different cohorts and did not follow individuals, and it looked only at students.
What it travels with
Perfectionism is described as “transdiagnostic”, a risk and maintaining factor for several conditions and not one of them itself. A meta-analysis of 284 studies and 57,200 participants found that both sides of it were related to depression, anxiety disorders, obsessive-compulsive disorder and bulimia, with concerns usually showing the stronger link. Nearly all of those studies measured people at one point in time, so they show association, not cause. If low mood, constant worry, obsessions or changes in your eating have arrived alongside the perfectionism, see a physician or nurse practitioner. In Ontario a diagnosis comes from a physician, nurse practitioner, psychiatrist or psychologist.
A Canadian-led review of 45 studies found small-to-moderate links between perfectionism and thoughts of suicide. If you are thinking about suicide, or you do not feel safe, do not wait for an appointment: use the numbers below.
If you are in crisis or thinking about suicide, help is available right now.
- Call or text 9-8-8, the Suicide Crisis Helpline, at any hour.
- Call Here 24/7 at 1-844-437-3247 for addictions, mental health and crisis services in Waterloo Region, at any hour. here247.ca
- Call 911 or go to the nearest emergency department if you or someone else is in immediate danger.
The emergency departments in Waterloo Region are:
- WRHN @ Midtown (formerly Grand River Hospital), 835 King St. W., Kitchener
- WRHN @ Queen’s Blvd. (formerly St. Mary’s General Hospital), 911 Queen’s Blvd., Kitchener
- Cambridge Memorial Hospital, 700 Coronation Blvd., Cambridge
If you cannot get there safely, call 911.
What the evidence says about treating perfectionism
- Where this comes from. A 2022 systematic review of 15 randomized trials of cognitive behavioural therapy (CBT) for perfectionism, with 912 participants; a 2023 re-analysis of 16 trials, published in Canadian Psychology; and the first group’s reply to it.
- By the end of treatment, CBT reduced perfectionism. Compared with waiting-list or control groups, the 2022 review found large reductions in concern over mistakes and in clinical perfectionism, and a medium reduction in personal standards.
- Symptoms improved too. Depression and eating disorder symptoms fell by a medium amount and anxiety by a small-to-medium amount.
- Self-help formats did about as well. The trials used face-to-face therapy, groups, guided and unguided online programs and self-help books, and results were similar across them. Few trials tested face-to-face therapy alone.
- Who was studied. Mostly young women: the average age was 23 and 82% were female. Only one trial was in adolescents. The comparisons were with waiting lists or control groups, not with other psychological treatments.
- Whether it lasts is disputed. The 2023 re-analysis confirmed gains at the end of treatment on several measures, but found no significant difference on self-oriented, socially prescribed or other-oriented perfectionism, more drop-out in the treatment groups, and no significant differences at follow-up. The original researchers reply that the drop-out is typical for CBT and that the follow-up finding rests on very few studies. They agree that too few trials have compared this therapy with another active treatment at follow-up.
How CARESPACE helps with perfectionism
Counselling & Psychotherapy
CARESPACE counsellors offer cognitive behavioural therapy (CBT). Applied to perfectionism, that work typically covers what keeps the pattern going, the costs and benefits of changing it, small experiments in doing things differently, challenging perfectionistic thinking, loosening rigid rules and assumptions, and rethinking how much of your worth rests on achieving. A counsellor can also watch for depression, anxiety, obsessive-compulsive symptoms or eating problems alongside it. Given the open question about lasting effects, it is reasonable to ask how you will keep the gains going once sessions end.
Other services people ask about
Mental performance. Perfectionism in athletes has been studied on its own. A 2018 review of 52 studies found that perfectionistic concerns went with poorer motivation and wellbeing and had no relationship with performance, while strivings went with somewhat better performance and a mixed picture for wellbeing. Its authors suggest that practitioners be mindful of the dangers of the concerns side for athletes. They point to a growing body of research in which techniques many sport practitioners already know, CBT being their example, may be effective at reducing perfectionism, and they call those techniques the first point of call. Only a small number of studies have tested interventions for perfectionism in sport itself, and some of those report success with these or similar techniques. If your perfectionism is mostly about sport or performing, ask about mental performance when you book.
Where most people start
With a counsellor. If low mood, anxiety, obsessions or eating problems are part of it, see a physician or nurse practitioner as well.
How your team works together
For perfectionism itself there is one service to see, counselling. The conditions it travels with are another matter: depression, an anxiety disorder or obsessive-compulsive disorder brings in a physician or nurse practitioner for diagnosis and any medicine, and an eating disorder brings in a specialized program as well.
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Available this week
Josh Zettel, BA (Hons), MA, RP, CMPC, CCC
Psychotherapist, Certified Mental Performance Consultant, Clinic Director, Assistant District Manager
You do not have to keep carrying anxiety, pressure, or life-transition stress alone when the right support can help you feel steadier in both mind and life.
Browse by service: counselling.
What to expect at your first visit
At a first visit the counsellor works to understand your concern and comes up with a plan, so nothing needs preparing. If you like to arrive ready anyway, think about:
- Where the standards bite. Work, school, sport, parenting, your home, your body.
- What a mistake does to you. How long it stays, and what you say to yourself about it.
- What it costs. Hours, sleep, deadlines missed through delay, things not attempted.
- What has arrived alongside it. Low mood, constant worry, obsessions or changes in your eating.
The plan is yours to take away.
What you can do on your own
Western Australia’s Centre for Clinical Interventions publishes a self-help workbook, Perfectionism in Perspective, built on the same CBT approach, which can be downloaded from its website. After two opening modules on what perfectionism is, its steps run in this order:
- Notice what keeps it going
- Work out what your perfectionism does for you and what it costs
- Run small experiments in behaving less perfectly, and see what actually happens
- Challenge the thinking, then the rules and assumptions underneath it
- Reconsider how much your worth should depend on achieving
- Write a plan for keeping the changes going
Self-help formats did about as well as face-to-face therapy in the trials above, though this workbook was not necessarily the one they tested.
Outlook
None of the sources gives a timeline. The trials support change by the end of a course of CBT; whether it holds months later is the open question in the research.
Help with perfectionism in Kitchener, Waterloo and Cambridge
Kitchener. Counselling in Kitchener. Locations: Victoria North, Fischer-Hallman, Westmount East and Deer Ridge.
Waterloo. Counselling in Waterloo. Locations: Weber North, Uptown Waterloo and Waterloo GoodLife.
Cambridge. Counselling in Cambridge. Location: Hespeler Road.
The city pages linked above show the locations and practitioners for each service, with their next availability.
Common questions
Is perfectionism a mental illness?
It is a pattern, not a diagnosis. Researchers describe it as a risk and maintaining factor for several conditions, including depression, anxiety disorders, obsessive-compulsive disorder and eating disorders.
Is some perfectionism healthy?
High standards can be. The striving side goes with somewhat better performance in athletes, but a mixed picture for wellbeing, and the Canadian-led review of suicide research found that even striving was linked to suicidal thoughts. Its authors question the idea that such striving is healthy.
Is perfectionism the same as OCD?
No. The two are related in studies, but obsessive-compulsive disorder is a diagnosable condition with its own treatment.
Does perfectionism cause procrastination?
It can feed it: putting off a task for fear of not doing it perfectly is a recognized perfectionist behaviour. See Procrastination.
Is perfectionism getting more common?
Among students in the United States, Canada and the United Kingdom, average scores rose between 1989 and 2016, most of all for the belief that other people demand perfection of you.
Can I see a counsellor about perfectionism in Cambridge?
Yes: Counselling in Cambridge has the details. Book online or call 519-208-2273 and our Central Reception Team will find the closest location with an opening.
Do I need a referral?
No. Book online or call 519-208-2273. You pay at each visit and receive a receipt for your extended health plan. More on fees and insurance →
Sources
- Galloway R, Watson H, Greene D, Shafran R, Egan SJ. The efficacy of randomised controlled trials of cognitive behaviour therapy for perfectionism: a systematic review and meta-analysis. Cognitive Behaviour Therapy, 2022.
- Smith MM, Hewitt PL, Sherry SB, Flett GL, Kealy D, Tasca GA, Ge S, Ying F, Bakken K. A meta-analytic test of the efficacy of cognitive behavioural therapy for perfectionism: a replication and extension. Canadian Psychology, 64(4), 2023 (read as an abstract only).
- Egan SJ, Wade TD, Watson HJ, Öst L-G, Cuijpers P, Shafran R. Towards high standards of evidence for cognitive behaviour therapy for perfectionism: a critique of Smith et al. (2023). Canadian Psychology, 64(4), 2023 (accepted manuscript, University College London repository).
- Limburg K, Watson HJ, Hagger MS, Egan SJ. The relationship between perfectionism and psychopathology: a meta-analysis. Journal of Clinical Psychology, 2017.
- Curran T, Hill AP. Perfectionism is increasing over time: a meta-analysis of birth cohort differences from 1989 to 2016. Psychological Bulletin, 2019.
- Smith MM, Sherry SB, Chen S, Saklofske DH, Mushquash C, Flett GL, Hewitt PL. The perniciousness of perfectionism: a meta-analytic review of the perfectionism–suicide relationship. Journal of Personality, 2018.
- Hill AP, Mallinson-Howard SH, Jowett GE. Multidimensional perfectionism in sport: a meta-analytical review. Sport, Exercise, and Performance Psychology, 2018.
- Centre for Clinical Interventions, Western Australia Department of Health. Perfectionism: self-help resources. Updated October 2019.
Related conditions
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Book online with a counsellor, or call 519-208-2273 and our Central Reception Team will match you with the right person and the closest location.