When does conscientiousness become perfectionism?
Traits, self-presentation styles, and cognitions suggest a persistent psychopathology.
Psychodynamic treatments focus on perfectionism’s underlying mechanisms and attempt to alter the patient’s personality structure. Studies suggest that intensive psychotherapy is most appropriate.
One of the first treatment evaluations from a reanalysis of Menninger Clinic data found the greatest improvements in patients receiving intensive psychoanalytically oriented treatment, compared with short-term psychotherapy or other treatments.16 More recent evaluations suggest that highly perfectionistic individuals can be treated effectively only with intensive, long-term psychodynamically oriented treatment17 and short-term interpersonal, cognitive, and medication therapies do little to alter perfectionistic behavior.
In our experience [PLH] perfectionistic individuals can improve significantly with long-term intensive treatment. On the other hand, we recently completed a study of the efficacy of a short-term, intensive psychodynamic/interpersonal group approach for treating perfectionism and its sequelae.
In this study,18 we focused on treating the interpersonal precursors or causes of perfectionism, such as attachment styles; interpersonal needs for respect, caring, acceptance, and belonging; and need to avoid rejection, abandonment, and humiliation. In 70 patients with high levels of perfectionism, this treatment significantly decreased perfectionism, symptoms of depression and anxiety, and interpersonal problems. These symptoms continued to be reduced from baseline 6 months later.
Cognitive-behavioral approaches. Several researchers’ findings suggest that cognitive restructuring, bibliotherapy, role-playing, coping strategies, homework assignments, and relaxation may help reduce the cognitive component of perfectionism.19,20 Other work indicates that cognitive interventions can reduce perfectionism. One study linked reductions in socially prescribed perfectionism to concomitant reductions in depression.21
Cognitive interventions can reduce perfectionistic concerns about mistakes and doubting actions, but other aspects of perfectionism—such as perceived parental unrealistic standards and criticisms—remain elevated and appear more treatment-resistant.24
Collectively, these data suggest that some treated patients may be at risk for relapse because persistent perfectionism contributes to a vulnerability to distress.
Medication. No studies have specifically assessed whether medications might reduce perfectionism. Imipramine did not have a significant effect on perfectionistic attitudes when used in the medication protocol of the National Institute of Mental Health Collaborative Study on Depression.17 Amitriptyline has alleviated some dysfunctional attitudes in depressed patients but not perfectionism.25
Research is needed to evaluate the efficacy of various treatments. At this early stage, it appears that:
- short-term gains might be achieved by reducing symptoms
- long-term, intensive psychodynamic treatment may be required to change the perfectionistic personality and its vulnerability effects.
Table 5
Treating perfectionism: Common patient challenges
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- Flett GL, Hewitt PL. Perfectionism: theory, research and treatment. Washington, DC: American Psychological Association; 2002.
- Greenspon T. Freeing our families from perfectionism. Minneapolis: Free Spirit Publishing; 2002.
- For more information on interpreting self-report measures of perfectionism, contact Dr. Paul Hewitt, phewitt@psych.ubc.ca; 604-822-5827.
- Amitriptyline • Elavil, Endep
- Imipramine • Tofranil
The authors thank Jonathan Blasberg for his help with this paper and the Social Sciences and Humanities Research Council of Canada for supporting this work.
