When does conscientiousness become perfectionism?

Table 2

Psychopathologies associated with perfectionism

Traits tied to psychopathology

Each of the 3 traits of perfectionism in our model has been associated with psychopathology in multiple studies.

Self-oriented perfectionism is often involved in Axis I disorders, including unipolar depression. This trait is elevated among adults and children diagnosed with major depressive disorder and may be pernicious in the presence of stressors, particularly achievement-related ones.⁶ In other words, self-oriented perfectionism appears to be a risk factor for unipolar depression.^7,8

It also is elevated in women with anorexia nervosa compared with normal and psychiatric controls.⁹ Individuals with anorexia nervosa appear to have the highest levels of self-oriented perfectionism among clinical groups.

Other-oriented perfectionism is associated with antisocial and narcissistic personality disorders.^10,11 It also is related to interpersonal problems and difficulties with marriage and intimate relationships.¹²

Socially prescribed perfectionism is highly elevated in patients with social phobia¹³ and narcissistic¹¹ or borderline personality disorder.¹⁰ It also is associated with severity of depression, anxiety, and symptoms of hostility.⁷

Perhaps most important, determining a patient’s level of socially prescribed perfectionism can aid in assessing suicide risk. Socially prescribed perfectionism has been shown to be highly relevant in suicide ideation, ratings of suicide risk, and moderate- to high-intent suicide attempts in adults,¹⁴ adolescents, and children.¹⁵ Socially prescribed perfectionism has been found to be a unique predictor of suicide behaviors even after controlling for common predictors such as depression severity and hopelessness.

In addition, perfectionistic self-presentation appears to impair patients’ ability to access and benefit from treatment. Researchers (Hewitt PL, Lee-Baggley D, Sherry SB, et al., unpublished data, 2007) have found that the various dimensions of perfectionistic self-presentation are associated with:

• difficulty in seeking help for psychological problems
  
• increased distress in clinical interviews
  
• fears of psychotherapy and psychotherapists
  
• early termination of treatment.
  

Assessing perfectionistic behavior

A variety of brief self-report measures of perfectionism components—and at least one interview measure—can aid your assessment. These are brief instruments and take only a few minutes to complete. Each self-report measure assesses different aspects of perfectionism, such as traits, self-presentational styles, or cognitions (Table 3). The interview can be used as an alternative to the self-report tools.

Mr. C’s scores on several of these measures appear in Table 4. Interpretive information is available from the authors (see Related Resources). Empirical evidence supports the reliability and validity of these measures in clinical samples of both adults and children/adolescents.

Table 3

Perfectionism self-report assessment tools

Interpreting scores on perfectionism self-reports

Limited data on treatments

Few treatments for perfectionistic behavior have been systematically evaluated. Numerous studies have attempted to assess changes in perfectionism as the result of treatment for a specific Axis I disorder, but few have addressed treatment for perfectionism as a clinical entity.

Overall, it seems reasonable to expect that because perfectionism is a personality style, improvement would require fairly intensive, long-term treatment that explicitly emphasizes reducing dimensions of perfectionism.