Feature

Paul Hewitt, PhD, does not have much patience with researchers who argue that perfectionism--the need to be or appear perfect--can sometimes serve as a healthy motivation for reaching ambitious goals. "I don't think needing to be perfect is in any way adaptive," he says.

Hewitt should know. In more than 20 years of research, he and his colleagues--particularly psychologist Gordon Flett, PhD--have found that perfectionism correlates with depression, anxiety, eating disorders and other mental health problems. This summer, several new studies were published that help explain how perfectionism can contribute to psychopathology.

"In the literature right now--this astounds me--people have said that self-oriented perfectionism is adaptive," says Hewitt, a practicing psychologist and professor at the University of British Columbia. "People will make that claim, and they'll just ignore the fairly large literature that says that it's a vulnerability factor for unipolar depression, anorexia and suicide."

The question of adaptiveness

Since the early 1990s, Hewitt and Flett, a professor of psychology at York University in Toronto have championed the idea that perfectionism comes in different flavors, each associated with different kinds of problems. Some of those problems may be less severe than others, they argue, but no form of perfectionism is completely problem-free.

Other researchers, however, have suggested that some forms of perfectionism--particularly those that involve high personal standards--can be adaptive. World-class athletes, they argue, have extraordinarily high standards; they shouldn't be labeled pathological just because they aim high.

That's an oversimplification, says Hewitt, one that conflates two very different things: the desire to excel and the desire to be perfect.

To illustrate the difference, Hewitt tells a story about one of his patients, a depressed university student who was convinced he needed to get an A+ in a particular course.

The student studied hard and aced the class, but when Hewitt saw him afterward, he was even more depressed and suicidal than before. "He proceeded to tell me that the A+ was just a demonstration of how much of a failure he was," says Hewitt. If he were perfect, the student argued, he wouldn't have had to work so hard.

Defining perfectionism

At the heart of the debate lies a disagreement over definitions--what exactly is meant by the words "adaptive" and "perfectionism."

For some researchers, the debate can be resolved by dividing perfectionists into two types, adaptive and maladaptive. That's the path taken by psychologist Kenneth Rice, PhD, and his colleagues in a recent study in the Journal of Cognitive Psychotherapy (Vol. 17, No. 1).

They found that both adaptive and maladaptive perfectionists have high personal standards, but failing to meet those standards is more stressful for the latter than for the former.

Not everyone agrees that such a distinction is the best solution.

"I think it's unfortunate that we have evolved into a language in which we talk about perfectionism as 'adaptive,'" says psychologist Randy Frost, PhD. "That might not be a productive way of thinking about it."

In particular, talk of adaptiveness often ignores the role of context in determining whether a particular attitude or behavior is adaptive, says Frost, a professor at Smith College. High standards might be adaptive in one situation but not another, or for certain people but not others, he says.

Furthermore, while high standards are a part of perfectionism, they alone are not enough to make a person a perfectionist.

"One thing that's clear is that the setting of high standards for oneself isn't always related to pathology," says Frost.

Links to psychopathology

While the debate over the adaptiveness of perfectionism continues, researchers have made significant progress in understanding how perfectionism can contribute to psychopathology.

For some varieties of perfectionism, the link is clear. Socially prescribed perfectionism--believing that others will value you only if you are perfect--has been associated with depression and other problems, including suicide.

"I think the reason for that is that socially prescribed perfectionism has an element of pressure combined with a sense of helplessness and hopelessness," explains Flett. Socially prescribed perfectionists, he notes, tend to feel that "the better I do, the better I'm expected to do."

There are also clear problems with other-oriented perfectionism, the tendency to demand perfection from friends, family, co-workers and others. It can be particularly damaging for intimate relationships, says Hewitt.

"If you require your spouse to be perfect, and you're critical of that spouse, you can tell right away that there's going to be relationship problems," says Hewitt.

For self-oriented perfectionism--an internally motivated desire to be perfect--the picture is less clear.

Studies by Hewitt and Flett and their colleagues, as well as other research groups, have found links to mental health problems, particularly eating disorders. In a recent paper in Cognitive Therapy and Research (Vol. 26, No. 6), Hewitt, Flett and their colleagues reported a correlation between anorexia nervosa and self-oriented perfectionism.

Other studies, however, have failed to find such connections. Hewitt and Flett suggest that this is because self-oriented perfectionism is a risk factor, or vulnerability, for psychological disorders--not a disorder itself. Self-oriented perfectionists do fine in situations of low stress, they argue, but are more likely to become depressed, anxious or suicidal when things go wrong.

"Essentially, what we've found for the so-called adaptive dimension of perfectionism--self-oriented perfectionism--is that when people experience life stressors, it didn't turn out so successfully," says Flett.

Support for Hewitt and Flett's "specific vulnerability hypothesis" is not yet conclusive, but some evidence for it has been found. In a recent issue of the Journal of Counseling Psychology (Vol. 50, No. 3), they and their colleagues reported that the effect of perfectionism on depression in female students was moderated by "hassles"--minor interpersonal and achievement-related problems.

Other supporting evidence comes from a recent study by British psychologists Rory O'Connor, PhD, of the University of Strathclyde, and Daryl B. O'Connor, PhD, of the University of Leeds.

They found that hopelessness and psychological distress among college students could be predicted by the interaction between perfectionism and avoidance coping--dealing with problems by avoiding them--but not by perfectionism or avoidance coping alone.

Perfectionists with positive coping styles, O'Connor and O'Connor found, were no more depressed than average. The results, reported in the Journal of Counseling Psychology (Vol. 50, No. 3), support the idea that perfectionism interacts with other traits and life events to produce psychopathology.

Perfectionistic self-presentation

The desire to present oneself as perfect also has important consequences for psychopathology, especially in the context of treatment. Hewitt, Flett and their colleagues have recently devised a new scale, the Perfectionistic Self-Presentation Scale (PSPS), to measure it.

The PSPS rates three aspects of perfectionistic self-presentation: advertising one's own perfection, avoiding situations in which one might appear to be imperfect and failing to disclose situations in which one has been imperfect.

Hewitt and Flett have found that the PSPS predicts psychological distress above and beyond what is predicted by their original measure of perfectionism, the Multidimensional Perfectionism Scale. The finding is reported in the Journal of Personality and Social Psychology (Vol. 84, No. 6).

"Those types of individuals tend not to disclose anything that's going to make them look imperfect," says Hewitt. "It's difficult to keep them in treatment, because you're asking them to do the thing they've been fighting against."

As a practicing psychologist who frequently treats perfectionists, Hewitt avoids focusing on high personal standards. Patients have likely been told hundreds of times to lower their standards, and the therapist who repeats that risks being ignored, he says.

"I work more on the precursors of perfection--the need to be accepted, to be cared for," says Hewitt, "Those interpersonal needs are what drive the perfectionistic behavior."