Perfectionism – setting yourself high standards at home or work – is seen as laudable. But research suggests it has a dark flipside, causing not just psychological stress as perfectionists feels the weight of pressure to be perfect, but physical harm – irritable bowel disease (IBS), insomnia, heart disease and even early death.
Experts such as Dr Danielle Molnar, a psychologist at Brock University, Canada, are suggesting perfectionism should be considered as a risk factor for disease in the same way as obesity and smoking.
‘We’re always promoting perfectionism and its benefits of academic and professional achievement, but it’s such a strong factor for so many illnesses, including increased infection and early death, that I think it should be considered by doctors as part of a patient’s long-term health,’ says Dr Molnar.
It’s estimated that two in five of us display perfectionist tendencies. And thanks to social media, such as Facebook and Twitter, increasing numbers are concerned about being – or appearing to be – perfect, says Gordon Flett, professor of health psychology at York University in Canada, who has studied the link between perfectionism and health for 20 years.
‘It’s natural to want to be a perfectionist in one area of your life, such as your job,’ he says. But when it becomes an obsessive need for the perfect job, child, relationship, bank balance and body, it causes extreme stress and can affect not only relationships, but your health.
What type are you?
Professor Flett and his team have identified three types of perfectionist.
Self-oriented perfectionists, who focus on their high personal standards of perfection; other-oriented perfectionists, who have exacting standards for those around them – ‘the chef Gordon Ramsay comes to mind,’ says Professor Flett; and socially prescribed perfectionists, who believe other people, such as their parents, bosses or colleagues, demand perfection from them. He cites the example of tennis star Andre Agassi, whose father ‘was a demanding other-oriented perfectionist. He’d send 1,000 balls to his son in the hot Florida climate, no matter how Andre was feeling’.
‘Those demands to be perfect drove all the enjoyment out of Agassi to the point he opened his autobiography many years later with the words: “I hate tennis,” ‘ says Professor Flett.
‘I don’t know if he would attribute it to perfectionism, but Agassi suffered from chronic back pain, which I believe could have roots in over-training and over-striving as a child.’
Certainly research by Dr Molnar suggests socially prescribed perfectionists suffer more physically. Her study involved 500 adults aged 24 to 35 who took a questionnaire called the Multi-Dimensional Perfectionism Scale, which determines if you’re a perfectionist and, if so, which type.
The research, published in 2006, suggested socially prescribed perfectionists had worse physical health, made more visits to the doctor and took more sick days.
Alarmingly, another study found constantly striving for perfection could raise the risk of premature death. In a six-year study, researchers at Trinity Western University, Canada, studied 450 adults – non-perfectionists and perfectionists – aged 65 and older. The perfectionists had a 51 per cent greater risk of dying early.
So, what is going on? Part of the problem is that perfectionists rarely ask for help, says Dr Molnar.
‘Even when they are getting social support from other people, they will often interpret it as interfering and being judged as not being able to take care of themselves.
‘Social support and community has been found in numerous studies to be a leading contributor to health and increased lifespan – perfectionists are often deprived of that.’
The stress response
Perfectionism is also about being under continuous pressure to perform and this has unhealthy consequences, says Professor Flett.
When the body is under stress, the adrenal glands – above each kidney – release two brain neurotransmitters, adrenaline and noradrenaline.
This prepares the body for fight or flight by increasing the heart rate, blood pressure, dilating the airways and coronary arteries and increasing metabolic rate.
A study in 2011 at Tehran University, Iran, looked at what happened in the bodies of perfectionists in a stressful situation – where they had to complete an intelligence test in a set time – compared with ‘hardy’ individuals, i.e., people who were more controlled and resilient.
The perfectionists found the situation more stressful, their blood pressure and heart rate increased and there were changes in their breathing. Hardy candidates stayed calmer.
This is known as the stress response, where activity in areas of the body not needed for fight or flight is reduced, for instance in the immune system and the skin.
But this response is designed to be over quickly so our bodies can recover and rest, says Stephen Palmer, visiting professor of psychology at Middlesex University.
‘If the stress response is prolonged, the body is always in threat mode, which means the immune, digestive, cardio- vascular and other systems suffer,’ he says.
It doesn’t help that perfectionists – who often become doctors, lawyers, editors, engineers and other occupations requiring exacting standards – are at increased risk of workaholism.
A study last August from the University of Kent looked at 131 employees and found self-oriented perfectionists were highly likely to be driven workaholics.
‘That leads to exhaustion and when you’re depleted you’re a sitting duck in terms of risk of illness, especially when exposed to viruses, because the chronic stress they’re under compromises the immune system to such a degree,’ says Professor Flett.
And perfectionists are also more likely to be insomniacs.
A study in 2010 by the University of Coimbra, Portugal, found socially prescribed perfectionists had more difficulty falling asleep and staying asleep than other students.
‘Such people equate their self-worth with their ability to meet the goals. If they fail, even in a small way, their resulting emotions include “awfulisation” – labelling themselves as failures,’ says Professor Palmer. As a result, they worry – no wonder they can’t sleep!’
And when they fall ill, perfectionists can face another major problem.
‘They are not big on self-care,’ says Professor Flett.
‘They often think “Why do I feel this way?” seeing their illness as a failure and pushing themselves through it, not taking time to get better and putting off seeking help. This slows recovery and can lead to further illness.’
Last year, Professor Flett looked at 100 heart attack patients and found the perfectionists recovered more slowly and were at higher risk of further cardiac problems.
‘We identified three factors in the lives of perfectionists that slowed down their recovery: stress from the pressure they put on themselves; chronic negative emotions from never feeling joy in their achievements; and lack of social support,’ he says.
This is backed up by a Dutch study published in the journal Circulation in 2010, involving more than 6,000 heart disease patients. Perfectionists with a negative outlook were three times more likely to experience more heart problems than those with positive personalities.
Links to IBS
Perfectionists are more prone to developing IBS after a bout of food poisoning, suggests 2007 research from the University of Auckland, New Zealand.
The researchers followed up 620 people who had an acute episode of food poisoning and found those who developed IBS were more likely to have perfectionist tendencies, such as carrying on regardless until they were forced to rest.
‘These are people who have high expectations of needing to do the right thing. Taking time off work may go against their beliefs,’ says Rona Moss-Morris, professor of psychology at the Institute of Psychiatry, King’s College London, who led the research.
Those who went on to develop IBS had impossibly high personal expectations, then beat themselves up when they didn’t achieve them.
Ongoing, relentless stress could certainly increase the risk of developing IBS. Stress felt in the brain can have a direct effect on digestion through symptoms such as bloating, diarrhoea and cramping, says Dr David Forecast, a consultant gastroenterologist at the London Clinic.
‘The chronic stress perfectionists put themselves under plays a part in the development and exacerbation of IBS,’ says Dr Forecast.
He points to a 2011 study of 149 people published in the Journal of Research in Medical Science that found those with characteristics which include perfectionism had a 40.7 per cent chance of having IBS compared to 20 per cent in the general population. A large body of research has associated perfectionism with increased risk of eating disorders such as anorexia nervosa – a psychological disorder in which people reduce their calorie intake until they become dangerously underweight and unable to eat.
But more suprisingly, perfectionists are also more likely to be binge eaters, research in 2009 in the Journal of Personality and Social Psychology found.
‘The rigidity of their perfectionism influences the rigidity of their dieting, so they set themselves impossible goals of cutting out entire food groups or subsisting on extreme low-calorie diets,’ says Roz Shafran, professor of psychology at University College London and author of Overcoming Perfectionism.
‘When they are unable to fit the rigid goals they set for themselves, they binge. Eating can calm them momentarily, but that leads to shame and guilt and more rigid control, so the cycle continues.’
It’s been suggested that we evolved to strive for perfection through a need to belong or fit in with our tribe, for example by seeking approval with our accomplishments. Another theory is that we strive to be perfect to find our role in society – by developing expertise in a particular area – or to win affection from others.
However, perfectionism is not all bad news for health. A study from Trinity Western University followed 385 patients with type 2 diabetes for 6½ years and found that those with self-oriented perfectionism had a lower risk of early death.
Moderate self-oriented perfectionists can make good patients because they adhere to their doctor’s advice and apply their perfectionism to looking after themselves, says Professor Flett.
In the case of the diabetes patients, they check blood sugar levels and adhere to strict diets.
But perfectionists can change and reduce the negative effects, by learning to accept themselves and mistakes without self-criticism.
‘Lower your standards and accept the occasional failure as an essential ingredient on the road to success,’ says Professor Flett.
‘Most importantly, if perfectionists feel that they need help – physically or emotionally – they mustn’t be afraid to seek it rather than suffering in silence.’