Perfectionism – risk factor as obesity and smoking
It’s estimated that two in five of us display the perfectionist “trait”.
And thanks to social media, such as Facebook and Twitter, “increasing numbers are concerned about being – or appearing to be – perfect”, according to Gordon Flett, professor of health psychology at York University in Canada. “It causes extreme stress and can affect not only relationships, but your health.”
Given these concerns, some experts such as Dr. Danielle Molnar, a psychologist at Brock University, Canada, go so far as to suggest perfectionism should be considered as a risk factor for disease in the same way as obesity and smoking. Whether this trait is a modifiable risk factor like the latter two remains to be determined.
The tennis megastar Andre Agassi opened his recent autobiography with the saying, “I hate tennis.” According to Professor Flett, Agassi’s 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.”
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.
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.
Perfectionists are described as those who consider high standards, follow them obstinately, and define their values based on achieving those standards. The need to achieve high standards is associated with an increased concern about self-assessment in ambiguous situations as well as the desire for self-criticism.
Dr. Flett and his team distinguish three types of perfectionists.
1) “Self-oriented perfectionists”, who focus on their high personal standards of perfection; 2) “Other-oriented perfectionists”, who have exacting standards for those around them; and 3) “Socially prescribed perfectionists”, who believe other people, such as their parents, bosses or colleagues, demand perfection from them.
A large study involving 500 adults who took a questionnaire called the “Multi-Dimensional Perfectionism Scale”, indicated that “socially prescribed perfectionists” had worse physical health, made more visits to the doctor and took more sick days.
Another study published in Circulation, involving more than 6,000 heart disease patients showed that perfectionists with a negative outlook were three times more likely to experience more heart problems than those with positive personalities.
Thus, recent studies provide clear and convincing evidence that psychosocial factors contribute significantly to the pathogenesis and expression of coronary artery disease (CAD). This evidence is composed largely of data relating CAD risk to 5 specific psychosocial domains: (1) depression, (2) anxiety, (3) personality factors and character traits, (4) social isolation, and (5) chronic life stress. Chronic psychosocial stress can lead, probably via a mechanism involving excessive sympathetic nervous system activation, to exacerbation of coronary artery atherosclerosis as well as to transient endothelial dysfunction and even necrosis.
Personality traits are broad dimensions of individual differences between people that relate to the way in which we engage with our social worlds. Personality traits are thought to be derived from early life differences in temperament; these are partly genetically determined and shape exposure to social experiences. A few personality traits such as optimism, conscientiousness, openness to experience, and curiosity have been found to be protective factors against development of cardiovascular diseases (CVDs) and therefore are called ‘cardioprotective’ personality traits.
On the whole, recent research suggests that perfectionism is causing not just psychological stress as perfectionists feels the weight of pressure to be perfect, but increased risk of irritable bowel disease (IBS), insomnia, heart disease and even early death.
The link to the stress response
Perfectionism is also about being under continuous pressure to perform and this has unhealthy consequences, says Professor Flett.
A study last 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 increased 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.’
Read more: DailyMail
Updates
2023
A 2023 systematic review and meta-analysis by Jessica Lunn et al. aimed to examine the association between perfectionism, and symptoms of anxiety, obsessive-compulsive disorder (OCD) and depression among young people aged 6–24 years. The systematic literature search retrieved a total of 4,927 articles, with 121 studies included.
According to the authors this was the first meta-analysis to focus on the association between perfectionism and symptoms of anxiety, OCD, and depression among young people.
The authors found that perfectionistic concerns had medium, pooled correlations with symptoms of anxiety, OCD, test anxiety and depression among young people. Perfectionistic strivings had smaller, though significant associations with symptoms of anxiety and OCD in young people.
Overall, this systematic review and meta-analysis confirmed in youth the consistent association between perfectionistic concerns, and symptoms of anxiety, OCD, and depression. The authors concluded that perfectionistic concerns had a positive association with psychopathology in youth, and perfectionistic strivings had a smaller, though significant relationship with some aspects of anxiety and OCD symptoms.
2025
A 2025 study by Patricia D. Simon et al. investigated the association of the two dimensions of perfectionism (High Standards and Discrepancy) with bidimensional mental health, which includes positive (life satisfaction, presence of meaning, and search for meaning) and negative aspects (depression, anxiety, and stress).
Overall, the authors found partial support for their hypotheses on the relationship of High Standards and Discrepancy with both positive and negative aspects of mental health.
Thus, High Standards positively predicted stress and life satisfaction, and negatively predicted depression, presence of meaning, and search for meaning. High Standards did not have a significant effect on anxiety.
Discrepancy positively predicted depression, anxiety, and stress and negatively predicted life satisfaction. Interestingly, presence of meaning was significantly and positively associated with Discrepancy while search for meaning was not.
Taken together, the study contributed to the literature by determining the influence of the two dimensions of perfectionism on both positive and negative indicators of mental health. Importantly, it demonstrated the distinct influence of Discrepancy and High Standards perfectionism on several indicators of positive (life satisfaction, presence of meaning, and search for meaning) and negative indicators (depression, anxiety, and stress symptoms) of mental health.
Another 2025 study by Nathalie Claus et al. examined longitudinal associations between perfectionism, body dissatisfaction or responsibility, and symptoms of eating disorders (ED) or obsessive-compulsive disorder (OCD).
The authors found that perfectionism predicted subsequent OCD symptoms, but not ED symptoms. OCD symptoms were positively predicted by earlier perfectionistic concerns and negatively predicted by earlier perfectionistic strivings.
Rather than predicting, perfectionism was predicted by symptoms of eating disorders. Both perfectionistic concerns and, to a lesser extent, perfectionistic strivings were positively associated with earlier eating disorder symptoms. No interaction effects between perfectionism and the disorder-specific processes were found. Instead, body dissatisfaction independently contributed to both ED and OCD symptoms, whereas inflated responsibility/threat overestimation predicted specifically OCD symptoms.
Taken together, the authors concluded that their results suggested that temporal relations between perfectionism and psychological well-being may not be clear-cut. The investigators could not demonstrate multifinality, with perfectionism predicting only symptoms of one type of disorder specifically, nor could they answer the question of divergent trajectories, seeing as disorder-specific processes failed to interact significantly with perfectionism.