Speaking of Psychology - Perfectionism: When good is never good enough, with Gordon Flett, PhD, and Bonnie Zucker, PsyD

Episode Date: July 6, 2022

Perfectionism might seem like a minor hurdle to overcome – or even a welcome personality trait. But perfectionism is different from simply striving for excellence and perfectionistic people are at higher risk for anxiety, depression and other mental health disorders. Perfectionism researcher Gordon Flett, PhD, and clinical psychologist Bonnie Zucker, PsyD, discuss where perfectionism comes from, why it’s an increasing problem, how it affects people’s mental and physical health and how to treat it. Links Gordon Flett, PhD Bonnie Zucker, PsyD Speaking of Psychology Home Page Learn more about your ad choices. Visit megaphone.fm/adchoices

This episode is sponsored by Newport Healthcare, providing evidence-based results-driven treatment for teens and young adults ages 12 to 28. Newport treats clients who are struggling with mental health conditions, co-occurring disorders, and issues like toxic perfectionism. Newport's outpatient and residential programs around the country provide supportive, caring environments where adolescents and young adults can be their authentic selves without needing to be perfect. Learn more at Newport Healthcare.com. Are you the type of person for whom good is never good enough? At first glance, perfectionism might sound like a minor hurdle to overcome, or even a positive personality trait. After all, what's wrong with wanting to excel?

But perfectionism is different from simply striving for excellence, and perfectionistic people are at higher risk for anxiety, depression, and other mental health disorders. So what's the difference between being a perfectionist and just being a high achiever? Where does perfectionism come from? Is it innate or learned? How does perfectionism affect people's physical and mental health? What's the difference between expecting perfection from yourself and expecting it from others?

And if you, your child or someone else close to you, struggles with perfectionism, what can you do to help? Welcome to Speaking of Psychology, the flagship podcast of the American Psychological. Association that examines the links between psychological science and everyday life. I'm Kim Mills. We have two guests today. First is Dr. Bonnie Zucker, who is author of A Perfectionist Guide to Not Being Perfect, published in February by APA's Magination Press imprint. The book aims to help teens and their families understand perfectionism and learn strategies

to cope with it. Dr. Zucker is a licensed clinical psychologist and private practice in Rockville, Maryland. She has a particular expertise in treating stress, anxiety, and anxiety-related disorders. In addition to her new book, Dr. Zucker has written several previous books that aim to help children and families, including anxiety-free kids, and take control of OCD, the ultimate guide for kids with OCD. Our second guest is Dr. Gordon Flett. Dr. Flett is a professor in the Department of Psychology at York University in Toronto, where he holds a Canada Research Chair in personality and health. Dr. Flett is also author of a new book published by the American Psychological Association called Perfectionism in Childhood and Adolescence, a developmental approach. Together with his collaborator, Paul Hewitt, Dr. Flett has spent more than three decades studying

perfectionism, including how to measure it, how perfectionism is associated with depression, anxiety, and other disorders, and the role of perfectionism in physical illness. Thank you both for joining us today. Thank you, Kim. Thank you. I'm thrilled to be here. So I mentioned in the introduction that people often confuse perfectionism with simply striving for excellence. What is the difference between the two? How is perfectionism different from just working hard and striving to excel?

And Dr. Flett, let's start with you. Sure, thanks for that. It's a key distinction. People are perfectionists, they're all or none thinkers who want absolute perfection. Falling short might even be more frustrating than falling way short for them. So they need to be absolutely perfect. A big difference between someone who's a perfectionist and somebody striving for excellence is, are they satisfied? The person striving for excellence is more likely to be happy with what they've done.

But the extreme perfectionist usually is never satisfied, even when there's a great accomplishment or achievement. So it's just on to the next attempt rather than basking in any satisfaction that might have been experienced. Are we seeing an uptick in the number of people who struggle with perfectionism, especially among younger kids and teenagers? There have been a lot of articles recently about the hyper-competitive youth culture in the U.S. And how kids have to have perfect grades and star in multiple sports and all of those things to get into college. Dr. Zucker, does this track with what you're seeing in your practice? Absolutely.

And I often wonder why, because I have kids saying to me, well, you know, I have a have to have a thing in high school in order to get into college. So I'm figuring out what my thing is. I said, oh, what kind of thing do you mean? Well, you know, I need to have something either a sport or photography or, you know, I have to do something. That's my thing. And I feel that the pressure that we see coming from social media, the image of success and needing to do college is just a launch, you know, the idea that you have to go to graduate school if you want to do anything meaningful. The bar is just so high. And then there's this belief that I have to go to a really elite college or a prestigious college in order to have a successful future, which we know is

all untrue. But that's the stereotype that's really being portrayed that I think kids are absorbing. And so we are, I am definitely seeing more perfectionism and also around body image and appearance, which is where I think the social media plays a role. Dr. Flood, is there research into the prevalence of perfectionism? And if so, is there an upswing? Yes, there is. And it certainly fits with the observations that Pani's shared with us. We have a summary in our book of 10 studies that look at prevalence of different types of perfectionism. And alarmingly, across the 10 studies, it looks like one out of three adolescents have some form of perfectionism that puts them at risk. And we also cite some other data, some survey data, one study done in Canada, over 24,000

high school students, and over half of them indicate that they're feeling some pressure in terms of expectations to be perfect. And of course, the worry there is that it suggests that the pressure is now normative if it's more than 50 percent, but also how do you define perfect? You know, it's so subjective. So, you know, the adolescent who really is not certain is somebody who's going to define perfect at an extreme level and is going to feel intense pressure, even if they don't take on those standards themselves, they're going to feel that others are expecting them to be perfect. Let's talk for a minute about the role of social media. Another common refrain is that social media encourages people to compare themselves to a false, perfect-seeming vision of other people. people's lives. Do you think that's the case and is social media harmful to people who are

struggling with perfectionism? Well, I certainly see it in terms of the research that we've been conducting. We study a concept called perfectionistic self-presentation. And one way that it's really expressed is online with people with these crafted perfect lives that nobody actually has. And unfortunately, if you're on social media and you're susceptible to these cues, you're going to be bombarding yourself with images of how others are doing. And it's not just comparing now with how you did on a test or on a paper or whatever, but now it's the life. Are you having the perfect life? And there's a lot of ways that you can make yourself feel very badly about this. And general advice is for any young person or anybody not to do too much of this because there's

no way that you can feel really good about yourself in the long run. Dr. Zucker, is that what you're seeing in your practice? And do you tell young people in particular to stay off of social media? I actually encourage them to have a healthy relationship with social media. And I love, Gord, what you said about crafted, because I always explain to kids, you know, this is constructed. Social media, it's our constructed view that we want to portray. And people don't post themselves when they're struggling or when they have a bad day or

they don't look good. They only post themselves often with filters, looking their, absolute best, living their best life. And so we teach kids, this is constructed. It's not real. And we have to have a healthy relationship with it. So perfectionists often have an obsessive style. They're very detail oriented. And that's their approach to looking at social media as well. When they look at other people's pages, they're really taking it all in. And so I do encourage a healthy social media diet where you limit the amount of time. some days you don't even go on it. You notice how you feel when you're on it. And Kim earlier

said something about comparisons. And I really encourage teens and younger children as well to have relative comparisons versus normative ones. Normative is when we compare ourselves to other people. Relative is when we compare ourselves relative to us. So how am I feeling about myself this week compared to last week? How did I do in my math test this week compared to last week as opposed to How did I do compared to the top student? Where does this drive for perfection come from? Are some people born perfectionists, or do they learn this trade, or is it some combination? Definitely, it's a combination.

And a key thing to realize right from the start is that two kids could both be perfectionist, but have got there in very different routes depending on what their experiences are in the family. So there is a role. Typically, the historical view was to focus on. parents do a lot of parent blaming or even just imitating a parent. But also, of course, that could mean that there's a genetic element to the perfectionism in the family. And the six or seven studies done on that indicate that there is a heritable component to it. But then, of course, with most things, we realize that there's also environmental factors. And we've already talked

about social media and the pressure. A big thing would be the peer environment, if you're hyper-competitive if peers are expressing the need to be perfect, you feel the need to keep up. And then, you know, broader socio-cultural factors in terms of belief that certain countries or certain areas of the United States, for instance, have more of a focus on perfectionism, such as in Utah and in Mormon culture. At the end of the day, though, the question is, does the person internalize it in terms of how they see themselves and are they judging themselves according to needing to be perfect, or are they seeing it just imposed externally?

And as I reiterate, that how you get to be perfectionistic could be very different in terms of the roots. One subset of thinking about this is that some people are experiencing adverse life experiences. So they try to be perfect as a way of coping as a sort of very defensive orientation. And when somebody says, well, there might be a positive side to perfectionism. Not for these people. They're just trying to manage what's ever going on and thinking that if I'm perfect, whatever's happening will stop happening. So they are very concerned about trying to establish a sense of control over what's going on in

their daily lives. Dr. Zucker is focusing in on parents, one of your strategies? And is that kind of where you start? Or do you start with the young people themselves? So I start with the young people themselves. And I want to know what their perspective is on their family. And so I really take it from them in terms of, is everyone in their family an MD or an MD PhD? Right.

Because even if the parent, which we, in Montgomery County, which is where I practice, you know, we have a lot of high achieving families. And that achievement orientation is, in fact, the book over Achievers is written about the students at one of our local high schools, Whitman High School. And I want to hear from the kids because sometimes the parents. are not really doing anything wrong, but it's just who the parents are and the life they're living that, again, goes back to setting this bar really high. And in those cases, too, I want to find out from the parents are how are they responding. Most of the time the parents are responding just right and they notice the perfectionism. They're bringing the child in to help them be less perfectionistic. They don't want their child to be burdened. And then every now and then, though, I do get a really

perfectionistic parent. Sometimes they're aware, sometimes they're not. I had a parent respond to her daughter proudly telling me that she got five A's and two Bs on her report card with, well, it could have been seven A's. And I said, can I meet with your mom, just your mom and I for a minute? I said, do you know the message? What was your intention? She says, my intention was I want her to know that if she put a little more effort into those, that she really could be a straight A student. I said, what do you think the impact was? She's like, well, I assume it wasn't good since we're meeting alone. And I fell in love with the mom at that moment, right, that I could have this dialogue with her.

I said, the impact was, it's not good enough. That's the messaging there. So sometimes you get really well-intentioned parents, you know, thinking they're enforcing one thing. And unfortunately, reinforce something else. So those corrections, if you have an open system, you can make great strides in giving better messaging. Is this obsession with perfection more prevalent in American culture? Dr. Flett, do you see it as much among Canadians because that's where you are or other countries, other cultures? It's really a worldwide phenomenon from what we can tell. I mean, research is being done around the world, a lot of research in Europe and Asia. And it just seems to be a problem worldwide and one that seems to be growing based on indicators of one that.

of the studies that I was referring to in terms of prevalence was a study of almost a thousand high school students in Australia, where they were assessed with multiple measures. And again, we're talking at least one out of three having some form of maladaptive perfectionism. I think what needs to be looked at is the interpretation culturally about what perfection means. I think that varies substantially. And we still need some sound research on what does perfection mean, but the pressures are pretty much seemingly universal. And this was shown in a study that looked at about 110 different symptoms, and it was done with 27, 30 cultures in this data set. And the item that had to do with the pressure to be perfect came out in the top 10 out of

110 indicators based on data from gathered around the world. And regardless of whether you're asking the actual children or their parents or their teacher. So that pressure seems to be very ubiquitous. This episode is sponsored by Newport Healthcare, delivering accessible and ethical treatment to young people ages 12 to 28 who are struggling with mental health conditions and behavioral issues. Newport's integrated whole person approach addresses the underlying trauma that can lead to depression, PTSD, and substance abuse, as well as issues like toxic perfectionism and high-functioning anxiety. With outpatient residential programs for teens and young adults, Newport provides tailored treatment

plans designed for each client's individual needs and history. Young people learn how mistakes and so-called failures can help them become stronger and more resilient. Learn more at newporthealthcare.com. How is perfectionism associated with mental health disorders such as anxiety and depression? Dr. Zucker, in your practice, do you? you see these things going together often? I do. And I am pretty much limited to seeing people with anxiety disorders and OCD and related

conditions. So I might be a little bit of a biased sample, but often I am treating someone with anxiety. And we learn that at the root is really perfectionism. And when you look at the research, and I know Dr. Flett would be even better to share this, it's very clear that perfectionism causes anxiety, depression, eating disorders, and suicidality. And it goes back to how Dr. Flett started with this all or nothing thinking. I either need to be completely perfect and get that 100 or I've failed. And also, I noticed I was reading your book, Dr. Fled, and in the beginning you talk about the sense of self. And that's something I speak about constantly in my practice because when I'm working with teenagers, they are figuring out who they are. There's that, that whole Eric Erickson

identity versus role confusion. That's the phase they're in. And we want their identity to be about who they are, not about what they're accomplishing. What they accomplish can be a part of it, but it can't be the whole story. And so when you're a perfectionistic, your accomplishments and your achievements become your identity. So there's not much wiggle room. And that's where you see the depression. It's where you see the anxiety. It's very challenging. So more objectively then, Dr. Flett, do you see these connections? Is that what shows up in the research, the connection between anxiety and these other disorders and perfectionism? And to what degree? It's moderate to high. And one of the things that we say, especially with things like

meta-analytic results indicating the length between perfectionism and suicide is that these research studies are done focusing on variables, but ultimately we're concerned about people. And the problem is that perfectionism is associated when you look at it at the person level with a host of other vulnerability and risk factors that in the one individual sort of as a confluence of heightened risks. So for instance, the suicidal adolescent who is perfectionistic is also likely to put on the front, they're overrepresented sadly among suicides where people say nobody saw it coming. The planfulness of perfectionism then turns out to be not so adaptive because of,

and we know about how methods are perfected really. And again, it's the all or none approach. And say there's a particular risk if there's been a past attempt because of the concern that perfectionists have with failure and shame. But the research certainly bears this out. And this is both cross-sectionally and longitudinally. But when I try to think of research studies, as my colleague Paul Hewitt, we try to take the person focus and think, okay, how can we study this? Because at the end of the day, it's about safeguarding people and getting them to help.

And we're particularly concerned about this tendency to hide behind a front. Perfectionists, I think, have a great deal of loneliness and sense of isolation, not realizing that other kids are feeling the exact same way. And they tend to see that something about them as if they're defective. yet we really need to start asking what kind of society we have and highlighting the societal pressure so that it's not seen as a personal defect or shortcoming. It's a pressure that everybody's having trouble dealing with. I mentioned in the intro the difference between expecting perfection from yourself and expecting it from others. Dr. Fleck, can you talk about the different forms of perfectionism? Sure, glad too.

Well, we have talked about perfectionism as multidimensional. Most people talk about self-oriented, which is pushing yourself and demanding it from yourself, but you can also demand it from other people, which is a problem, of course, because that tends to lead to conflict and people not wanting to be around you. And that's called other-oriented. The flip side of that is probably the worst form, and that's called socially prescribed. That's the perception that others expect or demand. perfection from you.

And socially prescribed perfectionism might be veritical. You might actually have people like that in your lives or in a role where you're expected to be perfect. But often it's a way of viewing the world and being sensitive to these cues. And then, of course, we talk about the self-presentational part that I've talked about. Another element that is important to think about in terms of that front versus what's going on inside is we also measure the cognitions that deal with perfectionism. And perfectionists might seem calm and incapable and in control on the outside,

but in the inside they're having a barrage of these negative thoughts about themselves and negative thoughts about not being perfect. And we measure this with a scale call a perfectionism cognition inventory. And this is why we think it's very important for people to reach out to somebody who's a struggling perfectionist, but only on the inside. we want to make sure that they know that people are concerned about how they're doing in terms of their emotions and their feelings and they're not suppressing them trying to live up to this image. Dr. Zucker, how do you treat the people who come to your practice who have perfectionistic

tendencies? Okay, that's my favorite question so far. So, of course, I use cognitive behavioral therapy, which is the most empirically supported approach to treating perfectionism. The concept here is we definitely have to look at the thoughts like the all or nothing, catastrophizing, shoulds, shoulds is I, you know, I should be doing this perfectly or I shouldn't make mistakes. So we look at thinking errors. We look at cognitive schemas, my sense of how I see myself, others in the world. We change the person's self-talk so they can say things like I must face my fears to overcome them. What would someone who's not perfectionistic think in this situation, what would they do? But the crux of it is really the behavioral exposures. So I create these

ladders. I literally draw it out like a ladder with rungs where we come up with anywhere from 10 to 20 exposures or practices that the child or teen does to challenge their perfectionism. So you are changing the behavior with the expectation that the thoughts will change after. So for example, we make a mistake. We purposely answer in math class the wrong answer. So you have the person exposed themselves to their fears. I had a girl I worked with who I just was crazy about. And I said, you know, you're straight A. You have to get a B on one of your math tests. And she said, this is terrible therapy. I don't want to come back here. Why would you tell me to fail in school? I said, well, first of all, I didn't say fail. I said get a B. And I did say in school.

I said on a test. So she and I negotiated that she would hand in homework late one day. And in her class, if you handed in late one day, you would get knocked down. Of course, she was getting an A, so she's supposed to get a B, right? So she and I talk about this for weeks. We finally decide she's going to do it. And she goes to school and she says to her teacher, you know, I'm sorry, I don't have my homework. I'm going to have it to you for tomorrow. And the teacher says, is everything okay? And she says, no, everything's fine. I just, I had some other things going on. And she said, everything's okay at home. She says, yes.

She goes, well, don't worry. Just bring it in tomorrow. You'll still get the A. Because the teacher's expectation. She loved the girl and wanted her to achieve. And so anyway, we had to do it again. And she came back and she said, this teacher's going to think my parents are getting a divorce or something.

I said, I know you've got to get the B. So anyway, she did it the following week. And the teacher said, I, you know, I'm surprised this is happening again. But I think it'd be unfair. if I didn't drop you down to a B, she goes, no, that's okay. I think it's good for me to get a B every now and then, you know? So it really helped. She still got an A in her class. She still had straight A's in her report card, but she had to go outside of her comfort zone, right? We have to teach kids that they can go outside of their comfort zone and tolerate the discomfort. When you

tolerate the discomfort, you build up that resilience. And then you understand people still like you. You could still be happy. You know, you have to actually experience it differently. in order to think differently about it. So it's a behavioral exposure approach. Dr. Flett, what does the research say about effective treatments for perfectionism? Well, it's complicated, and I don't want to contravene Bonnie because I think she hit the nail on the head in multiple ways. But one of the things we talk about in our book and my colleague really is championed

is taking a more relational approach to the treatment of perfectionism. And we've got some interesting results from a controlled study that's currently under review, not with kids, but with adults. And, you know, part of the interpersonal model that looks at other oriented perfectionism and socially prescribed takes into account that sometimes perfectionism is driven by interpersonal needs. One I'm focusing on is the need to matter to other people. And one of the ways that you can cope with a sense of not mattering or not mattering enough is to try to be absolutely perfect, you know, sort of if I'm perfect, now I'll be on the radar. are now we'll get the love and respect. So our approach, we tend to advocate more of an

interpersonal focus where we're getting at that, which reflects more of the, you know, psychoanalytic object relations approach. And, you know, but again, it comes back to how and why is somebody a perfectionist, you know, perhaps it's driven by needs that are well suited at cognitive behavior therapy. And in the cases of where it might actually be the case that somebody does have a demanding parent, for instance, or somebody who's really got some toxic expectations, it's about managing how to get through that relationship and not internalize the negativity. And the negativity usually comes in intense criticism that is directed right at the self in a way that makes people, again, feel inadequate or not worthy. So, you know,

so I guess the message here is that it depends really on what, what is at the root of the perfectionism. And also, when somebody actually has a life setting where they have to be perfect, here we'd be talking about adults, but, you know, it's very important with somebody with a high-stressed job where they're not allowed to make a mistake to learn how to keep it focused on the workplace and not internalize that and generalize that in terms of interactions on the home front. So if you're an air traffic controller, for example, you can't make any mistakes on your job, but you can make mistakes elsewhere in your life. Yes, you want to land that plane.

So what can parents or adults do themselves if they sense that they're, you know, tending toward perfectionism that is maybe becoming a problem? What advice do you give folks, Dr. Zucker? And you're talking about adults who are experiencing their own perfectionism, not necessarily models as parents. Could go either way. All right. So in general, I always encourage parents to,

model making mistakes and to put words to times when they're not doing their best. So, for example, sometimes I might be rushed and stressed and I'm sort of barking at everyone. And I try not to have these moments often. But when I do, I'll say, you can tell I'm really stressed, right? And you can see, I'm not handling myself well right now, right? You know, and so I think when parents say I messed up or I didn't handle that well. They're modeling that it's okay to make mistakes. And to say things like we don't need to be perfect. And then to mirror their child,

which does actually highlight what Gorge just said about the relational part, to mirror their child for who they are and to say, you're not perfect and I love you. And the who of you, right, the person in there, the you of you, which is always there is someone I love. and it has nothing to do with your performance. So I do think we have to be modeling that, expressing that. And then for the adult, who is just on their own perfectionist,

they need to do the same approaches. I don't treat kids and adults all that differently. I do ladders for them. In fact, they're more passionate sometimes about putting star stickers on their ladder than some of the kids I see. They're like, get your stars out. You ready? You know, because we, I'm working with an adult now with perfectionism.

who is very frustrated all the time that people in her life at work and also socially are not doing things in the way she would do them. They're not on time, right? So I'm having her practice things like showing up late herself and being apologetic, getting there super early so it feels like someone's late even when they're on time, really getting comfortable, again, stepping outside of our comfort zone and recognizing the value of meeting. with colleagues and with friends is to get along with them and to be productive. And that that's not compromised even if the meeting starts 20 minutes late. So it's getting them to shift their perspective, but again, going back to these exposures.

People love the exposures. They really build confidence as well. So last question, Dr. Flett, what's next on the research front? I mean, you've been looking at this issue for 30 years. What's their left to look for? That's the thing. There's always something more to look at. And it's part of the problem.

And fortunately, we have researchers around the world who are setting up new ideas all the time. Great work on developmental trajectories and how kids may not stay at the same level of perfectionism as they get older. But we currently have two papers under review with some great work by my former postdoc, Danielle Mulnar, who's at Brock University in St. Catharines, Ontario, looking at kids in the pandemic who are perfectionistic and some fabulous work that they've done there to show. show the struggles. And it's really intriguing because this is the first full-scale qualitative examination of perfectionistic kids. And one thing we've learned just as an illustration is that, you know, we say in our book, well, you know, maybe if you're heightened awareness and they realize the cost and the consequences, these kids almost to every single one of them are well aware

that perfectionism is a problem. They're well aware of the fact that it's costing them in variety of ways and might lead to mental health issues or physical health issues, but they can't stop because they're afraid of what's going to happen if they do stop. It's sort of like, yeah, I know it's a problem, but if I stop this, what's next, you know, in terms of what the world has for me. So we're learning things new all the time. And I think that that again illustrates the importance of focusing on the individual person and really trying to fashion research that will help us capture what they're telling us

and showing us as a source of just trying to understand them better. Well, I want to thank you both for joining us today. This has been really illuminating. I appreciate you. You came at it from slightly different vantage points, and I think they were both really, really useful. Thank you. Thank you so much.

Yes, thanks very much, Kim. And great, great speaking to Bonnie. You've got to do this again sometime. I know. I want to do it again now. Thank you so much. It's wonderful. Well, thank you again.

You can find previous episodes of Speaking of Psychology on our website at www. www. speakingof psychology.org or on Apple, Stitcher, or wherever you get your podcasts. And if you listen on Apple and you like what you hear, please leave us a review. If you have comments or ideas for future podcasts, you can email us at Speaking of Psychology at APA.org. Speaking of Psychology is produced by Lee Wynerman. Our sound editor is Chris Condyenne.

Thank you for listening. For the American Psychological Association, I'm Kim Mills.