By Andrew M. Jacobs, Psy.D. & Martin M. Antony, Ph.D., ABPP
While perfectionism is a trait found in various forms both in the general public and across anxiety disorders (Antony, Purdon, Huta, & Swinson, 1998), it often holds a particularly focal place in the experiences of individuals with obsessive-compulsive disorder (OCD). Theory and research regarding the role of perfectionism in OCD suggest that at its core, perfectionistic thinking and behavior in OCD stem from an ongoing effort to avoid the discomfort that results from a sense of uncertainty, danger, judgment from others, or imprecision. Although it is likely that all individuals are motivated to some degree by the avoidance of these negative outcomes, several theorists have suggested that in OCD, the desire to avoid discomfort overtakes the desire to perform well or reach a specific goal (Frost, Novara, & Rhéaume, 2002). Whereas the desire to perform well might be seen as more characteristic of “healthy” perfectionism, perfectionism associated with an extreme desire to avoid discomfort can lead to the obsessive-compulsive traps all too familiar to those with OCD. Excessive perfectionism involves holding standards that are impossible to attain and experiencing negative outcomes (for example, anxiety or depression) when one’s impossibly high standards are not met.
Among the available ways to help individuals with OCD, a form of treatment called cognitive-behavioral therapy (CBT) has been consistently demonstrated as the most effective way to reduce symptoms and improve quality of life (Antony, Purdon, & Summerfeldt, 2007). In essence, the core ways CBT is used to help individuals with OCD is by helping them to identify and examine thinking styles about obsessions and compulsions that can lead to increased anxiety and worsening symptoms. Additionally, a fundamental part of CBT for OCD involves directly facing situations and triggers that are likely to cause symptoms, staying with them until anxiety has decreased, and refraining from engaging in compulsive rituals. The good news is that these strategies can also be used to specifically target perfectionistic tendencies within OCD (Antony & Swinson, 2009). This article provides suggestions for individuals with OCD for dealing effectively with perfectionism.
One of the foundations for perfectionistic tendencies in OCD is the way in which we view ourselves, the world, and our experiences. As we move through our lives, we form assumptions or “rules of thumb” that help us to make sense of our experiences and increase the chances that we will respond to situations appropriately. Quite often, our assumptions and beliefs are helpful and lead us to act in a healthy fashion – for example, if we genuinely believe that good intentions are what matters, we may be likely to interact with others in a relatively positive and cooperative fashion. Additionally, we might have more flexible standards for ourselves and others.
Our beliefs lead us to automatically think in particular ways, depending on the situation we are in. In CBT, these snap judgments are often called “automatic thoughts.” Automatic thoughts are informed by our general “rules of thumb” and provide us with the means to interpret what is going on in our lives. For example, the person described in the earlier example who believes that good intentions are all that matters might notice an ink smudge on a card that he or she just wrote and think “that’s not a big deal…at least my message can still be read.” In turn, the individual’s subsequent action might be to simply send the card without trying to fix the smudge or replace the card with a new one.
However, our assumptions can often take forms that are less helpful. To illustrate, imagine the individual who has the assumption that “it’s better to do nothing at all than to do something imperfectly,” rather than “intentions are what’s important.” The same ink smudge might now lead to thoughts such as “my friend will think I don’t care about him,” “why did I even bother” or “this card is ruined.” Our action might then be to rewrite the card until no ink smudges are present, or even to give up and send our friend nothing. As we then manage to prevent mistakes through this extreme attention to detail or avoidance of the situation altogether, we are able to escape the anxiety that would otherwise be present. Avoiding the anxiety that is triggered by making mistakes helps to keep the perfectionism alive.
Fortunately, there are several tools we can use to work with and challenge perfectionistic thinking patterns once you notice them. Below are a few ideas to begin thinking outside the “perfectionist” box:
- Test your perfectionistic predictions. For example, if you assume that a typo in an e-mail to your boss might lead to ridicule or judgment, identify a timeframe when this judgment would likely come up (for example, by your next staff meeting), and then deliberately make an error in your next e-mail. Did the prediction come true? If it did, were you able to cope with the situation?
- Put your perfection into perspective. While you may find yourself thinking that “everything” must be perfect, this may not be the case. Try to think of areas where you are actually quite comfortable with imperfection. Once you’ve come up with a few ideas, ask yourself what makes these things different. Is it possible that a similar level of imperfection would be okay in the “problem areas” of your life?
- Define ‘perfect.’ Have you stopped to think what ‘perfect’ means to you? Is ‘perfect’ even a possibility? Very often, recognizing that ‘perfect’ is an exceptionally hard concept to pin down can help us understand why it’s such a challenge to strive for it.
- Try a different point of view. What would you say to a friend who was as exasperatedly aiming for “perfect” as you are? Would you think less of your friend if he or she did something imperfectly? What about your children? Not surprisingly, we often hold remarkably more rigid standards for ourselves than for others. Recognizing this tendency and putting ourselves in another’s shoes can be a very useful way to counter perfectionistic thinking.
- Do some investigating. Sometimes we might be unsure whether our standards are too perfectionistic. Do most people use spell check on every e-mail they send? Do other people need to make sure the house is spotless before they leave for the day? Think of a few people whose judgment you trust and ask whether their standards are at the same level as yours.
Facing Imperfection Directly
While aiming for perfection may cause a great deal of difficulty in the moment, it can also make it even harder to break the habit in the future. Every time we successfully make something “perfect enough” or correct a mistake, we lower the anxiety or discomfort we would have otherwise felt. This feels like quite a relief in the short term, but in the long run that feeling of relief strengthens our urge to “perfectionize” in the future. In addition, by preemptively aiming for perfection right away, we miss our chance to learn whether our need for perfection is truly warranted. In addition to the thinking patterns discussed above, this avoidance of imperfection (and the discomfort that comes with it) is another way the patterns of perfectionism are ultimately laid in place.
One of the most effective ways of coping with obsessive-compulsive symptoms – including perfectionism – is called exposure and response prevention. To use response prevention, a person would deliberately stop him or herself from performing rituals or other activities that he or she would normally do to work toward perfection. If you think this sounds unpleasant, you’re right – when perfectionists first stop their perfectionistic behavior, they typically feel an increase in anxiety, at first. The key to making this work is recognizing that over time, the anxiety decreases, despite the fact that something has been done imperfectly. As the person gains more and more experience with letting things remain imperfect and learns that there are no serious consequences, future encounters with imperfection become easier and easier.
The other component, exposure, involves deliberately doing something imperfectly and then resisting the urge to fix it. This strategy allows us to tolerate imperfections above and beyond those that occur on their own, and increases our ability to comfortably go without achieving perfection. A good idea is to start with imperfections that are not too difficult to tolerate, and then to gradually increase the difficulty until you can face some of the more challenging imperfections you’ve been avoiding or trying to prevent.
If you’d like to try exposure and response prevention, it is important to keep a number of factors in mind:
- Make sure your exposures are planned and predictable. As you purposely confront imperfection, it is important to plan in advance what you will be doing and when you will be doing it. It is also useful to anticipate possible outcomes. As your skill increases, you can try less predictable exercises.
- Stay in the situation until your discomfort has decreased or until you learn that your feared consequences don’t occur. It is useful to “let the imperfection be” until it is no longer bothering you. If you correct the imperfection too soon, you may reinforce your initial fear and avoidance.
- Practice exposures frequently. As with any skill, you will find your exposures become easier and easier the more you practice. Practicing several times per week is better than practicing less frequently.
- Don’t take an easy way out. Be careful to notice whether you are doing anything to quickly lower your anxiety, such as trying to distract yourself, asking for reassurance from others, or checking to be sure your imperfection hasn’t caused problems.
- Expect to feel uncomfortable. While it may sound counterintuitive, the more discomfort you are able to tolerate during exposure, the more imperfection you will eventually be able to face in your day-to-day life.
Virtually any area where you find yourself excessively striving for perfection is fair game for an exposure. Below are some ideas for exposure to help you get started:
- Wear mismatched socks
- Turn random books upside down on your shelf
- Place a stain or wrinkle in your clothing
- Leave an area of your floor or table uncleaned
- Deliberately include typos in an e-mail or letter
- Mispronounce words
- Purchase clothing articles discounted for manufacturing imperfections (and wear them!)
- Put your books, CDs, or DVDs in a random order
- Hang pictures slightly crooked
The strategies in this article, with practice, can help you make a significant difference in the way perfectionism is influencing your life. Cognitive and behavioral techniques such as those described here have been repeatedly demonstrated to be the most effective ways of combating OCD and perfectionism. To read about identifying and treating perfectionism in greater depth, we recommend the self-help book When Perfect Isn’t Good Enough: Strategies for Coping with Perfectionism by Drs. Martin M. Antony and Richard P. Swinson (2009).
While many people are able to make tremendous gains with self-help treatment, it is also very common to find that perfectionism or other OCD symptoms are so firmly ingrained or overwhelming that an individual needs outside support and guidance from a professional. If you feel that you may benefit from working with a person trained to use the approaches discussed in this article, we suggest looking for a psychologist, psychiatrist, social worker, or other mental health professional who is trained in cognitive behavioral therapy. To find such therapists, you might contact your family doctor or a local department of psychology or psychiatry at a university near you. Additionally, the following websites contain names of therapists near you who may be able to help:
- Academy of Cognitive Therapy (http://www.academyofct.org)
- Anxiety and Depression Association of America (https://adaa.org/)
- Association for Behavioral and Cognitive Therapies (http://www.abct.org)
- Intnernational OCD Foundation (https://iocdf.org/)
References Antony, M.M., Purdon, C., & Summerfeldt, L.J. (Eds.) (2007). Psychological treatment of OCD: Fundamentals and beyond. Washington, DC: American Psychological Association. Antony, M. M., Purdon, C. L., Huta, V., & Swinson, R. P. (1998). Dimensions of perfectionism across the anxiety disorders. Behaviour Research and Therapy, 36, 1143-1154. Antony, M. M., & Swinson, R. P. (2009). When perfect isn’t good enough: Strategies for coping with perfectionism (2nd edition). Oakland, CA: New Harbinger. Frost, R. O., Novara, C., & Rhéaume, J. (2002). Perfectionism in obsessive compulsive disorder. In R. O. Frost & G. Steketee (Eds.), Cognitive approaches to obsessions and compulsions: Theory, assessment, and treatment (pp. 91-105). Amsterdam: Elsevier.
For more information on this topic, check out When Perfect Isn’t Good Enough: Strategies for Coping with Perfectionism, Second Edition, by Martin M. Antony, Ph.D., and Richard P. Swinson. Dr. Jacobs is a clinical psychologist in the Anxiety Treatment and Research Centre at St. Joseph’s Healthcare in Hamilton, Ontario, Canada. His professional interests focus on interpersonal and motivational factors in cognitive behavioral therapy for anxiety and mood disorders, cultural minority considerations in psychotherapy, and the dissemination of empirically-based psychological knowledge to the general public. Dr. Antony is a clinical psychologist and professor of psychology at Ryerson University in Toronto, Canada. He has authored more than 25 books on topics related to anxiety disorders, perfectionism, and cognitive behavioral therapy. Dr. Jacobs works at the Anxiety Treatment and Research Center in Hamilton, ON, Canada.