Ambitious individuals tend to call themselves “perfectionists,” and many wear the label as a badge of honor. Giving perfectionism this positive connotation can hide larger, more deep-seated issues. A distinction must be made between the “pursuit of excellence” and perfectionism [7]. Working hard or pushing oneself to the brink to achieve a goal is the sign of a dedicated individual, not necessarily perfectionism. In most cases, perfectionism derives from anxiety or self-esteem issues, which themselves have been linked to less personal satisfaction and an increased risk of suicide [7, 9]. Indeed, perfectionists have a higher risk of eating disorders, anxiety disorders, and depression [3]. Such a life is riddled with fear and extreme caution. Creativity, joy, inspiration, and even productivity are stunted when perfection is the only option. Ironically, according to Flett and colleagues [5], successful people actually are less likely to be perfectionists, as the symptoms of perfectionism are more likely to thwart higher levels of success one might achieve [2, 7].

Many of us try to attain perfection. We try to cultivate (or at least project) perfect marriages, and yes, we strive to perform perfect surgical procedures—even though we inwardly know that perfection is an illusion. Yet we all have tales of surgeons spending more than 6 hours in an operating room attempting to achieve the “perfect” fracture reduction in a case which typically requires a fraction of that time.

In a vocation as demanding as orthopaedic surgery, perfectionism can sap a surgeon’s energy—leaving little room for self-care and relationships. For the surgeon, challenging cases may be deferred. Patients an average surgeon could readily handle on a given day are often referred elsewhere.

In essence, perfectionists fear imperfection, and equate any error with personal defectiveness. Perfectionists are generally exceedingly sensitive to criticism. They procrastinate, waiting for the perfect time to attend to tasks [5]. Even when a perfectionist achieves success, they do not experience the delight of the accomplishment. Instead, there is only relief that this time they did not fail. They lead their lives convinced that perfection is the only means to self-acceptance [6].

Origins of Perfectionism

Beneath perfectionism usually lies a self-esteem issue. During formation, the perfectionist likely received messages of conditional acceptance from a significant caretaker, usually a parent [6]. The message was interpreted loud and clear: “I will love you if … .” The demands for academic, behavioral, or athletic perfection from a parent can fashion a wounded self-image in a child. The presence of affectionless and overcontrolling parental figures, coupled with a tendency for neuroticism have been found as common denominators in the childhood of perfectionists [10]. Our childhood experiences, as well as genetic influences, largely determine the burden of intrusive thinking we each experience. The pressure to perform generates intrusive thoughts in the young mind and will linger for the remainder of his or her life, unless recognition of dysfunctional thought patterns are recognized and addressed.

Cognitive Distortions

Clearly, perfectionism is a byproduct of dysfunctional thinking. Cognitive behavioral psychologists have characterized faulty, inaccurate thinking into several cognitive distortions or patterns of erroneous thoughts [1]. Each “cognitive distortion” is merely a lie our brain sends to our conscious mind. Common distortions include ignoring the positive [1], whereupon one’s mind is flooded with thoughts of all that is wrong with a particular situation, rather than positive aspects of a given occurrence. A preoccupation of the one errant screw in an otherwise superb fracture reduction is a classic example of ignoring the positive.

Another distortion commonly found in perfectionists is all-or-nothing thinking [1]. That is, one negative event may trigger a cascade of intrusive thoughts which generalize misfortune into all aspects of one’s life. For instance, a difficult surgery to the perfectionist may generate a stream of negative thoughts along the lines of “I am no good,” “I am a lousy surgeon,” or even “I don’t deserve to be called doctor.”

Perfectionists also are prone to several other patterns of distorted thinking including personalization and blame [1]—the tendency to blame oneself for something he or she was not entirely responsible for. Another is labeling [1], whereby one tends to base his or her entire identity on their shortcomings. Instead of acknowledging a mistake, labelers are quick to identify themselves as “losers” or abject failures. Perfectionists may experience as many as 10 common thought distortions [1], which all lead to diminished personal happiness and joy (Table 1).

Table 1. Ten Cognitive Distortions [1]

Recovery: Courage to Accept Imperfection

The recognition and awareness of these distorted thoughts is the beginning of the road to recovery. Recovery from perfection requires a correction of improper thinking. Create space with perfectionistic thoughts. When they arise, simply breathe and let these intrusive thoughts pass. Recognize that perfectionistic thoughts and perfection-driven emotional movements are lies that your mind is presenting to you. The compulsions and neurotic movements that distorted perfectionistic thoughts are to be observed as simply tricks your mind is playing. Refer to our previous column on mindfulness, or living in the moment [8]. When we are entirely present, intrusive and compulsive thinking wanes. Reading books and attending courses on mindfulness, coupled with daily practice, will yield great benefits in managing our minds.

In his 2008 study, psychologist and marriage and family therapist, Thomas S. Greenspon PhD proposed “building an environment of acceptance” through empathy, encouragement, self-reflection, and dialogue [7]. These are not steps, Greenspon argued, but rather fundamentals of an approach that will help an individual move beyond thoughts of perfectionism.

“Perfectionism, in this approach, is seen as a self-esteem issue arising from emotional convictions about what one must do to be acceptable as a person,” Greenspon wrote in the study. “It reflects a perfectionistic person’s basic sense of reality, not simply a set of irrational beliefs that can be changed by deciding to think differently. There is a great deal at stake emotionally, for which perfectionism is a defense. Overcoming perfectionism is a recovery process, more like nurturing a flower’s bloom than like fixing a broken object” [7].

Beyond Greenspon’s view, recovery can be attained with the help of a therapist, and cognitive behavioral therapy has been shown to be especially effective [4]. A trained therapist can help examine thoughts that evoke anxiety and fear and reframe them into more realistic cognitions. In addition, seeking a mentor who has the right balance of self-compassion and acceptance may serve as highly effective patterning for one’s life. An appreciation that others will accept us more fully when we are authentic and real, rather than a “perfect” pseudoself that our minds have constructed out of fear, may help us become more tolerant of ourselves.

Tomorrow, Try This

  1. 1.

    In the words of David Burns MD [1]: “Dare to be average” for the next 30 days. Accept that you are imperfect and resist the temptation to give into fear. Just be, and reconnect with your creative self. Let inspiration and passion rule rather than contemplating what you should be doing.

  2. 2.

    Make a list of pros and cons on a piece of paper about your perfectionism. Burns uses this exercise to convince his patients that they are less productive when perfectionism takes hold [1]. I have included my own personal edition to illustrate (Table 2).

    Table 2. Dr. Kelly’s personal pros and cons of perfectionism list
  3. 3.

    Another tactic Dr. Burns recommends is to become more “process oriented” rather than results oriented [1]. For example, focus on a good consistent effort in the operating room and release the compulsion to attain the perfect surgery. Implicit with a process orientation is the setting of realistic time limits to each task. Be sure to adhere to them. You will be surprised at the satisfaction and productivity boost you will realize.

  4. 4.

    Look at mistakes as opportunities for growth, rather than as signs of failure. We learn from errors, not successes. Each apparent step backward merely brings us closer to our goals.