Recent media coverage of the striking increase in adolescent and young adult anxiety highlights what therapists and pediatricians see every day, sleep deprived, overly stressed and unhappy patients and families. Rising rates of depression, anxiety and suicide, requires us to attend to a vulnerable group of students who are often overlooked, perfectionists.

Perfectionism in our society is associated with motivation, a drive to do well and a willingness to work hard. Unhealthy Perfectionism is emotional torture afflicting children already vulnerable to anxiety. It can be nearly impossible to distinguish a healthy persistence from unhealthy perfectionism. These students look great to the outside world and they go to great lengths to mask their struggles.

Unhealthy perfectionism is marked by:

Excessively high standards for oneself and others
Measuring self-worth only in regard to productivity or accomplishment
Over-emphasis on “shoulds”
Persistent self-doubt, never feeling good enough
Belief that others are easily successful
Intense fear of making mistakes and of failure

Underlying traits that are often precursors to unhealthy perfectionism include:

Rigid adherence to narrow sets of rules or expectations
Strong need for external approval
“All or Nothing” patterns of thinking; leading to belief that all mistakes are failures.
Anxious, ruminative and obsessive thoughts or behaviors

Academic perfectionism afflicts student prone to perfectionistic standards but with an obsessive and compulsive drive to achieve perfection at almost every level of academic expectation. Academic perfectionists are terrified of making mistakes or failure. They maintain a belief that academic imperfection will result in overall life failure and rejection.

Specifically these students might:

Hyper focus on grades
Obsess about work appearing perfect
Miss the big picture because of focus on minor details
Have great difficulty starting assignments, particularly writing, because of the need to “get it right” the first time.
Catastrophize
Struggle to work through obstacles because of intolerance of mistakes
Anticipate and expect disapproval and rejection
Appear in control and focused, at odds with internal experience of loss of control and negative pre-occupations.

How does perfectionism become a problem?

Reinforcement: Family members, teachers and other important adults often inadvertently reinforce unhealthy perfectionism. Praise, admiration and focus on the achievement, strengthens the child’s core belief that failure equals rejection. The pressure intensifies as expectations increase until a breaking point occurs. Parents feel confused or shocked, as their child seemed “happy”, “focused” and “successful”

Procrastination and Avoidance is inevitable. The need to “get it right” the first time and rigid thinking does not allow for prioritizing, writing drafts or mediocrity. Falling farther and farther behind and fear of asking for help, leads to crisis. When the student is “found out” the situation is often beyond repair and serious mental health symptoms have begun.

What can we do?

Teachers, Guidance Counselors, Pediatricians, School Nurses and most importantly parents, are in key positions to recognize the signs of unhealthy perfectionism and intervene quickly and with authority. For those with a “bright”, “gifted”, “high achieving” or “stressed out” student in their lives it is important to watch for following signs:

Social isolation
Performance anxiety
Procrastination
Limited interests
Excessive time spent on one task with little outcome
Disruption in sleep
Changes in appetite
A tendency to talk about all or nothing beliefs “If this isn’t perfect I will fail”
“The harder I work the better I will do.”
"I can’t relax or be happy unless I have all A’s”

1. Find a Therapist

Careful diagnostic assessment is necessary and your child should be evaluated for Depression and all Anxiety Disorders. Specific assessment of perfectionism is fundamental. Therapists will collaborate with family and teachers to identify and reduce perfectionist behaviors and routines. A therapist trained in Cognitive Behavioral Therapy is suggested; there are developing cognitive behavioral treatment (CBT) plans specific to academic perfectionism and CBT has long-standing evidence-based success in the treatment of Anxiety.

Therapy goals include:

Learn flexible coping strategies for periods of uncertainty
Increase awareness of maladaptive thinking.
Understand biopsychosocial factors that may interfere with healthy identity development
Examine core values that are separate from external achievement.
Exposure to vulnerability

Confronting mediocrity and failure while developing coping strategies for uncertainty, can lead to core self concept change: “I am lovable even when, especially when, I am not perfect.”

2. Learn Coping Skills in Therapy and Beyond

Encourage realistic assessment of outcomes to address fear of failure and focus on setting realistic goals.
Learn to break up overwhelming tasks into small pieces and work on one thing at a time
Set time limits and learn pacing
Focus on the here and now rather than the “future” or “regrets”
Deliberate exposure to mistakes to reduce fear and reinforce the value of mistakes
Learn relaxation and distress tolerance skills
Practice compassionate self-talk, assign pleasant event tasks
Prioritize routines that promote balance: sleep hygiene, nutrition, exercise and relaxation

3. Model balance and focus holistically on healthy development and core values.

Communicate deliberate and mindful messages about achievement and success. Model the importance of intrinsic self-worth. Focus on the development of compassion, contribution, love and health as primary sources of life long happiness.
Insist on balance and be vigilant about supervision. Monitor deteriorating sleep, appetite or self-care. Develop family self-care rules and discourage a “success at all cost” attitude.

Careful attention to students presenting with unhealthy perfectionism and deliberate, early intervention and treatment could go a long way in turning the tide of the anxiety epidemic in our adolescent and young adult populations.

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