The Ignored Personality Trait of Perfectionism and its Relationship to Suicide

Acceptance from parents and society can feed the perfectionism. Sometimes I cringe when I hear parents or relatives describe their child/student as a straight A student. They are proud. Maybe I am overreacting?

Dr. Jay Slosar, Psychologist

Andrew Holter PhD, SHRM-CP As I noted my original paper and presentation on perfectionism was for law enforcement . I think morality is a factor of intensely wanting to do the right thing.Striving to do your absolute best and then having a poor or catastrophic outcome can be devastating. Perfectionistic tendencies can make things worse.

Dr. Jay Slosar, Psychologist

I don't know if perfection is a neglected factor in short- or long-term talk therapy but one insight about perfectionism and suicidal thoughts seems to be overlooked routinely: in my experience, depressed and anxious perfectionists spend an inordinate amount of time in the mind looking for a perfect solution, or at least a certain/guaranteed solution. And because nothing in the future can be certain, they spin out countless iterations of the future. It is exhausting. No rest. Until one solution appears that is guaranteed to end the experience of the problem - death. It is a comforting thought because the mind can rest on the certainty of death at least for brief moments, even though the mind can start up again about how to die, when to die, who would be hurt, etc. If the client/patient can see thoughts of death as an artifact of the exhaustion of rumination and obsessive thoughts, they are in a position to make some second-order change.

John Petersen, PsyD

Suicide mostly happens when someone feels hopeless, when there is no hope for change or help. When things have to be perfect and only one way, it is often hard to see other options. Suicide can become the only thing that helps. Being a perfectionist means you are often disappointed. Repeated disappointment can lead to a cycle of depression. Once that downward cycle begins, it is hard to come back without help. Perfectionists have a hard time with acceptance of the things they cannot control. That is a frustrating way to live. Acceptance can be learned; and believed. Just wanting things a certain way does not make you suicidal. Not accepting that you can't always have it the way you believe you need can, indeed, make you suicidal.  As therapists, we all believe this can be helped. Like any problem, it takes recognition of the problem and acknowledging the need for help and then asking for it.

Dennis Rozema

Perfectionism may be an additional component that increases the risk of suicide, what should not be forgotten however is the structural nature of medicine, and the philosophy of do no harm. Physicians are medical providers that are to trained enhance the quality of life of patients, alleviate symptoms and again do no harm the patient. Perfectionism, then plays a role here in which they want to do their job to the highest degree possible that will result in the most significant satisfaction and benefits for their patients. The perfectionism in and of itself may not actually be the determining factor to suicide as much as serving in medical systems that do not take into consideration, a patient centered approach, or take into consideration the welfare and well-being of the provider themselves. Doctors have a significant burn out rate, work in a stressful environment that often include harassment, discrimination, and retaliation practices, when accounted for altogether result in higher rates of suicide. Please do not blame the medical provider as being a perfectionist, which results in them killing themselves when you do not take into consideration the systemic structures and policies of medicine that are in play.

Kiana N.

Great article! Perfectionism is often something that goes ignored in relation to abrupt suicide. I’m so glad you’re bringing this to light. Let’s keep the discussion going.

Sonia Guilfoos, MSW, LCSW

It is a huge issue, I deal with perfectionists all the time in my practice. It is an offshoot characteristic of complex trauma. Clients who have it can learn to loosen their grip on performance and give themselves breathing room. The work of Pia Mellody is invaluable in learning how to go into recovery from it.

Becky Whetstone, Ph.D.

Approximately 10 years ago, after being in the field for 10 years at that point, I learned for the first time that Dentists had the highest rates of suicide of all professions. I did a little research and asked a few Dentists who all confirmed this as well as the fact that they are taught this fact in their dental programs. This was shocking that we as MH clinicians aren’t informed if this during our education or training. They confirmed what my research suggested as the main cause: Perfectionism. Based on all of my years working in the medical field and many different specialists throughout the medical community, perfectionism that entails expectations that few if any human can meet and maintain. The real question and cause for additional exploration and a deeper understanding of the underlying psychopathology regarding the development of perfectionism. For example, often times people with Narcissistic PD were often raised by mothers/caregivers who weren’t emotionally available and whose responses to their children was one of indifference, leaving the child to feel invisible & irrelevant. This is obviously a bare bones description but illustrates the point. Continued to #2

Susie Guffey

Perfectionism can sometimes lead an individual to be a high achiever given the constant drive for success, despite the tendency to downplay their own achievements. They may struggle to share their experience of inadequacy with others as this is further evidence for their own perception of a lack of perfection stemming from their inability to deal with “failure.” It is easy for outsiders to dismiss the possibility for distress given an assumption that success and a lack of observed or spoken suffering results in happiness. Lacking positive support can further feelings of loneliness and negative self-talk for perfectionistic individuals. This can lead to feelings of loneliness, increasing the risk of suicide. The all or nothing mentality associated with perfectionism becomes a chronic source of stress given the reality that perfection does not exist, no matter the time or resources given to a solution. Even if progress is made, it is not celebrated or acknowledged, but rather perceived as evidence for failing to meet a goal. Taken to the extreme, this pattern of thought can lead to a sense of hopelessness, an identified factor of suicide. Perfection is an all or nothing mentality, and suicide is an all or nothing solution.

Evan Neufeld

This is a great discussion to have. Perfectionism can as others have said be a component of Suicide and it can also be very isolating and interfere in relationships with other people. I've learned over the years that sometimes what we call laziness or procrastination also coincides with perfectionism. Because if someone feels they can't do it perfectly what's the point of doing it at all? I have many clients who strive to be "on" or "productive" all the time. I feel in my experience as a clinician and as a human being, even though some view perfectionism as positive and hard working it's also kind of said negatively. Usually, people who have high standards or perfectionism themselves don't give themselves a break and feel they have to present this aura of perfection all the time. As I saw in another post here, people whose perfection comes from anxiety or depression can set them up for disappointment because there may not be a perfect answer.

Irene Ramirez

This requires additional study and research in this area to build and capitalize on our current understanding afforded to us by the persistent work of pioneers in this field. This includes underlying individual psychopathology and family systems, etc. Based on research, we know that adverse childhood events are the biggest predictors of people experiencing MH/SA issues later on. We also know that if those underlying issues aren’t eventually addressed, the likelihood of people continuing to struggle with bouts of depression/anxiety going forward is high. The endless amounts of research and data have provided enough evidence showing the impact of childhood events on us developmentally, socially, psychologically, emotionally, etc. as well as the generational impact along with the impact of family dynamics, etc. as a domino effect if not addressed early on. Yet, very few people I’ve treated over the years have ever demonstrated a basic understanding of MH because they’ve never been educated. People can’t change what they don’t know and don’t understand. We have a responsibility to equip them with the vital knowledge and via every mode of transmission available to us.Perfectionism isn’t the issue. It’s a RESULT of the issue

Susie Guffey

It's an important point to note that strong perfectionism can be linked to impulsive suicide when a person's very high expectations for self are suddenly threatened, by an interpersonal or career crisis. However, I don't see perfectionism on its own as increasing suicidal risk. I find that perfectionism is much more often linked with high anxiety and vulnerability to panic attacks.

Christine Elliott

What an interesting article! I'm based in the Bay Area of California and with all of the innovation here, it is also a perfect hub to foster the trait(s) of perfectionism and undue pressure to succeed. I have primarily worked with pediatric patients over the past few years, and now with adults in my private practice. I've seen the tendency towards perfectionism over a large age range and also varying socioeconomic demographics. As far as suicidality and perfectionism, from what I have gathered, it's more challenging for some individuals to reach out for support, as they believe they should not need a therapist or outside support as this is a sign of weakness. This sign of weakness can feel very uncomfortable to them as this is outside of the scope of expectations (perfection) they have for themselves.

Kavita Nandra, LCSW

This is interesting....the dentists I have spoken to informed me they have chosen to become a dentist because either their parent was a dentist or they could not get into medical school. Perfectionism, as I recall studying it, can cause OCD (survival solutions) behaviors because the impracticality of not completing the task is too emotional for the mind to experience. Thus, the body must create a hidden backdoor excuse for an out that doesn't then have the mind think it failed. The trauma-produced experience developed into the ANS trauma strategy of getting out ahead of it. But unlike the kid who was bullied and later turned into the older kid now acting as the bully is not obvious because the person is bullying themselves. Ugh, I know! I remind myself and my clients that if my brain is working well, I'm going to be blind to it.

ms MISSY ms CMH Counselor and Trauma Prevention Advocate

Being a therapist myself and having had experienced suicidal thoughts in the past, I can see how perfectionism played a part. It's hard to see it as perfectionism but I can see how there were beliefs that I'm not showing up as "good enough" or "right" for my family and friends which increased or contributed to my suicidal thoughts at least. As I've worked with clients, I've heard many of the same things voiced. Specifically, that they feel they're not showing up well enough or that they're not showing up right for their loved ones.

Aaron I Anderson

Heidi Elias, LCSW, SEP (She/Her) serving NY, NJ and FL. I believe that there are a variety of causes of suicide, one of which is perfectionism. I consider suicide to be a person’s final act of ultimate control, when they have felt powerless and hopeless, with no other way out. I also view suicide as a culminating expression of anger, and in having the final word. Suicide offers relief from the depths of tormenting despair, in someone suffering from deep depression.  In my work as a Psychotherapist, I want to know the root causes of the behaviors that brought a client into therapy. Once identified, we then go about processing the unresolved thoughts and feelings utilizing both talk therapy, and Somatic Experiencing (SE), which works to heal the body.  I view perfectionism as a reaction to something that went wrong in the early years, in the family of origin, where perfectionism was used as a survival coping mechanism by the individual in order to keep safe. Once processed in psychotherapy, individuals are no longer stuck in old, outdated patterns that are no longer needed and no longer work, and can actually choose how they want to live going forward. heidielias.com

Heidi Elias

Perfectionism comes from parents who give conditional love depending on a child's performance in school and at work. It is this way for most Asian people, The younger generation complains about this way of internalized perfectionism and not feeling good enough due to these parents that favor money and prestige over character and only offer affection if a child performs well in school or makes a lot of money,

Georgina Nunez

Great article. As someone who works on suicidal prevention, I agree that more needs to be done to educate on the connections between suicide and perfectionism. The greatest predictor of suicide is a lack of hope. For a perfectionist who is disappointed in the lack of perfection in the world, it is surely overwhelming and they can easily loose hope. And personally the pressure to always produce at a perfectionistic level can lead to a loss of hope when they fail to succeed at that level. Let’s keep the dialog going on this connection of suicide and perfectionism! LCPC and owner of Capture Your Path Couseling

Geri Condon

Doctors I have known, work in a emotionally detached culture, where perfection in their work is an expectation, even under conditions of stress, fatigue or lack of rest. They receive little praise for their perfect performance, as it is an expectation and not something that they just happened to do well. They bring this detached state into their home life and it is very hard on their family or spouse; which in turn creates distance between them. This sometimes creates a state of personal depression, as their standard of living tells them that they must continue this cycle to maintain their family and home. There doesn't seem to be any way out of these expectations for them. A less than perfect event in their practice, threatens their whole way of life and also gives them a sense of hopelessness. They find it very hard to keep this standard of expected perfection up for a extended period of time, although they try to do so. Family also often put them under financial pressure to meet their extended needs, which only creates more stress and pressure in their life.

Gary Michael aka "Mick" Leach Lazer

In my clinical experience, perfectionism can be understood as a coping response to pathological shame. Early experiences of emotional neglect, harsh parental criticism, and disconnection in all of its forms can lead to core beliefs of defectiveness. Feeling never good enough most certainly can drive high achievement behaviors that are unrealistic and result in performance based self-esteem. When performance becomes the basis of self worth, being perfect becomes a preoccupation that preserves the ego. All can be lost in this precarious ego state. It makes a lot of sense to me that being a perfectionist can put someone at risk for suicide.

Lisa H. Brown, MA, LMFT

As a fellow psychologist, I understand perfectionism as being rooted in the desire for control. I wonder if one of the reasons why many become surgeons and medical doctors is precisely because they are seeking control. The more a person has a need for control, the more they are likely to subscribe to attitudes and engage in behaviors that are meant to grab control. Obviously, this is a risky game because there is only so much we can control. Imagine the disappointment when you're seeking control for so long only to come up short so frequently. It's disappointing, saddening, and perhaps even depressing. Suicide is a way out of that pain. Of perpetually falling short.

Dr. Raymond Nourmand

Perfectionism has nature and nurture components, and I have been fortunate to work with several physicians. In psychotherapy and neurotherapy sessions, family of origin and culture often have tremendous impacts in the genesis and growth of perfectionism. In the framework of growth mindset versus fixed mindset, the self-talk retraining toward growth mindset has clinically helped many previously perfectionist clients break free. This is an important topic and I glad to see discussion around such an important matter, and I hopeful that this will lead to further research.

Andrew Bindewald

Dr. John A Otte Licensed Clinical Psychologist Thank you Dr. Slosar. Perfectionism as a block to honest, open, accepting, and loving relationships is something most of us have encountered. I was not aware of the connection to suicide, so thank you for that insight. The relationship between perfectionism and obsessive and compulsive behavior - not necessarily OCD - has always intrigued me, mostly because there is almost a magical thinking to perfectionism. I have always thought of suicidal ideation and behavior as reflecting deep (intolerable to the person with SI) emotional pain and persistent, unrelenting perfectionism certainly can lead one to that experience. Thanks to all for your informational and insightful comments!

John Otte

In my clinical practice, I come across internalized shame in my clients on a regular basis. This often manifests in perfectionism, which many people interpret as "striving for greatness; settling for nothing less". While it's true that growth is an important process for all, perfectionism deviates from this goal. I've found that perfectionism is much more related to shame-avoidance than progress towards a goal. Perfectionism revolves around the idea that "if I meet my own/others' expectations of me, then I won't feel less-than" or "then I'll feel like I'm enough" in whichever capacity. Many individuals have a deeper insecurity about themselves/their own capabilities, and seek to soothe these distressful emotions by focusing on "how to do better" ad nauseum rather than coping with and moving through these understandably uncomfortable emotions. Suicide, unfortunately, can often be a symptom of individuals who have come to the conclusion that they "will never be enough". This distorted perception and conclusion does often take the form of suicide, which at the end of the day is a permanent solution to a temporary problem.

Aaron Herman MS, LCPC

Thank you for raising this very important topic for collaborative discussion. My specialty are is complex PTSD, including childhood emotional neglect, which is often overlooked or underestimated for its lasting effects. Children raised in environments in which acceptance, approval, and affection are withheld or ineffectively demonstrated will strive to prove themselves to "earn" the vitally important acceptance from their parents/guardians. Perfectionism, in this sense, is a survival response. This desperate attempt to win the love of an emotionally distant parent/guardian (upon whom the life of the child depends) shows up in other aspects of life as the child enters performance based realms of experience; academics, sports, music, etc. The grade, the goal, the applause are a temporary fix, but the nagging underlying belief that they still aren't good enough persists. The hopelessness of never being good enough, no matter how hard one tries, can cause a feeling of futility, unworthiness, and self hatred. In the absence of trauma treatment and support, maladaptive coping strategies like substance abuse and other self destructive behaviors can add to the fatal combination that makes suicide look like the only solution.

Jennifer McCarthy RN, MFT

I agree that perfectionism and suicide are not correlated enough. Hopelessness is a major driving force for suicide. I believe that individuals who struggle with perfectionism have a hard time coping with living up to the perfection they perceive others demand of them; which can perpetuate hopelessness. John Petersen, PsyD #suicide

Tara Emerick, LCSW

I would love to see more research done on this topic. I agree that there is a direct correlation between suicide and perfectionism. I have had clients whom have struggled with self-harm, suicidality, and perfectionism. In what I have observed, there is a correlation between a high ACES score and unrealistic expectations from their family of origin and if there is a culture of ridigity or fundamentalism. I believe that this is not only a problem in high-performing people who become professionals, Doctors and Police officers it is a problem that crosses various socioeconomic backgrounds.

Celine Elise Redfield (they/them)

My specialization is with misophonia, a neurological disorder with intense emotionality and complex family dynamics. Among the common traits of my mostly adolescent clients are perfectionism and straight As ... or often A+. We discuss Wabi Sabi, the Japanese art of appreciating the perfection of IMperfection, as well as their pottery technique of repairing cracks with gold lacquer rather than throwing out the broken piece. I ask how perfectionism is helpful to them, and also how it sometimes gets in the way. I give two examples that happen to be common in our lexicon: "Well, it isn't rocket science" or "it ain't brain surgery." I ask why perfection matters in those two examples. We look at examples of their own perfectionism (clothing has to be folded a certain way, or hung in closet in a certain manner, or books kept on shelves according to their own scheme, etc.) and i challenge them to do something "wrong" and tolerate the discomfort for a while, noticing that nothing bad happens, no one dies. We make the connection between perfectionism and the stress they create for themselves, and look for self-acceptance as a normal, imperfect human. That also goes for parents who have extremely high expectations.

Jaelline Jaffe PhD, LMFT

This could not be a more timely topic, Jay. Our society does not tolerate mistakes and miscalculations, thus many of us are inherently individualistic and perfectionistic (and often narcissistic, but that's another conversation). In these days of astronomical malpractice insurance costs, a highly litigious society, and near universal pressure to achieve perfection in all matters, it's no wonder physicians are taking their own lives in record number. Add to this the corporatization of healthcare and the ongoing pressure of the 15-minute visit for both specialists and primary care docs, it's no wonder that we have a shortage of physicians. And when we also consider the unreasonable expectations that our doctors be all-knowing superhumans with no room for error or simply not knowing the answers, we have a recipe for self-recrimination, self-hatred, and self-harm. Don't we owe our physicians a whole lot more?

Keith Carlson, BSN, RN, NC-BC

Interesting.

Katy G.

As a former firefighter/paramedic, I think we can absolutely look at perfectionism within this population as a possible root cause, but also forgotten is the impact of moral injury. I think combined, these two can be a knock out punch. Having personally experienced the impact of both, striving for perfection, and suffering constant moral injury in healthcare, you absolutely lose sight of reality and begin to look for an escape. I'm speaking more from personal experience and a candid place rather than a research informed one on this subject as this subject is more personal to me than others.

Dr. Andrew Holter

Dr. Jay Slosar, Psychologist I was recently discussing with a colleague that many parents need to see their children more holistically. They are much more than their grades. They may be kind and thoughtful people, with a passion for building, inventing, animals, nature etc. They may be really funny, or adventurous or patient, or a sensitive and deep thinker. A hard worker, persistent, a good leader, a good follower etc. So many more important things than being a straight A student.

Danielle Hanchett Friedman, LCSW

As I noted with Lisa's post this is so true. Its just getting the person to longer term therapy because short term models won't work.

Dr. Jay Slosar, Psychologist

OCD is in the DSM and gets diagnosed by the repetitiveness of behaviors--and rigidity. The movie as Good as it Gets with Jack Nicholson was the classic. Perfectionism is less identifiable in that sense and has an end point like success.

Dr. Jay Slosar, Psychologist

Dr. Jay Slosar, Psychologist I would argue that the perceived endpoint for perfectionism is not actually an endpoint as perfectionists seem to be constantly raising the bar on themselves or unlikely to be satisfied when then get to the “endpoint,” unfortunately.

Danielle Hanchett Friedman, LCSW

That is so true. Some professions are very demanding and controlling and may in fact attract people who have that in their nature. Military dynamics are quite recognized as authoritarian by design. Air traffic controllers are well documented in personality factors (16PF) as being controlling. There is a whole vocational needs theory that we choose our careers to math our emotional needs.

Dr. Jay Slosar, Psychologist

Thank you very much for this insight. I believe it is so true. It cuts to a core clinical issue and has been my experience also. As I noted above while it is a result, it still may interfere with treatment and response to treatment.

Dr. Jay Slosar, Psychologist

Working conditions seem to need a lot of attention. Perhaps all of us need to realize how much pressure medical professionals are under.

Dr. Jay Slosar, Psychologist

I have attended suicide CE classes with experts who do not mention perfectionism.

Dr. Jay Slosar, Psychologist

We value innovation and being an entrepreneur to excess. Sometimes I feel like there is this tremendous pressure to "think out of the box." I think we need more people who think well in the box.

Dr. Jay Slosar, Psychologist

Very good point. The depth/severity of symptoms always need to be considered and avoid overgeneralizations.

Dr. Jay Slosar, Psychologist

We know Adverse Childhood Experiences or ACES certainly has an impact on social,. emotional and cognitive development. This includes neurodevelopment as ACES interfere with the immune system and neuroendocrine systems. If the result is perfectionism, that person may not seek or stay in treatment. presenting with depression their perfectionism may result in stopping treatment as Blatt noted in the article I referenced. On a societal and day to day level it seems to me people get fixated and anxious and their coping mechanisms freeze up. Thus, an increase in rigid/perfectionistic tendencies. Education as you note is critical and I think that's our job, Hence, this post.

Dr. Jay Slosar, Psychologist

It is important to note that perfectionism gets things done. I think there is a difference between high levels of productivity and perfectionism. An over productive and driven person may overdo it and burnout but hopefully put on the brakes before that happens. They also probably are able to make corrections along the way and correct mistakes. Not so for a perfectionistic person who is driven to be flawless and collapses when they fail.

Dr. Jay Slosar, Psychologist

The all or nothing reflects the rigidity and a lack of support b;locks natural healthy responses.

Dr. Jay Slosar, Psychologist

I hope we can too.

Dr. Jay Slosar, Psychologist

The healthcare system and how it works can be extremely harmful. The way residents and interns have been treated is abusive. But the abuse also applies to nurses too. The MBI or Maslach Burnout Inventory was developed long ago when it was discovered that nurses had the highest burnout rates of all professions. The article features a surgeon who tells her story of a driven upbringing and the pressure of a surgeon who like the committed professional always puts patients first. I do not believe perfectionism is a causative factor for any suicide. In the medical field there are, as you note, too many systemic stressors. Especially, the stress of being a surgeon means you cannot make a mistake. If you do someone can die. Thus, the job demands itself breed the components of perfectionism.-- be perfect--be flawless-no mistakes.- and don't acknowledge any mistakes. Calling attention to the aspect of perfectionism overall and its relationship to suicide is an important discussion. -

Dr. Jay Slosar, Psychologist

I separate suicides from depression and hopelessness with an identifiable psychosocial stressor but your comment that hopelessness and depression are enhanced by perfectionism is certainly true. It is a form of rigidity that can become self destructive.

Dr. Jay Slosar, Psychologist

Within these internal thought processes of a perfect solution, I try to focus on one acknowledgement that is important. That is, an acknowledgment a person can make a mistake. Trying for the perfect solution may mean you try something and it doesn't work. So what? This is a key feature of a perfectionistic person--they cannot accept mistakes or learn from them.. I remember the APOOLO 13 movie and heroics --the message to the astronauts ---Failure is not an Option. But this heroic hopeful necessary message in the crisis became very popular. But its the worst message to pass on to kids. The better message is you will make mistakes and you learn from them. That's how you grow. When a perfectionist is the rising star and going to the top, a setback is not just a mistake. It is a complete failure. Then they can fall-- with an unexpected suicide.

Dr. Jay Slosar, Psychologist

John Petersen, PsyD I’m not an academic, but I’m an individual who has personally experienced this and been self-reflective enough to say your words are exactly how I’ve felt at time but didn’t know how to articulate it in a way that would be heard and not categorized. I’d love the opportunity to delve into this more with you.

Kristin Dowlut