Clinical perfectionism is a problem of strategy, not outcome. Perfectionists have high standards and expectations for themselves and others. This value can be a strength, as long as perfectionistic strategies aren’t compulsively used to control thoughts and feelings.

Adaptive perfectionism is a healthy, ego-syntonic way of approaching tasks that leads to a good outcome. Clinical perfectionism occurs when anxiety and OCD hijack your values and bully you into approaching goals in a way that undermines your performance.

Some of the characteristics of clinical perfectionism include:

● Rigidly following rules (“I should or must do things this way.”)

● Every task is equally important.

● Mistakes are catastrophic.

● Repetition until it feels/looks/sounds “right.”

● Missing deadlines due to procrastination.

To shift clinical perfectionism into adaptive perfectionism:

● Prioritize based on values.

● Experiment and take risks.

● Notice when your efforts result in diminishing returns.

● Fight procrastination.

● Identify conscientious people as models.

Self-talk that reduces Clinical Perfectionism includes:

● It’s okay for me to have high ideals. At any given moment, it’s also okay to be uncertain or make a mistake.

● Any progress is better than no progress.

● I’m willing to take a risk or make a mistake in this instance, in light of my values.

Behavior that reduces Clinical Perfectionism includes:

● Practice guessing at the smallest next step and ending work on a task before it feels done.

● Monitor whether you do tasks in order to feel “just right,” not due to what you value.

● Bring up an attitude of curiosity so that you can learn from the consequences of your decisions and alter your future decisions. This type of learning prevents paralyzing self-criticism and eventually allows you to relax into uncertainty and being a work in progress.

You know that you are responding with clinical perfectionism if you’re procrastinating the task if you can’t do it perfectly. You probably feel like there’s always more to do and you’re always behind. You approach tasks wanting to feel just right, to have a certain emotion or to get relief from an emotion. Rather than finishing a task when you’ve met the objective, you continue with the task until you feel correctly. You’re waiting to not feel anxious or uncertain.

Clinical perfectionism is seductive. Sometimes clinical perfectionism will drive you to avoid and sometimes it will drive you to over-compensate and work too hard. Your all-or-nothing thinking drives all-or-nothing behavior. If you have a habit of all-or-nothing thinking and behaving, you might not trust when to do what. You might be looking for a set strategy where you can feel in control of your clinical perfectionism. The reality is that responding well to the thinking patterns and behavioral urges that clinical perfectionism triggers requires that you are flexible and your responses are dynamic.

What does it mean to respond dynamically and with flexibility? You have to use the feeling of anxiety and urgency to guide your decision making for any given task. By being guided by anxiety, I mean always doing the opposite.

If your anxiety wants you to avoid a task, take the smallest next step towards that task. In that moment, you are not focusing on the outcome. You are focusing on relating well to your anxiety. It will probably make you more anxious to start the task without doing it perfectly. If you are left feeling anxious and uncertain, you are practicing well.

If your anxiety wants you to compulsively over-perform on a task, stop before you’re ready. You might try not starting the task while you feel anxious. That is, when your body feels urgent, slow down. Take some deep breaths. Set a timer for five minutes to mindfully pay attention to your sensations rather than your thoughts. Then, take the smallest next step. Continue your behavior until but you hit the choice point.

You know you’re at the choice point when a conscientious model might stop the task, but you feel the urge to keep going. You might have to guess where the choice point is while you’re getting used to changing your behavior. If you do it wrong by your own standard, you’re practicing well.

You might wonder why you should make mistakes on purpose, not strive to do your best at every opportunity. Focus on your opportunity cost. When you are acting in anxiety driven way, you are missing your life. You’re missing moments of connection with yourself and others. You’re missing opportunities to purpose other things you value. Some part of you knows you are making decisions based on your anxiety, not your values, and that erodes your trust with yourself over time.

It’s uncomfortable at first, but the habit of not listening to the voice of clinical perfectionism will give you time, peace, and the chance to live by your values.  It’s a lie that you need to be perfect to earn your own worthiness. You’ll feel worthy when you live by your values and treat yourself with compassion. Challenging clinical perfectionism will gradually offer you trust in yourself. Acting good enough will make you feel good enough.

Perfectionism is a cognitive pattern, with behavioral implications, that maintains many different responses leading to anxiety. Many perfectionists struggle to challenge their perfectionism because they’re afraid that it will lead to dropping their standards. They will no longer be striving for excellence. The most important concept here is: We are challenging the strategies you use to strive for excellence. We are not challenging the idea that you should strive for excellence.

When your strategies for trying to arrive at excellence are undermining your goals, then we consider that perfectionism. The goal is to be on the lookout for anxiety driven behavior that undermines your overall goals. It is not to make your work mediocre.

We’re still striving for productive work. We’re still striving for excellence. We’re just trying to use strategies that actually allow us to get there in the long term. When I’m thinking about clinical perfectionism, I’m going to start with the underlying fears that drive the compulsive behaviors.

There are four main fears that I see most frequently as the drivers of perfectionism.

The four main fears are:

● Fear of evaluation

● Inflated responsibility

● Intolerance of uncertainty

● Perfectionism about the “just right” feeling

If your underlying fear is a fear of evaluation — either fear of failure or fear of success — then you might think, “I want perfect performance in order to avoid a judgment, rejection, or the feeling of embarrassment.”

If you have this fear and this thinking pattern, then the behavioral manifestations or implications of it would likely show up as checking and rechecking your work, getting reassurance from their co-workers, avoiding tasks, or doing tasks at the last minute. When you are doing tasks at the last minute, you avoid them up to the point where you have to do them, rather than having a priority-based effort that is not contingent on the deadline.

The next fear is inflated responsibility. The thinking for this one is more like, “If I make a mistake, will it harm someone? I want to avoid — I want to be perfect — so that I don’t harm anyone.” This might show up in behavior similar to fear of evaluation. It could be checking and rechecking work, getting reassurance, doing tasks at the last minute, or avoiding tasks altogether.

The difference would be the exposure we do in response to either of these thinking patterns. For inflated responsibility, you need exposure to the feeling of guilt and to the thinking of the possibility of harm. For fear of evaluation, you need exposure to the feeling of embarrassment and to thinking of the possibility of judgment and rejection.

The next use of perfectionistic strategies is to reduce uncertainty. This might sound like, “If I could just make the perfect decision, then I wouldn’t feel so uncertain.”

In this case, my response is, “No, no, no, the decision is inherently uncertain. For most decisions in life, there’s no clear right answer. The more that you try to be perfect the more uncertain you’re going to feel.” The exposure would be to try to see what parts of any given decision are inherently uncertain. Then you do the best you can to problem-solve the things that can be problem solved and let go of the things that you can’t control.

Finally, the fourth form of OCD perfectionism is seeking the “just right” feeling. In this case, exposure is not typically to a fear. You won’t be able to describe any type of catastrophe that you fear. You just want the “click” of a task feeling complete. I’ve noticed that people who experience this tend to feel ashamed of it or experience it as ego-dystonic, especially when it really gets in the way of their life. You might even notice that you have tasks where you either have diminishing returns or you’re not able to execute and complete things in a timely way, because you’re trying to get the feeling of it being complete. They think, “Why do I have to keep going? Even though I really want this feeling, I don’t like it that I have to keep going!”

A good way to get through this is to validate the skills and the values behind it.

For instance, people that have anxiety and OCD tend to value and behave in a detail-oriented, creative, persistent and conscientious manner. It is not anxiety and OCD that makes them this way. You still have all of these values and attributes without your anxiety and OCD. That said, you don’t have to do what your anxiety and OCD tells you to do in order to live these values. In fact, you can get control of these attributes by challenging your anxiety and OCD when it tells you that you have to finish something to completeness.

The way to challenge anxiety and OCD is to say, “I still am striving for excellence. I still want to be detail-oriented but I don’t have to get the “click” feeling. In fact, waiting for the click or the feeling of completeness is actually undermining my striving for excellence.”

If your fear is evaluation, then your self-talk is going to sound like, I want to be embarrassed. I want to live with the possibility of rejection. I’m going to go towards situations where I can see that the chance of rejection is possible.

If your underlying fear is inflated responsibility, we want your self-talk to be, The feeling of guilt doesn’t mean I’ve done something wrong. I can live with the possibility of making a mistake that harms people in order to live by my values. I want to be able to do this action and live with the possibility that I’m going to harm someone and so even if I have the feeling of guilt, it doesn’t again mean that I’ve done something wrong.

If the fear is intolerance of uncertainty, then you will ideally live in their decision. Their self-talk will be, I’m making a decision and I’m living in it. Uncertainty is evidence of my growth, not a problem for me to solve.

If the fear is based on the need for a just right feeling, your self-talk is going to be, It’s okay for me to have this ‘just right’ urge right now. I’m going to have diminishing returns if I keep going, though. So, it’s an exposure or it’s a value-based behavior for me to not get the click.

Generally speaking, perfectionistic work sounds like, I must do this urgently. I must do it perfectly. I’m not going to stop until it feels just right.

Productive work sounds like, I’m going to prioritize based on my values and accept that I have limitations. Just because my mind thinks I can do something better doesn’t mean I have to do it. In fact, it definitely doesn’t mean I have to do it. If my perfectionism makes it hard for me to know when to stop, I’m going to use a conscientious model, which is a person who I respect doing the same type of task. I’m going to use what I know about how they behave as an example for deciding when it’s okay for me to stop. I’m willing to experiment and take risks knowing that I have to accept where I am to get where I’m going next. Rather than avoiding or bracing against feedback, I want collaboration so that I can grow.

Exposure to anxiety without understanding and without curiosity or compassion is just torture. It’s just more of what you are already experiencing and it isn’t therapeutic. You aren’t doing something wrong if you can’t do something different when faced with some of your triggers. It just means that the mechanisms that maintain that response, whether cognitive or behavioral, are too sticky for you. We need more curiosity about what’s keeping you stuck and we need more patience and compassion while you’re practicing.

Clinical perfectionism says, There is a right way of doing things and I must always be acting the right way.

Emotional perfectionism says, There is a right way of feeling and I must always be feeling the right way.

When emotional perfectionism shows up about treatment, it says, There is a right way to get better and I must always be thinking, feeling, and acting in the right way to get better.

Here’s the paradox: There is a right way. The right way to approach exposure to anxiety is with curiosity, compassion, and patience. Trying to be perfectly curious and compassionate is the opposite of curiosity and compassion. Getting back to the basics of developing a curious and compassionate attitude, your path is through observing what’s happening.

Emotional perfectionism is:

● Urgent (I must relate to this effectively right now!)

● Critical (I know what to do. Why can’t I do it?!?)

● Comparative (Other people don’t have this problem or are better at relating to it. What’s wrong with me?)

● Compulsive (What do I feel? What am I thinking? What do I feel now? Oh no, where did that thought come from? What does that mean? Am I better? Will I get better? Is that surrender? Oh no, why do I have that feeling now? What does that mean? Am I better? Will I get better?)

A curious and compassionate attitude towards recovery is:

● Patient (Some triggers are harder than others for me. I’m going to focus on my next step and take pride in my process.)

● Compassionate (Even though I intellectually know what to do, practicing it is really challenging. I’m very uncomfortable and it is really courageous to stay with this experience.)

● Self-respectful (Other people may have a different process than I do, but I choose to own my own process.)

● Curious (I’m noticing some sensations showing up. Let me describe them to myself. I’m noticing some thoughts too. Interesting. Is the content signaling anything to me or are my thoughts just sticky noise that showed up because I’m sensitized? Do I have any feelings now? Interesting. Maybe I have more than one feeling. Interesting…)

If your belief is that you will be better when you no longer experience anxiety or OCD, then checking whether you are experiencing anxiety and OCD is reasonable. Hopefully this explanation will help you understand why recovery is about how you relate to your experience, not whether anxiety and OCD show up.

If you must check, check on your attitude. Is your self-talk patient, compassionate, self-respectful, and curious?