Specific dispositional characteristics are thought to predispose individuals to depression. One such predisposing factor is maladaptive perfectionism. Perfectionism is defined as setting excessively high standards of performance, alongside a tendency to make critical self-evaluation periods perfectionism is distinct from healthy attitudes of striving to achieve.

In particular, maladaptive or neurotic perfectionism can impact individuals across all backgrounds; through understanding how to identify perfectionists and elucidating strategies to manage perfectionism, individuals prone to this can lessen vulnerability to depression.

According to the Diagnostic and Statistical Manual of Mental Disorders DSM-IV-TR, depression is defined by a note mood, significantly diminished interest or pleasure, psychomotor agitation, insomnia or hypersomnia, increased or decreased weight associated with an increased or decreased appetite, feelings of worthlessness or guilt, reduced ability to think or concentrate, and recurrent thoughts of death.

Symptoms of depression are variable, and while some can present as mild responses to distressing life events, others can be severely disabling and alter how individuals view themselves and society. Research that reveals positive correlations between perfectionism and symptoms of depression has begun to offer important insights.

What is perfectionism?

Perfectionism is a stable personality trait where individuals persistently engage in the same patterns of behavior and thinking or how individuals think about those behaviors. Perfectionist personality traits are not considered a disorder, but a vulnerability factor that predisposes an individual to depression as well as other psychological problems.

Perfectionism is  multidimensional and composed of self-oriented perfectionism, other-oriented perfectionism, and socially prescribed perfectionism:

1. Self-oriented perfectionism: this is an intrapersonal dimension that requires a person to be perfect themselves; individuals strive to meet unrealistically high standards and are prone to critical self-evaluation
2. Other oriented perfectionism: this is an interpersonal dimension that causes individuals to hold others to unrealistically high expectations, and is associated with a harsh evaluation of their performance
3. Socially prescribed perfectionism: this is an interpersonal dimension that involves perfectionist standards held by influential people in an individual's life, and these influential others demand perfection of the individual, evaluating their performance critically.

Perfectionist personality styles demand perfection in themselves, in others, or hold the belief that others will only accept perfection from them.

Perfectionism and vulnerability to depression

Maladaptive perfectionist personality traits demonstrate concern over mistakes and consistent doubts about their behaviors or performance. In these cases, they can be identified as ‘clinically significant perfectionists’. Clinically significant perfectionism results in individuals with an increased vulnerability to depression, with an inflexible attitude towards changing patterns of thought, despite the consequences that the pursuit of perfectionism has on their quality of life.

The most salient concern associated with clinically significant perfectionists is an increased risk of suicide. Socially prescribed perfectionism correlates positively with perfectionist thinking; those with eating disorders, depression during pregnancy, postpartum depression, or a combination of both are all particularly significant vulnerability factors for depression when it becomes clinically significant.

Interestingly, when perfectionist tendencies increase, the strength of the association between perfectionism and obsessive-compulsive symptoms greatens, while the association with depression lessens.

A reason that perfectionism is linked to depression is due to the conflation of self-worth and success and the active working towards goals. Therefore self-worth is contingent on fully achieving high goals; depressive symptom etiology is therefore highly likely to occur when some goals are not met. Inability to meet all set goals can exacerbate lowered self-esteem. Moreover, perfectionism is correlated with internalized shame.

Some clinically significant perfectionists experience sustained feelings of decreased self-worth, lowered self-esteem, feelings of shame, increased tendency to ruminate about mistakes, and a tendency to expect adverse outcomes. These unrelenting negative self-reflections subsequently become habitual and contribute towards the development of depressive symptoms.

The mediating role of rumination

People with self-oriented perfectionism frequently ruminate about situations in which they have failed to attain perfection in the form of self-imposed goals. Moreover, those with self-oriented perfection are preoccupied with productivity, leading them to ruminate about events that have prevented their ability to obtain perfect goals efficiently.

This is also true of those who are subject to socially prescribed perfectionism. In this setting, individuals are overcome with the belief that others are overly critical, judgmental, and disappointed in their performance. Those with socially prescribed perfectionism tend to view that approval and acceptance as being conditional on perfection.

This leaves those with socially prescribed perfectionism susceptible to ruminations about how they have fallen short of others' high expectations and ruminate on the negative feedback they receive or anticipate because of it. Those with socially prescribed perfectionism are also prone to misinterpreting and ruminating about events that reinforce the idea that they are less than perfect. Socially prescribed perfectionism is particularly prevalent in undergraduate and adolescent populations.

Why are self-oriented and socially prescribed perfectionism tied to depressive symptoms?

In short, self-oriented and socially prescribed perfectionism predict depressive symptoms through rumination and difficulty accepting the past. Notably, difficulty in accepting past events mediates the link between depression and socially prescribed perfectionism, but not self-oriented perfectionism.

Therefore, rumination, rather than difficulty accepting the past, is more relevant to the link between self-oriented perfectionism and depression.

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Clinical implications

According to research, treatment efforts for depressed people who have self-oriented perfectionism may be augmented through treatments that promote an accepting view of past experiences. In addition, psychodynamic treatment that focuses on the deeply ingrained aspects of perfectionism is thought to be a strategy to reduce depressive symptoms for distressed perfectionists.

Short-term psychodynamic treatment for perfectionism has been shown to result in significant improvements in self-oriented perfectionism, socially prescribed perfectionism as well as ruminations about not being perfect.

Continue reading about depression here.

References:

• Smith MM, Sherry SB, Ray CM, et al. (2019) The Existential Model of Perfectionism and Depressive Symptoms: Tests of Unique Contributions and Mediating Mechanisms in a Sample of Depressed Individuals. doi: 10.1177/0734282919877777.
• Suh H, Kim S, Lee Dong-gwi. (2021) Review of Perfectionism Research From 1990 to 2019 Utilizing a Text-Mining Approach. doi: 10.1177/10892680211018827.
• Melrose S. (2011) Perfectionism and depression: vulnerabilities nurses need to understand. Nurs Res Pract. doi:10.1155/2011/858497.

Further Reading

• All Mental Health Content
• World mental health support and the effect of stigma and discrimination
• A Guide to Coping with Change
• Managing and Reducing Stress
• Analyzing the Stigma Surrounding Mental Health

Written by

Hidaya Aliouche

Hidaya is a science communications enthusiast who has recently graduated and is embarking on a career in the science and medical copywriting. She has a B.Sc. in Biochemistry from The University of Manchester. She is passionate about writing and is particularly interested in microbiology, immunology, and biochemistry.