Perfectionism and Chronic Illness

Source: Katie Willard Virant

We all know someone who is a perfectionist. We tend to admire those people who seem to effortlessly succeed at whatever task they undertake. But there’s a dark side to insisting on excellence at all costs, and this dark side is intensified when chronic illness comes into the mix. This column explores the costs of perfectionism for those living with chronic illness and offers strategies to transform the idea that one has to be perfect into the reality that one can be “good enough.”

Perfectionism is defined as a personality trait characterized by a drive for flawlessness, excessive self-scrutiny, and harsh self-criticism over mistakes (Linnett & Kibowski, 2018). Researchers note three aspects of perfectionism: self-oriented, socially-prescribed, and other-oriented (Flett, et al., 2011). Self-oriented perfectionism involves setting unrealistically high standards and criticizing oneself harshly when those standards are not met. Socially-prescribed perfectionism describes the perception that important others (family, friends, society as a whole) are holding the affected individual to excessively high standards. Other-oriented perfectionism involves the perfectionist’s judgment of others as she holds them to her exacting demands.

We know that perfectionism is associated with negative outcomes such as low self-esteem, depression, and anxiety (Linnett & Kibowski, 2018). Research also shows that it is associated with maladaptive adjustment to chronic illness (Molnar, et al., 2016). Let’s look more closely at some of the ways this plays out:

Loss of control: Perfectionists are terrified of losing control (Molnar, et al., 2016). They have structured their lives to avoid experiencing the painful feelings that accompany the loss of control, including shame, disappointment, anger, fear, and grief. Their unspoken mantra is “If I am perfect, I will remain safe from these feelings that are too hard to bear.” Of course, chronic illness, with its unpredictability and propensity to derail the best-laid plans, presents a huge obstacle to perfectionists. Perfectionists don’t make allowances for external circumstances that affect their performances. Rather, they double down on self-criticism, telling themselves to get over it and try harder. This self-criticism creates stress-induced harm to physical and psychological well-being (Molnar, et al., 2016).

Self-concealment: Perfectionists need to see themselves and be seen by others as perfect (Molnar, et al., 2016). Chronic illness changes our appearance, our energy levels, and our abilities. It’s difficult to maintain the facade that all is well when all is NOT well. It’s a lot of work pretending to be fine. It uses up our finite energy and disconnects us from our own experience. It also disconnects us from others, who know our facade rather than our reality. Perfectionists are lonely, and perfectionists with chronic illness often deprive themselves of much-needed social support (Flett, et al, 2011).

Daily reminders of imperfection: One of the most frustrating aspects of living with chronic illness is the constant uncertainty as to cause and effect (Friis, et al., 2016). Our cultural narrative of illness is that we get sick, we receive medical treatment, and we get better. This narrative is not the case with most chronic illnesses. Rather, we get sick, we try various medical treatments, we may get worse or better, we tinker with our medical treatments, we may get worse or better, and so on. While this state of limbo can feel to perfectionists like a personal failure, chronic illness is not an academic course to be aced or a race to be won. Rather, it’s an ongoing, life-long state of being that can’t be willed or worked away. It’s challenging when medicine that has been working for two years suddenly stops working when surgery that promised relief proves disappointing when we are active one day and bedridden the next with no apparent explanation for the change. For perfectionists, it can lead to an indictment of self: “Why can’t I figure this out? I’m not working hard enough to change this. I’m failing at conquering this disease.” Some perfectionists even will opt out of caring for themselves, using the logic that their efforts are not producing desired results and therefore must be worthless (Linnett & Kibowski, 2018).

Are perfectionists living with chronic illness doomed to poor quality of life? Absolutely not. We can change our perfectionistic tendencies to improve both our adjustment to illness and our overall experience of being in the world.

Cultivate Self-Compassion as an Antidote to Perfectionism

Research is clear that self-compassion can act to reduce perfectionism (Linnett & Kibowski, 2018). Self-compassion is comprised of self-kindness (treating yourself with the same love and tolerance you would treat others), common humanity (viewing suffering as part of life experienced by all people), and mindfulness (understanding that you are not your suffering). See my prior column on Chronic Illness and Self-Compassion (https://www.psychologytoday.com/us/blog/chronically-me/201808/self-comp…) for a more detailed explanation of both the concept and the implementation of self-compassion strategies.

Challenge All-or-Nothing Thinking

Perfectionists tend to think of themselves as either perfect or worthless. The truth is that most of us hang out on the continuum between these two poles. Neither perfect nor worthless, we are simply “good enough”. If you’re struggling with perfectionism, it’s important to take in this concept of being “good enough”. Dr. Donald Winnicott, a pediatrician and psychoanalyst, introduced the idea of the “good enough mother” in 1953. He spoke of the importance of mothers gradually failing to meet all of their children’s needs, stating that “her failure to adapt to every need of the child helps them adapt to external realities” (Winnicott, 1953). In other words, the good enough mother offers her child advantages that a perfect parent cannot.

Similarly to Winnicott’s good enough mother, a good enough person learns resilience. She accepts herself as someone who makes mistakes, drops balls, tries and sometimes fails. She accepts that there’s a lot she can’t control, and she bends with challenges instead of shattering as she fights against them. The next time you are railing against yourself for not being perfect, ask yourself if you can be okay with being good enough.

Perfectionism Essential Reads

Choose to Be Present Rather Than Perfect

Do You Suffer From Perfectionism or Procrastination?

Look for Opportunities to Make Mistakes

The specter of failing strikes fear into every perfectionist’s spirit. There is an underlying belief that failure cannot be survived. The antidote for this? Challenge the belief in ways that feel relatively safe. Choose an activity at which you’re not going to excel. You may balk at this, as perfectionists tend to feel discomfort when they are engaged in activities where they are less than perfect. This is precisely the point, though. You want to experience that feeling of being mediocre or even terrible and notice what happens to you. What emotions does it call up? What thoughts about yourself does it bring forth? Remind yourself as you feel the discomfort that you’re not supposed to be good at this. Notice that nothing terrible is happening as you bungle your way through your chosen activity. Is there a way to have fun with this activity? Can you feel a sense of pride in yourself for banging out “Twinkle Twinkle Little Star” on the piano, for example? Can it be okay that you’re not Chopin?

Embrace Your Imperfect Body

To live with chronic illness is to live with imperfection. Our bodies are letting us down, not doing what they are supposed to do, not being close to perfect. Can we love them in spite of this? When my Crohn’s Disease is particularly active, I often use a heating pad on my abdomen. It’s likely that the heat is therapeutic, but equally important is the fact that I am providing loving care to a part of my body that hurts. I am accepting my gut in its imperfection. I am saying, “I see you. I hear you. And I am tending to you exactly how you are in this moment.” Right now, as you’re reading this, place your hand on a part of your body that hurts. Take a deep breath and send loving kindness to this area. Just for a moment, try not to judge your body and find it wanting. Just for a moment, embrace and care for it as you thank it for doing its best.

Do you struggle with perfectionism? How does it affect living with your chronic illness? What do you do to challenge the belief that you must be perfect?