Canadian Counselling and Psychotherapy Association

Definition of Perfectionism
Comprehensive Treatment of
Perfectionism is a disposition to
Perfectionism
regard anything short of perfection
May 17, 2013
as unacceptable
Martin M. Antony, PhD, ABPP
Merriam Webster Dictionary
Professor and Chair, Department of Psychology,
Ryerson University, Toronto
Director of Research, Anxiety Treatment and
Research Centre, St. Joseph’s Healthcare, Hamilton
www.martinantony.com

Definition of Perfectionism Definition of Clinical Perfectionism

A perfectionist is someone “whose “The overdependence of self-

standards are high beyond reach or evaluation on the determined pursuit
reason” and “who strains compulsively (and achievement) of self-imposed,
and unremittingly toward impossible personally demanding standards of
goals and who measures their own performance in at least one salient
worth entirely in terms of productivity domain, despite the occurrence of
and accomplishment.” adverse consequences.”

David Burns (1980) Shafran, Cooper, & Fairburn, 2002

Domains of Perfectionism Domains of Perfectionism

§ Work (58%) § Way of speaking (28%)
§ Bodily hygiene (54%) § Romantic relationships (28%)
§ Studies (43%) § Eating habits (25%)
§ Physical appearance (40%) § Health (23%)
§ Social relationships (38%) § Domestic chores / cleanliness (18%)
§ Presentation of documents (37%) § Time management / punctuality (17%)
§ Spelling (36%) § Correspondence / mail (17%)
§ Dress (33%) § Leisure activities (17%)
Stoeber & Stoeber, 2009 (109 college students indicated yes/no to whether § Oral presentations (17%)
they were perfectionistic in each domain)
 Domains of Perfectionism Categorical vs. Dimensional Views

§ Although some perfectionists exhibit § Taxometric research suggests that

perfectionism across domains, most dimensional conceptualizations best
exhibit perfectionism only in selected fit the data.
domains

Stoeber & Stoeber, 2009 Broman-Fulks et al., 2008

Perfectionism and
Transdiagnostic Nature of Perfectionism
Psychological Functioning
§ Social and performance anxiety
§ Worry and generalized anxiety disorder § When the discrepancy between personal
standards and actual academic performance
§ Obsessive-compulsive disorder
increases (in high school students),
§ Obsessive-compulsive personality disorder depression increases and self-esteem
§ Eating disorders decreases.
§ Body dysmorphic disorder
§ Anger
§ Physical Health
§ Depression
Egan et al., 2011; Molnar et al., 2006 Accordino et al., 2000

DSM-IV OC Personality Disorder Pathways to Perfectionism

§ Preoccupied with details, rules, lists, order, § Genetics (Tozzi et al., 2004)
organization, schedules § Operant conditioning (e.g., reinforcement)
§ Perfectionism that interferes with task completion § Classical conditioning
§ Excessively devoted to work and productivity § Observational learning (e.g., modeling)
§ Overconscientious, scrupulous, and inflexible
§ Informational or instructional learning
about matters of morality, ethics, or values
§ Unable to discard worn-out or worthless objects
§ Reluctant to delegate tasks or to work with others
§ Miserly spending style toward both self and others
§ Rigidity and stubbornness
 Peer Victimization and Perfectionism Social Learning
§ Recalled history of indirect peer aggression § Athletes’ perceptions of their parents’
(exclusionary acts, gossiping, rumor perfectionism is more predictive of
spreading) in childhood predicts perfectionism among athletes than was the
perfectionism in adults, whereas recalled parents’ actual levels of perfectionism.
history of direct aggression (e.g., physical,
verbal) does not.

Miller & Vaillancourt, 2007 Appleton et al., 2010

Personality and Perfectionism

§ Among adolescents (ages 14-19), the trait of

conscientiousness predicts longitudinal
increases in self-oriented perfectionism 5 to
8 months later. ASSESSMENT OF
§ Although the trait of neuroticism is
associated with socially prescribed
perfectionism, it does not predict longitudinal
PERFECTIONISM
increases in this trait.

Stoeber, Otto, & Dalbert, 2009

Popular Perfectionism Measures Frost Multidimensional

Perfectionism Scale
§ Frost Multidimensional
Perfectionism Scale (Frost et al., Concern over Mistakes
§ If I fail at work/school, I am a failure as a person.
1990) § I hate being less than best at things.
§ Hewitt and Flett Multidimensional Personal Standards
Perfectionism Scale (Hewitt & Flett, § I set higher goals than most people.
1991) § I am very good at focusing my efforts on attaining a goal.

Doubts about Actions

§ I usually have doubts about the simple everyday things I do.
§ It takes me a long time to do something right.
 Frost Multidimensional Hewitt and Flett Multidimensional
Perfectionism Scale Perfectionism Scale
Parental Expectations Self-Oriented Perfectionism
§ My parents set very high standards for me. § When I am working on something, I cannot relax until it is perfect.
§ My parents wanted me to be the best at everything. § I demand nothing less than perfection of myself.

Parental Criticism Other-Oriented Perfectionism

§ I seldom criticize my friends for accepting second best.
§ As a child, I was punished for doing things less than perfectly. § The people who matter to me should never let me down.
§ My parents never tried to understand my mistakes.
Socially Prescribed Perfectionism
Organization § Those around me readily accept that I can mistakes too.
§ Organization is very important to me. § My family expects me to be perfect.
§ I am a neat person.

Positive and Negative Perfectionism General Perfectionism Measures

§ Almost Perfect Scale - Revised (Slaney et al.,
Maladaptive Evaluative Concerns 2001)
§ Hewitt & Flett MPS: SPP § Behavioural Domains Questionnaire (Lee et al.,
§ Frost et al MPS: CM, PE, PC, DA 2011)
§ Burns Perfectionism Scale (Burns, 1980)
Positive Striving § Clinical Perfectionism Questionnaire (Fairburn et
§ Hewitt & Flett MPS: SOP, OOP al., 2003)
§ Frost et al MPS: PS, OR § Consequences of Perfectionism Scale (COPS;
Kim, 2010)
§ Multidimensional Perfectionism Cognitions
Bieling et al., 2004; Frost et al., 1993 Inventory (MPCI; Kobori, 2006)

General Perfectionism Measures Child Perfectionism Measures

§ Neurotic Perfectionism Questionnaire (Mitzman § Adaptive/Maladaptive Perfectionism Scale
et al., 1994) (AMPS; Rice & Preusser, 2002) (for children)
§ Perfectionism Cognitions Inventory (Flett et § Child and Adolescent Perfectionism Scale
al., 1998) (CAPS; Flett et al., 1997)
§ Perfectionism Inventory (Hill et al., 2004) § Childhood Retrospective Perfectionism Scale
§ Perfectionistic Self-Presentation Scale (CHIRP; Southgate et al., 2008)
(PSPS; Hewitt et al., 2003) § Perfectionistic Self-Presentation Scale –
§ Positive and Negative Perfectionism Scale Junior Form (PSPS-JR; Hewitt et al., 2011)
(PANPS; Terry-Short et al., 1995)
 Domain-Specific Questions to Determine Whether
Perfectionism Measures Standards are Overly Perfectionistic
§ Perfectionism in families and relationships
§ Are my standards higher than those of other
§ Perfectionism in sports and athletics people?
§ Perfectionism in body image and eating § Am I able to meet my standards? Do I get
disorders
overly upset if I don’t meet my own
standards?
§ Are other people able to meet my
standards? Do I get overly upset if others
don’t meet my standards?

Questions to Determine Whether

Standards are Overly Perfectionistic
§ Do my standards help me to achieve my goals

TREATING
or do they get in the way (e.g., by making me
overly disappointed or angry when my
standards are not met; by making me get less
work done, etc.)?
§ What would be the costs of relaxing a particular PERFECTIONISM
standard or ignoring a rule that I have?
§ What would be the benefits of relaxing a specific
standard or ignoring a rule that I have?

Cognitive Features Examples of Should Statements

§ I should always push myself to achieve
§ All-or-nothing thinking / should statements
§ I should always do things thoroughly
§ Excessively high or inflexible standards
§ I should never waste time
§ Double standards
§ I should always be productive
§ Probability overestimations
§ I should always be trying to better myself
§ Overgeneralizing
§ I should leave as little time as possible for tasks so
§ Being overly focused on details I don’t waste time, even if I am late
§ Catastrophic thinking § I should work harder
§ Excessive need for control § I should try to be the best
§ Biases in attention and memory
Egan, Wade, Shafran, & Antony, in press
 Changing Perfectionistic Thinking Identifying Double Standards
§ Examining the evidence § Do you have one set of rules for yourself,
§ Education and another set of rules for other people?
§ Perspective shifting § Are the rules for yourself harder than your
§ Compromising with self and others rules for others?
§ Hypothesis testing
§ Changing social comparison habits
§ Looking at the big picture
§ Tolerating uncertainty and ambiguity
Egan, Wade, Shafran, & Antony, in press

Challenging Double Standards Identifying Overgeneralization

§ Is it fair to have harsher rules for yourself than § What do you think of yourself as a person
for everyone else? overall when you make even just a small
§ What is the impact of holding a different set of mistake?
standards for yourself than for others?
§ What happens to your self-esteem when
§ What would you say to a friend who had a harder your performance has not met your
set of rules for him or herself than others?
standards?
§ How does it follow that rules need to be harder
for yourself than for other people?

Egan, Wade, Shafran, & Antony, in press Egan, Wade, Shafran, & Antony, in press

Challenging Overgeneralizing Identifying Should Statements

§ How does it follow that someone’s worth as a § What runs through your mind when you
person can be judged from one mistake or one think of the “to do” list that you have to get
instance of not meeting a goal? through?
§ What is the universal definition that people in
society would hold of a “failure?” How do you
§ How often do you say “should” and “must” to
compare to that definition? In what ways are you yourself when you are thinking of everything
similar or different? you have to do?
§ What does your belief that one small makes you
are a complete failure do to your self-esteem and
mood?
Egan, Wade, Shafran, & Antony, in press Egan, Wade, Shafran, & Antony, in press
 Challenging Should Statements Behavioral Experiments

§ How does saying “should” to yourself constantly General Principles

make you feel? In what way does it impact on § Make sure rationale is clear.
your sense of self? § Be clear about the belief to be tested (as well as
§ What impact do you think it might have if you the alternative or helpful belief).
applied the sort of pressure you apply on yourself § Ensure that perceived risk is low, and that
to a close friend? experiment is likely to yield useful information.
§ Design experiment collaboratively.
§ Ensure that predicted outcomes are specific and
measurable.
Egan, Wade, Shafran, & Antony, in press Egan, Wade, Shafran, & Antony, in press

Behavioral Experiments Behavioral Experiments

Steps Example
§ Identify belief to be tested. § Belief: I must always be busy. It is wrong not to be
§ Collaboratively brainstorm possible experiments. busy. I could not tolerate being idle. Belief rating
§ Elicit predictions and design a method to assess = 100%.
the outcome. § Alternative Belief: It’s okay to be idle sometimes.
§ Anticipate problems and brainstorm solutions. § Experiment: Sit in a café for 20 minutes and read
§ Conduct the experiment. a newspaper.
§ Review the experiments (and predictions) and
draw conclusions.
Egan, Wade, Shafran, & Antony, in press Egan, Wade, Shafran, & Antony, in press

Pie Chart Technique

Example
§ David recently gave a presentation (along with his
boss and two coworkers) to representatives from
another company with the goal of making a big
sale.
§ The company chose not to purchase from David’s
group.

Egan, Wade, Shafran, & Antony, in press

 Behavioral Features
Behavioral Features
§ Overcompensating
§ Failure to delegate
§ Excessive checking and reassurance
seeking § Hoarding and excessive acquiring
§ Repeating and correcting § Avoidance
§ Excessive organizing and list making § Attempts to change the behavior of
others
§ Procrastination
§ Perseverating for too long on tasks
§ Giving up too soon on tasks

Behavioral Strategies Changing Perfectionistic Behaviour

Exposure-Based Strategies
§ Exposure § Design practices that are predictable, structured
and planned in advance
§ Response prevention
§ Continue the practice until anxious predictions are
§ Prioritizing challenged or until discomfort has decreased
§ Practice frequently and schedule practices close
§ Overcoming procrastination together
§ Expect to feel uncomfortable
§ Mindfulness and acceptance-based
§ Don’t use subtle avoidance strategies
approaches § Use cognitive strategies to cope with discomfort
following practices
 Sample Exposure Hierarchy
Fear of Making Mistakes in Front of Others
Item Anxiety (0-100)
Give a formal presentation about unfamiliar 99
material in front of people I don’t know well
Throw a party for people from work and prepare 85
an unfamiliar dish
Purposely forget my wallet when in line at the store 85
Ask someone to repeat themselves at a meeting 75
Show up for a haircut on the wrong day 60
Have lunch with a co-worker and allow 50
uncomfortable silences
Abramowitz (2009) Forget my ticket when I pick up my dry cleaning 40

Motivation to Change

§ Clinical patients with elevated negative

perfectionism report more positive and
DOES
negative consequences for their
perfectionism, and less willingness to PERFECTIONISM
change perfectionistic standards,
compared to athletes who are low on
negative perfectionism.
RESPOND TO
TREATMENT?
Egan et al., 2012

Does Treatment Work? - Study 1 Does Treatment Work? - Study 1

§ N = 107
Measure Pre Post p
§ Diagnosis = Social Anxiety Disorder
§ Treatment = 12 sessions of group CBT for social SPS 39.08 25.51 < .0001
phobia SIAS 51.95 38.05 < .0001
DASS-Depression 17.07 13.27 < .0001
§ Ashbaugh, A., Antony, M.M., Liss, A.,
DASS-Anxiety 13.51 10.17 < .0001
Summerfeldt, L.J., McCabe, R.E., & Swinson, R.P. DASS-Stress 19.72 15.88 < .0001
(2007). Changes in perfectionism following
cognitive-behavioral therapy of social phobia. From: Ashbaugh, A., Antony, M.M., Liss, A., Summerfeldt, L.J., McCabe,
Depression and Anxiety, 24, 169-177. R.E., & Swinson, R.P. (2007). Changes in perfectionism following
cognitive-behavioral therapy of social phobia. Depression and Anxiety, 24,
169-177.
 Does Treatment Work? - Study 1 Does Treatment Work? - Study 2
§ N = 20
Measure Pre Post p
§ Participants – high scorers on the Clinical
Concern over Mistakes 29.13 26.40 < .0001 Perfectionism Examination and the Clinical
Doubts about Actions 13.65 12.70 < .05 Perfectionism Questionnaire (Fairburn, Cooper, and
Personal Standards 22.41 22.03 n.s. Shafran).
Parental Expectations 13.71 13.71 n.s. § CBT treatment vs. a wait-list control condition
Parental Criticism 11.43 11.16 n.s. § Treatment = 10 sessions of individual CBT over 8 wks.
Organization 21.94 20.01 < .01
§ Riley, C., Lee, M., Cooper, Z., Fairburn, C.G., & Shafran,
FMPS Total 90.32 85.90 < .01
R. (2007). A randomised controlled trial of cognitive-
behaviour therapy for clinical perfectionism: A preliminary
From: Ashbaugh, A., Antony, M.M., Liss, A., Summerfeldt, L.J.,
McCabe, R.E., & Swinson, R.P. (2007). Changes in perfectionism study. Behaviour Research and Therapy, 45, 2221-2231.
following cognitive-behavioral therapy of social phobia. Depression and
Anxiety, 24, 169-177.

Does Treatment Work? - Study 2 Does Treatment Work? - Study 3

70 § N = 49
60 § Participants – high scorers (84 or higher) on Frost
Multidimensional Perfectionism Scale
CPE Score

50

40
§ Guided self-help (eight 50-minute sessions) vs.
Pre
pure self-help (no therapist)
30 Post
§ Treatment based on first edition of When Perfect
20
Isn’t Good Enough (Antony & Swinson, 1998).
10
§ Pleva, J., & Wade, T.D. (2006). Guided self-help
0
versus pure self-help for perfectionism: A
Immediate Waitlist
randomised controlled trial. Behaviour Research
Riley, C., Lee, M., Cooper, Z., Fairburn, C.G., & Shafran, R. (2007). A randomised controlled
trial of cognitive-behaviour therapy for clinical perfectionism: A preliminary study. Behaviour
and Therapy, 45, 849-861.
Research and Therapy, 45, 2221-2231. CPE = Clinical Perfectionism Examination.

Does Treatment Work? - Study 3 Does Treatment Work? - Study 3

Results 60
% With Clinically Significant Change
(pre-treatment to 3 mo. follow-up)

§ Generally, participants in both groups 50

showed improvement on measures of 40

perfectionism, OCD symptoms, 30

GSH
depression, and anxiety. 20 PSH

§ Overall, improvement was greater in the 10

GSH condition than the PSH condition 0

CM PS DA
§ Generally, gains were maintained at 3 Pleva, J., & Wade, T.D. (2006). Guided self-help versus pure self-help for perfectionism:
month follow-up. A randomised controlled trial. Behaviour Research and Therapy, 45, 849-861.

GSH = Guided Self-Help; PSH = Pure Self-Help

CM = Concern about Mistakes; PS = Personal Standards; DA = Doubts about Actions
 Other Findings Perfectionism Self- Help Readings
§ Providing feedback to perfectionists on
§ Antony, M.M., & Swinson, R.P.
their perfectionism can help to reduce (2009). When perfect isn’t good
psychological distress associated with enough: Strategies for coping with
maladaptive perfectionism (Aldea et al., perfectionism, second edition.
Oakland, CA: New Harbinger
2010). Publications.

§ Shafran, R., Egan, S., & Wade, T.

(2010). Overcoming
perfectionism: A self-help guide
using cognitive behavioral
techniques. London, UK:
Aldea et al., 2010 Constable & Robinson.

Perfectionism Self-Help for Children Perfectionism Book for Professionals

§ Burns, E.F. (2008). Nobody’s § Flett, G.L., & Hewitt, P.L.

perfect: A story for children (2002). Perfectionism: Theory,
about perfectionism. research, and treatment.
Washington, DC: magination Washington, DC: American
press. Psychological Association.

Perfectionism Treatment DVD

§ Antony, M.M. (2008).

Cognitive behavioral
therapy for
perfectionism over
time (DVD Video).
Washington, DC:
American
Psychological
Association.