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A Help Guide for Perfectionism. When is it healthy and when is it neurotic?

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Perfectionist self help guide from Harley Therapy - Counselling & Psychotherapy in London

Updated Oct 31, 2022 by Dr. Sheri Jacobson Dr Sheri Jacobson

Perfectionism: A Help Guide

What is Perfectionism?

In psychological terms, perfectionism is largely deemed a personality trait that involves constantly trying to be the very best at all that you do, and not wanting to make any mistakes.

There is controversy over whether perfectionism can be divided into different types.

Recently some psychologists even hold that perfectionism is an obsessive personality type over a trait, which implies needing to feel in control at all times to ensure their own safety.  

What are the different types of Perfectionism?

Many psychologists feel that perfectionism can be divided into two different types. 

For some people, perfectionism is seen as having positive affects. They use their drive to do well, achieving their goals and creating a life that makes them happy. They can seek perfection without it affecting their esteem, and they feel good about their efforts. Psychologists call this sort of perfectionist a 'normal', 'adaptive', or 'positive' perfectionist.

For others, perfectionism can hold them back and have negative side effects. They rarely if ever feel satisfied with their own efforts and their life, but only see lack, and can also have difficulty maintaining relationships if they are too critical of others over perceived shortcomings. Their sense of self is low because of perfectionism and their thoughts are self-defeating. This sort of perfectionist is called a “neurotic', 'maladaptive', or 'negative' perfectionist.

Of course perfectionism is not always so cut and dried. Someone can be a neurotic perfectionist in some areas of life and not in others. Perhaps, for example, you push yourself too hard at work and constantly feel not good enough, but when it comes to your home life you try very hard to be the best partner and parent but don't beat yourself up if you aren't.

And some psychologists prefer to not see anything positive about perfectionism, stating that striving for excellence should not be seen as perfectionism. They believe that those who seek to be the best but take criticism on board without taking it personally are not perfectionists. In their veiw, perfectionism only applies to the negative experience where one sees everything as a personal assault and thus suffers.  

Debate aside, what matters more than any label is that if you suffer from perfectionism you are honest with yourself about where your perfectionism is out of control, and thus holding you back or lowering your self-esteem.

 *Note that from here on out  this article will speak about negative or 'neurotic' perfectionism, as per the definitions above. 

What are the signs of Perfectionism?

Perfectionists often share a particular way of looking at the world and a distinct collection of views about themselves and others. This can include some or all of the below:

Exaggerated fear of failure

Perfectionists typically live their lives in a state of high alert, constantly on the look out for failure in all its forms. Making mistakes, far from being an acceptable human trait, is considered a sign of weakness, stupidity or “undeservedness”. This is especially true when it comes to their own competencies. Perfectionists might even see failure as something that is absolute, an ending, or a sign of doom.

Excessive criticism

Rampant self-criticism can turn into a way of life for individuals living with negative perfectionism. An inner voice constantly putting you down and finding fault is common. Happiness, too, may turn into something to be suspicious of rather than to accept, as the perfectionist chooses self-punishment over joy. 

Excessive self-criticism might lead perfectionists to isolate themselves from family and friends because they don’t feel good enough about themselves to contribute to a relationship. Finally, people in the grip of perfectionism often direct undue criticism towards others, seeing others' flaws over strengths.


Even though perfectionists can be hard on others, it does not mean they enjoy others being hard on them. If appraisal does come their way, they tend to be extremely sensitive if it is not positive. Even constructive criticism will be shut out or taken the wrong way.

Black and white thinking

Many people who are burdened by neurotic perfectionism view the world around them, and even their own existence, in the starkest terms. Everything is either right or wrong and black or white, with no shades of grey and no middle ground that can be shared with others. This all-or-nothing thinking, often called 'black and white thinking', is populated with highly moralistic “shoulds” and “musts” that take their toll on relationships and make perfectionism a very lonely and alienating place. A perfetionist's view might be that people either love you or hate you, are with you or against you.

Perfectionists might also believe there is only one way of doing things. And this 'right way' coincides with the perfectionist’s preferred choice.

Unrealistic standards

A perfectionist's desires for themselves and their lives tend to be unattainable. This leads to depression when their unrealistic goals are not reached. They might also hold unrealistic standards for those around them, constantly feeling let down by others.

Or, they might have an unrealistic idea of how easily other people achieve things and how happy others are, a sort of false yardstick they then compare themselves to when really they are seeing others through very rose-coloured glasses.


The inability to tolerate being average often results in chronic procrastination and indecision. Perfectionism can dictate it is better to not start a project at all then start it and fail.

Constant stress

Perfectionists suffer the combined stress of procrastination on one hand, compulsive attention to detail or workaholism when one does start a project on the other, and as well the inability to finish a project for fear of failure. 

Low self-esteem

Both ongoing self-criticism, and constantly failing to achieve goals because they were unrealistic in the first place, can leave a neurotic perfectionist constantly feeling negative about themselves.

What causes Perfectionism?

Why do some people feel compulsively driven to be perfect? There is no short and simple answer. We all have our own personal history and are propelled by unique motivations. New research on the brain is constantly discovering a genetic aspect to certain personality traits. This aside, is there a childhood precursor? Often, yes.

It is not uncommon for a perfectionist adult to have grown up with demanding parents who pushed them to be a success, or who only saw how many they got wrong on a test instead of how many they got right.

Or perfectionism can be a reaction to the exact opposite sort of upbringing – one of chaos. If a child never felt safe, and didn't have a stable enviroment, perfectionism can grow as a way to create a sense of reliability from a world that can appear dangerous.

It can also be a reaction to a lack of attention. If a child does not get the love and approval they seek they can feel driven to be perfect in order to 'earn' attention. And this pattern can continue as they get older and feel they have to be the best in order to be liked.

If you are aware that you are suffering from negative perfectionism, you might find one or all of the below related triggers to be behind your need to be right at all times:

Masking anxiety

One of the defining characteristics of perfectionism is that it is an all-engrossing pursuit. So intent is the perfectionist on the task at hand that he or she has little time and even less energy to devote to anything else. 

And this may well be one of the unconscious purposes of perfectionist behaviour: to fill up every nook and cranny of one’s mind with the aim of masking other unpleasant, and perhaps more terrifying, feelings such as loneliness, depression or low self-esteem. In common with other emotional defence mechanisms and compensatory behaviour, the relief from anxiety is, of course, time-limited.

Mastering the world

The perfectionist’s highly polarised view of the world – where people, ideas, and even thoughts are divided into right and wrong – may be a way of trying to master his or her universe. Or, in other words, to retain an illusion of complete control. It's a way to avoid feeling bad. The hidden belief is that "if nobody can find fault in me, then I will banish embarrassment and humiliation for good."

Winning approval

Perfectionism may be an unconscious way of trying to win approval from others and from oneself. If you are perfect, and maybe even flaunt your achievements, then the belief is that your partner will love you and never leave, your my boss will respect you and never fire you, etc.

Psychological conditions related to Perfectionism

Anxiety: Constantly worrying what other people think and if you are measuring up often leads to a constant level of worry and anxiety that then brings health issues like insomnia, muscle tension, and possible panic attacks.

Depression:  A soundtrack of self-defeating thoughts makes it very hard to feel good about yourself and your life.

Eating disorders: Perfectionists often apply unrealistic standards to their own bodies that can lead to things like anorexia, bulimia, and exercise addiction.

Fear of intimacy: Part of connecting with others is letting them see your weaknesses and mistakes, but this can be too hard on a perfectionist, who instead can have a fear of intimacy and keep people at arm's length to the extent they not only have unsatisfactory relationships but start to fear anyone getting to close and seeing their flaws or judging them.

Personality disorders: Perfectionism puts you more at risk of developing Obsessive Compulsive Disorder (OCD) or Obsessive Compulsive Personality Disorder (OCPD).

Recommended treatment for Perfectionism

Psychotherapy is a recommended intervention for managing negative perfectionism. Most forms of therapy can help as therapists are trained to create a non-judgemental environment of acceptance to work within that in itself challenges the stance of perfectionism. And exploring the past helps perfectionists recognise where their view of themselves and the world has formed, and allows them to begin to challenge these potentially untrue beliefs.

Cognitive behavioural therapy (CBT) helps perfectionists challenge the rationality of their thoughts and helps them find new ways of thinking and acting. It has been proven to help with perfectionism.

Person-centred or 'Humanistic' therapy is known for gently helping you recognise positive aspects of yourself and can also be helpful.

What is the risk if Perfectionism is help is not sought?

As stated above, not all perfectionism is about doom and gloom. Some people have the trait of perfectionism and it does not lower their self-esteem but instead makes them goal-oriented, ambitious, gives them a sense of fulfillment, and causes them to be excited to try new things and excel.

But for those who suffer the negative side of perfectionism, it can lead to the following:

  • fear and anxiety
  • low self-esteem
  • feelings of shame, guilt, inadequacy and helplessness
  • obsessive thought patterns
  • mild depression
  • social phobia
  • compulsive habits
  • dread or paranoia
  • loneliness and/or isolation
  • body image issues
  • substance abuse
  • workaholism

Perfectionism can also lead to being hard on others, which can cause challenges with parenting as well as create conflict within relationships and when at work.

Useful resources for dealing with Perfectionism

Self-help books

'Self therapy' can be very helpful when trying to challenge your perfectionism. Here are some recommended reads:

Fear of the Abyss: Healing the Wounds of Shame & Perfectionism. Aleta Edwards.

Overcoming Perfectionism: Finding the Key to Balance and Self-Acceptance. Ann W. Smith.

Too Perfect: When Being in Control Gets Out of Control. Alan Mallinger M.D,  and Jeannette Dewyze.

When Perfect Isn't Good Enough: Strategies for Coping with Perfectionism. Anthony M. Martin. 

Counselling and Therapeutic Services and Organisations

There are many trained professionals who will be able to support you such as counsellors, psychotherapists, psychologists and psychiatrists.

Counselling and psychotherapy clinics - search through online directories for one in your area. Harley Therapy is one such private practice in London, UK that can assist with depression treatment. Most workplace insurances now cover visits to a therapist, enquire with human resources at your organisation.

The NHS - an alternate to a private practice in the UK is seeing your GP and asking for a referral to a specialist.

You might also find our guide to low cost counselling useful in your search.


Perfectionism Infographic - Harley Therapy


Disclaimer: This Guide has been produced to complement but does not replace any advice, guidance or information from a health professional. See here for full disclaimer.
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