Essay: Unhealthy perfectionism – signs and symptoms

Some perfectionism is helpful, but it can also become destructive without careful attention

Within the world of medicine, it seems as though you have to be a perfectionist just to get the grades to get into medical school! And perfectionism is a very valuable trait in those who have responsibility for the lives of others. When it comes to neurosurgery or ophthalmology, or the calculation of drug dosages in young children, it’s obvious that aspects of perfectionism are highly desirable.

But healthy forms of perfectionism can easily transform into much more unhealthy and negative forms. Here are some of the signs of unhealthy perfectionism. Perhaps it may be useful to regard this next section as a check-list.

Signs and symptoms of unhealthy perfectionism

There may be obsessive self-criticism, and a constant sense of failure. Sometimes there are desperate attempts to make ourselves try harder in order to achieve our self-imposed standards. There may be procrastination and an inability to get down to work because of fear of failure and rejection. Another common sign is ‘Black and white thinking’. Either something is wonderful, brilliant and excellent or else hopeless, useless, terrible and worthless. ‘Unless I can be the best at something I refuse to even try’. Excessive criticism and contempt for others who don’t meet the required standards is also common.

Other signs are perpetual feelings of guilt and failure. There is a tendency to worry and obsess about past failures and mistakes, coupled with feelings of shame and anxiety about how I am perceived by others. For those who are working in a responsible position there are anxieties about whether ‘I am good enough’, and fear of future failures.

As the syndrome of unhealthy perfectionism becomes more severe and long-lasting it may lead to feelings of exhaustion and burnout. There may be eating disorders, self-harm depression and suicidal thoughts.

The causes of unhealthy perfectionism

There seems to be a genetic component behind perfectionism. Some individuals are much more likely to develop perfectionist patterns compared with others. But a genetic tendency in this direction is often exacerbated by childhood experiences, especially pressure from parents and teachers who demand hard work and high standards. High parental expectations and frequent parental criticism seem to be a common factor. Sometimes the person seems to hear their parent’s voice in their head, criticising and accusing. There are also cultural factors in our world such as advertising and social media which emphasise the importance of appearance, looking perfect, having a wonderful life and so on.

Sometimes conservative Christian churches and preaching can make the situation worse – they may constantly emphasise the need to work hard to serve Christ, to pray harder, to evangelise more, to read the Bible more and so on. This only exacerbates the constant feelings of failure, self-criticism, and guilt. The person feels that they have to work harder to try to please God who is always disappointed in our lack of achievements and progress.  

Spiritual aspects of unhealthy perfectionism

One of the spiritual aspects of perfectionism may be a subtle form of pride. Perhaps we secretly believe that we are better than other people and therefore we need to live to higher standards than they do. Or it may be that we can feel better about ourselves if we compare ourselves favourably with others. We have to prove that we are superior by the way we live, by how hard we work, by our religious activities and commitment to Christ. But when we are faced by someone who seems to have higher standards than we do, we feel threatened and inadequate. The paradox is that the perfectionist can oscillate between excessive feelings of pride, when they feel superior to others, followed by episodes of self-criticism and feelings of failure, guilt and shame. 

At the heart of pride is a pre-occupation with self, constantly worrying about what other people think of us, and how well we are doing, rather than developing a healthy Christian self-forgetfulness which focusses on the needs and concerns of others. 

A second spiritual element is a longing to be in control and a fear of being out-of-control or dependent on others. We want to be the ruler of our own world and to make sure we are in control. Often the root of this desperate desire is fear. I need to be in control so that I can make the world safe. This way I can avoid failure and the shame that goes with it. I can make sure that I will be accepted by others. But behind this is a deep spiritual issue – we want to be like God and to make our world in our own image. Or perhaps we want to earn our own salvation and earn God’s approval. Perhaps we are frightened by a deep-buried anxiety that in reality we are not acceptable, we are not good enough to be Christians. The spiritual issue here is a failure to trust God’s love and acceptance of me, and a corresponding failure to accept myself as God accepts and loves me. 

The challenging message at the heart of biblical Christianity is that it is impossible to earn the right to be accepted by God. Instead we come with empty hands and a repentant heart to God to receive the free gift of his forgiveness and love. But this is desperately hard for some of us because we are secretly proud and we don’t want to be in debt to anyone else, not even to God himself.

A third spiritual element is the nature of personal evil and its attack on perfectionists. As soon as we talk about personal evil there are twin dangers. On the one hand we can become so obsessed with the topic that we over-emphasise the power and influence of evil in our lives and thinking. On the other hand we may underplay or ignore the possibility that personal evil and the temptations it represents are an element within our own thought life.

The scriptures have a number of statements about the nature and activity of personal evil or the evil one.

First, he is the father of lies, “When he lies, he speaks his native language, for he is a liar and the father of lies.” (John 8:44)

Second, he is the accuser of Christian believers, “Now have come the salvation and the power and the kingdom of our God, and the authority of his Messiah. For the accuser of our brothers and sisters, who accuses them before our God day and night, has been hurled down.” (Revelation 12:10)

Third, he masquerades as an angel of light. (2 Corinthians 11:14)

These three elements – lies, continuous accusation and masquerading as the voice of conscience or of God himself – are all features of the internal accusatory voice which we may hear in our heads.

Evil whispers in our ear that God is very disappointed with us. We always fail and let our Father down. We’re never good enough. So we need to try harder. We need to pray more, we need to read our Bible more, we need to evangelise more, we need to work harder to pass our exams. This internal accusatory voice masquerades as the voice of our conscience and needles away in our minds, filling them with negative thoughts hour after hour. 

Because we are perfectionists we often have an exaggerated tendency to self-criticism and self-rejection. This means we are especially vulnerable to listen to and to accept the lies of the evil one. We have an inbuilt tendency to listen to this internal voice telling us that God is very disappointed in us, that we constantly let him and other people down, that we are useless and complete failures. We not only listen to that voice, but we end up agreeing with it. “Yes that’s right, I am useless”, “Yes I always get things wrong, I’ll never be good enough to be acceptable to God.”

In the New Testament descriptions of the temptations of Jesus in the desert, the evil one’s strategy was the selective and misleading quoting of scripture. And we may notice that the accusatory voice in our heads adopts a similar strategy. We are reminded continually of those passages which emphasise the need for hard work and self-discipline, the need to ‘be perfect’ like our heavenly Father and passages which warn of coming judgement. At the same time we tend to ignore the many biblical passages which emphasise the grace and forgiveness of Christ, the tender and compassionate love of the Father for his children, and the gentle, healing encouragement of the Holy Spirit.


Perfectionism is at heart a desire and longing for excellence. It is a highly desirable trait, especially in medics and health professionals, but it easily transforms into unhealthy forms. This can lead to a range of signs and symptoms including obsessive self-criticism, constant feelings of failure, guilt, shame, anxiety, and ‘black and white thinking’. Perfectionism has genetic elements but childhood experiences and parental pressure may exacerbate unhealthy forms of thinking and behaviour. There may also be spiritual aspects including subtle forms of pride, fears of being out-of-control and internal accusatory voices.

However all is not lost! In my second accompanying essay we shall be looking at ways of becoming a ‘recovering perfectionist’. Click here to read it.

This Post Has One Comment

  1. John Risbridger

    Very helpful essay, John. Thanks. The recognition of parental, personal and spiritual aspects is particularly helpful

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