Doris C Gundersen, MD

By now, every practicing physician could, without preparation, give a TED Talk on burnout. Why? Because we have been talking about this painful, sometimes debilitating syndrome for years. Early on, we were educated about specific traits associated with burnout, but little explanation was provided about why certain traits increase vulnerability to burnout and other mental health conditions, including depression and anxiety.

One significant driver of burnout is perfectionism, a trait that has helped launch many medical careers. Adaptive perfectionism, or striving for flawlessness, is not necessarily a bad thing. Athletes, to improve their performance, set the bar high. Similarly, as physicians, we engage in lifelong learning to hone our expertise and provide the very best patient care possible. Adaptive perfectionism is achievement oriented.

According to the American Heritage Dictionary, perfectionism is: “A propensity for being displeased with anything that is not perfect or does not meet extremely high standards.” This is considered maladaptive perfectionism in which entirely unrealistic expectations are coupled with a deep fear of failure or harsh judgment. It invariably leads to emotional distress and, ironically, poor performance or failures. Unlike adaptive perfectionism, maladaptive perfectionism is fear-driven; making an error is experienced as a fatal flaw rather than a learning experience or opportunity for growth. Adaptive perfectionism can become maladaptive perfectionism when taken to an extreme, for example when an athlete engages in “doping” to enhance his performance to set a new world record.

How is maladaptive perfectionism created? Early childhood experiences can play a role. Highly critical or demanding parents who only recognized a child’s accomplishments or were intolerant of mistakes may lead to the child believing love is conditional. A child in this situation will perform well to achieve or maintain love. Significant fear may develop that failing to meet parental expectations will lead to emotional abandonment or rejection. Alternatively, children growing up in unpredictable and chaotic homes or who have experienced trauma may utilize perfectionism to create a sense of safety and control. Low self-esteem can lead to perfectionism to prove one’s worth or value. Certainly, societal influences play a role in perfectionism. For example, restrictive eating disorders tend to be more prevalent in the West where unhealthy body images are idealized.  Finally, research supports that perfectionism can be genetically influenced.

What are signs of maladaptive perfectionism? Failing to delegate in the spirit of “If you want the job done well, do it yourself,” leads to overwork and distress. Some jobs can be done “good enough for government work” and not diminish the final product, including patient care. If you are prone to avoidance, you may be fearful that the project or task you are responsible for will lead to failure. This is true for procrastination. Finally, devoting disproportionate time to organizing, reviewing or editing work may be a sign that you do not accept anything less than perfection from yourself and often others. Too much attention to detail may also lead to a loss of creativity.

How do you maintain adaptive perfectionism? For one, if you have skeletons in your psychological closet, get help. Insight-oriented and cognitive behavioral therapies can help you understand the origins of maladaptive perfectionism, confront irrational beliefs and help you set more realistic goals. Developing self-compassion is important. Reframing your definition of success may help. CPHP is happy to talk with you through our Doc2Doc service and provide additional resources when needed.