What Is Perfectionism OCD? Symptoms, Causes, and Treatment
Reading Time: 8 minutesWe all know people who are hyper-focused on making sure things are done properly—whether they’re writing a research paper, sending an email, washing a dish, or ordering in a restaurant. There’s nothing wrong with trying to do your best. But people who feel tormented by their perfectionistic thoughts and behavior may be suffering from a form of OCD known as perfectionism OCD.
Clinically reviewed by Meredith Hettler, LMFT, National Director, OCD and Anxiety Program
What You’ll Learn
- What is perfectionism OCD, or “just right” OCD?
- What’s the difference between perfectionism OCD and typical perfectionism?
- What are some examples of “just right” OCD behaviors?
- What is the best treatment modality for perfectionism OCD?
Quick Read
Perfectionism is a personality trait characterized by setting extremely high standards for oneself, which can manifest in conscientiousness about appearance and performance. While perfectionism can lead to positive outcomes such as goal-directed behavior and resilience, it can also become maladaptive. Maladaptive perfectionism is marked by obsessive thoughts and behaviors that hinder daily functioning and cause significant distress. This distinction is crucial in understanding the difference between healthy and unhealthy perfectionism, where the latter can trap individuals in a cycle of anxiety and compulsive actions.
Perfectionism OCD, also known as “just right” OCD, is a subtype of Obsessive-Compulsive Disorder that is associated with distress and low self-esteem. Unlike general perfectionism, which may involve mild stress and a sense of control, perfectionism OCD is characterized by overwhelming fear and dread if one fails to meet their compulsive standards. Research indicates a link between this subtype and emotional dysregulation, as well as a higher likelihood of experiencing depression. It is important to note that while perfectionism may contribute to OCD symptoms, not all perfectionists will develop OCD.
Individuals with perfectionism OCD experience intrusive thoughts and compulsive behaviors centered around the need for order, symmetry, and perfection. For instance, while a perfectionist might carefully proofread an email, someone with perfectionism OCD may rewrite it multiple times to achieve a sense of balance in sentence length. Common obsessions include a fear of making mistakes and an intense need for tasks to be completed perfectly, while compulsions can involve excessive checking, reassurance-seeking, and ritualized behaviors aimed at alleviating anxiety. This cycle of obsession and compulsion reinforces irrational fears and can severely impact daily life.
Coping strategies for perfectionism OCD include seeking therapy, engaging in distracting activities, focusing on controllable aspects of life, and practicing acceptance of intrusive thoughts. Effective treatments such as Exposure and Response Prevention (ERP) therapy and Acceptance and Commitment Therapy (ACT) help individuals confront their fears and reduce compulsive behaviors. Specialized treatment programs, like those offered at Newport Institute, provide tailored approaches for young adults, combining therapy with life skills training to support their recovery and future success.
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What Is Perfectionism?
It’s useful to define perfectionism before defining perfectionism Obsessive-Compulsive Disorder (OCD). By itself, perfectionism isn’t a mental health disorder. It’s a personality trait that causes people to have extremely high standards for themselves. Perfectionists are highly conscientious about their appearance and/or performance. Their drive for perfectionism not only ensures they’ll achieve excellence, but often springs from a need to feel in control.
Adaptive/healthy perfectionism is associated with psychological well-being and self-esteem. Healthy perfectionism doesn’t trap you in a cauldron of obsessive thoughts. Instead, it can lead to goal-directed behavior, strong organizational skills, and persistence in the face of adversity.
Maladaptive or unhealthy perfectionism, on the other hand, is characterized by obsessive thoughts about needing to perform actions perfectly or needing things to be just so. People who suffer from maladaptive perfectionism struggle to think and behave in a relaxed manner. This type of extreme perfectionism interferes with the ability to function in daily life.
Perfectionism vs. Perfectionism OCD: What’s the Difference?
Perfectionism OCD, also called “just right” OCD, is an OCD subtype. Unlike perfectionism, perfectionism OCD is associated with distress and low self-esteem.
One study found a link between this type of maladaptive perfectionism and emotion dysregulation. Another study found that people with perfectionism OCD are more likely than others to experience depression as well.
Does Perfectionism Lead to OCD?
Not necessarily. Some research has shown that perfectionism and intolerance of uncertainty can be predictors of OCD symptoms in youth. But being a perfectionist doesn’t mean you have OCD or will develop it.
One of the main differences between perfectionism and perfectionism OCD is the way people feel about their behaviors and rituals. Perfectionists may feel mild stress when they’re working on something, but they could also feel a sense of mastery and control.
However, people with perfectionism OCD experience tremendous fear and dread if they don’t compulsively respond to their obsessive thoughts about making things perfect. And even though they realize their behaviors and rituals are irrational and distressing, they’re incapable of stopping them.
Examples of Perfectionism OCD vs Perfectionism
People with Perfectionism OCD are consumed by a desperate need to make things feel just right. They’re plagued by intrusive thoughts and compulsive behaviors around order, balance, and symmetry.
For example, a perfectionist might carefully comb through an email to ensure all the spelling, grammar, and punctuation are correct before sending it. But someone with Perfectionism OCD might be overcome by anxious thoughts because each sentence isn’t the same length. Therefore, they might painstakingly rewrite the email again and again until each sentence looks perfectly balanced.
Here’s another example: A perfectionist might not leave for work until all the dishes they washed last night are put away. But someone with Perfectionism OCD might return to the kitchen multiple times before leaving home, to ensure the dishes are stacked in perfect order.
Furthermore, people with perfectionism OCD can spend hours cutting their nails so they’re the exact same length. Or, they might tie their shoelaces repeatedly so the tension in both laces is identical.
Perfectionism OCD Obsessions
The hallmark of perfectionism OCD is an all-encompassing need for things to look, sound, or feel “just right.” People with this OCD subtype fear that if things aren’t just so, something bad is going to happen to them. Common “just right” OCD obsessions include:
- Intense need for things to be symmetrical and organized
- Overwhelming concern with performing tasks to completion
- Excessive preoccupation with order and sequence
- Debilitating fear of making mistakes or the “wrong” decision
- Deep anxiety around the possibility of losing or forgetting important information
- An all-consuming need to perform tasks “perfectly”
Perfectionism OCD Compulsions
Compulsions are ritualized, repetitive behaviors or mental acts that a person with OCD feels they must perform to reduce anxiety, discomfort, or dissatisfaction. Perfectionism OCD compulsions can reduce stress in the short term. However, in the long term, compulsions reinforce irrational fears, causing the vicious cycle of repetitive behavior to continue. Some common perfectionism OCD compulsions include:
- Reassurance-Seeking: repeatedly asking friends or family to promise that something you’ve done looks or sounds perfect; alternatively, repeatedly asking friends of family if they also notice that something doesn’t look, sound, or feel right
- Fixing: spending long stretches of time rearranging objects on a desk so they’re perfectly symmetrical or straightening every picture in a room before leaving it
- Checking: rereading a text message countless times before sending it to make sure all the grammar, punctuation, and spelling are correct; or turning a faucet on and off countless times just to be sure no water is running
- Avoiding: not stepping on cracks in the sidewalk for fear of bad luck or staying away from situations that trigger your obsessive-compulsive disorder, like avoiding texting because your OCD forces you to reread texts repeatedly before sending them
- Touching: touching your left arm if someone accidentally touches your right because you need physical sensations to be balanced, or placing food in a pantry in a certain order
- Counting: counting the number of steps you’ve taken from the kitchen to the bedroom to ensure you’ve stepped the same number of times with each foot, or needing to turn a light switch on and off a specific number of times before going to bed
What Causes Perfectionism OCD?
As with OCD, the causes of Perfectionism OCD aren’t always clearcut. A variety of factors can increase the likelihood of developing the personality disorder. One of these is genetics. Research shows that OCD runs in families.
But genes are only partly responsible, it seems. Other theories suggest OCD is a brain disorder brought about by a deficiency of serotonin. Serotonin is the brain chemical that sends messages back and forth between the front of the brain and the deeper structures within.
Longstanding stress and anxiety can trigger OCD as well, such as childhood trauma, abuse, or significant life changes. In some, personality traits like neuroticism can increase the likelihood of developing OCD. And in children, a strep bacteria can produce an immune reaction called PANDAS syndrome (pediatric autoimmune neuropsychiatric disorders associated with streptococcal infections), which can lead to OCD-like symptoms.
How to Cope with Perfectionism OCD
Living with “just right” OCD can be exhausting. Because of an uncontrollable need for perfectionism, sufferers can ruminate over past mistakes and worry about future ones. Obsessions and compulsions can cause them to miss deadlines, experience burnout, and have difficulty in relationships. Finding ways to cope with the disorder is essential. Here are few helpful strategies:
Talk to a Therapist
Most important, seek support from a mental health professional to manage your OCD and help you build coping strategies. Look for a licensed therapist trained in treating OCD and OCD subtypes. Therapy can help sufferers reduce and release anxious thoughts so they can reclaim their lives. In addition to therapeutic approaches, a psychiatrist may recommend medication to help reduce distressing OCD symptoms.
Distract Yourself
When you feel compelled to engage in fixing or checking behaviors, for example, try shifting your attention to another activity. You might take a walk, watch your favorite show, call a friend, go to the gym, or engage in a creative pursuit. Don’t worry if you don’t feel better right away. Just keep at it and trust that the intensity of the compulsion will pass.
Focus on What You Can Control
People with perfectionism OCD suffer from the erroneous belief that if they ensure things are perfect, nothing bad will happen to them. In truth, controlling everything is impossible. Uncertainty is part of life. It can help to make a list of what you have control over and what you don’t. Instead of worrying about what you can’t control, put your focus on what you can.
Practice Accepting Intrusive Thoughts
When intrusive thoughts arise, it’s normal to want to get rid of them. Ironically, however, the more you consciously try to dispel a certain thought, the more it pops into your mind. Instead of working to push intrusive thoughts away, acknowledge them. When you think, “If I don’t arrange all the pillows on the couch in perfect order, something bad is going to happen,” say to yourself, “There’s that intrusive thought again.” Doing so helps put distance between you and the thought so it has less power over you.
Treatment for Perfectionism OCD
Exposure and Response Prevention (ERP) therapy, a form of Cognitive-Behavioral Therapy, is the gold standard for OCD treatment. Research shows that ERP therapy is highly effective inhelping sufferers tolerate uncomfortable feelings. With ERP, clients purposely engage in activities that elicit anxiety, like scrambling the items on their desk or the shoes in their closet. This is the exposure component of the therapy. The other component is response prevention. With time, clients learn how to resist compulsions and rituals. They realize that nothing terrible happens when they don’t complete a ritual. Over time, their anxiety-provoking thoughts no longer have power over them.
Another effective treatment for perfectionism OCD is Acceptance and Commitment Therapy (ACT). With the help of a clinical psychologist or other mental health professional, clients learn to develop awareness of their thoughts without trying to change them. As they come to see that their thoughts are not facts, they become less reactive to them. ACT-based strategies help clients identify whether their behaviors bring pleasure or are a response to OCD-related anxiety. Ultimately, ACT helps people detach from their intrusive thoughts and stay focused in the present.
Other cognitive-behavioral techniques can be helpful in treating perfectionism OCD. For example, cognitive restructuring helps clients evaluate the likelihood and potential consequences of making mistakes. Medication is another form of treatment that can help decrease the anxiety and distress of perfectionism OCD symptoms.
OCD Treatment for Young Adults at Newport Institute
Without treatment, perfectionism OCD and other types of OCD are unlikely to diminish or disappear on their won. At Newport Institute, we offer specialized OCD treatment for young adults that includes ERP therapy, the gold standard OCD treatment. We also provide teen OCD treatment through our program for adolescents, Newport Academy.
Our multidisciplinary team consists of ERP-trained therapists, registered nurses, psychiatrists, registered dieticians, residential care staff, and more. We tailor each treatment plan to a young person’s specific needs. In addition to therapy and medication management, we offer body-based and experiential therapies such as art, music, and outdoor adventure therapy.
Additionally, we provide a robust life skills component to prepare young adults for educational and professional success. Contact us today to learn more about our specialized young adult OCD treatment and schedule an assessment.
Frequently Asked Questions
Is perfectionism a form of OCD?
What is perfectionism OCD?
What’s the difference between perfectionism and perfectionism OCD?
What compulsive behaviors are hallmarks of perfectionism OCD?
How can I get out of the OCD loop?
