Perfectionism is a bigger risk factor in suicide than we may think, says York University psychology professor Dr. Gordon Flett. Closer attention to its potential destructiveness is needed, says Dr. Flett, adding that clinical guidelines should include perfectionism as a separate factor for suicide risk assessment and intervention.
“There is an urgent need for looking at perfectionism with a person-centered approach as an individual and societal risk factor, when formulating clinical guidelines for suicide risk assessment and intervention, as well as public health approaches to suicide prevention,” says Dr. Flett.
Over 800,000 people die due to suicide every year, including an estimated 40,000 in the U.S., and many more attempt suicide. Suicide occurs throughout the lifespan and was the second leading cause of death among 15-29 year olds globally in 2012.
We’ve long known that the risk of suicide is higher among people with depression and other mental illnesses, as well as among those with substance use disorders, chronic physical illnesses, and previous suicide attempts. Other risk factors for suicide include:
- Family history of suicide
- Family history of child maltreatment
- Feelings of hopelessness
- Impulsive or aggressive tendencies
- Cultural and religious beliefs (e.g., belief that suicide is noble resolution of a personal dilemma)
- Local epidemics of suicide
- Isolation, a feeling of being cut off from other people
- Barriers to accessing mental health treatment
- Loss (relational, social, work, or financial)
- Easy access to lethal methods
- Unwillingness to seek help because of the stigma attached to mental health and substance abuse disorders or to suicidal thoughts
Now, in a new research article, Dr. Flett and his co-authors Dr. Paul Hewitt of the University of British Columbia and Dr. Marnin Heisel of Western University warn that physicians, lawyers and architects – whose occupations emphasize precision – and also those in leadership roles, are at higher risk for perfectionism-related suicide, citing the recent cases of prominent perfectionists who died by suicide.
Their article, The Destructiveness of Perfectionism Revisited: Implications for the Assessment of Suicide Risk and the Prevention of Suicide, published in the American Psychological Association journal, Review of General Psychology, highlights several concerns, including how suicidal thoughts can be linked to external pressures to be perfect.
When good enough is never enough
Perfectionists often lead a life of continual anxiety and fear of failure, says Dr. Flett. Even when they succeed, he adds, perfectionists never feel satisfied. Past research shows that, although perfectionists are often high-achievers, they are also at a higher risk for psychological and behavioral disorders eating disorders, sexual dysfunction, obsessive-compulsive disorder, depression, divorce, and – as the authors highlight in the new article – suicide.
Because perfectionists are very rarely obsessive about only one aspect of their lives, they can’t stand mistakes in anything they do, explains Dr. Flett. If they don’t have the perfect body, they develop an eating disorder. If they don’t have the perfect marriage, they get divorced. Dr. Flett calls this type of all-or-nothing thinking the “just right” phenomenon. If something isn’t “just right” to a perfectionist, then it might as well be thrown away. This may explain the high incidence of suicide among perfectionists: They think that if life isn’t perfect, then it’s worthless. Get rid of it.
Other research, however, has failed to find such connections, and certainly not all (or even most) perfectionists are driven to suicide. The authors suggest that this is because perfectionism actually comes in different “flavors,” each associated with different kinds of problems. Some of those problems may be less severe than others, they argue, but no form of perfectionism is completely problem-free.
For instance, self-oriented perfectionism – an internally motivated desire to be perfect – may be less harmful than other types of perfectionism. On the other hand, socially prescribed perfectionism – the belief that others will value you only if you are perfect – is linked consistently with negative emotional states (such as hopelessness) and suicide. Socially prescribed perfectionists, he notes, tend to feel that “the better I do, the better I’m expected to do,” which often leads to feelings of low self-worth. “They also tend to experience hopelessness, psychological pain, life stress, [and] overgeneralization …,” adds Dr. Flett.
The desire to present oneself as perfect can also have important consequences, particularly when it comes to treatment-seeking and suicide assessment and prevention, notes Dr. Hewitt. “Those types of individuals tend not to disclose anything that’s going to make them look imperfect,” and often display “a form of emotional perfectionism that restricts the willingness to disclose suicidal urges and intentions,” he says.
Perfectionistic self-presentation and self-concealment can lead to suicides that occur seemingly without warning, as seeking help or disclosing suicidal thoughts could be perceived as failure to a perfectionist. What’s more, perfectionists often come up with thorough and precise suicide plans, which tend to be more lethal, the researchers say.
Based on the clear link between suicide and perfectionism, the authors urge psychologists and other mental health professionals to take an individualized approach to suicide assessment that recognizes the heightened risk for perfectionists. The team also says it is essential to proactively design preventive programs tailored to key personality features with specific components to enhance resilience and reduce levels of risk among perfectionists who hide behind a mask of apparent invulnerability.