Treat the thought “other people demand perfection from me” as a symptom, not as fact

Cost

Free. The hard part is treating this kind of thought as something to deal with, rather than as an accurate measure of what other people really demand.

What you get

Pooling several studies (a meta-analysis): 45 studies, N = 11,747, in undergraduates, medical students, community adults and psychiatric patients, using a random-effects model. Below are the weighted average correlations with suicidal thoughts. Perfectionistic concerns r = .28 (95% CI .24–.32, the plausible range; 42 studies, 7,936 people). Perfectionistic concerns is a bundle that includes socially prescribed perfectionism, worry about making mistakes, doubts about actions, and the gap between reality and standards. Of these, socially prescribed perfectionism counted on its own was also r = .28 (.25–.32, 30 studies, 3,640 people). Perfectionistic strivings r = .10 (.07–.13, 31 studies, 4,588 people), a bundle of self-oriented perfectionism and personal standards. Parental criticism r = .20 (.11–.29). Now the link with suicide attempts. Perfectionistic concerns r = .12 (.07–.17, 15 studies, 5,275 people). Socially prescribed perfectionism r = .19 (.08–.29, 8 studies, 689 people). In the part that followed people over time: after removing the suicidal thoughts present at the start, socially prescribed perfectionism still moved in the same direction as suicidal thoughts at later follow-up, though modestly. Neither self-oriented nor other-oriented perfectionism showed a link.

Notes

The reason it is graded B: most of the included studies were one-time questionnaires, which cannot show what came first. The strength of the correlation is moderate (r about .28), which roughly explains only a few percent to a tenth of the differences. It measures suicidal thoughts and suicide attempts, not death itself, so the size of the benefit is rated small, since there is only a substitute outcome. The authors themselves say the group of perfectionistic concerns and suicide attempts looks like it has publication bias. Publication bias means studies with unattractive results were not published. After adding back the estimated missing studies, the direction of the conclusion did not change. High standards are not a problem in themselves, and there is no need to lower your demands because of this. The difference is where the standards come from, and whether failing to meet them makes you feel “I am finished as a person.” Like the pessimistic expectations in §3.15 (treat thoughts like “things will definitely get worse” as a symptom), this can be treated as a symptom. If you have thoughts of suicide, call 12356 first and move the means of death farther away; see §1.25. For what you can do when someone near you shows such thoughts, see §8.15. For depression screening in children, see §30.8.

Evidence grade

B : Supported by research but without a precise number, or based on small or single studies.

Sources

1. Smith MM, Sherry SB, Chen S, Saklofske DH, Mushquash C, Flett GL, Hewitt PL (2018). The perniciousness of perfectionism: A meta-analytic review of the perfectionism-suicide relationship. Journal of Personality, 86(3), 522–542. https://doi.org/10.1111/jopy.12333

Translated from the Chinese original. Original book, section 3, tip 22. Content may be out of date and rules differ by place. When you actually deal with an agency, a doctor or a court, follow what local officials, doctors and lawyers tell you. Disclaimer