Perfectionism and youth suicide

The headlines are shocking, confusing and all too familiar. A teen commits suicide without warning, ending a life full of accomplishment and promise — a seemingly perfect life. But UBC Psychology Prof. Paul Hewitt suggests that a seemingly perfect life could signal the risk of teen suicide.

“Most people don’t understand the toxicity of perfectionism,” he says. “Perfectionists put enormous pressure on themselves, making their lives far from perfect.”

Hewitt and Gordon Flett of York University are conducting a variety of studies to examine the relationship between the need to appear perfect (perfectionistic self-presentation) and suicide, including studies that include youth. They are also testing a model they developed, called the Social Disconnection Model (SDM) that links social disconnection with perfectionism and suicidal thoughts. One study looks specifically at the social disconnection markers of bullying and feelings of social helplessness or never being able to fit in.

“Suicide rates are increasing among youth,” says Hewitt, a registered clinical psychologist. “We urgently need to know more about the mechanisms of perfectionism, how it starts and how it develops. If we are to provide better interventions and targeted treatments, we don’t need more evidence that perfectionism is a problem, we need to know why it’s a problem.”

Fuelled by fears of rejection and abandonment as well as a strong need to belong, be approved of and cared for, individuals with perfectionism do whatever is required to get the acceptance they need. This difficult path is characterized by severe and routine self-criticism, retreat and disconnection from the world as well as frustration, anger, and depression.

Hewitt has been intrigued with perfectionism from the time he was an undergrad at the University of Manitoba in Winnipeg. He has conducted extensive research on perfectionism and its relationship to problems such as suicide, depression, personality disorders, as well as relationship, achievement, and health problems. He also conducts research on the treatment of perfectionism and provides assessment and treatment for individuals with perfectionism problems and trains clinicians in the treatment of perfectionistic behaviour.

A recent study involved working with children and adolescents aged 8–20, to complete a variety of questionnaires and scales that measure: perfectionistic behaviours, need to appear perfect, experiences of bullying, social hopelessness and suicidal thoughts and actions. Participants were involved in psychiatric outpatient counseling for anxiety and depression at B.C. Children’s Hospital.

“The perfectionism and suicide connection among teens is especially relevant because of adolescents’ inherent self-consciousness and concerns about social relationships,” says Hewitt.

Perfectionist children believe if they are perfect others will like them and won’t abandon them — they can fit in. However, just the opposite happens. The child is seen to be someone outside the norm of the group and therefore a perfect target for bullying. Worsening the situation is the fact that teens are known to hide their negative feelings, making them especially vulnerable to depression and suicide.

There is a real difference between needing to be perfect and needing to be excellent, Hewitt emphasizes. Striving for excellence can motivate individuals. Striving for perfection can hinder individuals. It can lead to procrastination to avoid possible failure or unconscious self-handicapping so the goal of perfection is not tested. For example, an individual may enter a race without having trained sufficiently. When they don’t win first place, they can blame the “failure” on the lack of training rather than their own imperfection.

People who need to appear perfect are often difficult to be around. They can be hostile, rigid thinkers, and exquisitely sensitive to criticism, earning rejection by others. The phenomenon is called a neurotic paradox — the individual creates the very outcome they so desperately want to avoid.

Hewitt has worked with artists, entertainers, physicians, elite athletes and others who can become paralyzed by their perfectionism and suffer from writers’ block and other aversion behaviours. Their sense of disconnection and alienation from others, the most feared state of the perfectionist, makes them vulnerable to suicide.

“I have worked with extreme perfectionists for many years and I am still surprised by the depth of their pain and the level of their desire to die,” says Hewitt.

Perfectionism is a basic personality style and treatment is intensive and long-term, made uniquely difficult because patients do not want to disclose any problems.

“Perfectionists try to be the perfect patient,” says Hewitt. “Our goal is to help them see and accept who they are under the perfect façade.”

More information about perfectionism may be found on the FAQ section of Hewitt’s website at: http://hewittlab.psych.ubc.ca/

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