Treat “others expect me to be perfect” as a symptom, not as a fact

People who keep feeling “people around me demand I be perfect, and if I fall short I will be rejected” are more likely to have suicidal thoughts. “I demand perfection of myself” links much more weakly to suicidal thoughts, only about one third as strong as the first. After subtracting thoughts already present, the first feeling still tracks later rises in thoughts, though the size is modest.

Cost

No money. The hard part is treating this thought as something to handle, not as an accurate reading of what others really demand.

Benefit

Pooling several studies (meta-analysis): 45 studies, N = 11747, samples of undergraduates, medical students, community adults, and psychiatric patients, random-effects model. Below are weighted average correlations with suicidal thoughts. Perfectionistic concerns r = .28 (95% CI .24–.32; 42 studies, 7936 people). Perfectionistic concerns is a bundle including socially prescribed perfectionism, concern over mistakes, doubts about actions, and gaps between reality and standards. Socially prescribed perfectionism alone is also r = .28 (.25–.32, 30 studies, 3640 people). Perfectionistic striving r = .10 (.07–.13, 31 studies, 4588 people), a bundle of self-oriented perfectionism and personal standards. Parental criticism r = .20 (.11–.29). Then links to suicide attempts. Perfectionistic concerns r = .12 (.07–.17, 15 studies, 5275 people). Socially prescribed perfectionism r = .19 (.08–.29, 8 studies, 689 people). Then the follow-up part. After subtracting suicidal thoughts present at the start, socially prescribed perfectionism still moved in the same direction as later follow-up suicidal thoughts, modestly. Self-oriented and other-oriented perfectionism showed no link.

Notes

Grade B because most included studies are one-time questionnaires, so sequence is unclear. Correlation strength is moderate (r about .28), explaining only a few percent to about one tenth of the variance. What is measured is suicidal thoughts and attempts, not death itself, so benefit magnitude is logged as small for “surrogate endpoint only.” The authors also say the perfectionistic-concerns and attempt set looks like publication bias. Publication bias means studies with unflattering results were not published. After filling in estimated missing studies, the direction holds. High standards themselves are not the problem, and you need not lower them for that reason. The difference is where the standard comes from, and whether falling short feels like “I as a person am finished.” Like the pessimistic forecasts in item 15 (treat thoughts like “things will get worse” as a symptom), this is something that can be handled as a symptom. For suicidal thoughts, call 12356 first and move lethal means farther away; see Section 1, Item 25. What you can do when someone close shows such thoughts is in Section 8, Item 15. Depression screening for children is in Section 30, Item 8.

Sources · 1

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. doi.org/10.1111/jopy.12333