Do you blame yourself for pushing too hard and crashing afterwards? Have you created a 40 item treatment plan in your bullet journal? Do you judge yourself for not taking all your supplements, doing your strengthening exercises, meditating, or other lifestyle treatment strategies? Of course, you probably know that all the guilt and self-blame isn’t helpful, but it’s hard to stop the voice of your inner perfectionist that says, “Why can’t I even manage to do this one thing?”

The faulty premise behind this thinking is that we have complete control over our symptoms. That it’s just a matter of finding the magic combination of treatments to end flare-ups, when really, most self-management strategies relieve symptoms, but don’t end them. Fear of losing control, and the difficult emotions of frustration, disappointment, and guilt, drive us to try harder to get it right, to get it perfect (Moinar, et al., 2016). However, what you really need to do is give yourself a break. You can’t have 100% control over the flux of your symptoms. Contrary to the voice of your inner perfectionist, it’s sometimes better to go with the flow of illness, than paddle upstream.

What is perfectionism?

Perfectionism is defined as a personality trait characterized by a drive for flawlessness, excessive self-scrutiny, and harsh self-criticism over mistakes (Linnett & Kibowski, 2018). There are three types of perfectionism: self-oriented, socially prescribed, and other-oriented (Flett et al., 2011). Let’s take a look at what each of these mean in turn. 

• Self-oriented perfectionism: setting unrealistically high standards and criticizing yourself harshly when those standards are not met. 
• Socially-prescribed perfectionism: when important others (family, friends, society as a whole) hold the individual to excessively high standards. 
• Other-oriented perfectionism: refers to the perfectionist’s judgment of others as they hold them to exacting demands.

Self-oriented perfectionism means that you set unachievable standards for yourself, and then berate yourself for failing to live up to them. Some judge themselves harshly for not succeeding at living up to their pre-illness potential, for seeing what they can accomplish while ill as paltry in comparison. You may now criticize yourself for struggling to do basic things like doing the laundry, making the bed, cooking dinner, or meeting a friend for coffee. You may push yourself beyond your limitations, or ask yourself, “Why can’t I manage to do anything?”

Before illness, you may have had ambitions to be great at whatever it was you loved doing. Perhaps you drove yourself hard in pursuit of those goals. And then along the way, you got sick. You may now blame yourself for becoming ill, seeing it as a failure. Meanwhile, such self-blame only perpetuats the cycle of toxic perfectionism!

Socially prescribed perfectionism means that important people in our lives, or society at large, hold us to unrealistic standards. We can internalize these judgments; that we’re not trying hard enough, that we aren’t productive members of society. People with chronic illness are also all too familiar with the toxic positivity evangelists, who healthsplain that all you need is the right attitude and you will be cured. This implies that it’s your bad attitude that keeps you sick today, and you aren’t doing enough to correct that.

 In addition, there is a huge amount of social pressure to seem ‘fine’ and end conversations on a positive note, regardless of reality. This form of socially prescribed perfectionism is the mask you feel you have to wear outside of your inner circle to pretend everything is ok. But sometimes, we impose this mask onto ourselves, when we could admit we’re not ok, and ask for help. In those situations, socially prescribed perfectionism gets in the way, because we want to be seen by ourselves, and others, as holding it perfectly together. The pressure to do that can feel enormous. The criticism if you don’t put on the mask can really sting.

Other-oriented perfectionism is less relevant to individuals with chronic illness, since this involves holding other people to our high standards. However there can be a disappointing reaction among some people in the chronic illness community to an individual expressing their no-end-in-sight distress. The “But have you tried…” response piles judgement on someone who is suffering. Even worse is the “But I cured myself doing…”. Expressing sympathy means acknowledging that each person’s situation is unique, and accepting others where they are at, instead of lecturing them on not trying hard enough.

How can you break free of toxic perfectionism?

 Befriend yourself. Treat yourself with the understanding and kindness of a good friend. “What would a best friend say?” is something you can ask yourself when you’re feeling anxious, guilty, critical, frustrated, or ashamed. There are 3 components of self-kindness, and one of them is to remind yourself of your common humanity:

“You’re only human.”

 “It’s ok to struggle and to not be ok.”

 “You can always try again tomorrow.”

“Maybe this is just beyond your control right now.”

It may feel very cheesy, but it’s worth it to stop the self-blame around managing your illness! There needs to be a mental counterpoint to the damaging words of your inner perfectionist. A second component of self-kindness is mindfulness. Bring yourself to the present by using your senses, to disrupt your negative self-talk. When you’re internally cringing because you feel you messed up, or berating yourself for not being better, ask yourself, right now:

What are 5 things you can see?

What is the texture of 4 things you can touch?

What are 3 things you can hear?

What are 2 things you can taste?

What is 1 thing you can smell?

 Take a few deep breaths. Remind yourself of your common humanity. Connect to a feeling of self-compassion. One amazingly effective way to do this is to put a hand over your heart for a minute, or rub your upper arms like you’re cold. Ask yourself what the best thing you can do for yourself right now would be- a cup of tea, a walk, soft PJs, a good book, a treat.

For a more formal practice, there are self-compassion mindfulness meditations (loving-kindness meditations) that you can do, in which you repeat silently to yourself goodwill wishes for your own well-being: “May I be safe, May I be peaceful, May I embody self-kindness, May I live fully,” are the ones that resonate with me. Silently repeat these phrases for a minute or two, while breathing quietly.

Here are some more resources if you struggle with your inner perfectionist:

Tara Brach, Radical Acceptance: Embracing your life with the heart of the Buddha.

Kristin Neff, Self-Compassion: The proven power of being kind yourself.

Christopher Germer, The Mindful to Self-Compassion.

Originally published in the UK Fibromyalgia magazine

Works Cited

Flett, G.L, Baricza, C., Gupta, A., Hewitt, P.L., & Endler, N.S. (2011).  Perfectionism, psychosocial impact and coping with irritable bowel disease:  A study of patients with Crohn’s disease and ulcerative colitis.  Journal of Health Psychology, 16(4), 561-71.  

Friis, A.M., Johnson, M.H., Cutfield, R.G., & Consedine, N.S. (2016).  Kindness matters:  A randomized controlled trial of a mindful self-compassion intervention improves depression, distress, and HbA1c among patients with diabetes.  Diabetes Care, 39(11), 1963-71. 

Linnett, R. J., & Kibowski, F. (2018, June 22). A closer look at multidimensional perfectionism and multidimensional self-compassion. https://doi.org/10.31234/osf.io/bcu37 

Molnar, D.S., Sirois, F.M., & Methot-Jones, T. (2016).  Trying to be perfect in an imperfect world:  Examining the role of perfectionism in the context of chronic illness.  In F.M. Sirois & D.S. Molnar (Eds.), Perfectionism, Health, and Well-Being, pp. 69-99.  Switzerland:  Springer International Publishing.

Willard, K. (2019, June 17). Perfectionism and Chronic Illness. Psychology Today. Retrieved from: https://www.psychologytoday.com/ca/blog/chronically-me/201906/perfectionism-and-chronic-illness