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The American Journal of Psychiatry, VOL. 161, No. 8
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Book Forum: Personality Disorders   |   August 01, 2004 
Perfectionism: Theory, Research, and Treatment
STEFANO PALLANTI, M.D.
Am J Psychiatry 2004;161:1511-1511. 10.1176/appi.ajp.161.8.1511
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Edited by Gordon L. Flett, Ph.D., and Paul L. Hewitt, Ph.D. Washington, D.C., American Psychological Association, 2002, 435 pp., $49.95.
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Take it easy! This is probably one of the most frequent pieces of advice you are likely to hear, especially if you are a perfectionist. Even general practitioners and psychiatrists are prone to offering this "commonsense" suggestion, and to all kinds of patients—people suffering from depression, anxiety, obsessive-compulsive disorder, or eating disorders.
But it is not that easy to take it easy. Perfectionism, the striving for flawlessness, can sometimes be a source of subjective strength enabling the achievement of terrific goals. This is the first distinction that needs to be grasped—adaptive versus maladaptive—a distinction that requires the adoption of a multidimensional rather than a unidimensional perspective.
In the clinical setting what is really important is how to assess the condition. The editors are to be thanked for the fact that their book contains specifically constructed tools for different disorders, because perfectionism does not belong exclusively to obsessive-compulsive and related disorders but also involves panic disorder, social phobia, and eating disorders. The impact of perfectionism in mood disorders has been documented in depression +(1) and bipolar disorder +(2, +3). Maladaptive evaluation aspects of perfectionism are associated with negative affectivity rather than anxiety per se (the chapter by Frost and DiBartolo in this volume makes this point).
In my opinion, other conditions, such as the psychopathology of dementia and hypochondriasis, could be better understood by adopting an evolutionist perspective of perfectionism as a construct. It is possible to distinguish it from the irrational illusion of control, which pertains to a variety of cognitive distortions ranging from superstition to magical thinking, as the origin of obsessions and compulsive behaviors.
Perfectionism runs in the family, from parents to children, but when adjusted can lead to an excellent level of achievement in gifted kids. Alternatively, it may represent a stable vulnerability factor—"I break but I don’t bend"—features that represent a fragile side to stress that can be targeted with both psychological therapies and drug treatment.
This is a great book for clinicians, particularly for psychiatrists who want to devote more attention to the core features of vulnerabilities in such a large number of different conditions. It is also an excellent book for researchers interested in developing research projects to define empirically the different dimensions of this fundamental typology in terms of neurocognitive functions, memory, and social cognition.
I am enthusiastic about this book and regard it as essential reading for anyone wishing to take on patients with perfectionism or to extend their knowledge of the subject. As one of the characters says at the end of Billy Wilder’s Some Like It Hot, "Nobody’s perfect." This book is not either, but the way the collection of papers has been presented is a genuine breakthrough.
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Hewitt PL, Flett GL: Perfectionism in the self and social contexts: conceptualization, assessment, and association with psychopathology. J Pers Soc Psychol  1991; 60:456–470[PubMed][CrossRef]
 
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Scott J, Stanton B, Garland A, Ferrier IN: Cognitive vulnerability in patients with bipolar disorder. Psychol Med  2000; 30:467–472[PubMed][CrossRef]
 
3 +
Scott J, Pope M: Cognitive styles in individuals with bipolar disorders. Psychol Med  2003; 33:1081–1088[PubMed][CrossRef]
 
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1 +
Hewitt PL, Flett GL: Perfectionism in the self and social contexts: conceptualization, assessment, and association with psychopathology. J Pers Soc Psychol  1991; 60:456–470[PubMed][CrossRef]
 
2 +
Scott J, Stanton B, Garland A, Ferrier IN: Cognitive vulnerability in patients with bipolar disorder. Psychol Med  2000; 30:467–472[PubMed][CrossRef]
 
3 +
Scott J, Pope M: Cognitive styles in individuals with bipolar disorders. Psychol Med  2003; 33:1081–1088[PubMed][CrossRef]
 
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