It is difficult to grasp what goes on in the thoughts of someone who appears to have it all together yet secretly, or openly, struggles with feeling that they are not enough. They may suffer from depression, anxiety and a combination of many other illnesses of the mind. This article is based on a research article called “The destructiveness of perfectionism revisited: Implications for the assessment of suicide risk and the prevention of suicide.” by Flett, Gordon L.,Hewitt, Paul L.,Heisel, Marnin J.
The World Health Organisation suggests that a suicide occurs every 40 seconds across the globe. There are many varied contributing factors for mental illness and suicide. The role of perfectionism needs to be discussed. Research by Flett et al suggests that even though the role of perfectionism in suicide is acknowledged, it is ‘underappreciated and unrecognised.’
Funnily, these terms, underappreciated and unrecognised, are thoughts I had of myself before I suffered from anorexia. I interpreted not being allowed to have a voice in my adolescent years as ‘I am not valued and I do not matter.’ This turned into ‘I am not good enough, so I have to try harder to be a perfect daughter’. I did more chores, learned not to speak up in case I displeased anyone, and tried to hide anything that I thought would be a flaw in others eyes.
Looking back on this time, undiagnosed depression and anxiety loomed. Changes in eating habits, which are one sign of a merging mental illness, for me, was a decreased appetite. I DID NOT INTENTIONALLY START A DIET AND I WAS NOT DISSATISFIED WITH MY BODY. However, this change got the attention of my parents and suddenly I felt I was being heard; for the wrong reasons but I was being heard. This is what makes me valuable I thought and the restricted eating and excessive exercise became my coping mechanism. These unhealthy behaviours became messed up with the unhealthy thoughts of feeling I had to be perfect. It was not about having a perfect body but feeling I was not enough to be loved.
These behaviours became my identity. They gave me a voice. To dare challenge them meant that that my identity was at risk. I did not know who I was without these. To be seen eating meant to me that others saw this as a ‘failure’. It was a daily battle between not wanting to be living like that but frightened to let those thoughts and behaviours go.
For those that do suffer from eating disorders and have body dissatisfaction, I believe that the complexity of eating disorders and comorbidity with other mental illnesses such as anxiety, depression, OCD and post traumatic stress make them so much more than ‘body image’ issues. This in itself projects misunderstanding and projects a stigma, that adds to the barriers that may be placed before a perfectionist to seeking help. Being treated as a ‘problem’ rather than a human being who is suffering and needs help is not appropriate treatment.
The role of perfectionism on suicidal ideation, also needs to be considered for the fitness industry, sports coaches and any other activity where body composition and body shape are often portrayed as more important than performance or overall health. If a person is vulnerable to the unhealthy coping mechanisms of a perfectionist, is not resilient and suffers from an eating disorder, then ‘fitspo’ images, the practices and language of coaches and others may add to the problem.
As with many mental illnesses , the circumstances and risk factors are varied, yet one fact is that the rate of suicide amongst those with eating disorders is the highest of all the psychiatric illnesses. When combined with depression, anxiety, OCD, trauma and other factors there exists a perfect storm for suicidal ideation. There is never a point of ‘good enough’.
We should not only consider people showing signs of depression and low mood being at risk of suicide. Those that are by nature perfectionists may hide the fact that they are not coping, feeling that others would see this as a flaw. Not coping makes a perfectionist feel shame, hopelessness and self-loathing. These feelings are hidden behind masks.
The idea of perfectionism is complex and it is not just a ‘need to be perfect.’ Flett uses a few terms for consideration.
Perfectionist Self Presentation
Here the person presents a ‘false image of flawlessness and invulnerability.’ This leads to never ending thoughts of not living up to the perception of a perfect ideal self. Not being heard and validated caused me to believe that I was never enough. I constantly judged myself and always believed that if something went wrong it was always because I was not good enough. I was highly critical of myself. When I noticed changes in my mood and thoughts when cracks were appearing in my marriage, I did not recognise these as depression. I felt like I was treading water every day, not knowing who to turn to or even wanting to let anyone know that I was struggling. I had to show others that I was strong and capable. This is when I first had thoughts of suicide. There was a huge disconnect between what was going on inside and the front that all could see. I felt like a fake and that I was failing as a wife and mother. When the depression got worse, and crying increased, I didn’t want others to see. If they happen to I felt more a failure and experienced extreme shame.
Socially Prescribed Perfectionism
As well as the notion of ‘self-presentation’, a perfectionist may perceive that others demand perfection from them. Research shows that this is consistently linked to suicidal ideation. The perfectionist who is vulnerable may compare and judge themselves to the slightest of criticism. This can be destructive when we consider over critical parenting, a boss or a partner that is difficult to please, sports, careers or even church or faith-based settings where errors may not be tolerated.
Being in a culture that emphasizes perfection is not helpful to people that are perfectionists. Targum and Kitanaka (2012) speak of ‘overwork suicide’ in Japan. For those perfectionists that are retired from their workplace, this may be a challenge.
Mistakes and Perfectionism
The pressure a perfectionist places on themselves is heightened at times when mistakes are made or when external pressures increase. The sense of despair, failure and hopelessness deepens at these times. Combining the nature of a perfectionist and their perception that others require them to be perfect, when mistakes are made, this is crushing.
The shame and guilt is unbearable and there is a huge fear to disclose an error. This makes a perfectionist feel like they are unable to turn to others, perceiving themselves to be a burden due to the disappointment of their mistakes. When the mistakes are publically known, these feelings of shame and inadequacy are intensified.
The history of anorexia, combined with depression, anxiety and having a perfectionist nature, increased the thoughts of suicide after mistakes. I loathed myself. I hid behind a facade and did not tell a soul. It was during these times, that I had thoughts and plans to take my life.
When my mistake became public, I isolated myself and stayed locked in my apartment. Others that I thought may support me, also stayed away, further increasing the shame. I remember sitting on my lounge in utter despair, feeling hopeless, worthless and dirty.
Two things stopped me from carrying out my suicidal plans. One was that I hung by my little finger, onto my faith in Jesus. The other was the thought of the effect of suicide on my children.
A perfectionist who has had a suicide attempt is at greater risk of dying by a subsequent attempt. This person may experience increased shame as they will see themselves as more of a failure. Psychache is described by Schneidman (1993) as intense psychological pain, and is an identifying element in suicide. This shows the need to not dismiss that a person with improved mood after discharge from hospital, needs follow up and care.
Early intervention and Prevention
Programs for prevention and early intervention need to take into account that perfectionists will conceal that they are not coping, and these interventions assist de-escalation of thoughts of suicide. It would be helpful to recognise that perfectionists may not use protective means as to do so may show vulnerability. They would feel more of a failure if they were to do so.
As individuals, parents, employers and society as a whole we can assist by:
· Promoting self-acceptance and self-love
· Being compassionate towards each other in order to foster self-compassion
· Not setting unrealistic goals and standards
· Allowing room for error
· Being non-judgmental, as a perfectionist is already by nature very self-critical.
· Showing forgiveness to allow others to forgive themselves
· Acceptance to ‘just be’ rather than the need for constant striving.
· Not shaming individuals
· Developing resilience to cope with rejection
· Promote seeking assistance as a strength
· Creating work programs and protocols that consider and assist adults struggling with perfectionism.
· Being aware that eating disorders have causes that are not often related to body dissatisfaction
· Being aware of how our language and words we use can effect a person who is a perfectionist
Being aware that individuals who continually strive, who are sensitive to criticism and who project an image that they are coping, may actually be struggling. The more they feel like they are failing (or have failed) the more they will try to appear that they are perfect. This creates feelings of being inauthentic and so the feelings of inadequacy intensify. Combine this with mental illnesses like depression, anxiety, mistakes and public shame, the risk of suicide is heightened.
The best unlearning I had as a result of the adversity I found myself in was discovering firstly the unconditional love of my family and friends. I did not know this. It took mistakes where I hit rock bottom to find this out. It took a lot of effort to change the thought patterns I had all my life and I could not have done so without appropriate professional help that I had to have. However, in between these appointments, I had much work to do to stop believing that I was a failure and it was the support of those around me to reinforce what I had to unlearn.
It is not weakness to get help from your GP in the first instance to tell them you are not coping. It is not weakness to call the crisis mental health team. It is not weakness to need medication in conjunction with other appropriate psychological treatment. It is NOT weakness to make mistakes. WE ARE HUMAN. It is one thing to have slogans saying “It is ok to NOT be ok” and another for a person to start believing this of themselves. Look out for people who appear to be constantly striving and are hard on themselves. Look out for each other as HUMAN beings. Be compassionate. Do not judge or be critical, so that a person who constantly criticises themselves may find self-compassion, self-love and finds rest in self-acceptance.
Reference
The destructiveness of perfectionism revisited: Implications for the assessment of suicide risk and the prevention of suicide. Flett, Gordon L.,Hewitt, Paul L.,Heisel, Marnin J.
Review of General Psychology, Vol 18(3), Sep 2014, 156-172
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