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Perfectionism is manifestation of personality disorder

Case vignette

Mr. R., working as pharmacist in a Government hospital, experiences ‘mental tension’ whenever he sees things at home or at the pharmacy in a disorderly fashion. He wants everything in orderly way and neat and tidy condition. He often scolds his only son studying in the higher secondary class for not keeping his books in neat and tidy manner. He did his daily exercise to keep himself fit but his son never bothered to do exercise. He couldn’t gather why he is all the time worried and dissatisfied. He was constantly disappointed with his wife and son who, according to him, never rose to his standards. He has been pointing out their faults, lecturing them about their duties and warning them about how their future would be doomed unless they changed their easygoing nature. His wife and son are becoming more and more detached and irresponsible, quite contrary to what he wanted. They seemed to be purposely not following his instructions. They avoided him even to the extent of refusing to sit together to have a meal. Obviously, they found his constant blaming and advising unacceptable.  He concluded: “Doctor, I am a perfectionist. But my wife and son are not. That is why I am worried about them. What should I do to correct them?”

Perfectionism is a personality disorder

Mr. R. was absolutely correct when he said that he was a perfectionist. But perfectionist is, as William Shakespeare said in King Lear, “striving to be better, oft mar what's well”. Perfectionism is the manifestation of a personality disorder called obsessive-compulsive personality disorder. In the international classification of diseases it is designated as ‘anancastic personality disorder.’ It is characterized by the following:

1. feelings of excessive doubt and caution;
2. preoccupation with details, rules, lists, order, organization or schedule;
3. perfectionism that interferes with task completion;
4. excessive conscientiousness, scrupulousness, and undue preoccupation with productivity to the exclusion of pleasure and interpersonal relationships;
5. excessive pedantry and adherence to social conventions;
6. rigidity and stubbornness;
7. unreasonable insistence by the patient that others submit to exactly his or her way of doing things, or unreasonable reluctance to allow others to do things;
8. intrusion of insistent and unwelcome thoughts or impulses.

Perfectionists may be mistaken for high achievers, but there are some key differences between them. How to identify a perfectionist? Following are the telltale traits of perfectionist:

All-or-nothing thinking:

Perfectionists, like high achievers, tend to set high goals and work hard toward them. However, a high achiever becomes satisfied with doing a great job and achieving excellence or something close to it. They are not tense even if their very high goals aren’t completely met. Perfectionists will accept nothing less than perfection. Even “almost perfect” is considered as failure by perfectionists. This kind of evaluation of achievements is due to their “all-or-nothing thinking’. This type of thinking is a cognitive distortion. They see everything in black or white. Therefore this type of thinking is also called black-and-white thinking.

Harsh self-criticism:

Perfectionists are far more critical of themselves than are high achievers. While high achievers take pride in their accomplishments and tend to be supportive of others, perfectionists tend to spot tiny mistakes and imperfections in their own work, as well as in others work.

Perfectionists are pushed by fear:

High achievers tend to be pulled toward their goals by a desire to achieve them, and are happy with any steps made in the right direction. Perfectionists, on the other hand, tend to be pushed toward their goals by a fear of not reaching them. They see anything less than a perfectly met goal as a failure.

Unrealistic goals:

A perfectionist’s goals aren’t always reasonable. While high achievers can set their goals high, perhaps enjoying the fun of going a little further once goals are reached, perfectionists often set their initial goals out of reach. Because of this, high achievers tend to be not only happier, but more successful than perfectionists in the pursuit of their goals.

No result orientation:

High achievers can enjoy the process of chasing a goal. Perfectionists see the goal and nothing else. They’re so concerned about meeting the goal and avoiding the dreaded failure that they can’t enjoy the process of growing and striving.

Depressed by unmet goals:

While high achievers are able to bounce back fairly easily from disappointment, perfectionists tend to beat themselves up much more and wallow in negative feelings when their high expectations go unmet. This leads to depression.

Afraid to fail:

Perfectionists are also much more afraid to fail than are high achievers. Failure becomes a very scary prospect. And, since anything less than perfection is seen as ‘failure’, this can lead to procrastination.

Procrastination:

Procrastination is deferring an action to a later time. Perfectionism and procrastination do tend to go hand in hand. This is because, fearing failure as they do, perfectionists will sometimes worry so much about doing something imperfectly that they become immobilized and fail to do anything at all! This leads to more feelings of failure, and a vicious cycle is thus perpetuated.

Defensiveness:

Because a less-than-perfect performance is so painful and scary to perfectionists, they tend to take constructive criticism defensively, while high achievers can see criticism as valuable information to help their future performance.

Low self esteem:

High achievers tend to have high esteem of themselves; not so with perfectionists. They tend to be very self-critical and unhappy, and suffer from low self-esteem. They can also be lonely or isolated, as their critical nature and rigidity can push others away as well. This can lead to lower self-esteem.

Get rid of perfectionism

Perfectionism can rob you of your peace of mind, enjoyment of life, and self esteem. Though it’s a process that may take a little time, shedding the burden of perfectionism can greatly decrease the level of stress you feel on a daily basis.

Recognizing that a change may be needed is a very important first step toward creating a more easygoing nature and achieving the inner peace and real success that comes from overcoming perfectionism and being able to say that ‘almost perfect’ or ‘less than perfect’ is also a job well done.

A restructuring of cognition or mindset and personality is needed to get rid of perfectionism; here are some important steps you can take to maintain a healthier attitude:

Make a cost-benefit analysis:

Take a closer look at your perfectionist traits. You may think you’re more effective because of them. Many researchers have proved that this isn’t true. Perfectionism has many negative consequences, and you may be experiencing several of them right now. Make a list of all the ways perfectionism is hurting you (and those around you), and you’ll be more motivated to shed these tendencies.

Self-awareness of your tendencies:

By becoming more aware of your patterns, you’re in a better position to alter them. It is better to record your perfectionist thoughts as they pop into your mind. If it is impractical for you to write down thoughts as they come, try to go over your day each night and remember the times when you felt you’d failed, and write down what you thought at the time. This will help you become more aware of perfectionist thoughts as they come to you in the future.

See the positive:

Try to stop spotting mistakes. It may be difficult to just stop. But you can soften your tendency to notice the bad by making a conscious effort to notice all that is good with your work and the achievements of others. If you notice something you don’t like about yourself or your work, for example, look for five other qualities that you do like. This will balance out your critical focus and become a positive new habit.

Change your self-talk:

A perfectionist always engages in negative self-talk like ‘my work isn’t good enough’, ‘I am not trying hard enough’, and ‘they are not good enough’. Negative self talk can perpetuate unhealthy behaviors and wreak havoc on your self esteem; by altering your self-talk, you can go a long way toward enjoying life more and gaining an increased appreciation for yourself and your work. 

Set realistic goal

Perfectionists tend to set goals of unreasonable excellence. These goals tend to be unrealistic and cause problems by being so rigidly demanding and leaving little room for error. Instead, you can reduce a lot of stress by changing your goals.

Enjoy the process:

You may be used to focusing on results, and getting depressed if your results are less than perfect. One important way to recover from perfectionism is to begin focusing more on the process of reaching toward a goal, rather than just focusing on the goal itself. You can also enjoy the process of reaching a goal by getting involved with a group who is also trying to achieve the same goal you’re after. If you find you don’t achieve perfection, you can then reflect back and see all that you’ve gained in just working toward a worthy goal, assessing and appreciating the gains you did make in the process.

Learn to handle criticism:

Do not look at criticism as an attack and react defensively. Constructive criticism can give you important clues on how to improve your performance, making your less-than-perfect performances into useful stepping stones that lead to excellence. If the criticism you’re receiving is harsh, just remind others and yourself that mistakes are a great way to learn.

Quantitative literacy and mathematics disorder

Let us consider first the distinctions and relations between mathematics, arithmetic, and numeracy.

Mathematics and arithmetic

The related sciences that collectively fall under the term mathematics are concerned with the study of number, quantity, shape and space, and their interrelationships. Mathematics includes algebra, calculus, arithmetic geometry, analytical geometry, chaos theory, number theory and set theory. Arithmetic is based on numerical calculations and quantitative number theory. Arithmetic requires an understanding of basic numerical law and the rules that govern the four basic operations of addition, subtraction, multiplication, and division. Arithmetic also does decoding and manipulating symbols. The basic skills of arithmetic are an essential foundation to the learning of more complex mathematics.

Numeracy

Numeracy or quantitative literacy is the ability to reason with numbers and other mathematical concepts. A numerically literate person can apply different aspects of mathematics to understand, predict, and control routine events in daily life. Aspects of numeracy include number sense, operation sense, computation, measurement, geometry, probability and statistics. The Combination of words “numeracy literacy” was coined in 1959 by the UK committee on Education, presided over by British economist Sir Geoffrey Crowther. Innumeracy is a lack of numeracy.

Number sense

In simple terms the number sense is an intuitive understanding of numbers.  A person with number sense would understand the magnitude, relationships of numbers. He/she would know how the numbers are affected by operations like addition, subtraction and multiplication. Development of number sense helps a child learn to solve problems conceptually rather than procedurally. Specific skills and topics related to number sense include place value, mental arithmetic, and estimation.

Number sense is a biologically based nonverbal system. It is genetically determined and biologically conserved across species. Many animal species as well as human infants are able to discriminate smaller from larger quantity, order a series of relative quantities (e.g. 3, 1, 4, 2 à 1, 2, 3, 4), and manifest a rudimentary nonverbal system for counting. There is a language-based secondary system capable of representing numbers exactly. This system is developed later just like the development of language.

Place value: In our decimal number system, the value of a digit depends on its place, or position, in the number. Each place has a value of 10 times the place to its right. A number in standard form is separated into groups of three digits using commas. Each of these groups is called a period.

Mental arithmetic or mental calculation comprises arithmetical calculations using only the human brain, with no help from calculators, computers, or pen and paper. People use mental calculation when computing tools are not available, when it is faster than other means of calculation (for example, conventional methods as taught in educational institutions), or in a competition context. Mental calculation often involves the use of specific techniques devised for specific types of problems.

Estimation: When checking the mental calculation, it is useful to think of it in terms of scaling. For example, when dealing with large numbers, say 1531 × 19625, estimation instructs you to be aware of the number of digits expected for the final value. A useful way of checking is to estimate. 1531 is around 1500, and 19625 is around 20000, so a result of around 20000 × 1500 (30000000) would be a good estimate for the actual answer (30045875). So if the answer has too many digits, you know you've made a mistake.

Mathematics disorder or dyscalculia

Mathematics disorder refers to impairment in the development of arithmetic skills, including computational procedures used to solve arithmetic problems. It involves retrieval of basic arithmetic facts from long-term memory. Mathematics difficulties, mathematics disorder, specific disorder of arithmetic skill, math anxiety, and developmental dyscalculia are different terms used to denote mathematics disorder. These terms are not synonyms; but they are similar terms with subtle differences in their meanings. The difficulty is classed as disorder only when the individual’s performance in arithmetic is substantially below that expected for age, measured intellectual abilities, and education. Also, the impairment must be sufficiently serious to interfere with academic achievement or daily living.

Math learning difficulties occur in children with low IQ. But dyscalculia occurs in people across the whole IQ range.  Sufferers often, but not always, also have difficulties with time, measurement, and spatial reasoning.

When compared to the reading disability mathematics disorder is less prevalent. Studies in developed countries have established prevalence ranging from 3 to 11 percent of the school children.

Causes: Psychological factors causing mathematics disorder

The causes of mathematics disorder are unknown, but multiple causative factors have been proposed including psychological, neurological, genetic, and social factors. The social factors include poor teaching and math anxiety. Cognitive psychologist Mark H. Ashcraft, Ph.D. defines math anxiety as a feeling of tension, apprehension, or fear that interferes with math performance.

Math anxiety

According to Ashcraft, because math anxiety can cause math avoidance, a dilemma arises. For instance, when a highly math-anxious student performs disappointingly on a math question, it could be due to math anxiety, or the lack of competency in math because of math avoidance. In order to distinguish between real math anxiety and lack of competency specially devised psychological tests have to be applied. (Ashcraft, M. H., & Kirk, E. “The relationships among working memory, math anxiety, and performance.” Journalof Experimental Psychology: General  2001, Vol. 130, No. 2, 224-237) 

Defects in development

Number sense discussed earlier is primary factor. Basic quantitative capacities develop further through formal education and require additional cognitive capacities, including short-term working memory and symbolization of number in the language. The child also develops a mental number line.

The mental number line

Mental number line

Close your eyes and imagine the numbers 1 through 9 on a line. What does the image that appears in your mind look like? Most people will say that they imagine a horizontal line, with 1 on the left, and an orderly progression to 9 on the right. Naturally, this finding could be an effect of cultural convention in societies that use Arabic numerals, but research indicates that there may be more to it than that. As children in Western cultures grow, they learn to place numbers on a mental number line, with smaller numbers to the left and spaced further apart than the larger numbers on the right.

E.g. 1     2     3     4   5   6  7  8 9 10 11 12 13.  

Then the number line changes to become more linear, with small and large numbers the same distance apart.

E.g. 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16.  

The mental number line is a product of schooling and experience. If the number sense is not inherited the child may lean numbers and acquire a mental number line but the numbers will remain void of the meaning of numerical magnitude. They will have gross mathematics disorder.

Neurological causes of dyscalculia 

Brain area playing major role in number processing 

Neuro-imaging studies have established that lower part of the parietal lobe of the brain plays a dominant role in numerical processing. Developmental lag of or injury to this part of the brain may cause gross dyscalculia.

How to identify dyscalculia?

The commonest feature of mathematics disorder is deficit in calculation fluency. In kindergarten and early elementary school the children shows deficit in counting skill. They fail to understand concepts such as more, less, and equivalence. They fail to recognize numerical values of numerals. They are unable to determine which of a pair of numerals is greater or smaller. They cannot copy numbers or write numbers to dictation. They usually count object more than once or out of order.

In older children i.e. third grade and above, major impairments are evident in rapid retrieval of number facts (e. g. 6 x 7 = 42), and in completing procedures necessary to solve more complex arithmetic problems in addition, subtraction, multiplication and division.

Treatment

Psycho education about the disorder and its longer-term implecation is an essential first step. Treatment of mathematics disorder is typically conducted within educational settings, by professionals trained in special education or educational psychology. 

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Mitral valve prolapse and panic disorder

Mitral valve prolapse (MVP) is a condition in which the heart's mitral valve doesn't function properly, causing a usually sporadic and benign heart murmur. Medical types have long suggested a link between the condition and panic disorder. Which makes sense to me, since MVP-caused palpitations may well have triggered my first-ever panic attack.

But a new meta-study (i.e. a study of other studies) calls the connection between MVP and panic into question:

Published results are insufficient to definitely establish or to exclude an association between MVP and panic disorder. If any relationship does actually exist, it could be said to be infrequent and mainly occur in subjects with minor variants of MVP.

At this point, 20 years later, I'm much less concerned with what caused my panic attacks, because I realize that question is a distraction from what should be my focus vis-a-vis panic: namely, how to accept and cope with its presence in my life. Does mitral valve prolapse cause panic? Or, rather, do panic attacks cause mitral valve prolapse? Those are chicken-and-egg-type questions: unanswerable and ultimately meaningless.

The article does include a paragraph that is closer to what I believe in my gut is the actual relationship between MVP and panic: MVP causes heart palpitations. When it does so in a person biologically predisposed for panic disorder, that person will be more likely to consider his palpitations to be mortally dangerous:

An alternative to a direct causal relation could be that MVP contributes other factors to the triggering of panic crises in individuals with greater biological vulnerability. A cognitive model suggests that patients with panic disorder tend to interpret different stimuli or bodily sensations in a catastrophic manner.81 These stimuli may include, for example, a cardiologic diagnosis communicated to the patient in an abrupt manner or the perception of a tachycardia with no major clinical significance, situations that can be encountered among patients with MVP. These stimuli may be interpreted as a risk to life and may lead to more anxiety, with autonomic symptoms triggering panic crises in predisposed persons.46

So panic isn't caused by MVP. Rather, the stress resulting from misinterpreting MVP as a threat to life can trigger panic, in much the same way as other stressors (losing a job, a relationship break-up, financial troubles, health troubles, violent accidents...) can trigger panic. Bad wiring in that thumping, pulsing thing in your chest, in other words, can be seen as akin to the roadside improvised explosive device that sends the soldier home from Iraq with nascent post-traumatic stress disorder.

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