Perfectly Anxious: the link between Generalized Anxiety Disorder and Perfectionism
Updated: Aug 1, 2022
by Alejandra Sandoval, BS
Have you ever set unrealistic goals for yourself and then felt anxious about not being able to achieve them?
Has your fear of failure stopped you from following through on what you have set out to achieve? Does this make you feel overwhelmed, tired and distressed?
If your perfectionism is leading to anxiety, you’re not alone. Numerous studies have shown a direct association between perfectionist tendencies and anxiety disorders.
A study published by Hadley and Colleagues (2014) found perfectionism to be a significant predictor of pathological worry, a defining characteristic of generalized anxiety disorder (GAD).
So, what exactly is Generalized Anxiety Disorder?
Generalized Anxiety Disorder is a type of anxiety disorder characterized by chronic worry about everyday tasks and activities. It involves excessive worry and tension even when there is no clear rationale to the outside observer. For example, a common manifestation of generalized anxiety might be a student working significantly more than his peers on an assignment due to fear of failure even though that student has maintained very good grades throughout the year.
Symptoms of Generalized Anxiety Disorder
The DSM-5 states that in order to be diagnosed with generalized anxiety disorder (GAD) you must experience 3 or more of the following symptoms for most days over a 6-month period.
A feeling of restlessness
Struggling to fall or stay asleep, or having unsatisfying sleep
GAD can also be accompanied by a wide range of bodily sensations such as muscle aches, insomnia, headaches and stomachaches.
What is Perfectionism?
The American Psychological Association defines perfectionism as "the tendency to demand of others or of oneself an extremely high or even flawless level of performance, in excess of what is required by the situation"
While perfectionism in moderation can be a healthy motivator, excessive perfectionism can cause stress and hinder our chances of success.
Patients with perfectionist traits and generalized anxiety disorder describe it as paralyzing, stressful and exhausting. They may judge their self-worth based largely on their ability to achieve the unreasonable standards they have set for themselves. At its worst, they may continue to strive to meet these standards despite incurring significant personal consequences.
This is why it is important to distinguish between healthy high performance expectation vs unhealthy perfectionism in order to understand if we are helping our hurting ourselves.
Some common examples of maladaptive perfectionism include:
All-or-Nothing thinking- Accepting nothing less than perfection, “almost perfect” is seen as failure.
Excessive criticism- Perfectionists tend to be highly critical of themselves and others due to their unreasonably high standards.
Feeling pushed by fear- While high achievers are drawn toward their goals and by a desire to achieve them, perfectionists, on the other hand, are pushed toward their goals by a fear of not reaching them.
Unrealistic standards- While high achievers can set their goals high, perfectionists often set their initial goals out of reach.
Focusing only on results- Perfectionists are so concerned about meeting the goal and avoiding failure that they don’t enjoy the process of growing and striving.
Procrastination- Perfectionists will sometimes worry so much about doing something imperfectly that they become immobilized and fail to do anything at all.
So how do Perfectionism and Generalized anxiety disorder relate?
Perfectionism and generalized anxiety often go hand in hand. A meta-analysis published in the Journal of Clinical Psychology shows that people who’ve been diagnosed with generalized anxiety, tend to display more perfectionistic traits than the average person. This makes sense given that both perfectionism and generalized anxiety are grounded in an intolerance of uncertainty. The perfectionist wants to achieve an unreasonable level of control over their environment without any possibility of failure. The ultimate downside to this expectation is its impossibility.
And given that perfectionists self-worth is often tied to performance, “they can experience extreme anxiety when their performance doesn’t meet the high standards, they have set for themselves.
In fact, left unchecked, perfectionism can interfere with important everyday aspects and can even impair performance. This is known as the paradox of perfectionism.
How to manage perfectionism and anxiety
There are various treatment options for anxiety disorders. The two most common treatments are psychotherapy and anxiety medications.
Cognitive behavioral therapy (CBT) teaches patients skills to change negative thoughts and behavioral patterns. These techniques can help treat and prevent panic attacks.
In cognitive therapy patients are taught ways to tolerate and manage uncertainty, solve problems effectively and decrease perfectionism.
Exposure therapy and imaginal flooding can be used to help patients face their uncertainty directly by testing whether or not their feared outcome was as serious or menacing as they perceived it to be. The fear of failure triggered by perfectionism can be treated the same way as many phobias, exposure therapy can help make room for imperfection and will allow patients to set more realistic and achievable goals.
There are numerous types of medications that can treat anxiety disorders. These are some of the most common classes of drugs your doctor may prescribe.
Selective serotonin reuptake inhibitors (SSRIs)
Selective serotonin reuptake inhibitors (SSRIs) are the most commonly prescribed antidepressant medications and are often used to treat anxiety symptoms. They work by blocking ("inhibiting") reuptake of serotonin in brain, meaning more serotonin is available to pass further messages between nearby nerve cells). These chemical messengers are thought to be involved in the regulation of mood, sleep, and energy levels.
Popular brand names of SSRIs are Lexapro, Zoloft, Prozac, Paxil and Celexa.
Serotonin-norepinephrine reuptake inhibitors (SNRI)
Serotonin-norepinephrine reuptake inhibitors (SNRIs) are antidepressants that work by increasing neurotransmitter levels in the brain. They do this by blocking the reabsorption of two neurotransmitters, serotonin and norepinephrine. The resulting increased levels of serotonin and norepinephrine help regulate patients moods, which is how they treat symptoms of both depression and anxiety.
Commonly prescribed SNRI’s are Effexor and Pristiq
Much like SSRIs and SNRIs, they work by affecting the monoamine system in the brain leading to subsequent chemical and electrical changes. These changes are now thought to be conducive to regulation and neurogenesis.
Some brand names include Tofranil and Anafranil.
Benzodiazepines are a group of medications commonly prescribed for their anti-anxiety and tranquilizing effects. They induce a state of relaxation by influencing the gamma-aminobutyric acid (GABA) receptors of the brain, resulting in the slowing of the central
Because of their fast acting and sedative effects, they are sometimes prescribed for insomnia and muscle spasm, as well as panic attacks and anxiety. Due to their high risk for abuse they are best utilized as part of a more holistic treatment package that includes a tapering off once symptoms are better managed.
The most common benzodiazepines include Xanax, Librium, Valium, Ativan and Klonopin.
While CBT and medications are the preferred first line treatments for Generalized Anxiety. Complementary approaches such as relaxation techniques, mindfulness training and yoga, can also be helpful adjuncts.
Breaking the cycle of perfectionism and anxiety may be hard. However, perfectionism does not have to be a fixed personality trait. It’s never too late to seek professional help to identify and change the unhelpful behaviors that are holding you back.
Handley, A. K., Egan, S. J., Kane, R. T., & Rees, C. S. (2014). The relationships between perfectionism, pathological worry and generalized anxiety disorder. BMC Psychiatry, 14(1). https://doi.org/10.1186/1471-244x-14-98
Frances, A., First, M. B., & Harold Alan Pincus. (1995). DSM-IV guidebook. American Psychiatric Press.
The Anxiety Center. (2022). GENERALIZED ANXIETY DISORDER. theanxietycenter.com. Retrieved July 11, 2022, from https://www.theanxietycenter.com/generalizedanxiety
American Psychological Association. (n.d.). American Psychological Association. Retrieved July 11, 2022, from https://dictionary.apa.org/perfectionism
Thomas, M., & Bigatti, S. (2020). Perfectionism, impostor phenomenon, and mental health in medicine: a literature review. International Journal of Medical Education, 11, 201–213. https://doi.org/10.5116/ijme.5f54.c8f8
Bevier, D. (2022, June 5). The Torture of Living With Generalized Anxiety Disorder. Publishous. https://medium.com/publishous/the-torture-of-living-with-generalized-anxiety-disorder-38e7bd79ad68
Limburg, K., Watson, H. J., Hagger, M. S., & Egan, S. J. (2016). The Relationship Between Perfectionism and Psychopathology: A Meta-Analysis. Journal of Clinical Psychology, 73(10), 1301–1326. https://doi.org/10.1002/jclp.22435
Perfectionism and Anxiety: Why They’re Linked and Ways to Cope. (2022, April 26). Psych Central. https://psychcentral.com/anxiety/perfectionism-and-anxiety#recap
Tyler, J., Mu, W., McCann, J., Belli, G., & Asnaani, A. (2020). The unique contribution of perfectionistic cognitions to anxiety disorder symptoms in a treatment-seeking sample. Cognitive Behaviour Therapy, 1–17. https://doi.org/10.1080/16506073.2020.1798497
Exposure Therapy: Types, How It’s Done, and More. (2021, June 21). Healthline. https://www.healthline.com/health/exposure-therapy#conditions
Ph.D, H. L. (2020, March 3). What is Flooding Treatment for Anxiety? WithTherapy. https://withtherapy.com/therapist-insights/what-is flooding/#:~:text=With%20imaginal%20exposure%2C%20though%2C%20a
Yes, There Is a Medication You Can Take as Needed for Anxiety. (n.d.). Verywell Mind. https://www.verywellmind.com/mental-health-medications-for-anxiety-2337705
Bandelow, B., Michaelis, S., & Wedekind, D. (2017). Treatment of anxiety disorders. Generalized Anxiety Disorders, 19(2), 93–107. https://doi.org/10.31887/dcns.2017.19.2/bbandelow