Podcast: Overcoming Perfectionism in Kids & Teens

Episode Transcript

Jenn: Welcome to Mindful Things.

The Mindful Things podcast is brought to you by the Deconstructing Stigma team at McLean Hospital. You can help us change attitudes about mental health by visiting deconstructingstigma.org. Now on to the show.

Hi folks. Good morning, good afternoon, good evening. And thank you so much for joining us wherever you are, whatever time it is there, to tune into our chat today about perfectionism in kids, teens, and young adults.

I’m Jenn Kearney. I’m a digital communications manager for McLean Hospital, and I am joined by Dr. Elizabeth McIngvale today.

Chances are, if you’re tuning in, you’ve noticed that your child or adolescent, whether it’s your own kid, a kid you look after, whatever, may be unusually hard on themselves, setting unreachable expectations, avoiding challenges, or just overly self-critical.

And it turns out that these all may be signs of perfectionism. One of the challenges of addressing perfectionism in our loved ones is that sometimes it’s seen as a good thing because we want our kids to be successful and to go on to achieve great things, right?

But it turns out that this perfectionism can actually hinder our kids. It can make them avoid new adventures and opportunities. So, how do we strike a balance between that success and avoiding failure? So, for all of these reasons and more, I am so excited to have Liz with me today.

So, we are going to talk about the varying signs and symptoms of perfectionism, the short and long-term impacts of unaddressed perfectionism, and a way to teach our loved ones, or, you know, maybe even ourselves how we can foster a growth mindset.

So, if you are unfamiliar with her, I have the distinct pleasure of introducing you to her today. So, Elizabeth McIngvale, PhD, LCSW, is the director of McLean’s OCD Institute in Houston. She’s also a founder of Peace of Mind, which is a nonprofit foundation dedicated to OCD, as well as the manager of ocdchallenge.com, which is a self-help website for OCD.

She was actually the first ever national spokesperson for the IOCDF, and now serves as a board member. At the age of 12, she was diagnosed with OCD, and underwent both inpatient and outpatient therapy.

Now she engages in clinical work, research, and advocacy, aimed at improving OCD treatment and access to care with a life goal to make a difference in the lives of those of OCD. So, Liz I’m so thrilled to see you again. Thank you so much for joining me.

I want to get started by asking very basically, what exactly is perfectionism, and is it more than just being particular?

Elizabeth: Yeah, it’s a great question. Thank you for having me, Jenn, and thank you for shining a light on this.

And I love what you just said, which I think is really important is that there is a difference between when perfectionism needs to be treated, versus when it may be seen as a good quality or a good thing. Right?

And the reality is, is that many of us do have high expectations for ourselves or for our loved ones, and we want them to succeed. We want them to be successful, but really, what we’re going to be shining a lot of light on today is when does perfectionism start to become problematic?

And it actually isn’t helping you anymore. It’s starting to hurt you. And that’s really when we would want somebody to consider seeking treatment. And so when we think about perfectionism, it’s interesting because clinically, I don’t know exactly how to categorize it.

We have perfectionism for OCD. We have some people where we might say like, “Oh, they’re a perfectionist,” but it really falls more in the anxiety category. They may not meet criteria for OCD.

So, it really depends. We need to really do a pretty detailed and thorough assessment to understand what are kind of those core fears? What is at the root of their perfectionism?

Is it just, “Oh, I want to get into a good school, and I’m anxious about that,” or, you know, “This is what I think makes sense,” or “My parents might be disappointed in me?”

Or is the core fear something like, “If my handwriting isn’t perfect, something bad’s going to happen,” or “people are going to be upset with me,” or “there’s going to be this negative outcome,” that’s kind of this irrational thought, right?

We can see where perfectionism can look like anxiety. It could look like OCD, or it could look like a normal behavior that actually serves for some functioning for individuals, if it hasn’t crossed that line of being interfering in their life. And so it really depends.

So, sorry that I can’t give a specific answer, but I think this is where as clinicians, we want to better understand the root, the core fears and kind of, what’s at the bottom of the perfectionism?

Jenn: So, it seems like there isn’t one specific or particular cause of perfectionism, but it could actually be a variety of things lending itself to it, right?

Elizabeth: 100%. Right? And it could be, I mean, think about it. For some of us, we might take more pride in certain things versus others.

Maybe if I’m going on a date, I’m going to be more particular about the way I look that day, than if I’m just going to run errands by myself. And that kind of extra time or effort, or maybe even anxiety that might go into looks or appearance is normal, right? It’s normal. It can serve a functioning behavior.

However, if I’m stuck every morning, spending 30 minutes putting just my mascara on because it needs to be perfect, and if it’s not, something bad’s going to happen, or my bosses are going to think that I don’t care about myself, and I don’t put myself together, and now it’s interfering in my life.

Jenn: So, would you say that perfectionism could possibly be a learned trait? So, do you think that there’s any correlation between having a parent that’s a perfectionist would end up leading to having kids that are also perfectionists?

Elizabeth: You know, I definitely think that there are cultural, societal and even familial, or even school based, education based norms, or influences that can impact the way we feel, think, and behave, you know, for sure we know that.

You know, and I think sometimes parents, you know, sometimes we may not even realize statements. So, let’s give an example of, you’re a mom with three kids and you are giving one child praise for getting an A, or something like that, or you’re happy or excited for them.

What we know as parents is that every child is different and everyone’s anxiety is different, and so one kid may be able to handle that in a really healthy way of like, “Oh, thanks, mom’s proud of me, this is awesome. I worked really hard.

I got an A. I want to keep working hard,” but it’s a normal behavior where another kid may interpret that as, “Oh, I’m expected to get an A, and if I don’t get an A, mom’s going to be disappointed in me, and I need to perform.”

And so we interact with our children, with our loved ones all differently, because we know their anxiety, or the way they function right, is different. There’s no one size fits all, and so I certainly think that it can influence how we feel.

I will say that anxiety, OCD is neurobiological, so you’re born with it, but you, as a parent, tend to know, “Okay, I can parent one kid this way, and one kid a different way,” and there’s not a right or wrong. It’s just the way that they respond, or the way that they receive feedback is going to be different.

Jenn: So, I know you had mentioned previously that perfectionism isn’t necessarily a mental health condition in itself. But it’s tied to other mental health conditions. You had mentioned OCD and anxiety.

Are there any others that it may be affiliated with?

Elizabeth: Definitely. Definitely. So, one I really want to highlight is body dysmorphic disorder, BDD.

And we see this a lot where one example is individuals who may be really fixated on the way their hair looks, or the way their appearance looks, and it can feel like perfectionism, like, oh, they want to make sure that their hair is perfect, or they want to make sure that they look a certain way.

And when you get to the bottom of it and understand the core fear, it’s actually this fear that it’s distorted, and also this fear that people see a certain thing, or people view me a certain way and it can be rooted actually in body image, and so body dysmorphic disorder.

So, we certainly can see perfectionism and BDD go hand in hand. We also can see it go hand in hand with social anxiety. This fear that, if I make an error, if I don’t look a certain way, people are going to have these really negative thinking.

Like, these really negative cognitions we have about ourselves that we think people will interpret us in this negative way, can be really prominent.

Jenn: Do you think that perfectionism could be affiliated with a desire to have control, and then could also be tied to a trauma response?

Elizabeth: For sure. You know, I think that there are many things like safety behaviors that we can see that may appear or come out, in the perfectionism realm when they’re really a safety behavior tied to a trauma response.

We also know that when you think about personality disorders or certain diagnoses, that overcontrol is a way that this disorder may present, it may look like perfectionism, but it really may be even eating disorders. Is the perfectionism the root, or is it the desire to have some sort of control in our life, and the perfectionism is something we can control?

And so again, this is where, what I said early on is so important is when you see perfectionism on the surface, let’s not just treat it as perfectionism on the surface. Let’s really get to what’s at the root, what’s at the core? Where does this come from?

And so the question I want to ask is, kind of, why, and so what, right? So, if it’s like, well, this has to be perfect. Okay. Well, what if it’s not perfect? Well, then I might get a bad grade.

Okay. So what if you get a bad grade? Well, then something, you know, I won’t get into the college I want. Okay, and if you don’t get into the college you want then what, right? Let’s really get to, what is that core fear?

Is it, if I don’t get into the college, I’m letting people down. Is it, if I don’t get into college, my career and my life is going to be doomed. So, what is the core fear that’s at the root of these things that we need to really target?

Jenn: I would be remiss if I did not ask an OCD expert, about the ties between perfectionism and OCD. One of the things that really, I mean, it grates on me. I can’t imagine what it does for you, is when people are just particular in general and they go, it’s just my OCD.

Elizabeth: Yeah.

Jenn: Is it. Is it exactly? Probably not, but, so what are some of the similarities, but also some of those key major differences between perfectionism and OCD, and an overlap between the two?

Elizabeth: The biggest thing I would say is the function, right? The function of the behavior. So first and foremost, what you just spoke to that I love is important is OCD is not an adjective, and it shouldn’t be used as one.

So, people shouldn’t say statements like, “Oh, you should see my coworker’s desk. She’s so OCD.” Or “You should see my mom’s kitchen. She’s so OCD.” That’s probably not OCD. That’s probably particular, or a personality, or characteristic that they have where they like things a certain way.

But again, when people talk about having my desk, for example, is pretty organized. If you could see it right now. And you might ask me, well, tell me about this. And I would tell you that the organization on my desk doesn’t cause me any anxiety, but it actually helps me function.

So, things have a place and it’s functional, right? It serves a purpose for me. There’s not anxiety attached to it. There’s not fear attached to it.

I’m not going through and reorganizing it every night, making sure that the labels are perfect, making sure that, right, where with OCD, maybe somebody gets stuck going back and forth of, like, “Is this place exactly where it should be? Because if it isn’t something bad might happen and someone might die and it’s going to be my fault.”

Or writing and erasing multiple times to make sure their handwriting is perfect, because if it’s not perfect, something bad’s going to happen. Very different where that actually doesn’t serve a healthy function, that is simply serving our mental health.

It’s serving our anxiety. It’s serving our OCD. It’s serving our intrusive thoughts. Organization can actually serve healthy functioning. People will talk about how being organized, or having a system in place helps them function, and they find some joy or relief or benefit in it. That is not OCD.

That is when perfectionism or perfectionistic behaviors, I would actually say are healthy. And we talk a lot about OCPD, obsessive compulsive personality disorder.

And oftentimes these perfectionistic qualities or tendencies are actually OCPD not OCD, and what’s the big difference. OCD is egodystonic, right? Individuals with OCD do not like their intrusive thoughts. They do not like their rituals.

They do them because they feel like they have to, and they do them in an attempt to alleviate or get rid of the anxiety and distress that the thoughts bring on. OCPD individuals will talk about how these behaviors actually serve a function.

That, you know, yeah, organizing my closet while it might be annoying to organize it, afterwards I feel really good, and I really love the end product, and I actually find pleasure in the process, or afterwards I feel good about it.

I have a one year old. I feel like I’m constantly cleaning out her toys and organizing, and it feels great after. There’s not any fear or anxiety attached. I mean, sometimes it bothers me of how messy things get, but it’s like, afterwards, you feel good.

There was a function, there was a purpose compared to, I’m doing these behaviors because of my fear, and because of my anxiety, or because of my thoughts, and so I want you to think about the function, and I want you to think about the distress.

If you actually can say it serves a purpose, it’s probably not OCD, but it might be perfectionist qualities or tendencies. The piece here is, what is the impact it has?

For most people, especially like with OCPD, for example, they don’t really show up at our office, because to them, it serves a function, and it’s not really interfering in their life. What happens though is it does start to impact their family systems if it’s significant.

Because if you live with someone else and you expect other people to follow your rules, or your norms, or function in this way that you do, and someone else has the conflict with that, doesn’t agree with that, that’s when it can become problematic.

And so you still may want to address it even though for you, you may actually not see it as a big problem.

Jenn: So, if we have a loved one who is exhibiting both signs of perfectionism and OCD for example, the desk analogy you provided. If they don’t organize it every night before they go to bed, something bad will happen to someone they care about.

How do we actually address the “if, then” that’s showing that tie between perfectionism and OCD as the caretaker of that person?

Elizabeth: Yeah. So, if you’re a parent, I don’t want you to address it. I want you to get them to a great caretaker. If you’re a caretaker, we really want to use CBT interventions, and if it’s OCD, we want to use specific exposure and response prevention.

If it feels like it’s more general anxiety, you may use some more CBT interventions with exposures. But really what we’re going to do is we slowly and systematically want them to start taking perceived risks around not organizing.

And leaning into the uncertainty that might exist around things not being perfect, and something may or may not happen. We don’t have control over that. The big piece here is as a parent, if you’re seeing perfectionistic qualities that you are concerned about, you want to address those.

What we don’t want to do is just, “Oh, well, but like they’re getting A’s, so it’s great.” Don’t dismiss the fact that they’re still functioning, therefore it’s okay, because it will catch up with them.

And what you don’t want to happen is you don’t want your child to go off to college, and when they go to college, the perfectionism is so significant and severe, that they start to actually really struggle to make good grades because they’re not turning in products because they’re rereading them.

Every email you send to your boss, you’re going back and reading in your inbox and ruminating overnight of, “What if I said something wrong? What if I didn’t do it perfectly? What if they’re upset with me?”

Now this is destructive, and so the earlier we can catch it and just start to give some healthy techniques the better. The big thing I want to talk about for a second is like one of the biggest fears I hear, and the biggest feedback I get is, “Yeah, but Liz, doing well academically, is important to me.

And so I don’t really want to do therapy, if that means that, then I’m going to start doing bad academically.” It’s kind of like with the religious subtype of OCD called scrupulosity, we’ll always hear people say things like, “But my faith is important to me and I don’t really want to do treatment if you’re going to take it away.”

And that’s when we really need to help educate on the goals of treatment. The goal of treatment for scrupulosity is not that I make you less faithful.

It’s actually that you will have a more healthy, better functioning faith relationship when OCD isn’t involved, and that often your faith becomes stronger because it’s not controlled by anxiety, OCD, rules, and rituals. It’s just you’re able to practice the way you want.

And it’s the same with school. Our goal is not that we make you a bad student, or that we make you okay with turning in bad products at work.

But we want to remove the rules and rituals, that you feel bound by, that are interfering with you, and that are really making work and other things kind of miserable, and a lot of anxiety provoking situations, even more anxiety provoking.

Jenn: We had a couple folks asking for additional clarification between OCD and OCPD, so do you mind going back a bit?

Elizabeth: Sure. Sure. So, the biggest thing I’ll say is the function, and the enjoyment or pleasure. So, let’s talk about OCD. So, the defining characteristics of OCD are number one, the obsessions, the O, which is unwanted intrusive thoughts.

So, these are thoughts that are bothersome, they’re anxiety provoking, we don’t want them, we want to get rid of them, they cause us a lot of distress, they go against who we are as a person. The C in OCD is compulsions. The compulsions are repetitive behaviors or rituals. These can be mental or physical.

So, it could be a prayer. It could be rumination. It could be thinking, replaying a memory or a past situation, or it could be a hand wash, going through a doorway, you know, whatever it may be.

These compulsions are done in an effort to get rid of that intrusive thought, the obsession, and they don’t bring the individual joy or pleasure. So, the individual does not like doing the compulsion.

They’ll talk about how it’s annoying, they hate it, but they do it because they feel like they have to, they feel like they don’t have any other choice. And then of course the D and OCD is disorder.

So, when is it disruptive? When does it interfere with our life? And that’s when we diagnose it. With OCPD it’s quite the opposite.

So, most individuals with OCPD will talk about how they’re rituals, because it is still kind of ritualistic in the sense that maybe they like to organize their closet, and so the organization in and of itself is kind of a ritual, or they like to have their water bottles lined up perfectly in their fridge, or whatever it might be.

They may still do some rituals, but there’s often not a fear attached with the intrusive thought that’s disruptive and anxiety provoking and that scares and terrifies them. Instead, it’s much more about rigidity and there’s a right and wrong.

And oftentimes with the OCPD, individuals will say things like, “I’m not worried about something happening. It’s just, this is how this should be done. This is what’s right. This is what’s wrong.” Or, “Why would you not organize your closet that way?”

Compared to maybe someone with OCD, organizes their closet in a way of like, those clothes are contaminated, these clothes are not, they can’t touch each other ‘cause something bad’s going to happen.

Compared to, “Oh, no, they’re organized by color and style because that helps me function.” The biggest piece is that with OCPD, individuals will talk about how the rituals serve a purpose.

The rituals, while the organization might be kind of annoying to them at times, there is an outcome in the sense that, “Once it’s done, I feel really good. I enjoy the end product. It’s something that’s useful.”

So, I was doing consulting for a new provider recently, and he was talking about how he had a patient who had some OCD behaviors, but then also on his phone, he kept his home screen very organized, which I do as well, frankly, and I keep all my stuff in these little kind of boxes.

I want to get rid of my emails so I can show you, but sorry. See what happens when I try to pick up. So, you look at my phone and there’s just three boxes and everything’s organized, there’s my daughter too.

But he said to me, you know, the patient said to him said something like, “Are you going to make me unorganized my phone screen?” And the provider was like, “So do I need to do that?” And I said, “Well, what is the fear?”

And for the individual, he was like, “Oh no, I just literally, like, that’s how I function.” So for me, it’s how I function. I like things organized and clean. I don’t need to address that in treatment because it doesn’t impact my life. It’s something that I actually find helps me. It helps me be able to use my phone more efficiently.

I’ve got a box for my kid, a box for like finances or whatever, and it serves a healthy purpose in the sense. And so we talk a lot about this with surgeons, surgeons often talk about how in the operating room, they have a system.

Whether it’s the way that their tools are laid out, whether it’s the way that people hand them things, or the languages they use, but like it’s their system. It helps them function, and it might feel rigid, it might feel kind of annoying to other people, but for them, it allows them to not have to worry about those other things, they can compartmentalize.

So again, there’s a healthy purpose or service to it. With OCD, no one is talking about that. People with OCD are talking about how they hate the thoughts, they hate the compulsions, but they do them because they have to. The compulsions are not helpful. They do not serve a purpose.

Now of course, OCD will trick you. So, it will make you think that hand wash is useful, ‘cause you think it’s keeping you safe, but you’re able to acknowledge that like, I don’t want to be doing this, and I know that if I didn’t have OCD, I wouldn’t be doing this behavior.

Jenn: Got it. I want to backtrack back to perfectionism. I wanted to ask you about some of the signs and symptoms of kids that may be exhibiting perfectionist tendencies, but more importantly, do they change, do these signs and symptoms change as they get older?

Elizabeth: For sure. You know, I mean. If left untreated, things are always going to change, they’re always going to get worse and they could shift, but the signs and symptoms I want you to look for is, again, the function. Is your child functioning at a level that makes sense, and is it normal or not?

So for example, if classmates are saying that this homework assignment takes them 10 to 20 minutes, but it’s taking your child one to two hours, because even though they finish it in 10 to 20 minutes, they’re rereading it, they’re going back over it, they’re double checking, they’re triple checking.

That is a sign of like, okay, what’s going on? If you see your child writing and erasing, and rewriting and erasing, and sometimes we’ll see things like holes in the paper, because they’ve erased so much, because the letters needed to be perfect, and they needed to make sure things were okay.

Getting ready in the morning. Does straightening their hair, take them a normal amount of time or do you find, that they get really stuck and anxious?

So, my mom always talks about some of my... I live with OCD and I talk a lot about my personal story, but she talks about when I was a kid, just like little signs where I was a gymnast, and when we would do gymnastics meets, we would always put our hair in a ponytail, but how I would get so fixated if there was a bump.

And it would cause me this amount of anxiety and distress that wasn’t normal, not just, “Mom, I don’t like the bump.” It was overwhelming, and they would have to redo it, and redo it until it was perfect because I had so much anxiety and my distress, or my response was not a normal or healthy response.

And so as a parent, you typically know, this is where you can and should follow your gut a little bit. If it’s within a normal realm or you’re like, this is above the norm. So, are you seeing them spend excessive time on homework?

Are you seeing them start to avoid doing homework, or doing things they need to do because, it causes them so much anxiety to think about doing it that it’s easier to avoid it altogether.

So, sometimes perfectionism can actually be someone not doing assignments and someone making bad grades, because the anxiety around doing the assignment and how hard that will be for them to have to do it perfectly, makes it where they avoid it altogether.

And then of course, typical mental health signs and symptoms. Are you seeing disruption in their friendship, and their functioning, and the way they eat, the way they sleep, and just are you seeing them start to ask a lot of repetitive questions?

Are teachers noticing some things that, you know, classroom assignments take much longer than they should, that sort of thing?

Jenn: Have you heard of the phrase maladaptive perfectionism? And if so, do you have any guidance about how to address it and help our kids become a little bit more flexible?

Elizabeth: Yeah. So I mean, I think maladaptive perfectionism is exactly what we’re talking about. This is when there’s potentially a diagnosis somewhere. When is perfectionism helpful for us?

Where like, “Oh yeah, we like great quality things and we turn things in,” and I’m somebody that hopefully, Jenn, I live up to the standard, but I don’t always lately, but you know, I respond to emails quickly. I take care of things ‘cause it’s how I function.

Jenn: You’re great. You’re great. Don’t worry about it.

Elizabeth: Is it. Is it disruptive to me? No. Do I lose sleep over it? No. But it helps me function to be like, “Okay, taking care of that, that task is done and it’s gone.” Am I rereading emails to make sure that there’s no spelling errors? No. I’m not.

Maybe if it’s to our president, or Dr. Rauch or someone like that, sure. But you know, that’s really, the big piece is for us to kind of say, is it adaptive? So, does it help us function? Is it useful or is it maladaptive? So, is it starting to actually impact functioning and it’s not useful?

Jenn: Have you heard about kids being selective underachievers because instead of branching out beyond things that they’re good at, they just fixate on the things that they’re naturally good at?

And a follow up question would be, could you provide any guidance on how to help them branch out into the things that they might not naturally be gifted with from the start?

Elizabeth: Yeah.

So, you know, I actually want to pose this of like, is it that they’re focused more on only the things they’re good at, or is it because they’re so afraid of failing, or they’re so afraid and have so much anxiety around things not being perfect, that they’re not willing to try something new?

Either way, we’ve got to teach them to try new things, and we have to teach people to have experiences where we don’t always win. We’re not always perfect because that is actually how we learn and grow.

None of you as functioning adults will say that you are where you are, because you always did things right, and you never had a failure or bad experience. Our strength comes from our struggles. Resilience is built by these tough times, or these defining factors or learning.

Most of us don’t learn because we always did things great. We learned because we had to struggle. We had to learn a new concept. We have to understand it.

And so we really want to teach kids that, and this is where it’s really important for us to not get so black and white, and I will tell you, schools play a big role in this. I see a lot of kids from very high level private schools, and the perfectionism is really, really big there.

Not just because the school has these certain expectations, but so do their friends. And in the fifth grade they’re talking about SAT scores, and what school they’re planning to go to, and the competition is so strong. And sometimes it’s important as a parent for you to say, is this the right fit for my kid?

Because some kids can do okay with that, and kind of in one ear and out the other, and still manage themselves, and for some kids, it will tear them apart, and it will really impact their identity, and their functioning, and who they are?

And you need to kind of be thinking about that, but you also want to give them support. The thing you mentioned earlier that I didn’t loop back to that I want to, is really flexibility is exactly what we’re teaching people.

We are teaching people, we’re teaching individuals how to be flexible in life. How to take challenges, how to take difficult situations, and be flexible in anything, whether it’s OCD, whether it’s GAD, it doesn’t really matter, social anxiety.

We’re not trying to teach you that you’re never going to have a bad social experience, or for OCD, I’m not trying to teach you that nothing bad is ever going to happen. ‘Cause I can’t guarantee that, but I’m trying to teach you how to be flexible and how to live in the unknown.

Jenn: One of the things that you have addressed a couple times throughout the session so far is about, what you’ve seen in your practice, and I’m curious about as a provider, how you’ve addressed perfectionism in your patients who are in different ages and stages of life?

Elizabeth: Yeah. It’s all about coaching and teaching flexibility, and leaning into uncertainty.

So, we want to solely and systematically work on it. If a child is presenting with perfectionism around school performance. We’re not going to start with having them address a huge exam the first, week one.

We’re going to start with, “Okay, well, are you willing to turn an assignment in and only read over it once? Are you willing to read a book chapter, or read a chapter, or section of a chapter, whatever your homework is, and limit the amount of times you reread, or the amount of notes that you take?”

But eventually, we want kids being willing to read a chapter and leaning into the fact that like, “Yeah, I may have absorbed a lot of it, but I may not have absorbed all that information.” I want you to have more flexibility versus rigidity of like, I have to have understood everything perfectly.

I have to know exactly what I read, exactly what, we want to practice flexibility. We want to practice living in that, not to say good enough, but kind of good enough. That, like, “I’m okay with this.”

The biggest thing I will ask my patients with perfectionism is if you didn’t have perfectionism, what would doing this homework assignment look like? Because it’s really important for us to recognize that there is not a standard.

For some kids, they would always reread a homework assignment, and that would be a normal behavior for them. For some kids, they would never reread a homework assignment and that would be normal behavior for them.

So, it’s kind of like church. It was scrupulosity with OCD. For some patients, they might pray for an hour a day, and that’s what their norm is. Where for some people they want to be able to pray without rules and rituals for less than five minutes a day, and that’s their norm.

There’s not a right or wrong, this is where it’s like, what would you want, if you didn’t have OCD and anxiety, what would your behaviors look like? “Well, I’d rather be playing at the park with my friend and quickly do homework and get back to life.” Okay, great. Then that’s our goal.

And so what does that, quickly doing homework look like? And so we really want to, you know, this needs to be goal oriented from our patients. We want them to dictate what their norm would be, and what it would look like so, that we can help them get there and help them achieve that.

Jenn: If someone tuning in is a teacher or a caretaker outside of the home, how can they talk to parents, caregivers, guardians, about perfectionist behaviors that they see their children exhibiting?

Elizabeth: Yeah. You know, I think this is a tough question. Especially, if the parents feel like it’s serving a purpose. “Well, they’re making A’s so why is it a big deal?” Or like, “Oh, but it helps them, and so it’s fine.”

It’s really about teaching them flexibility and thinking through long term functioning. So yeah, right now they may be making A’s, but at what cost? If it’s at the expense of friendships and it’s at the expense of life, imagine what’s going to happen one day when they get a job?

We don’t want somebody to have a job where at five o’clock, when everyone else leaves their office, they stay till 10:00 PM, double checking their work and resending it for the day, because they don’t want to have accidentally made any errors, and they lose out on friendships, or taking care of themselves or self-care, and all these other important things in their life.

And so the way I always want to talk about it is that the treatment for perfectionism, us teaching individuals how to lean into anxiety versus running from it. How to address it appropriately and healthy versus giving into it or succumbing to it.

It will have such a long term impact on their life. This will not just be applicable to perfectionism, it will be applicable to so many different things. When you think about anxiety, nobody doesn’t have anxiety, no one in today’s world doesn’t live with anxiety to some degree.

But there’s a big difference between when anxiety can be healthy, it can be functioning, sometimes it can be disruptive, compared to it’s constantly disruptive and it gets worse.

And what we know is that if we don’t treat things now and help teach people how to be flexible, how to address anxiety, how to not be afraid of it, it will get bigger.

Jenn: So, I think the $64,000 question here is, how do I talk to my kid about their perfectionist behaviors, and how should I frame it depending on how old they are, or how severe these tendencies seem to be?

Elizabeth: I would say if it’s pretty severe, I really want you to be thinking about taking them to see a provider. I don’t want you to be just talking to them at home and trying to be their provider.

So, sometimes the conversation is much more about going to a provider. So it may be more of like, you know, “Hey, I’m seeing these things, and what I know is that I want you to be carefree and I want you to be able to function, in a way that’s really healthy and that serves you, and I’m worried that if we don’t address this, it’s going to really be disruptive.

And what I want you to know is that you can do great in school, but it not be overwhelming. It doesn’t have to be anxiety provoking. It doesn’t have to impact your sleep, your eating, your functioning. And so let’s get some help and let’s talk about how we can help you together.”

And let’s really join with them and help them feel supported and that this is a process we’re going to do together, not just, “Oh, you need to go work on this and address it.”

The second piece is, you know, if you’re just starting to notice some things, it’s really talking to them about the why, and what’s going on. You know, “Hey, I see you’re feeling really anxious about this exam. I know you’ve studied. You’re well prepared. What’s going on?”

“Well, if I don’t get an A, then,” and, you know, and so, kind of like, do you see these core fears as being pretty normalized, or are they really disruptive? And at that point, then we need to seek treatment with them.

The biggest thing though is, can we normalize perfectionism? We are in a world where comparison is bigger than it’s ever been. It’s on social media, it’s all over the place. It’s in the classroom, you name it.

And so I really want us to normalize it, but also to normalize that individuals don’t have to struggle. I think a lot of people have started to... It’s interesting because I’m really proud and grateful for the stigma reduction that’s happened in the mental health and anxiety world, and I think we’re talking more about mental health and anxiety than we ever have.

At the same time, one of the things I’m seeing happening that kind of scares me is I feel like people are accepting that anxiety and mental health struggles are normal, and that they just have to accept that you have to struggle with them.

And what I want us to do is accept, I want us to normalize mental health, but I don’t want us to accept that it has to be disruptive, or that we should just accept struggling. And so talk to your kids about that, that if you’re struggling, help is available, and we can allow you to have freedom so that these things don’t cause struggles.

Jenn: In regards to perfectionism and body image, what are some ways that we can identify if there’s an issue? And if there is one, how can we help kids get past this perfection mindset and allow them to be more happy and relaxed about themselves and how they look?

Elizabeth: This is tough. You know, it’s a question I wish I had the total answer to, and I’ll be honest, body image is not my specialty.

What I know though, and what I see is that the comparison on social media has just made this so much worse for kids, or at least it appears to be so much more in their face and prevalent, than what I’ve seen in the past.

I think the biggest thing is how can we teach self-compassion, self-love? And what does that look like as far as accepting ourselves for who we are and being proud of ourselves? And then the second piece is, there are things we need to limit.

There are some times where with kids, we need to limit exposure to certain social media, or to certain things because it’s, you know, remember as adults, we can look at a social media image of the Kardashians and know and understand, they probably took a million photos and had lighting, and they have makeup and they have airbrushing, and we can understand that.

A child, their ability to process that and understand it and see it as different and not necessarily real life is not there the way it is for us, and so there is... It’s kind of like, when COVID first happened and we were talking about like, how do we protect kids versus not, what does it look like?

And we talked a lot about, how leaving the news on was really detrimental for kids, just because every time a kid would hear about someone dying from COVID, even if it was the same story to them, it was a new death.

Kids, they’re not really necessarily able to fully understand that like, that’s the same situation or the same story. And also can they process that the way we can as adults?

Like, when is it helpful for us to say, and even as adults, right, we all had to start to set our own limits of like “I’m not going to leave the news on all day,” or “I’m not,” right, because then it’s overwhelming, it’s all-consuming, it’s all I can think about, it’s all I can do.

And so we want to think about healthy limits. I want you to be screening for BDD. I think this is really important. We want to understand, and eating disorders or disordered eating. We want to know, is there anything that goes much further than what just appears to be anxiety and body image fears?

Is that as far as it goes, or is there something else deeper rooted, what’s at the core, what’s at the root? And be able to get them to a specialist. I will tell you if I am able to diagnose and see that there’s disordered eating, I’m not going to try to treat it because I’m not an eating disorder specialist.

I’m going to refer them to an eating disorder specialist, so that they can treat it appropriately. And then of course, if there’s hair pulling, skin picking, anything like that related as well to the body image stuff, we want to address that as well.

Jenn: Do you have any suggestions for caregivers where the child might be using perfectionism as a way of gaining additional attention? And if so, how do we address that? Both as the caregiver addressing what’s going on, but also, do we talk about it with the child?

Elizabeth: For sure. So, I don’t believe in not talking about things with kids.

I think that, you know, in healthy ways, obviously, but also can we practice flexibility? Can we practice praising them and giving them attention when they didn’t do something perfectly?

You know, because the reality is, is that we should be praising kids for trying. We should be praising kids when they have struggles, but they gave it an effort, right? They were brave, they were courageous. They were strong.

These are some of the most important qualities for us to praise way over someone getting an A. And so, what can we do that we can really help promote and push that in a healthy way?

Important to remember though that kids cannot learn, individuals, adults cannot learn, if we’re experiencing shame at the same time. And also if we’re experiencing stress.

So, if a child is really distressed, that’s not the time to make them do something more challenging. We want people to be in a good stable state when we’re asking them to face new experiences or challenges that they’ve otherwise avoided or resisted.

Jenn: Do you-

Elizabeth: I think about this with my kid just because I have a daughter that I put her in ISR, which is infant swim rescue, and it’s this class where they teach them how to float. And she was doing fine at the beginning and then she really started to have almost a trauma response.

Like you would just show up at the place. Her lip would start trembling. She would start crying. And I gave it a day or two, and then I was like, we have to pull her from this class because the reality is, is that she can’t learn when she’s distressed.

And so we’re making no progress and we’re just causing further stress compared to being able to say, “Okay, can I learn the techniques as a parent and maybe teach her that at home in my own pool when she’s not feeling as stressed, and I know the learning is going to happen so much quicker and be so much healthier for her.”

Jenn: Do you have any ideas then for how parents could support kids a little bit older than your daughter, of course, who would get frustrated or stressed when they can’t do things perfectly, but they also don’t want the help of their parents?

Elizabeth: Yeah. Yes. This is the million dollar thing. What teenagers do want help from their parents? It’s a hard thing, I think.

So, what I always want to say to this is, how can I support, as a parent, I want to know if I were to support you in a way that you appreciated, or that you liked, what would that look like?

And maybe for that kid, they might say, you know, “Hey, every 10 minutes, can you check in on me?” Or, “After 30 minutes, can you just make sure I’ve submitted this assignment? ‘Cause at that point I should be done, and I’m overdoing it.”

What would healthy support look like? And then as a parent, you have to be willing to follow those boundaries that they help set. And so if a child says, this is what I would want and I would need and would be useful, it’s important for you to respect that and to not overdo it.

The second piece though is if the struggle is severe, and the individual is in treatment, I want you to work with the provider to come up with the plan. Don’t, as a parent, try to be a provider. Even if you are a provider. You’re not their provider, you’re their parent.

My mom always said, I want to be Liz’s mom, not her clinician. And so there were times she set boundaries, but my therapist was helping set those boundaries with us as a family and helping to find that, and then I could help follow through.

And if it didn’t work, don’t get into a power struggle or debate, talk to the provider about the fact that it’s not working and let them help readjust it.

Jenn: I think that’s such an important distinction too, that parents don’t always have to be providers.

Elizabeth: Yeah.

Jenn: Period, full stop. Because obviously parents want to be the person that fixes everything for their kid, and sometimes that’s just out of their scope.

And I think that setting that boundary is helpful for both the parent to recognize where their limitations end, and also for kids and recognizing that there are other people that are part of a support system.

Elizabeth: Totally. You know, and I get it as a parent. It’s like, well, no one knows my kid the way I do. I would probably say the same thing.

At the same time, nobody can offer, as a parent, you are limited in what you can offer them in an effective way because you’re their parent, and they want you to be their parent.

And so, if my daughter starts exhibiting signs of OCD, I may early on start to do some helpful, you know, try to set some helpful things in the house to prevent it from becoming a diagnosable condition. But if it’s diagnosable, I’m not treating her.

A provider’s going to treat her, because I need to be her parent. I need to support her and love her if she’s struggling, not be the person making her do therapy at home 24/7.

Jenn: Do you have any recommendations for providers that are working with younger kids? So, like ages seven to 10 who have perfectionist tendencies with emotional dysregulation and cognitive rigidity. So, someone-

Elizabeth: Oh boy.

Jenn: Yes.

Elizabeth: Okay. So, the first part is-

Jenn: Go ahead.

Elizabeth: Please. Please. Please. Go to ocdintheclassroom.org. So this is the International OCD Foundation has put together an incredible entire website resource, that has sections for parents, for teachers and for children dealing with anxiety.

And it will help give you tools and tips and options of what to do. If there are other things going on, so emotion regulation, let’s talk about emotion regulation for a second. If a child is really emotionally dysregulated?

The emotion dysregulation needs to be addressed first before we start to address perfectionism. Well, why? Well, because when we address anxiety or perfectionism, we are going to dysregulate you.

A part of the treatment is learning to live with anxiety. So, what it means is, so treatment in general, CBT, exposure therapy, ERP. When we experience anxiety, we’re teaching you not to respond. We’re teaching you to let anxiety be there, to not do anything about it.

Well, that’s going to dysregulate you. That’s going to make you uncomfortable. That’s going to make you more anxious. If you don’t have emotion regulation tools, it is going to be really difficult.

And so if we find that children are dealing with emotion dysregulation at the level where they are having behavioral problems, they’re having any sort of significant emotion regulation issues.

We want that to be addressed first because it’s not going to be good if we emotionally dysregulate you, if you don’t know how to cope with dysregulated emotions. And then there was another question within that, about cognitive something that I can’t remember.

Jenn: Cognitive rigidity. So, like being focused on this is one way to do it. This is the only way to do it.

Elizabeth: Yeah. So, the cognitive rigidity, I think we can address with perfectionism. Because again, the goal of treatment there, is we’re teaching you how to apply flexibility and how to be flexible. And so that will address a lot of the rigidity.

But again, as we were talking about earlier, we want to understand the functioning. Is this more of cognitive rigidity of there’s a right and wrong, and this is how it should be done, and this is how it should be done or not, where it might fall more in the OCPD realm versus OCD realm.

The reason that’s important, as was brought up earlier, and I want to go back to that too, is that OCPD 100% can be disruptive and can impact someone’s functioning. It could be OCPD characteristics, where it doesn’t really impact our functioning, but like we have certain...

I have certain OCPD characteristics. My desk, maybe my phone, my fridge, my closet, but it doesn’t disrupt my functioning. So, it’s probably not a diagnosis. And I appreciate that comment coming in earlier because it’s like, “Oh yeah, let me better clarify that.”

If someone’s being diagnosed, it’s impacting their functioning. The reason it’s important though is if a personality disorder, we do need to understand everything that goes into it and how it looks different than OCD because the treatment is going to be augmented differently.

We’re going to be treating OCPD much different than OCD, because OCD, it’s really about treating the thoughts, and leaning into uncertainty where with OCPD it might be more about learning flexibility and some other tools that would be better, more important for personality disordered patients to learn how to utilize.

Jenn: Do you have any advice for creative ways that we can help young kids unlearn perfectionist behaviors?

Elizabeth: Yeah. Making errors. So, we do this all the time. So, things like, painting, making a painting that looks messy and sloppy. Turning in an assignment with your handwriting not perfect.

Maybe sometimes you use cursive and sometimes you don’t. Having you write a letter or send an email. We do this all the time. Having you send an email with a typo in it. Having you send a text message that has a typo in it or that you don’t reread.

But like purposely doing things that feel off, feel wrong, and that don’t feel perfect so that we can teach you that while it might make you a bit uncomfortable. It’s not dangerous. It’s not scary.

Jenn: So, one of the things I wanted to talk about is when we typically look at mental health on social media platforms, we’ve had a couple of folks ask about this.

While it’s great that mental health is being addressed and stigma is being reduced around acknowledging mental health, there’s obviously some misinformation out there, even if it is with the best of intentions.

So, folks want to know, do you have any advice on how to decipher what is the right information versus things that may be misinformation?

Elizabeth: Yeah. This is like what my life goal is. You know, so first of all, there’s organizations that specialize in different diagnoses.

So, if you’re living with OCD, I want you to join and think about the International OCD foundation, iocdf.org. If someone’s dealing with anxiety, I want you to think about the Anxiety Disorder Association of America, adaa.org.

So, think about, are there governing bodies? There’s ones that exist for trichotillomania, you name it. And are there these kind of governing nonprofits that hopefully are going to help provide resources and tools within them that are evidence based.

And then that’s the biggest piece, is it’s all about evidence based care. At the end of the day, just because somebody has CBT background, doesn’t mean they can treat every disorder that CBT is effective for.

I, for example, am an OCD specialist. There’s no doubt. But does that mean I specialize in hoarding? No. Do I understand hoarding? And if someone lives primarily with OCD, and they have hoarding tendencies, could I get some consultation and treat it? Sure.

But if someone’s presenting with primary hoarding, I’m going to refer them to the hoarding specialist in town that I work with because that isn’t my specialty. And so it’s really about, can we refer and can we make sure that we’re encouraging individuals to seek out evidence based care? Because that is absolutely critical.

Sorry. I gave the wrong website I hear, so let me-

Jenn: That’s quite alright.

Elizabeth: Figure out what the right one. Did I say OCD in the classroom?

Jenn: Yes, you did.

Elizabeth: Oh, sorry. It’s anxiety in the classroom, which is even better.

So, it’s much more, it’s applicable, that’s what I was saying, to all of this. So, it’s anxietyintheclassroom.org. It used to be OCD in the classroom, but I forgot we totally broadened it, which is awesome.

So, go to anxietyintheclassroom.org, and it’s brought to you by the International OCD Foundation. But it’s incredible. It’s an amazing resource with great tools.

Jenn: Beyond Anxiety In The Classroom and the IOCDF website. Any other resources that you’d recommend for folks listening about perfectionism?

Elizabeth: There’s so many great books, so many great resources. I would go to, iocdf.org and look up books and resources specific to perfectionism ‘cause they’re always updating theirs.

You know, but really when you think about individuals who treat anxiety and OCD, we should be able to treat perfectionism ‘cause it often goes hand in hand.

Most important thing is the individuals, anyone who treats perfectionism needs to be really well versed in cognitive behavioral therapy and really well versed in exposure therapy, and that’s critical. You want them to have background and experience.

If after a thorough assessment it’s determined that it’s actually OCD underlying or BDD underlying or disordered eating, make sure you’re seeing a specialist in that area. Don’t just keep going to someone who does CBT work, but they maybe aren’t an OCD specialist, if it’s actually OCD based.

And so this is where, what I was saying at the beginning is let’s not just look at perfectionism on the surface, let’s get to the core of what what’s going on, and what the diagnosis may be.

Jenn: Are there any screening tools for perfectionists that you would recommend, that even parents might be able to use?

Elizabeth: You know, there are OCPD screening tools and other ones that I don’t know offhand that you can look at.

For OCD of course, our screening tools, our most effective one is the Y-BOCS, the Yale Brown Obsessive Compulsive Scale, Y-B-O-C-S, and it’s the CY-BOCS for children, so Children Y-BOCS.

But there’s so many different screening tools that can be useful. The thing I do want to like wrap back around to OCPD, a hundred percent as we talked about, and I corrected myself OCPD can be disruptive, and when we’re diagnosing it, it’s really interfering with their functioning. It’s a personality disorder.

Not all perfectionism is OCPD though. I want to be very clear about that, that I feel like maybe I want to make sure there hasn’t been an understanding that, “Oh, if someone lives with perfectionism, they have OCPD.”

Like perfectionism can actually be OCD, not OCPD. It can be generalized anxiety disorder. It can be rooted in BDD and not OCPD. It doesn’t have to be both. However, it could be both. So, about 20% of individuals with OCD live with OCPD as well.

And so, you may have both and this is where it’s important to say, which is which. That organization on that patient’s phone might be more of an OCPD tendency, or maybe it’s a characteristic, but they don’t meet OCPD diagnostic criteria.

But they’re hand washing or their excessive contamination fears might be OCD. So, we really want to understand what’s rooted in what so that we can appropriately treat it.

Jenn: And then my last but certainly not least question is, any imparting words of wisdom that you’d like to share with folks before we sign off.

Elizabeth: Yeah, I mean…

I think the most important thing I want to make sure we’re ending with is that it doesn’t matter if someone’s dealing with OCPD, if someone’s dealing with perfectionism, if they’re dealing with OCD or BDD or eating disorders, there’s effective treatment available.

But what does matter is that we make sure we connect them with effective treatment and effective resources. And with that, we’re really thinking about evidence based interventions. And so that’s where I’ll go back to step one is really getting an appropriate diagnosis.

We want to understand what exactly is going on. What’s the full picture? The thing I want to bring up really quickly is that, oftentimes individuals do talk about kids who are following rigidity and it feels like perfectionism, and saying things like, “Oh, they have OCD, they line things up a certain way.”

And when we do an assessment, we recognize that there’s ASD, or an autism spectrum disorder going on, right? And that sometimes this rigidity and these rules are not about perfectionism, they’re, they fit autism better.

And so we really want to understand the symptoms that are being evaluated and that the child or individual is presenting with, what are they? What is going on? What’s at the root?

And then think about a specialist. Not everybody who diagnoses is the specialist for, is a person who should be providing the treatment. But help and hope are always available, and we have to send that message.

I don’t want anyone to send the message that like, “Oh, perfectionism is normal, kids struggling is normal. That’s just how it is. They should just accept that.” Like, no, mental health conditions are, we should normalize them.

We shouldn’t be afraid of them and stigmatize them, but we should also encourage people to seek help because you don’t have to accept that because you live with a mental health condition, or because you’re struggling with perfectionism that you need to struggle forever.

Jenn: And I could not think of a better way to wrap this up. So Liz, thank you so much for joining. This has been a wildly interesting and fascinating conversation.

And to anybody tuning in this actually concludes our chat about perfectionism. So, thanks so much for joining and until next time, be nice to one another, but most importantly, be nice to yourself. Thanks.

Elizabeth: Absolutely.

Jenn: Have a great day.

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