When Perfectionism Leads To An Imperfect Appearance

For perfectionists, each day is a new opportunity to strive for success and avoid failure. Each day may also be the continuation of self-directed judgment and dissatisfaction due to one’s expectations of the self and the inability to achieve the impossible “perfect” appearance. When everything, according to the eye of the beholder, must be perfect, nothing is ever good enough. The continuous striving for something unattainable results in unpleasant emotions which are felt quite strongly.

Perfectionism is one characteristic of the “Type-A” personality. Other characteristics include an extreme level of competition with one’s self and others resulting in overworking and lack of enjoyment; striving and attaining goals without feeling happiness or satisfaction; a constant sense of urgency where unproductive time is viewed as a waste or a weakness; impatience and always rushing; easily angered and hostile; intolerant of free time/down time/unstructured time; and less tolerant of others. The aforementioned results in an individual who is tense, or “wound tight”, rarely happy, and spends the majority of life thinking about what is to come or what needs to be done next rather than living in the present moment.

Various research studies have shown that those with “Type-A” personality are at an increased risk for stress-related illnesses due an elevation in cortisol (the stress hormone). These same individuals are more susceptible to anxiety and depression due to constantly thinking about the future, rushing, and taking action, as well as feeling dissatisfied with one’s self and one’s place in life, while neglecting time spent engaging in fun, pleasurable activities.

Body-Focused Repetitive Behaviors

Then, what does one do with these strong, self-directed negative emotions? This is where coping strategies become essential. Researchers suggested there are two types of coping responses: emotion focused and problem focused. When the perfectionistic perspective on life is the source of stress, the sensible treatment approach is to work on restructuring thought processes as well as choosing positive, healthy coping strategies to reduce the negative emotional responses that come from stress.

Selected coping strategies are vast, ranging from positive and healthy to negative, extreme, overindulgent, or damaging. Body-focused repetitive behaviors (BFRBs), such as skin picking, nail biting, or hair pulling, are one family of behaviors selected as a maladaptive coping strategy. 

These behaviors are maladaptive because they lead to distress, impairment, and dissatisfaction with life or one’s self. Yet, according to the Frustrated Action model, BFRBs are triggered by – and also lessen – impatience, boredom, frustration and dissatisfaction. Does this sound like identified emotions of the Type-A personality? The problem here is that although these behaviors may reduce such feelings, the aesthetic consequences of the behavior (baldness, damaged skin, scarring, bald patches, swelling, bleeding fingers) are counterproductive to lessening dissatisfaction of one’s appearance. Instead feelings of unhappiness and dissatisfaction are exacerbated.

One study compared BFRB urges among those with a BFRB and a control group in an experimental condition which prompted feelings of boredom/frustration, stress and relaxation. For those in the BFRB group, there was a significant difference in urge when comparing the boredom/frustration condition to the relaxation condition. There was a stronger urge to engage in the behavior in the former rather than the latter. However, there was not a significant difference when comparing results between boredom/frustration condition or the relaxation condition to the stress condition.

These results are reflective of perfectionistic tendencies given that those with perfectionism may place undue stress on themselves which results in accomplishment and achievement, and may not increase BFRB urges due to being busy and accomplishing (which brings some level of satisfaction). However, those who view themselves as perfectionists, or of a Type-A personality, may view boredom to be a waste of time where one can be getting ahead of others and bettering oneself.

The irony is that those who are perfectionists and also pull, pick, or bite are lessening their chance of viewing themselves or having others view oneself as perfect. Yet, this choice to act upon the urge is not something that one may necessarily make the conscious choice to engage in as a coping strategy. It may only be selected because it is a quick, easily, and readily available tool for emotional coping. After all, time is precious to the Type-A personality.


Diefenbach, G., Mouton-Odum, S., & Stanley, M. (2002). Affective correlates of trichotillomania Behaviour Research and Therapy, 40 (11), 1305-1315 DOI: 10.1016/S0005-7967(02)00006-2

Folkman S, Lazarus RS, Dunkel-Schetter C, DeLongis A, & Gruen RJ (1986). Dynamics of a stressful encounter: cognitive appraisal, coping, and encounter outcomes. Journal of personality and social psychology, 50 (5), 992-1003 PMID: 3712234

Frost, R., Marten, P., Lahart, C., & Rosenblate, R. (1990). The dimensions of perfectionism Cognitive Therapy and Research, 14 (5), 449-468 DOI: 10.1007/BF01172967

PÉLissier, M., & O’Connor, K. (2004). Cognitive-Behavioral Treatment of Trichotillomania, Targeting Perfectionism Clinical Case Studies, 3 (1), 57-69 DOI: 10.1177/1534650103258973

Roberts, S., O’Connor, K., Aardema, F., & Bélanger, C. (2015). The impact of emotions on body-Focused repetitive behaviors: Evidence from a non-treatment-seeking sample Journal of Behavior Therapy and Experimental Psychiatry, 46, 189-197 DOI: 10.1016/j.jbtep.2014.10.007

Image via Sam72 / Shutterstock.

Lindsey Muller, MS, LPCCI

Lindsey Muller, MS, LPCCI, is a mental health therapist specializing in body-focused repetitive behaviors, such as trichotillomania, dermatillomania, and nail biting. She is the author of Life is Trichy and works in private practice in Los Angeles, California.
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