[Perfectionism: conceptual and clinical aspects]

Abstract

Objective: Study of the concept of perfectionism and its phenomenology, etiology, and treatment.

Methods: Review of the literature, phenomenological, and-clinical analyses.

Results: The International Classification of Diseases introduced the notion of perfectionism into psychiatric discourse in 1977. In DSM-III, DSM-III-R, and DSM-IV, perfectionism is a diagnostic criterion of obsessive-compulsive disorder, but has never been defined in the psychiatric literature. We differentiate normal perfectionism and pathological perfectionism, which is of some psychiatric interest: normal perfectionism is manifested according to the aptness of the target and its sociocultural value, and is therefore selective and flexible, whereas pathological perfectionism is the compulsive pursuit of a performance level not required by the circumstances and idiosyncratic in nature. Its symptomatology may resemble that of obsessive-compulsive disorder, but is actually quite different: whereas obsessive-compulsive symptoms are absurd and the product of ego-dystonic compulsion, pathological perfectionism is experienced as a personal obligation, and retain an identifiable cultural objective.

Conclusions: The phenomenology of the normal and abnormal manifestations of perfectionism is well defined. While pathological perfectionism and obsessive-compulsive disorder are similar and may even share a common etiology, they should be considered 2 distinct clinical entities. The therapeutic approaches to pathological perfectionism remain empirical.