Checking Perfectionist Thinking In Chronic Condition Management

Checking Perfectionist Thinking In Chronic Condition Management

Striving for perfection in your health can obviously get you results, whether it’s reaching a certain goal weight or keeping your blood sugars in a healthy range. But at what cost to your mental health (and, inevitably, your overall well-being)? Can perfectionism actually set you back in chronic condition management?

When engaging in perfectionist thinking, “many people feel they’re either doing everything ‘perfectly’ or they’re ‘failing’ as an individual,” explains Dr. Harpreet Nagra, Ph.D., licensed psychologist and VP of behavioral science at One Drop. Maybe you’re fixated on perfection in carb counting, or perhaps you get nit-picky when it comes to weight management. Either way, an all-or-nothing perspective can make it hard to learn from mistakes, accept help from others, and, ultimately, grow as an individual, says Dr. Nagra. 

Plus, considering we’re still in the midst of a global pandemic, “health-related anxiety is at an all-time high,” notes Dr. Nagra. “In addition to the layers of stress that already exist in chronic condition management, now we also have to think about whether or not to wear a mask, whether or not to spend time around people who are unvaccinated, whether or not to ask people about their vaccination status,” she explains. “All of that can intensify perfectionist thinking, and the resulting avoidance and anxiety that tends to happen.”

Why Perfectionism Is Common In Chronic Condition Management

“When living with a chronic condition, there are lots of opportunities to be judged and evaluated,” explains Dr. Nagra. With diabetes, it’s blood sugar numbers; with weight management, it’s the number of pounds you’re gaining or losing, or what BMI category you’re in.

But perfectionism isn’t always about achieving perfection in any of these areas, says Dr. Nagra. Rather, many of us hyperfocus on “perfection” as a means of relieving, or even avoiding, some other negative emotion or experience, such as shame, lack of approval, or guilt.

“Within perfectionism, there’s this idea that you perceive some sort of danger, and you need to figure out a way to address that danger,” she explains. “Oftentimes, the way we end up addressing it is by avoiding, hiding, or running from it.”

For example, if a perfectionist makes a mistake in front of co-workers, or their doctor or health coach, or someone finds fault in how they’re managing their condition, they may feel like they literally can’t survive the humiliation, explains Dr. Nagra. So, instead, they avoid that possibility at all costs by setting their sights on perfection, holding themselves to impossible standards, and, potentially, isolating themselves from others.

Another issue lies in what’s called probability overestimation, adds Dr. Nagra, which is when we overestimate the chances that something (particularly, something negative) will happen. For instance, let’s say you had a low blood sugar episode a few months ago. After having that experience, the theory of probability overestimation says that perfectionists are more likely to overestimate the likelihood of that low blood sugar episode happening again, not to mention underestimate their ability to manage those odds, explains Dr. Nagra.

The Vicious Cycle of Perfectionism

In many ways, perfectionism can often lead to self-sabotage. Not only can probability overestimation make you feel less confident in your ability to manage your health, but by placing unrealistically high expectations on yourself to achieve whatever you deem to be “perfection,” you’re essentially sealing the deal that you will disappoint yourself. Then, when you inevitably fall short of your own impossible standards, you’ll probably feel stressed about that “failure.” So, to relieve those negative emotions, you’ll get tunnel vision again as you strive for perfection, and the cycle will repeat itself.

Along the way, stress hormones such as cortisol can hold you back from reaching your health goals even more, explains Dr. Nagra. “Cortisol is definitely going to be much higher for somebody who’s engaging in perfectionist thinking, and all of the potential worries, fears, and concerns that come with it, compared to someone who’s not thinking that way,” explains Dr. Nagra. Over time, excessive amounts of cortisol can spike blood sugar levels, make it difficult to manage your weight, and increase the risk of heart conditions.

Long-term stress can also lead to other health issues down the road. In her work with people living with diabetes, for example, Dr. Nagra says she’s noticed that gastrointestinal health issues appear to be more common for folks who have anxiety in relation to their diabetes.

How to Check Your Perfectionist Thinking

“A lot of perfectionism is internal: how you’re talking to yourself, and whether you practice self-compassion,” says Dr. Nagra.

It can be helpful to work through these skills with a therapist, who can help you address what’s underlying your perfectionism and how to overcome it. If you’re not sure where to start looking for a therapist, the American Diabetes Association (ADA) has a mental health provider directory where you can search based on your location, as does mentalhealth.gov.

Whether you’re working with a therapist or on your own, here are Dr. Nagra’s suggestions for navigating perfectionism in chronic condition management:

  • Practice perspective-taking and reframing. Simply put, perspective-taking and reframing are all about repositioning your point of view on a situation or circumstance. For example, let’s say you’re trying to reach a certain weight, and no matter what you do—meal-prep healthy dishes, go for a walk after work every day—it seems that you’re not making any progress. Instead of looking at this from a self-defeating perspective (“No matter what I do, nothing works”), acknowledge what you’re doing right (“I’m taking care of my body to the best of my abilities”) and focus on how things like healthy eating and regular exercise make you feel (“When I go for my walk, I feel the stress melt away”), rather than the results (or lack thereof) they’re yielding.
  • Double-check your self-talk. The next time you beat yourself up for a high blood pressure reading or for eating a carb-heavy meal, ask yourself whether you would ever speak to a loved one the way you speak to yourself. “Give yourself that honest reality check of how you’re talking to yourself because it’s probably not the way you’d talk to anybody else,” says Dr. Nagra. Whenever you start to notice a negative streak in your thought patterns, use that as an opportunity to practice those reframing skills.
  • Embrace a growth mindset. Having a growth mindset means you believe your intelligence and abilities can change over time with practice and education, whereas a fixed mindset means you believe your abilities are fixed, regardless of what you do (e.g., if you’re not good at something now, you never will be). To help promote a growth mindset and express self-compassion, try writing down any “should” statements bouncing around in your head (“I should never make mistakes; I should never be anxious; I should never need help or support”), then rewrite those same statements with more growth-oriented takes (“Mistakes help me learn; when I feel anxious, going for a walk makes me feel better; asking for support is hard, but having help makes it easier to cope”).
  • Pay attention to your body. For example, if stress makes you get sweaty palms, butterflies in your stomach, or a knot in your throat, pay attention to those body signals and figure out what, exactly, is causing them, suggests Dr. Nagra. What are you saying to yourself that might be leading to that physiological reaction? How can you reframe that self-talk to be more positive, or, at the very least, neutral? Additionally, pay attention to how that switch in self-talk makes your body feel in comparison to negative self-talk.
  • Celebrate small successes. If you’re a perfectionist, you probably hyper-focus on where there’s room for improvement in your health and don’t dedicate quite as much time to rewarding yourself when you get things right. “Just as you would build any new habit into your life, make sure you’re building in time to celebrate small successes that happen, too,” says Dr. Nagra. “Acknowledge them and reward yourself when appropriate.” (Here are some creative ways to celebrate your accomplishments the next time you achieve a health goal.)

This article has been clinically reviewed by Jamillah Hoy-Rosas, MPH, RDN, CDCES, and VP of clinical operations at One Drop, and Dr. Harpreet Nagra, Ph.D., licensed psychologist, and VP of behavioral science at One Drop.

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Allie Strickler
Sep 21, 2021

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