Perfectionism is often thought of as the pursuit of excellence, but in reality, it can be a debilitating mindset, especially when it co-occurs with ADHD. Understanding the complexities of how these two conditions intersect can be important for effective treatment and well-being.
How Perfectionism Can Develop in Individuals with ADHD
Children with ADHD often face challenges in academic and other life settings due to issues with attention, hyperactivity, and impulsivity. The stress from these challenges can sometimes trigger perfectionistic tendencies as the child strives to meet external expectations from parents and teachers. Childhood perfectionism may not necessarily carry the same emotional weight as it does in adulthood; it might be more about a strong desire to please adults rather than the pursuit of perfection in itself, and certainly not every child with ADHD is concerned about pleasing adults, including my son!
The teenage years are a time of identity formation, peer comparison, and increased academic pressure, making adolescents particularly susceptible to comparing themselves negatively to others and striving for perfection. For teenagers with ADHD who may already struggle with self-esteem due to feeling different and having to expend far more energy than peers to achieve satisfactory outcomes, perfectionism can appear as a compensatory mechanism.
As individuals with ADHD move into adulthood, the domains in which they experience difficulties might expand to include workplace settings, relationships, and broader life management skills. The stress and challenges of adult life, combined with a history of feeling inadequate or not meeting expectations, can contribute to the emergence or intensification of perfectionistic tendencies.
Perfectionism in this context is less about striving for excellence and more about avoiding failure at all costs. The individual may set excessively high standards as a form of self-protection, aspiring to meet these ideals to finally attain approval from themselves and others. In reality, these standards are often unattainable, leading to a cycle of self-criticism, crippling procrastination and failing to deliver, and even lower self-esteem.
Treatment Approaches for Co-occurring Perfectionism and ADHD
If you're a reader of my blog posts you won't be surprised to see medication as the number one treatment in this life. ADHD medication can improve focus and attention, potentially reducing the stress and anxiety associated with perfectionism. Many of the clients I see in my practice experience a significant reduction in anxiety once they start stimulant medication. However, medication alone may not be sufficient to treat perfectionism, as it is usually a long-standing pattern of behaviour that needs to be deconstructed, and the development of new skills to manage tasks in a different manner.
Cognitive Behavioural Therapy (CBT)
CBT is effective in addressing both ADHD and perfectionism. The approach helps individuals recognise and challenge their negative thought and behavioural patterns, replacing them with more realistic and constructive thoughts and behaviours.
Mindfulness and Acceptance Therapies
Mindfulness can help individuals become aware of their thoughts and feelings and reduce self-critical engagement. Acceptance and Commitment Therapy (ACT) is the mainstay of my therapeutic practice, and utilises brief mindfulness practices to help people accept their difficult thoughts, predictions and imperfections, and commit to actions that improve their quality of life.
Understanding the interplay between ADHD and perfectionism allows for more comprehensive and effective treatment planning. When I notice it in an assessment or therapy client, I will bring it into the discussion, as it may require some specific intervention.
Life and well-being are not about achieving a state of 'perfection,' but about embracing imperfections as a part of the unique self and learning strategies to live a fulfilling life. I am a fan of aiming for "good enough" in all life settings and it is entirely possible to shift internal expectations and develop a more detached and self-compassionate attitude toward perfectionistic high standards, with a lot of practice.
For a more in-depth discussion of perfectionism in ADHD, see the article When Perfectionism Stems from ADHD: Challenging the Fallacy of “Not Good Enough" by clinical psychologist Dr Sharon Saline
Dr Saline also has a one-hour ADHD Experts webinar entitled “Perfectionism and ADHD: Making ‘Good Enough’ Work for You”