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Trailblazing Oxford University colleagues Drs. Roz Shafran, Zafra Cooper, and Christopher Fairburn posit that clinical levels of unhelpful perfectionism emerge when we keep pushing despite adverse consequences; we keep hammering away at the nail long after we've smashed our thumb. Two core elements lie at the heart of clinical perfectionism, both of which made my eyebrows shoot up in recognition.

First is a hypercritical relationship with oneself. We are our own worst critics. We focus on flaws rather than what's going well, what is lacking rather than what's good. When we don't fulfill those high expectations for ourselves, we are hard on ourselves, but when we do, we decide the expectations were insufficiently demanding in the first place.

Second is an overidentification with meeting personally demanding standards, which Shafran and colleagues call overevalution. Our evaluation of ourselves as a person is contingent upon our performance. In other words, we conflate meeting all our expectations for ourselves (or failing to do so) with our sense of self. If we define "failure" as not reaching our standards, a mistake or shortcoming means we've failed, even if our standards were unrealistic. Classic examples include striver students defining themselves by their grades, people struggling with body image measuring their self-worth by their weight or body shape, social media users who confuse their worth with their number of followers, athletes who only feel as good as their last game, or anyone struggling with social anxiety who feels like every interaction is a referendum on their character. We can overevaluate almost anything: how healthy we ate today, how adeptly we handled that weird thing Jim said at work, the tidiness of our house, or how much we managed

to get done today.

We're not perfectionistic about everything all the time; we're only perfectionistic about what matters to us, because meeting those demanding standards (or not) says something about us personally. I may be perfectionistic about my work and my social behavior, but I'm definitely not when it comes to the state of my home office (piles are a method of organization, right?).

Remember how I said those of us familiar with perfectionism are in a very big boat? There are actually three boats. Self-oriented perfectionism is when we're hard on ourselves. This is the classic version of perfectionism—what we think of when we say perfectionism. Since the only person we can change is ourselves, we'll hang out on this boat for most of this book.

But according to OG perfectionism researchers Drs. Gordon Flett and Paul Hewitt, there are two other boats, both of which we'll cover in chapter 5. Other-oriented perfectionism is when we're hard on the people around us—we have higher-than-necessary expectations for our partner, kids, or employees and get judgy and critical when they don't meet them.

The third boat is socially prescribed perfectionism, which is the sense that others have the highest of expectations for us and will come down harshly if we fail to live up to them. If the self-oriented kind comes from within, this type comes from all around us, from the minestrone soup of culture we all float in: capitalism, oppression in all its forms, consumerism. This is the most toxic breed of perfectionism. It's also the one that's increasing—no exaggeration here—exponentially. All three types of perfectionism are on an upward march, but in Drs. Thomas Curran and Andrew Hill's study, the trajectory of socially prescribed perfectionism looked less like a gentle slope and more like a rocket launch.

Our crystal ball shows the trend is likely to continue: in a meta-analysis of ten different studies, Flett and Hewitt found that one in three children and teens today deal with some "clearly maladaptive" form of perfectionism, where they grind themselves into the ground like a cigarette butt under a stiletto trying to meet their own standards.

And then? These kids grow up. Dr. Martin Smith of the University of British Columbia and distinguished colleagues published a meta-analytic review of twenty-five years of research on perfectionistic personalities. The biggest takeaway? While a lot of people mellow as they age, easing up on themselves and caring less about what others think, something different happens as type As get older: the wheels start to come off. As we fall short of our impossible expectations for ourselves again and again, we feel like failures. Life goes down the path of Walt Disney rather than Fred Rogers.

Or we flame out. In the words of Smith and his colleagues, "In a challenging, messy and imperfect world, perfectionists may burn out as they age, leaving them more unstable and less diligent." Life does not get easier for people with perfectionism.

One way that perfectionism does not make life easy is its contribution to actual disorders. Perfectionism itself isn't a diagnosis, but a meta-analysis of 284 different studies reiterated the link between perfectionism and depression, eating disorders, social anxiety, OCD, and non-suicidal self-injury. It even reaches its tendrils into problems that, on the surface, seem unrelated, like sexual dysfunction, mood swings in bipolar disorder, panic attacks, and migraines.

A sobering meta-analysis of forty-five different studies went even further, linking perfectionism to suicide. The Alaska Suicide Follow-Back Study tracked suicides in the state of Alaska from 2003 to 2006. With great care, the researchers interviewed grieving parents who had lost teens and young adults. Without any prompting at all, 62 percent of the bereaved parents described their deceased children as perfectionistic. The most alarming takeaway? Suicide among people with perfectionism comes out of nowhere. Many said they had no idea their children were even suffering. These promising young people hid their distress from everyone. But internally, they agonized to the point of believing the world would be better off without them. Perfectionism isn't technically a disease, but it can be fatal.