Is Perfectionism a mental disorder? The story of the man who had such low self-esteem, that he needed to think he was the Messiah to make up for it!

There are many individuals, both adults, teens and children, who struggle with perfectionistic tendencies, and they may wonder, “Is Perfectionism a mental disorder?” The answer is, sometimes no, but often yes!


Perfectionism of the mental disorder variety is when a person, due to certain childhood stressors, has developed very low self-esteem, a deep sense of shame, and a feeling of deficiency and inadequacy of the self. The amazing thing is the mechanism through which the developing perfectionist strives to relieve himself of his unhappy and difficult situation! Basically he develops a plan, which is really a fantasy, such as, “It is intolerable for me to feel so badly about myself! How can I stop feeling this way? I know I will become a good, even a great person. I will accomplish amazing things, I will achieve near perfect performance for good measure! And then I will be so accomplished and successful that I will be beyond reproach and criticism, and it will be impossible for me to not feel great about myself!” In this way he plans to redeem his self from his state of terrible self-worth. The plan is essentially and unfortunately grandiose, because he surmises that through greatness, especially compared to other people, he will heal his emotional health issues.

The only problem is, even if he is successful in becoming an extremely successful, near perfect person, the plan can never work.


Objective achievement can never cure mental health problems such as low self-esteem, shame and defects in the self. Only treatment can do that, through good psychodynamic and cognitive psychotherapy. Therefore the aspiring perfectionist, despite his many achievements, notices much to his chagrin that he still feels terrible about himself. Often that drives him to pressure himself to achieve even more exalted perfection, and he is truly on an endless rat race.

So the perfectionism disorder can have various levels of intensity.  


Some perfectionists plan to become excellent students, or winning athletes, or to have successful careers. Some feel even worse about themselves, and therefore their fantasies are even more vainglorious, they will not be satisfied unless they become great celebrities, or billionaires, and their life becomes an obsessive drive towards that goal. Some even feel they need to be the President of the United States to redeem themselves from such deep bad feelings. And there was one client who came to me once, who felt so devastatingly terrible about himself, who had such deep, intolerable shame over every aspect of his very being, that it just wasn’t enough for him to be famous, or a billionaire or even President! He felt so badly about himself, that the only way he could redeem himself was to become the Messiah! This client has since given me permission to speak about his case anonymously, so we could help other people.

The Messiah in our Judeo-Christian tradition, is supposed to be the ultimate redeemer and savior of mankind.


He will be the greatest king the world has ever known, and he will unite the entire planet into one happy unit, and on top of that he will be so brilliant, charismatic and successful, that he will solve all of every individual in the world’s problems! Becoming the most accomplished person the world will ever know is no small order! But this client was convinced that he was destined to be him. Over several sessions, I explored why he feels he truly is the Messiah, and how he got to be so. At one point, when I suggested just a bit of skepticism, such as, “Gee are you really sure that you’re the Messiah?” He welled up with bitter tears in his eyes, and his face turned deep red, and he proclaimed, “It has to be! I must be the Messiah!” He was just suffering so much emotionally, that his only hope to redeem himself and escape from such terrible feelings, to avoid dying of shame, was to achieve the ultimate fantasized goal.

Needless to say, he was plagued with terrible anxiety, self-imposed pressure and self-criticism.  


That is understandable with such a burden and pressure on his shoulders.

Most perfectionists are nowhere near this extreme, but even moderate perfectionism can generate debilitating anxiety, sleeping problems, anger issues, ADHD-like symptoms, and great interpersonal conflict. The simple truth is, if you are demanding of yourself great or near perfect performance in an attempt to relieve low-self esteem and shame, and you are very self-critical, such a plan will never bring you happiness, and you may be suffering from a form of perfectionism that can only be resolved through good psychotherapy.

After wondering “Is Perfectionism a mental disorder?” You may now be wondering, Ok now that I know I have it, how do I treat it?”

The answer is with 2 styles of psychotherapy concurrently, cognitive, and psychodynamic.

Cognitive-Behavior Therapy for perfectionism involves changing unhealthy thought patterns and beliefs such as, “You must achieve amazing, great things otherwise you’re a failure.” And “I am not acceptable when I perform less than perfectly.” And “If I make mistakes I am worthless.” It involves learning that it is indeed fine, even desirable to be average! 95 percent of the world lives their entire life being average. It requires appreciation of the beauty of the mediocre, a celebration of the great healthiness of the mundane. One must develop a deep appreciation of only ordinary, every-day accomplishments and events, one must learn to take great pleasure in the simple everyday activities of the self,  one must take great pride and satisfaction in the authenticity of one’s plain, moment to moment feelings.

Further cognitive work involves challenging such thoughts and beliefs of such shame and low self-esteem.


Are you really such a terrible and worthless person? One would have to be curious as to what are all the terrible things you have done to truly deserve to feel so badly about yourself. Then we need to reframe those thoughts in the light of reason. Weren’t you born a normal, decent person like everyone else? Aren’t you reasonably law abiding, hard-working, civil, and even sometimes kind? Don’t you deserve to feel decently about yourself like everyone else? You would employ a cognitive tool of writing down 2 small, good things you do each day in kindness and personal growth, and then at the end of the month, reviewing all 60 good things in therapy, exclaiming, “Wow look at all the good things I do! Maybe I shouldn’t feel so badly about myself!” Gradually your self esteem will begin to bubble up and you will start to feel less pressure to achieve grandiose accomplishments and perfection.

But more importantly, you must do Psychodynamic work, which involves going into your past,


and understanding the precise chain of psychological events that resulted in low self-esteem, shame and perfectionism. Almost always the root is in childhood. You probably had loving, dedicated, well-intentioned parents who made honest mistakes in raising you, and combined with your inborn sensitive temperament, the result was unhealthy psychological patterns. Very often perfectionists were overly criticized as children, then they internalize that voice and become their own harshest critic, fantasizing that only near perfect performance will place them safely beyond the dreaded criticism. Often perfectionists were overly controlled, or put down verbally, or there was a conflicted relationship between parents and child. Maybe there was a separation between parents, and the child fantasized, “If only I would be perfect, then my parent would get back together.” The trick in dynamic work is to understand very clearly what mistakes your parents made, and the effects of those mistakes on your entire emotional health, and then to mourn and grieve them. That means you must mourn and grieve the mistakes of your parents even more intensely then you would mourn a lost loved one! After all, suffering childhood adversity is the greatest tragedy that can ever befall a person! You would need to express your grief deeply with your therapist and a few other carefully chosen confidants.

Then you would have to gain conscious awareness of your anger and rage,


because mistakes made by parents always automatically generate significant and devastating anger, which drives you towards perfectionism and ill mental health. Not to mention the new research that repressed and unresolved anger is responsible for all sorts of serious physical health problems, such as heart disease, stroke, cancer, and auto-immune disease, among others! I recommend that my clients spend one half of an hour each day for several months crying and raging into their pillow, as well as journaling their angry feelings and sharing them in therapy.

Then ideally you will need to get an admission from your parents that they made unfortunate mistakes with you,


and if possible, an apology. I have a whole program of exactly how to accomplish that. One client I had who had been verbally abused by his mother approached her under my guidance and she responded sincerely, “I’m sorry I made those mistakes with you, I just didn’t know anything about parenting. I hope you get better!” That one 5-minute conversation caused years of anger, anxiety, depression and perfectionism to melt away! Not to mention a warm relationship between mother and son ensued.

It pays to invest 1-2 years in this important work. You will be left with decades of wonderfully improved emotional health and happiness!

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