The Destructiveness of Perfectionism Revisited Implications For The

Review of General Psychology
2014, Vol. 18, No. 3, 156 172
2014 American Psychological Association

1089-2680/14/$12.00 http://dx.doi.org/10.1037/gpr0000011
The Destructiveness of Perfectionism Revisited: Implications for the

Assessment of Suicide Risk and the Prevention of Suicide
Gordon L. Flett
Paul L. Hewitt
York University
University of British Columbia
Marnin J. Heisel
This document is copyrighted by the American Psychological Association or one of its allied publishers.
This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
Western University
Although perfectionism is recognized as a factor that is linked with suicide, we maintain that the role of
perfectionism as an amplifier of the risk of suicide has been underestimated due to several factors. In the
current article, contemporary research on the role of perfectionism in suicide is reviewed and summarized. Several themes are addressed, including: (a) consistent evidence linking suicide ideation with
chronic exposure to external pressures to be perfect (i.e., socially prescribed perfectionism); (b) the roles
of perfectionistic self-presentation and self-concealment in suicides that occur without warning; and (c)
how perfectionism contributes to lethal suicide behaviors. We also summarize data showing consistent
links between perfectionism and hopelessness and discuss the need for a person-centered approach that
recognizes the heightened risk for perfectionists who also tend to experience hopelessness, psychache,
life stress, overgeneralization, and a form of emotional perfectionism that restricts the willingness to
disclose suicidal urges and intentions. It is concluded that when formulating clinical guidelines for
suicide risk assessment and intervention and public health approaches to suicide prevention, there is an
urgent need for an expanded conceptualization of perfectionism as an individual and societal risk factor.
We also discuss why it is essential to design preventive programs tailored to key personality features with
specific components that should enhance resilience and reduce levels of risk among perfectionists who
hide behind a mask of apparent invulnerability.
Keywords: perfectionism, suicide, hopelessness, psychache, self-criticism, self-stigma
40 years of age (Centers for Disease Control & Prevention, 2010).

Data summarized by the World Health Organization suggest that a
suicide occurs somewhere every 40 seconds, and over the past 45
years, suicide rates have increased by more than 50% in several
countries (Krug, Dahlberg, Mercy, Zwi, & Lozano, 2002; World
Health Organization, 2007).
Clearly, suicide is a complex phenomenon with many potential
determinants and contributing factors. The current article focuses
on the role of perfectionism in suicide ideation, suicidal behaviors,
and deaths by suicide. It is motivated primarily by our concern that
perfectionism is playing an increasing role in suicide risk. Contemporary research on perfectionism and suicide is reviewed and
we present the argument that the role of perfectionism in suicide,
while acknowledged, is still underappreciated and underrecognized. A central premise of our paper is the need to translate
variable-centered research on suicide risk into a more personfocused approach to prevention and intervention; that is, there is a
need to focus on the whole person and consider cumulative risk
factors. In this instance, we maintain that unrelenting pressure to
be perfect is a factor that sets the stage for suicide attempts among
vulnerable individuals in general, but especially among those who
have a maladaptive form of perfectionism that is accompanied by
high levels of hopelessness, psychache, and social isolation. This
risk becomes heightened when particular elements of the perfectionism construct are considered. Most notably, Blatt (1995) emphasized the need to . . . avoid possible public criticism and the
He was very deliberate. He was a perfectionist. I have been

learning that perfectionism plus depression is a loaded gun
(Anonymous woman referring to her husbands suicide, as cited in
Froedge, 2006).
Suicide is a key public health issue that is receiving increasing
attention. At present, it is estimated that over one million people
worldwide, including over 40,000 people in North America, kill
themselves on an annual basis (Centers for Disease Control &
Prevention, 2012; Statistics Canada, 2011). Recent U.S. data indicate more than 100 people die by suicide every day, and suicide
is the second leading cause of death among people who are under
Gordon L. Flett, Department of Psychology, LaMarsh Centre for Child

and Youth Research, York University; Paul L. Hewitt, Department of
Psychology, University of British Columbia; Marnin J. Heisel, Department
of Epidemiology and Biostatistics, Western University.
This article is dedicated fondly to the memory of Sidney (Sid) Blatt.
Gordon L. Flett was supported by the Canada Research Chair Program and
funding provided by the Faculty of Health, York University. The authors
wish to thank Sabrina Hassan, Taryn Nepon, Lisa-Marie Coulter, and two
anonymous reviewers for their helpful suggestions.
Correspondence concerning this article should be addressed to Gordon
L. Flett, Department of Psychology, LaMarsh Centre for Child and Youth
Research, Technology Enhanced Learning Building, 5022K, York University, 4700 Keele Street, Toronto, Ontario M3J 1P3, Canada. E-mail:
gflett@yorku.ca
156
PERFECTIONISM AND SUICIDE
appearance of defect (p. 1005). Below, we discuss Blatts (1995)

observations about the need to maintain a certain image and
describe in more detail the tendency for perfectionists to engage in
perfectionistic self-presentation and to be characterized by selfconcealment behaviors that enable them to hide their sense of
shame, self-loathing, and hopelessness behind a mask of apparent
invulnerability. In addition, to the extent that perfectionism is
regarded as socially desirable and as having adaptive elements,
especially in educational and work settings, people who might be
in a position to identify the distress and suicidal intentions of
perfectionists might overlook possible indicators.
In recent years, several case accounts continue to point to the
link between perfectionism and suicide (e.g., Bell, Stanley, Mallon, & Manthorpe, 2010; Bialosky, 2011; Hyatt, 2010). General
public awareness of the role of perfectionism in suicides remains
quite high at present, in part due to attention given to the suicides
of famous people such as acclaimed director Tony Scott in 2012
and fashion designer LWren Scott in 2014, as well as highly
publicized public inquests conducted following the suicides of
perfectionists such as Nicola Worrall and Charmaine Dragun.
Initial public awareness of the risks inherent in perfectionism came
largely from media accounts of Sidney Blatts (1995) seminal
article in the American Psychologist titled The Destructiveness of
Perfectionism. Blatts article, published almost 20 years ago, was
a catalyst for more extensive empirical research. Asher Pacht
sounded the same alarm about the destructiveness of perfectionism
a decade earlier in his American Psychologist article (see Pacht,
1984). Pacht is a renowned psychologist who received the Gold
Medal Award for Lifetime Achievement from the American Psychological Foundation in 2006. Pacht (1984) highlighted the profound unhappiness of perfectionists even after achieving success,
as well as their loneliness and sense of isolation, and their penchant
for all-or-none thinking and a tendency to place themselves in
no-win situations. That is, their standards are so high as to either
ensure that failure will occur, or that they will experience success
but use such stringent self-evaluative criteria that undermine the
ability to experience personal satisfaction.
The current article follows in this tradition by reexamining the
link between destructive perfectionism and suicide. At present,
perfectionism is clearly regarded as a risk factor for suicide, with
one analysis leading to the conclusion that there is . . . strong
evidence in favor of perfectionism as an amplifier of risk (Johnson, Wood, Gooding, Taylor, & Tarrier, 2011, p. 572). But it is our
contention that while certainly acknowledged, the role of perfectionism in suicide and other forms of self-destructive behavior is
even greater than imagined, and it is important to heighten awareness, especially among people who are in a position to intervene
and assist demoralized perfectionists.
What factors contribute to the failure to fully appreciate the role
of perfectionism in suicide? First, there is an unfortunate lack of
widespread and sustained empirical investigation of perfectionism
and suicide ideation and suicide behaviors; although there are
some noteworthy exceptions, for the most part systematic and
sustained programmatic research on perfectionism and suicide has
not been conducted in regions around the world. OConnor (2007)
observed that there is an urgent need for longitudinal research
testing the predictive utility of perfectionism versus other predictors. Several new studies have been conducted since this
observation, and this research is summarized below, but it is
157
still the case that conclusive studies remain to be done. It

continues to be the case that a long-term longitudinal study
conducted over many years is needed in order to fully establish
the risk of suicide among vulnerable perfectionists.
A second reason for not fully appreciating the role of perfectionism in suicide is that perfectionism, as it is currently conceptualized and assessed, is an exceedingly complex construct with
some key elements such as socially prescribed perfectionism that
may not be immediately apparent to people, such as teachers,
employers, and family members, who are in a position to detect
self-destructive tendencies. One overarching theme of this article
is the need to carefully consider different facets of the perfectionism construct. The primary focus in the suicidology research
literature thus far has been on trait perfectionism and dysfunctional
attitudes reflecting a need to be perfect. Relatively little consideration has been given to other key dimensions of the construct,
including perfectionistic self-presentation (i.e., presenting a false
image of flawlessness and invulnerability). There is also a need to
consider how the frequent experience of perfectionistic automatic
thoughts may maintain and escalate suicide ideation and behaviors
and contribute to rigid thinking styles. These perfectionistic
thoughts represent a specific form of rumination involving a cognitive preoccupation with not living up to the perfect, ideal self
(Flett, Hewitt, Blankstein, & Gray, 1998), thus fuelling the sense
of inferiority, deficiency, and hopelessness at the root of suicide
ideation and suicide behaviors.
A third reason alluded to earlier is the failure to adopt a personfocused approach that allows for multiple risk factors coexisting in
the same person when considering the risk inherent in selfdestructive perfectionism. An emphasis on the whole person is
required in order to give sufficient weight to those factors associated consistently with perfectionism that combine with perfectionism to escalate the level of risk. We maintain that the risk to
individuals who are vulnerable perfectionists may not be fully
appreciated or recognized due to a predominant tendency to conceptualize and consider perfectionism in isolation from other variables without taking into account its synergies with other wellknown, key predictors of suicide, such as hopelessness, psychache,
overgeneralization, and all-or-none thinking. The predominance of
variable-centered research investigations has obscured the level of
risk inherent in dysfunctional perfectionism. Key risk factors that
can heighten suicide risk among certain perfectionists will be
discussed in greater detail in a later segment of this article.
The fourth reason reflects Blatts (1995) observation, noted
earlier, about the tendency for destructive perfectionism to be
associated with enhanced susceptibility to suicide due to a need to
be seen as free from defects and imperfections. Specifically, following his description of the three perfectionists with deaths by
suicide, Blatt (1995) observed sagely that Because of the need to
maintain a personal and public image of strength and perfection,
such individuals are constantly trying to prove themselves, are
always on trial, feel vulnerable to any possible implication of
failure and criticism, and are often unable to turn to others, even
the closest of confidants, for help or to share their anguish
(p. 1005). Subsequent research has confirmed that there is a clear
role of self-concealment in suicide behaviors (see Friedlander,
Nazem, Fiske, Nadorff, & Smith, 2012) and Frost and associates
have illuminated the tendency for perfectionists to be high in
self-concealment (DiBartolo, Li, & Frost, 2008; Kawamura &
158
FLETT, HEWITT, AND HEISEL
Frost, 2004). For some perfectionists, this self-concealment becomes a deeply ingrained and highly maladaptive interpersonal
style known as perfectionistic self-presentation that we believe is
shrouded in emotional perfectionism and concerns about stigma
and self-stigma; certain perfectionists need to be seen as in control
of their emotions and believe that people who are fallible and
prone to distress should be strong rather than weak (for a related
discussion, see Flett & Hewitt, 2013). Below, we describe recent
research on perfectionistic self-presentation and examine this interpersonal style within the context of seemingly high functioning
people who killed themselves with no apparent warning signs.
Finally, we contend that the risks inherent in extreme perfectionism cannot be considered without also emphasizing environmental contexts and associated life events. Chronic exposure to
situations and contexts that place excessive pressure (or perceived
pressure) on the individual to be perfect can have a destructive
effect on most individuals and this is heightened among those
people who are vulnerable and hypersensitive to criticism and
social comparison feedback. Consider, for instance, the vulnerable
perfectionist exposed regularly to a hypercritical parent, (boss/
supervisor) or romantic partner who is ever-present and seemingly
impossible to please. Alternatively, the vulnerable perfectionist
may have a work environment where mistakes are simply not
allowed and excessive standards are required by a tyrannical boss.
These pressures to be perfect at work are mentioned frequently in
discussions of why people with certain occupations (e.g., doctors
and lawyers) are at risk (see Legha, 2012).
At a broader level, the pressure inherent in being raised in a
culture that emphasizes the need to be perfect (e.g., China) must be
taken into consideration. When it is suggested that perfectionism
and perfectionistic expectations and demands are implicated in
culturally relevant phenomena such as overwork suicide in Japan (see Targum & Kitanaka, 2012), it seems evident that scholars
from various disciplines must work together to establish how these
phenomena occur and help us understand it. Moreover, it is important to acknowledge environmental and cultural factors that
promote dysfunctional perfectionism and associated behavioral
tendencies because this suggests that intervention efforts should
focus jointly on promoting resilience in vulnerable individuals as
well as taking extensive steps to create healthier, less demanding
situations and health promoting psychosocial environments where
mistakes are permitted and the pressure is not overwhelming for
the person at risk. In a subsequent section of this article, we will
more extensively discuss the need for prevention.
What is currently known about perfectionism and suicide from
an empirical perspective? Recent investigations are summarized
below. This summary is accompanied by an overview of mounting
evidence from public health research linking perfectionism with
deaths by suicide.
Contemporary Research on Multidimensional

Perfectionism and Suicide
The studies described in this section are focused primarily on
suicide ideation or self-reported suicide behaviors. The studies also
vary in terms of which conceptualization of perfectionism was
used. Numerous definitions and conceptualizations of perfectionism exist (see Flett & Hewitt, 2002), and various frameworks have
been applied to the study of suicide. Most studies of perfectionism
and suicide use either the Multidimensional Perfectionism Scale

created by Frost, Marten, Lahart, and Rosenblate (1990) or another
measure with the same name, the Multidimensional Perfectionism
Scale (MPS) developed by Hewitt and Flett (1991). Frost et al.
(1990) identified several trait perfectionism dimensions, including
high personal standards, concern over mistakes, doubts about
actions, high parental expectations, and high parental criticism.
Concern over mistakes and doubts about actions have been linked
consistently with maladjustment, including indices of suicide ideation (see Frost & DiBartolo, 2002; Hewitt, Flett, Sherry, &
Caelian, 2006). Hewitt and Flett (1991) focused on three trait
perfectionism dimensions, only one of which overlaps substantially with the dimensions described by Frost and colleagues
(1990). Self-oriented perfectionism reflects the tenacious striving
and importance of exacting personal standards. Other-oriented
perfectionism is a unique orientation that involves demanding
perfection of other people. Finally, socially prescribed perfectionism is a highly deleterious orientation that involves the perception
that others demand perfection from ones self. Hewitt and Flett
(1991) noted that in extreme forms, socially prescribed perfectionism incorporates elements of helplessness and hopelessness due to
the sense that perfect performance will only result in expectations
being raised even higher. While socially imposed expectations
may come from parents, pressures to be perfect can come from
several individuals or from the broader society.
Collectively, investigations of these trait dimensions show consistent links between suicide ideation and dimensions such as
concern over mistakes, doubts about actions, and socially prescribed perfectionism (for previous reviews, see Hewitt & Flett,
1993; Hewitt et al., 2006; OConnor, 2007). We will see in our
summary of newer research done over the past 7 years that socially
prescribed perfectionism continues to be linked consistently with
suicide ideation.
First, however, it is worth reiterating that when considering the
unique predictive ability of facets of perfectionism, previous data
indicate that perfectionism predicts suicide ideation above and
beyond the high predictive utility of hopelessness (e.g., Hewitt,
Flett, & Weber, 1994; Hewitt, Norton, Flett, Callander, & Cowan,
1998), including among individuals who have engaged in selfinjurious behavior (Hunter & OConnor, 2003). For instance,
Beevers and Miller (2004) conducted a longitudinal study of
people hospitalized for depression and found that a measure of
perfectionistic dysfunctional attitudes predicted suicide ideation 6
months later. Alternative models were tested, including whether
hopelessness was a full or partial mediator of the link between
perfectionism and subsequent suicide ideation, but perfectionism
was still a unique contributor. This study is illustrative in several
respects because implicit in this set of results is the notion that
inpatients with suicide ideation who do not experience significant
treatment reductions in their levels of perfectionism remain at a
particularly high level of suicide risk, especially if they are returning to settings where perfectionistic pressures and demands are
quite salient.
Self-oriented and socially prescribed perfectionism have also
been linked with the self-rated likelihood of a future suicide by
psychiatric patients (Hewitt et al., 1994). In addition, socially
prescribed perfectionism has been associated with an abject wish
to die among adolescents with a past suicide attempt (see Boergers,
Spirito, & Donaldson, 1998). OConnors (2007) insightful review
summarized 29 papers examining perfectionism and suicide risk

based on research done up until 2006. He concluded on the basis
of existing studies that perfectionism dimensions such as socially
prescribed perfectionism, concern over mistakes, doubts about
actions, and self-criticism are associated with suicide ideation.
These dimensions were deemed to have pernicious effects on the
etiology and course of suicidal behaviors. OConnor (2007) also
highlighted the need for comprehensive longitudinal research and
future evidence of the predictiveness of perfectionism within the
multivariate context that allows for the impact of other factors
linked with suicide risk.
More Recent Research on Perfectionism and Suicide

An impressive series of more recent investigations continues to
indicate a consistent association between perfectionism and suicide ideation. These investigations have also identified several
mediating and moderating factors that seem to contribute to the
perfectionismsuicide link. We begin our review by describing
research that treated perfectionism as unidimensional.
Suicide and Unidimensional Perfectionism

Four recent studies had narrow assessments of perfectionism
in that they did not assess broad and multiple aspects of the
construct. Still, some illuminating results emerged. Ansell et al.
(2010) evaluated a sample of Hispanic or Latino outpatients in
terms of their obsessive compulsive personality disorder (OCPD)
characteristics and they found that a general perfectionism measure emerged as the best predictor of suicide ideation. Another
study by Jones, Ramirez, Davies, Canino, and Goodwin (2008)
examined predictors of suicide behavior in large clinical and
community samples of adolescents in Puerto Rico. Perfectionism
was assessed by having both the adolescent and one parent respond
to five items in the Spanish-language version of the National
Institute of Mental Health Diagnostic Interview Schedule for Children. Elevated perfectionism was significantly more evident
among adolescents in either sample who displayed suicide behaviors or suicide ideation. While this investigation is limited by
looking at perfectionism as a unidimensional construct, it illustrates the need to examine perfectionism and suicide in younger
people and in people from various cultures.
Another very recent study has confirmed links between perfectionism and suicide behaviors in over 600 university students
despite assessing self-oriented perfectionism with a brief 4-item
factor with low internal consistency (see ORiley & Fiske, 2012).
However, these same authors failed to find a significant association when the same measures of perfectionism and suicide behaviors were administered to a smaller sample of 88 adults aged 65
years or older (ORiley & Fiske, 2012). Perhaps perfectionism is
more relevant in suicide among younger people, but the lack of an
association here could simply have reflected the need to assess
suicide ideation among elderly people with measures designed
specifically for seniors (for a discussion, see Heisel & Flett, 2006).
Indeed, we maintain that vulnerable perfectionists become increasingly prone to experiencing suicide ideation and associated urges
as they grow older due to various factors, including the tendency
for some people to become increasingly aware that grandiose goals
are not going to be achieved and work-obsessed perfectionists
experiencing difficult transitions to retirement.
159
Finally, in another study that is unique because of its longitudinal focus, Jacobs et al. (2009) assessed 439 clinically depressed
adolescents receiving treatment. They found that perfectionism, as
assessed by a measure of dysfunctional attitudes, was associated
significantly with suicide ideation at baseline and following 6 and
12 weeks of treatment. Importantly, it was also found that perfectionism impeded treatment progress, defined as reducing levels of
suicide ideation.
Suicide and Multidimensional Perfectionism

Two other recent studies have used multidimensional perfectionism measures, but the authors only reported the findings for a
composite perfectionism measure. Jeglic, Pepper, Vanderhoff, and
Ryabchenko (2007) found that perfectionism as assessed by both
MPS instruments was not linked with suicide indices in their study
of 392 college students, in part due to their primary statistical focus
on identifying unique predictors from among many predictors.
However, closer inspection of their results indicates that while it
was not a unique predictor, overall perfectionism had a small but
significant association with suicide ideation and there was a trend
for higher perfectionism among students with a history of suicide
behaviors. Another study with French Canadian adolescents transitioning to university indicated that overall Frost MPS scores
were associated with suicide ideation. Also, psychological distress
fully mediated the association between overall perfectionism and
suicide ideation (Bibeau & Dupuis, 2007). The role of perfectionism in suicidality was underestimated, however, due to the decision to focus on total scores rather than specific dimensions.
Another study that did distinguish among three Frost MPS
subscales (i.e., personal standards, concern over mistakes, doubts
about actions) evaluated these dimensions along with a plethora of
other measures in an attempt to distinguish among women with
eating disorders who have or who have not attempted suicide
(Pisetsky, Thornton, Lichtenstein, Pedersen, & Bulik, 2013). This
research was part of a broader investigation of the Swedish twins
from a twin registry. The investigators reported that women with
eating disorders, relative to those without eating disorders, had
more lifetime suicide attempts; however, no eating disorder or
personality features, including perfectionism, showed a consistent
link with suicide attempts. Nevertheless, within certain diagnostic
categories (e.g., the binge-purge subtype) where there was a history of suicide attempt, perfectionism was indeed elevated (see
Pisetsky et al., 2013).
As mentioned earlier, recent research has continued to highlight
the potential destructiveness of socially prescribed perfectionism
(i.e., perfectionistic demands imposed on the self) while helping
the field to progress by identifying several mediators and moderators. This research is summarized below. First, however, it should
be noted that in the perfectionism field in general, socially prescribed perfectionism is often included along with a cluster of
highly related dimensions (i.e., concern over mistakes, selfcriticism) in a higher order construct that is commonly referred to
as evaluative concerns perfectionism or self-critical perfectionism
(see Dunkley, Blankstein, Halsall, Williams, & Winkworth, 2000;
Dunkley, Zuroff, & Blankstein, 2003). The work described below
looks specifically at socially prescribed perfectionism as a unique
dimension and does not consider it along with these related factors.
Clearly, future research is needed to establish whether socially
160
prescribed perfectionism plays a unique role in predicting suicide

and suicide ideation beyond the variance attributable to factors
such as self-criticism and concern over mistakes.
Socially Prescribed Perfectionism and Unmet Social

Expectancies in Suicide
Several studies in this more recent phase of research were
conducted with adolescents or emerging adolescents. Blankstein,
Lumley, and Crawford (2007) examined suicide ideation in 205
university students. Socially prescribed perfectionism was associated robustly with suicide ideation in both women and men; a
small but significant link was also found between self-oriented
perfectionism and suicide ideation in women. Additional analyses
found evidence for an incongruence model in which achievementoriented women high in self-oriented perfectionism were higher in
suicide ideation if they also had elevated interpersonal stress; men
with high socially prescribed perfectionism had higher suicide
ideation if they had high levels of academic hassles. Social support
also buffered the association between self-oriented perfectionism
and suicide ideation among women, whereas high levels of hopelessness exacerbated the link between socially prescribed perfectionism and suicide ideation in men. Collectively, these data highlighted several processes by which perfectionism might increase
risk for suicide.
OConnor, Rasmussen, and Hawton (2012) examined predictors
of actual self-harm behavior and thoughts about self-harm in a
sample of over 5,604 adolescents in school between the ages of 15
and 16 years old. Perfectionism was assessed solely in terms of
socially prescribed perfectionism. The sample included 62 selfharm enactors and 675 people who had thought seriously about
self-harm. This study appeared to measure self-harm in a way that
did not distinguish nonsuicidal from suicidal self-harm. Nevertheless, adolescents who were enactors or ideators had elevated socially prescribed perfectionism, relative to those who did not have
self-harm tendencies.
One disappointing aspect of more recent research on perfectionism and suicide risk is the lack of sustained programmatic research
o the role of negative life events despite clear theoretical statements about the need to examine perfectionism and suicide from a
diathesis-stress perspective (see Hewitt et al., 1994, 2006). In
contrast, a recent investigation conducted at the University of
British Columbia did test a diathesis-stress model of perfectionism
and suicide ideation. This study was also one of the few investigations to adopt a longitudinal approach (see Chen, 2012). A
volunteer sample of 487 community adults from the Vancouver
area completed measures of perfectionism, hopelessness, depression, life stress, and suicide ideation at Time 1 and again at Time
2, six months later. The main findings emerging from this study
were that whereas socially prescribed perfectionism was associated with suicide ideation both concurrently and longitudinally,
self-oriented perfectionism interacted with achievement stressors
to predict future suicide ideation, after controlling for baseline
suicide ideation. This outcome was only found among women. The
need to consider sex differences in future research on suicide
ideation and behaviors was underscored by an overall pattern of
results indicating that perfectionism accounted for much more
variance in suicide ideation among women (Chen, 2012).
Another study tested the roles of goal-reengagement and the

behavioral inhibition system. OConnor and Forgans (2007)
cross-sectional investigation of 255 undergraduate students found
that socially prescribed perfectionism was associated with elevated
suicide ideation. In addition, low goal re-reengagement and high
socially prescribed perfectionism combined interactively to predict
elevated suicide ideation. Moreover, socially prescribed perfectionism mediated the link between an elevated behavioral inhibition system (BIS) and suicide ideation.
Additional support for this meditational model was provided by
Rasmussen, Elliott, and OConnor (2012). Their investigation of
125 recent suicide attempters found high mean levels of socially
prescribed perfectionism, and further established socially prescribed perfectionism as a mediator of the link between the BIS
and suicide ideation.
Rasmussen, OConnor, and Brodie (2008) had found in their
previous research with parasuicide patients that greater suicide
ideation was evident among people with a high level of socially
prescribed perfectionism and with poor recall of specific positive
autobiographical memories. Research on perfectionism and suicide
behavior in adolescents also underscores the pernicious role of
socially prescribed perfectionism. A study conducted in Israel
(with 100 inpatient adolescents) compared 45 nonsuicidal adolescents with 55 adolescents in a suicidal behavior group (see
Freudenstein et al., 2012). The latter group included 31 adolescents
who had made either a mild or more lethal suicide attempt. Group
comparisons indicated that the suicide behavior group had relatively higher levels of dependency and socially prescribed perfectionism, and a discriminant function analysis indicated that both
factors contributed to group differences.
Most recently, Hewitt, Caelian, Chen, and Flett (2014) examined trait perfectionism, stress, depression, hopelessness, and suicide potential in a sample of 55 adolescent psychiatric patients.
The main findings that emerged from this study is that socially
prescribed perfectionism was associated significantly with a measure of suicide potential even after controlling for the links between suicide potential and both depression and hopelessness. In
addition, socially prescribed perfectionism interacted with daily
hassles to predict suicide potential. These findings were specific to
a measure of suicide potential and were not found with a measure
of suicide ideation.
Finally, Roxborough et al. (2012) reported the results of a
unique study of children and adolescents who were psychiatric
outpatients. To our knowledge, this is the first published empirical
study with an explicit focus on both trait perfectionism and perfectionistic self-presentation (i.e., portraying the self as perfect in
public). Roxborough and associates found that both trait socially
prescribed perfectionism and perfectionistic self-presentation were
associated with a measure of suicide potential. Evidence for the
perfectionism social disconnection model (PSDM) was also obtained. The PSDM is based on the premise that interpersonal
perfectionism fosters a sense of isolation and interpersonal alienation that potentiates suicide risk (see Hewitt et al., 2006). Roxborough and colleagues (2012) reported that the association between suicide potential and the need to avoid seeming imperfect
was mediated by a history of being bullied and elevated interpersonal hopelessness. These data suggest that in cases in which being
bullied has contributed to suicide risk, the negative experience of
being bullied may be felt most acutely by interpersonally sensitive
perfectionists who would prefer to maintain an image of being

flawless and totally in control at all times. What remains to be
established are the processes implicated in how perfectionistic
youth become targets for bullying and teasing in the first place.
The role of perfectionistic self-presentation in suicide in vulnerable people of varying ages also merits urgent attention.
Additional new data indicate that perfectionism may be relevant
to the influential interpersonal model of suicide proposed by Joiner
and colleagues. This model includes an emphasis on deaths by
suicide occurring as a consequence of feeling like a burden to
others (see Van Orden et al., 2010). Rasmussen, Slish, Wingate,
Davidson, and Grant (2012) reasoned and found support for the
notion that perfectionists who feel like they have not lived up to
expectations, including the expectations of significant others, will
have a tendency to then conclude that they are a disappointment
and a burden to other people, and this fuels their self-destructive
behavior. This work is valuable in its emphasis on the role of
falling short of expectations. The notion of falling short of prescribed social expectations is a central theme in self-discrepancy
theory (Higgins, 1987) and in Baumeisters (1990) escape from
self model of suicide, and being discrepant from standards is a
factor that clearly distinguishes suicidal from nonsuicidal people
(see Orbach, Mikulincer, Stein, & Cohen, 1998). A particularly
important discrepancy to assess in future research on suicide is the
extent to which the perfectionistic person perceives that he or she
is falling short of meeting social expectations and feels a sense of
hopelessness in terms of the ability to address this discrepancy in
the future.
Further evidence of the need to consider perfectionism discrepancies was provided in a study of predictors of suicide ideation
among international students. Wang, Wong, and Fu (2013) found
in a sample of 466 Asian international students attending university in the midwestern United States that both a general measure of
perfectionism discrepancy (i.e., falling short of standards) and a
family measure of perfectionism discrepancy (i.e., falling short of
perfectionistic demands prescribed by ones family) were both
linked significantly with suicide ideation. These same discrepancy
measures were also linked significantly with other key predictors
of suicide ideation (i.e., perceived burdensome, thwarted belongingness needs, and racial discrimination). Importantly, in keeping
with our claim that perfectionism confers added suicide risk via its
association with other risk factors, higher levels of perfectionism
discrepancy interacted with and amplified the link that factors such
as perceived burdensome had with suicide ideation.
Unaddressed Issues
Several key issues in this field merit urgent attention but have
not been adequately addressed. We will focus on four such issues
in addition to the issues already mentioned. First, there is a need
for comparative cross-cultural research on perfectionism and suicide. In general, there is increasing research examining perfectionism and mental health as a function of culture and race (see
DiBartolo & Rendon, 2012) and this important empirical focus
should extend to systematic research on perfectionism and suicide.
We need more answers to basic questions such as In which areas
of the world is perfectionism particularly implicated in suicide?
Also, what factors contribute to these anticipated differences? A
sophisticated approach that contrasts people from cultures with
161
interdependent versus independent self-concepts should prove particularly informative. As noted by Kral (1998), attempts to understand suicide should be person-centered and there is much to be
gained by focusing on the complex dialectic of person and culture.
This seems especially evident when suicide ideation and behaviors
are clearly rooted in socially prescribed perfectionism and the
belief, veridical or not, that other people in particular and society
in general require that the self is perfect.
Second, little is known at present about how perfectionism
relates to well-known sex and age differences in suicide attempts
and completed suicides. The extent to which perfectionism contributes to these differences is not known at present due to a lack
of systematic inquiry that considers perfectionism within the context of these other predictive factors.
Third, research is needed on how perfectionism combines with
diagnosable conditions to predict suicide behaviors. Suicide behaviors are more likely among people suffering from comorbid
clinical conditions (see Kessler, Borges, & Walters, 1999; Nock &
Kessler, 2006). A possible role for perfectionism is suggested by
consistent evidence showing that perfectionism is linked with
comorbid conditions (see Wheeler, Blankstein, Antony, McCabe,
& Bieling, 2011). Another possibility is that perfectionism plays a
key role in elevating the suicide risk of depressed people suffering
from posttraumatic stress disorder, especially among those people
with high levels of shame and self-criticism and who feel personally responsible for the traumatic events having taken place. Perfectionism is likely implicated, for instance, in suicide behaviors
and deaths by suicide among traumatized military personnel described as model soldiers who were exceedingly conscientious.
Fourth, with the noteworthy exception of research on the role of
positive future-oriented thinking (see OConnor & Forgan, 2007),
research and theory on perfectionism and suicide has not been
informed by positive psychology; much is to be gained by examining protective factors and resiliency processes. Research is
needed to examine possible buffers of the perfectionismsuicide
link because fostering a positive orientation toward the self by
boosting levels of hope, self-compassion, and unconditional selfacceptance may prove essential in lowering suicide risk among
vulnerable perfectionists. A key consideration is whether the potentially vulnerable perfectionist has established a sense of personal meaning; personal meaning is a protective factor, especially
among older people (e.g., Heisel & Flett, 2004, 2006, 2014;
Moore, 1997). There is virtually no published work on perfectionism and meaning in life, but given the apparent role of existential
factors in perfectionism and depression (see Graham et al., 2010),
it follows that perfectionists should be substantially at risk for
suicide when they perceive that they their life is without purpose,
especially if something has happened to threaten, cloud, or take
away a prior sense of life meaning.
Is the Role of Perfectionism in

Suicide Underrecognized?
Despite the significant gaps in the literature, there is still ample
evidence pointing to perfectionism as a risk factor for suicide.
Suicide typologies include a depressed-perfectionistic type (see
Orbach, 1997) with perfectionism described as . . . an important
cognitive aspect of suicidal ideation and behavior (see Ellis &
Rutherford, 2008, p. 52). Wenzel and Beck (2008) also empha-
162
sized perfectionistic standards in their model of cognitive factors

in suicide. There is also a growing appreciation of the role that
exposure to perfectionistic demands and expectations can play in
heightening susceptibility to suicide. Top suicidologist Charles
Neuringer implicated developmental experiences that promote perfectionism during an interview conducted by Thomas Ellis, another expert in the field (see Ellis, 2006). When asked what sets the
stage developmentally for suicide, Neuringer pointed to harsh
parents who demand perfection from their children and who instill
in their children a focus on impossibly high ideals and related
forms of aberrant thinking. These insights accord with the
evidence summarized above that links perceived exposure to
socially prescribed perfectionism with suicide ideation and
associated tendencies.
Recall our contention that the role of perfectionism is underestimated and the perfectionismsuicide link is an emerging public
health problem of growing significance. Descriptive data highlighting the role of perfectionism in deaths by suicide are briefly
summarized below. While descriptive data are clearly not ideal
from a methodological perspective, it is difficult to ignore the
mounting evidence that points to the role of perfectionism in
suicide.
Contemporary events suggest that the need to understand and
pay greater attention to the perfectionismsuicide link is becoming
more urgent in terms of the human costs of failing to do so. For
instance, in June 2008, the Flemish Centre for Suicide Prevention
in Belgium issued an emergency public appeal after six teenagers
attempted suicide in a 2-week period, with only two surviving.
This urgent public appeal strongly emphasized the pressures of not
achieving perfectionistic standards. Teachers and parents were
asked to be particularly vigilant in order to detect the psychological pain of perfectionistic teens suffering from low self-esteem.
Perhaps the most compelling evidence linking perfectionism
with death by suicide emerged from the Alaska Suicide FollowBack study (Alaska Injury Prevention Centre and others, 2007).
Investigators reviewed deaths by suicide in Alaska from September 2003 and October 2006, and a team of interviewers then
conducted follow-back interviews with 71 informants who were
acquainted with 56 of the suicide decedents. Overall, 56% of the
decedents were described spontaneously by grieving informants as
perfectionists. That is, more than 1 out of 2 people taking their own
lives were deemed by their close acquaintances to be perfectionists. Perfectionism also emerged as a theme following qualitative
analyses of how parents make sense of their sons suicides (see
Owens, Lambert, Lloyd, & Donovan, 2008). Perfectionism was
identified as a key theme emerging from semistructured interviews with 14 sets of parents who lost a son to suicide. Perfectionism was emphasized in the category the son as agent of
his own destruction.
Perfectionism was further implicated in a separate series of
psychological autopsies conducted with the parents of 33 boys and
young men who died by suicide (see Trnblom, Werbart, &
Rydelius, 2013). According to the mothers interviewed, 71.4% of
the boys and young men with deaths by suicide had exceedingly
high demands and expectations that resembled classic definitions
of self-oriented perfectionism. This study also yielded evidence
relevant to a key theme discussed at length belowthat is, concealing distress and psychache behind a mask or front. The vast
majority of parents (9 in 10 parents) in this study mentioned
spontaneously how their lost sons concealed their problems and

hid behind masks.
Perfectionism was further implicated by Stanley, Mallon, Bell,
and Manthorpe (2009) in their analysis of student suicides. They
analyzed 20 deaths that occurred over a 5-year period. Overall, 11
students who died by suicide were deemed to be high in perfectionism and/or fear of failure. Accounts focused primarily on the
students perfectionistic self-expectations.
Finally, the previously mentioned study in Puerto Rico by Jones
and associates (2008) also highlighted perfectionism as a predominant factor in suicide risk among adolescents. Overall, 76.5% of
the suicidal adolescents in the community and 83.5% of the suicidal adolescents in the clinical sample were deemed to have
elevated perfectionism.
Overall, when examining completed suicides, perfectionism is a
central theme that is implicated in far too many actual deaths by
suicide despite the methodological limitations inherent in descriptive data. Accordingly, in the next segment of this article, we
examine some of the factors that escalate the risk of suicide among
perfectionists.
Reasons for Elevated Risk Among

Suicidal Perfectionists
Several factors are potentially implicated in the enhanced risk
for suicide among distressed perfectionists. We will restrict our
focus to four key factors: (a) the outward mask of the seemingly
invulnerable perfectionist; (b) features of perfectionism that promote more lethal suicide attempts; (c) the impact of shame in
elevating the risk for perfectionists who survived previous suicidal
behavior; and (d) the role of co-occurring factors such as hopelessness and psychache.
Beware the Mask: The Overrepresentation of

Perfectionism in Suicides Without Warning
Unfortunately, as noted earlier, and in keeping with Blatts
(1995) observations, many distressed perfectionists hide their distress and are secretive about their plans and their urges to kill
themselves until they actually take their own lives. Family members often report that there had been no apparent warning signs. In
many respects, self-concealment and silencing the self are linked
inextricably with perfectionism (see Besser, Flett, & Hewitt, 2010;
DiBartolo et al., 2008; Kawamura & Frost, 2004) and this amplifies the risk, especially when it precludes help-seeking and potential support providers are unaware of that help is needed.
This perfectionistic self-presentation and self-concealment were
depicted poignantly in the movie The Breakfast Club, when the
despair of the suicidal perfectionist named Brian Johnson only
became noticed when the gun he planned to use discharged prematurely in his locker. This fictional account occurs often in
reality. Friedman (2006) reported that a significant proportion of
adolescents are very secretive and hide mental health problems,
including keeping parents unaware of suicidal acts. This tendency
was first identified in research by Apter, King, and associates.
They described perfectionistic young soldiers who killed themselves without apparent warning signs (Apter et al., 1993; King,
Apter, & Zohar, 2007). They hid behind a self-presentation of high
achievement and apparent invulnerability.
These accounts are in keeping with our belief that perfectionists

with strong needs to seem perfect when they are in the presence of
other people are substantially overrepresented among those people
who kill themselves seemingly without warning; that is, they often
engage in Richard Cory suicides. This refers to the classic poem
by Robinson about Richard Cory who by all appearances was
doing well but then one day, inexplicably, kills himself. Perfectionistic self-presenters are low in self-disclosure and are typically
unwilling to communicate flaws, mistakes, and inadequacies that
are not in accordance with the goal of seeming perfect (i.e.,
nondisclosure of imperfections) (see Hewitt et al., 2003). People
with this maladaptive orientation react with strong, shame-based
negative affect in situations that may expose their deficiencies and
mistakes.
How does perfectionistic self-presentation contribute directly to
suicidality? First, we believe that the feeling of living an inauthentic life contributes to a negative self-view and sense of despair and
imposterism while also reminding the self-presenter on a continuing basis that he or she is far from perfect. Harter, Marold,
Whitesell, and Cobbs (1996) have suggested that hiding behind a
false self is, in part, a reflection of having parental support that is
conditional on meeting exceptionally high parental expectancies.
Whatever the case, these perfectionistic self-presenters are locked
into a style of behavior that maintains an aversive self-focus on
flaws and imperfections that are cognitively salient. Perfectionistic
self-presenters have a ruminative, brooding orientation that can be
totally hidden; for these individuals, while they are brooding and
contemplative on the inside, they may seem perfect and invulnerable on the outside.
Second, because many people are reasonably good at perfectionistic self-presentation, when it comes to some distressed people, no one may ever be in position to realize that these people are
in jeopardy. As noted originally by Burns (1980), many distressed
perfectionists have a disclosure phobia that limits access to social
support among people who already may have diminished social
contact. Sorotzkin (1998) has observed that gifted children and
adolescents are particularly good at engaging in behavior that
resembles perfectionistic self-presentation because their accomplishments deflect attention toward achievements and away from
feelings of inadequacy and noticing self-destructive tendencies.
Work by Apter and his associates has shown in general that low
levels of self-disclosure are implicated in suicidality and distinguish between those people who are merely thinking about suicide
versus engaging in actual suicidal acts (see Horesh & Apter, 2006;
Horesh, Levi, & Apter, 2012). The inability or unwillingness to
disclose not only limits the likelihood of detection, it also, according to the perfectionism social disconnection model of suicidality,
contributes subjectively and objectively to a heightened sense of
alienation, isolation, and loneliness (see Hewitt et al., 2006).
In light of these observations, clinicians and counselors who
suspect that a distressed client is actually more suicidal than this
person seems on the surface should give strong consideration to
probing further, including assessing perfectionistic self-presentation,
in order to get a more accurate picture of the actual degree of
suicide intent. This can be assessed via questionnaire, but also can
be evaluated less directly by establishing whether the client is
simply able to talk without much hesitation about mistakes he or
she has made. Those who are in a position to intervene on behalf
of younger people should consider evidence that perfectionistic
163
self-presentation is identifiable and has a destructive influence

among children and youth (see Hewitt et al., 2011). Although
warning signs are often in short supply, it is foreboding when
adolescents who should show some signs of distress seem invulnerable and are portraying life as absolutely fine. If life seems just
too perfect for a known perfectionist who probably should be
experiencing some distress due to life setbacks, this may be a cue
that just the opposite is true.
Parenthetically, this perfectionistic self-presentation when experiencing psychache and hopelessness may contribute to the sex
difference in suicide. As part of her discussion of why men are
more likely to take their own lives, Mller-Leimkhler (2003)
highlighted traditional views of masculinity and related roles and
suggested that suicide is more likely among men who are emotionally inexpressive and reluctant to seek help and who are
isolated and socially disconnected; these same features are associated with perfectionistic self-presentation, suggesting that this
element of the perfectionism construct contributes to sex differences. It is also plausible that males are too invested psychologically in the importance of being perfectly successful in the
achievement domain, and they have a strong need to be recognized
for their achievements. But when achievement setbacks occur and
when mistakes are made, and these things are publicly known,
intense feelings of shame and inadequacy may be experienced, and
perfectionistic men will be particularly at risk to the extent that
they lack key protective resources (e.g., social support networks,
adaptive coping and emotion regulation skills). These possibilities
point once again to the need for greater consideration of sex
differences in future perfectionism and suicide research.
Perfectionism and Lethal Suicide Attempts

Perfectionists are also vulnerable, in part, because of the likely
role for perfectionism in suicide planning. Although suicide is
often an impulsive act, it is generally accepted that the extent of
detailed planning involved in a suicide attempt is often predictive
of death by suicide. By nature, perfectionists are not impulsive
people; instead, they are very deliberate, planful, and quite purposive in their actions (see Hewitt & Flett, 1993); this determination
can take the form of a compulsion to plan out details in an exacting
manner. Thus, deliberate and highly conscientious perfectionists
may be much more likely to utilize more lethal means in suicide
attempts, perhaps even resorting to extensive Internet-based information searches to identify particularly lethal means, as suggested
by some case accounts. The role of perfectionism in the planning
of suicides is a vitally important topic for future research; to our
knowledge, this topic has been entirely neglected thus far with the
exception of some data linking trait perfectionism with the planning component of suicidality (see Flamenbaum & Holden, 2007).
The planfulness of suicidal perfectionists could have many implications. It is quite possible, for instance, that the sex difference in
rates of suicide discussed above is still detectable but not as
evident when comparing women and men who are perfectionists
and may be relatively equivalent in the planning and lethality of
their suicide attempts. A very testable hypothesis is that the rate of
death by suicide among women may be much higher for perfectionistic women who are suffering and who engage in conscientious planning.
164
Perfectionism and the Shame of Surviving

a Suicide Attempt
A related concern that has received no consideration thus far is
the amplified suicide risk for perfectionists once a failed suicide
attempt occurs and this prior attempt has become known to others.
People who have attempted suicide are exponentially more likely
to die from a subsequent attempt (see Bergmans & Links, 2009).
If perfectionism has not been ameliorated via treatment, in all
likelihood the risk of a subsequent attempt is especially high
among perfectionists with a history of self-injury, especially given
the propensity for perfectionists to experience shame (see Tangney, 2002). Suicide attempts that did not result in death could be
regarded by the already ashamed perfectionist as the most abject of
personal failures; shame and chronic rumination in such situations
may be precursors to a more lethal attempt.
Typically, the risk of committing suicide is especially high just
after someone who has engaged in suicide behaviors has been
released from care (see Christiansen & Larsen, 2012). Unfortunately, we have heard accounts of adolescents and young adults
who have killed themselves soon after successfully presenting in
clinical settings as being fine in order to get discharged, or in order
to avoid being admitted to hospitals and psychiatric facilities in the
first place. False displays of high functioning can actually lead
clinicians and counselors to wonder why the seemingly well person came into contact with the system in the first place. Clearly,
additional investigation and assessment is required when it is
known that someone who is now seemingly well is highly perfectionistic. It is also important to evaluate life circumstances; some people
with a past history of perfectionism and suicidality may now be
returning to a living situation that they see as intolerable, perhaps due
to the pressure that is waiting for them or a sense of being trapped.
This would suggest that great care be taken when evaluating the
apparent wellness of people who are both perfectionistic and high in
self-concealment and flawless self-presentation.
Conditions That Confer Added Risk:

Psychache and Hopelessness
We have made several references to perfectionists who are
experiencing (and often hiding) unbearable psychological pain
known as psychache. Psychache is the intense psychological pain
identified by Shneidman (1993) as perhaps the most essential
psychological element in suicide. Psychache is a robust predictor
of suicide and it mediates the link between other vulnerability
variables and suicide. Comparative research indicates that psychache often out-performs hopelessness and other risk factors in
predicting suicide ideation, suicide attempts, and self-injury behaviors (Holden, Mehta, Cunningham, & McLeod, 2001; Troister
& Holden, 2012). We emphasize it here because Flamenbaum and
Holden (2007) conducted an important study of perfectionism,
psychache, and various suicide indices among university students
that yielded several important findings. First, they demonstrated
that both self-oriented and socially prescribed perfectionism were
associated positively with psychache. They established further that
perfectionists are prone to psychache when they have significant
unfulfilled needs in areas such as achievement and affiliation. In
addition, Flamenbaum and Holden (2007) found uniquely that both
self-oriented and socially prescribed perfectionism were associated
with the planning component of suicide and a reported history of

suicide attempts. Finally, they established that psychache was a
full mediator of the association between trait perfectionism and
suicide ideation. These illuminating data establish a clear link
between perfectionism and profound psychological pain.
Aside from depression, hopelessness is arguably a leading
psychological risk factor for suicide. Its relevance in clinical
practice and assessment was illustrated in two surveys of practicing psychologists; these surveys identified hopelessness as
the leading psychological risk factor and one that is critically
important (see Brown, Bongar, & Cleary, 2004; Peruzzi &
Bongar, 1999). Parenthetically, it should be noted that perfectionism was not even considered as a potential risk factor in the
most recent Brown and colleagues (2004) survey. This omission
is just one of many reasons for our call for the need for greater
attention and emphasis being placed on perfectionism when
conducting suicide risk assessments.
Table 1 represents a unique summary of 29 published studies
that we compiled after surveying studies that included at least one
measure of perfectionism and one measure of hopelessness. A
consistent finding across almost all of these studies (27 of 29
studies) was that at least one measure of perfectionism was associated with hopelessness. The few studies that did not yield an
association had sample size concerns due to relying on relatively
small samples of depressed clinical adolescent patients (Hewitt et
al., 2014) or first-time self-harmers and repeat self-harmers (Rasmussen et al., 2008; see Table 1). Overall, 20 studies used the
Hewitt and Flett MPS or a downward extension of this measure,
the Child-Adolescent Perfectionism Scale. Another six published
studies used the Frost MPS, and three studies used the perfectionism subscale of the Dysfunctional Attitudes Scale. The 19 studies
that included assessments of socially prescribed perfectionism
showed almost uniformly that socially prescribed perfectionism
was linked with hopelessness. Because we focused on published
studies, we did not include the results of the new study conducted
in the Vancouver area that we described earlier (see Chen, 2012),
but here again it was found that socially prescribed perfectionism
was associated with hopelessness, and this association was stronger among women (r .41) than among men (r .29). The seven
published studies with the Frost MPS found consistent links between hopelessness and concern over mistakes and doubts about
actions or a composite measure combining these dimensions. This
clear conclusion that emerges is that most vulnerable perfectionists
experiencing psychological distress are also high in hopelessness;
they have abjectly negative views of the future and they feel a lack
of efficacy to do anything about it. This has profound implications
for the risk inherent in perfectionism given the established role of
hopelessness in suicide ideation and deaths by suicide. What has
yet to be investigated (even though it seems vitally important to do
so) is exactly what happens in the lives of socially prescribed
perfectionists with an excessive concern about mistakes to contribute to their profound sense of hopelessness. Is hopelessness
simply a result of chronic exposure to impossible demands? What
other factors contribute to hopelessness among perfectionists? For
our purposes at present, the main point is that the individual who
is characterized at the same time by an array of factors including
high levels of socially prescribed perfectionism, concern over
mistakes, doubts about actions, self-criticism, hopelessness, and
psychache is also someone who is very likely to have strong
165
Table 1
Studies Linking Perfectionism and Hopelessness
Author(s)
Becker-Weidman, Reinecke,
Jacobs, Martinovich, Silva,
& March (2009)
Beevers & Miller (2004)
Blankstein, Lumley, &

Crawford (2007)
Chang (1998)
Chang & Rand (2000)
Cheng (2001)
Dean & Range (1996)
Dean & Range (1999)
Dean, Range, & Goggin (1996)
Donaldson, Spirito, & Farnett

(2000)
Enns, Cox, & Clara (2005)
Measures
Predictors of Hopelessness Among

Clinically Depressed Youth
Dysfunctional Attitudes Scale (DAS)

Beck Hopelessness Scale
DAS perfectionism was significantly

correlated with hopelessness.
Perfectionism, Cognitive Bias, and

Hopelessness as Prospective
Predictors of Suicidal Ideation
Perfectionism, Hopelessness, and
Suicide Ideation: Revisions to
Diatheses-Stress and Specific
Vulnerability Models
Cultural Differences,
Perfectionism, and Suicidal Risk
in a College Population: Does
Social Problem Solving Still
Matter?
Dysfunctional Attitudes ScalePerfectionism Beck Hopelessness

Scale
MPS (Hewitt & Flett, 1991)
Extended Hopelessness Scale

Perfectionism as a Predictor of
Subsequent Adjustment:
Evidence for a Specific
Diathesis-Stress Mechanism
Among College Students
Life Stress, Problem Solving,
Perfectionism, and Depressive
Symptoms in Chinese
The Escape Theory of Suicide and
Perfectionism in College
Students
Testing the Escape Theory of
Suicide on an Outpatient
Clinical Population
The Escape Theory of Suicide in
College Students: Testing a
Model That Includes
Perfectionism
The Role of Perfectionism and
Depressive Cognitions in
Understanding the Hopelessness
Experienced by Adolescent
Suicide Attempters
Perfectionism and Neuroticism: A
Longitudinal Study of Specific
Vulnerability and DiathesisStress Models
MPS (Hewitt & Flett, 1991) Beck

Hopelessness Scale
MPS (Frost et al., 1990) Beck

Hopelessness Scale
SPP was a significant predictor of

suicide ideation, interpersonal
hopelessness, and achievement
hopelesssness for men and women.
Hopelessness was significantly
correlated with concern over
mistakes, parental criticism, and
doubts about actions in Caucasian
Americans. Hopelessness was also
linked with parental Criticism
among Asian Americans (p .05).
SPP was significantly positively
associated with hopelessness; the
relationship between SOP and
hopelessness was found to
approach significance.
Perfectionism was significantly
associated with hopelessness.

Hopelessness Scale
SPP was significantly correlated with

hopelessness.
MPS (Hewitt & Flett, 1991) The

Hopelessness Scale
SPP was moderately correlated with

hopelessness.
MPS- SPP subscale (Hewitt & Flett,

1991) Beck Hopelessness Scale

hopelessness.
Child-Adolescent Perfectionism
Scale Hopelessness Scale for
Children

the HSC.
MPS (Hewitt & Flett, 1991) MPS

(Frost et al., 1990) Beck
Hopelessness Scale
SPP was associated with hopelessness

at Time 1. Concern over mistakes
and doubts about actions were
significantly correlated with
hopelessness at Time 1 and
Time 2.
SPP was significantly related to
hopelessness. SPP, neuroticism,
and self-criticism showed the
largest cross-sectional correlations
with hopelessness and suicidal
ideation.
Maladaptive perfectionism
combined construct was
hopelessness.
Hopelessness was associated with
concern over mistakes and with
doubts about actions
(table continues)

Hopelessness Scale
Enns, Cox, & Inayatulla (2003)
Personality Predictors of Outcome

for Adolescents Hospitalized for
Suicidal Ideation
Children
Enns, Cox, Sareen, & Freeman

(2001)
Adaptive and Maladaptive

Perfectionism in Medical
Students: A Longitudinal
Investigation
Adaptation of the Beck
Hopelessness Scale in Hungary
Hopelessness and Perfectionism
MPS (Hewitt & Flett, 1991) MPS

(Frost et al., 1990) Beck
Hopelessness Scale
Forintos, Sallai, & Rozsa

(2010)
Halpin & Lester (2001)
Results Re: Hopelessness and

perfectionism
Title
Dysfunctional Attitudes Scale Beck

Hopelessness Scale
Hopelessness Scale
166
Table 1 (continued)
Author(s)
Hewitt, Caelian, Chen, & Flett
(2014)
Measures
Perfectionism, Stress, Daily

Hassles, Hopelessness, and
Suicidal Potential in Depressed
Psychiatric Patients
Perfectionism and Suicide
Potential
Dimensions of Perfectionism and
Suicide Ideation
Scale Childrens Hopelessness
Scale
Hewitt, Newton, Flett, &

Callander (1997)
Perfectionism and Suicide Ideation

in Adolescent Psychiatric
Patients
Hewitt, Norton, Flett,

Callander, & Cowan (1998)
Dimensions of Perfectionism,
Hopelessness, and Attempted
Suicide in a Sample of
Alcoholics
OConnor & OConnor (2003)
Predicting Hopelessness and

Psychological Distress: The
Role of Perfectionism and
Coping
Children Suicide Ideation
Questionnaire
Hopelessness Scale Achievement
and Social Hopelessness Seven
Point Agreement Measure
Clinician Ratings of Suicide
Attempt Lethality, Intent, and
Risk
Hopelessness Scale
OConnor, OConnor,
OConnor, Smallwood, &
Miles (2004)
Hopelessness, Stress, and

Perfectionism: The Moderating
Effects of Future Thinking

Hopelessness Scale
OConnor et al. (2007)
Predicting Short-Term Outcome in

Well-Being Following Suicidal
Behaviour: The Conjoint Effects
of Social Perfectionism and
Positive Future Thinking
Relationship of Perfectionism to
Depression and Hopelessness in
College Students

Hopelessness Scale
Psychological Distress and

Perfectionism in Recent Suicide
Attempters: The Role of
Behavioural Inhibition and
Activation
The Role of Perfectionism and
Autobiographical Memory in a
Sample of Parasuicide Patients
Perfectionism, Stress, and Social
(Dis)Connection: A Short-Term
Study of Hopelessness,
Depression, and Academic
Adjustment Among Honors
Students

Hopelessness Scale
Relations of Self-Oriented
Perfectionism to Depression
and Hopelessness
Multidimensional Self-Oriented
Perfectionism Scale (Sakurai &
Ohtani, 1997) Beck Hopelessness
Scale
Hewitt, Flett, & TurnbullDonovan (1992)

Hewitt, Flett, & Weber (1994)
Title
Ohtani & Sakurai (1995)
Rasmussen et al., (2012)
Rasmussen, OConnor, &

Brodie (2008)
Rice, Leever, Christopher, &
Porter (2006)
Sakurai & Ohtani (1997)
MPS (Hewitt & Flett, 1991) Fourpoint self-report of hopelessness

Hopelessness Scale

Hopelessness Scale
The MPS (Hewitt & Flett, 1991)

The Beck Hopelessness Scale
Almost Perfect Scale-Revised Beck
Hopelessness Scale

perfectionism
Hopelessness was associated
positively with socially
perfectionism but it was not
statistically significant.
SPP was correlated significantly with
hopelessness
SPP was significantly correlated with
hopelessness in psychiatric patients
and in college students.
SPP and hopelessness accounted for
unique variance in suicide ideation
scores. SPP was significantly
Higher levels of depression,
hopelessness, and SPP
differentiated suicide attemptors
from non-attemptors.
SPP was correlated with hopelessness

and interacted with avoidance
coping to predict hopelessness.
Higher SOP was only associated
with changes in hopelessness when
positive cognitive reconstruction
coping was low.
Hopelessness was positively
correlated with SPP and negatively
correlated with SOP and OOP.
Individuals with impaired positive
future thinking and high SPP
reported higher hopelessness scores
relative to those with low SPP.
SPP and hopelessness were correlated
at Time 1. Among repeat
self-harmers with high SPP,
hopelessness was elevated.
SPP was positively significantly
related to hopelessness. SOP was
negatively correlated with
hopelessness.
SPP was correlated marginally with
hopelessness (p .08, two-tailed,
p .04 one-tailed)
Perfectionism dimensions were not
hopelessness.
Discrepancy, high standards and
perceived stress were significantly
correlated with hopelessness at the
Time 1 (early semester).
Discrepancy and perceived stress
were significantly correlated with
hopelessness at Time 2 (late
semester).
Personal standards was related
negatively to hopelessness; but
concern over mistakes and
doubts about actions were linked
positively with hopelessness.
167
Table 1 (continued)
Author(s)
Title
Wei, Malinckrodt, Russell, &

Abraham (2004)
Maladaptive Perfectionism as a
Mediator and Moderator
Between Adult Attachment and
Depressive Mood
Measures
Almost Perfect Scale-Revised
Multidimensional Perfectionism
Scale (Frost et al., 1990) Beck
Hopelessness Scale
suicidal tendencies, especially if the perfectionist with a confluence of vulnerabilities is also experiencing significant seemingly
uncontrollable stressors such as achievement and interpersonal
failures or interpersonal difficulties such as bullying (see Roxborough et al., 2012). The notion that perfectionists have an amplified
level of risk when they are viewed from a person-centered perspective is in keeping with the conclusion that perfectionism
magnifies the risk level for those individuals who are already
vulnerable and perhaps mentally ill (see Stanley et al., 2009).
One clear treatment implication that emerges from a personcentered perspective is the need for clinicians and counselors to
follow the key recommendations put forth by Meichenbaum
(2005). Key goals include conducting ongoing assessments of
suicide risk, and proactively constructing a plan with various
elements and steps that increase the clients safety.
Treatment interventions should be informed by what is already
known about the challenges inherent in providing psychotherapy
and counseling to perfectionists. For instance, in addition to the
recommendations listed above, Meichenbaum (2005) also emphasized the need to develop a strong therapeutic alliance with the
suicidal client, and this is likely a key theme for vulnerable
perfectionists. Indeed, research has confirmed that difficulties in
establishing a strong working alliance have been implicated as
being among the factors and processes that hinder the progress of
perfectionists in treatment (see Hawley, Ho, Zuroff, & Blatt,
2006). In general, work by Blatt, Zuroff, and their colleagues has
made it clear that long-term interventions are often needed because
perfectionism involves core themes involving the self and personal
identity issues (see Blatt & Zuroff, 2002). While some progress
has been reported in terms of the effectiveness of psychotherapy
interventions designed to reduce perfectionism and associated adjustment problems (see Lloyd, Schmidt, Khondoker, & Tchanturia,
2014), this treatment research is still in its early stages, and
treatment outcome research focused on suicidal perfectionists remains to be conducted.
Ideally, the vulnerabilities of self-critical perfectionists should
be addressed proactively in order to limit the possibility that
perfectionism will undermine the well-being of perfectionists.
Accordingly, we now turn to a discussion of the need for prevention as a means of protecting vulnerable perfectionists who are at
risk.
Need for Prevention

Because many perfectionists are high in self-concealment and
will often remain silent about their despair while being unaware of
the potential destructiveness of perfectionism, prevention programs must be designed proactively and implemented broadly so
that the distress experienced by perfectionists does not escalate
into suicidality.

perfectionism
Doubts about actions and concern
over mistakes were significantly
The most recent review of community-based suicide prevention

programs found that most of the programs evaluated were schoolbased and involved youth participants. It was concluded that
suicide prevention programs yielded improvements in knowledge
and awareness and reductions in certain key indicators (e.g., levels
of hopelessness). However, there was little evidence indicating
that prevention programs result in reductions in suicide behaviors
(see York et al., 2013).
It is our contention that suicide prevention programs need to be
tailored and adapted to take specific themes involving perfectionism into account. Unfortunately, there is little evidence that the
complexities inherent in perfectionism are being translated and
incorporated into prevention programs. A related concern here is
whether suicide prevention programs have enough of a specific
focus on the individuals who suffer in silence and who hide their
suicide ideation, urges, and intentions behind a faade. Clearly,
prevention programs should be designed with the specific needs of
these individuals in mind. We have already noted that children and
adolescents may be particularly at risk, so it is vital to create
interventions designed to decrease levels of personal and interpersonal perfectionism and reduce self-stigma and concerns about
stigma.
Existing intervention research in the perfectionism field suggests that an explicit focus on reducing perfectionism and its
associated risk can be effective in specified circumstances, but
general prevention programs without an explicit or extensive focus
on perfectionism are less successful (for a review, see Flett &
Hewitt, in press). Even when some success is achieved (see Essau,
Conradt, Sasagawa, & Ollendick, 2012), there are indications that
interventions tend to reduce but do not ameliorate perfectionism; it
seems that higher initial levels of perfectionism have pernicious
negative influences that result in lasting vulnerabilities (see Nobel,
Manassis, & Wilansky-Traynor, 2012). A framework for preventing destructive perfectionism in school-based programs can be
found in Flett and Hewitt (in press). Key themes that can and
should be incorporated when designing and implementing multifaceted preventive programs in the future include: (a) fostering
self-acceptance and self-compassion instead of experiencing
shame and self-criticism; (b) promoting appropriate goal-setting
and goal appraisal versus setting and maintaining impossible standards; (c) combating ambivalence about giving up the need to be
perfect since the distressed perfectionist must be highly motivated
to change; and (d) developing resilience to feelings of shame and
the ability to cope with interpersonal conflict and feelings of being
rejected by others.
We maintain that suicide prevention efforts must take a nuanced
approach reflecting the complexities inherent in the perfectionism
construct. In essence, just as there are attempts to reflect personality vulnerabilities in treatments that are tailored to individual
168
needs, suicide prevention efforts must be tailored to reflect the

themes and needs of perfectionists. Typically, when summary lists
are made of risk factors associated with suicide and made publicly
available, the good news is that perfectionism is often included on
the list of predictors; unfortunately, however, the specific elements
of the construct are not specified. That is, the interpersonal elements of the perfectionism construct are not spelled out despite the
growing evidence of the role of socially prescribed perfectionism
in suicidality.
To illustrate, the practice guidelines endorsed by the American
Psychiatric Association describe perfectionism as excessively
high self-expectation and this is seen as a risk factor without
recognizing other key elements of the perfectionism construct.
Similarly, a recent manual on suicide risk management for health
professionals lists perfectionism as a personality risk factor but the
various facets of perfectionism are not listed (see Chehil &
Kutcher, 2012). When it comes to recognizing specific facets, we
have focused extensively on socially prescribed perfectionism, but
from a prevention perspective, it is just as important if not more
important to address perfectionistic self-presentation and perfectionistic self-concealment and related factors such as self-criticism
and concern over mistakes. Descriptions of perfectionism as a risk
factor should include the tendency for distressed perfectionists to
hide behind a faade. Moreover, prevention efforts should include
taking active steps to resolve the unwillingness of these extreme
self-presenters to seek help and the sense of social isolation and
disconnection felt by interpersonal perfectionists. Because perfectionistic self-presentation is a fairly new concept that has not been
studied extensively, it is not currently a focus for prevention in
applied settings.
When psychosocial factors are incorporated, prevention efforts
must also recognize that many perfectionists simply do not avail
themselves of protective resources (see Blankstein et al., 2007) and
there is a need to combat the self-stigma that limits the helpseeking of perfectionists. There is an urgent need for research on
the barriers to help-seeking that have an impact on vulnerable
perfectionists. Self-critical perfectionists are likely overrepresented among those people who feel that people who seek help are
weak individuals and they should think less of themselves when
they find themselves in need of help.
Screening programs can also be implemented in high schools,
colleges, and universities as well as in primary care settings to
identify distressed perfectionists who may be experiencing suicide
ideation. These programs are especially needed in settings that
tend to produce great pressures to be perfectly successful. Programs must also address particularly stressful times of year when
life problems may seem less controllable and feelings of personal
failure and shame can become magnified and overgeneralized.
Regarding work settings, it is also important to proactively
develop interventions for adults in occupations that promote struggles with perfectionism. For instance, there is now growing concern about levels of depression and the number of completed
suicides among lawyers, and perfectionism has been repeatedly
implicated (French, 2011). Indeed, the three people with deaths by
suicide who were described by Blatt (1995) included attorney
Vince Foster. Other key occupations to consider here include
physicians, occupations that emphasize a need for precision (i.e.,
architects), and executives and managers in leadership positions.
These occupations enhance the tendency for perfectionists to per-
ceive a sense of personal responsibility and culpability when

things go wrong and there are costly implications that follow for
making mistakes in a milieu of unrelenting pressure. These occupations also require people in these roles to project a sense of
infallibility and not show weakness or self-doubt. Given the role of
perfectionistic self-presentation, risk may be especially high
among individuals who project an image of being the perfect
worker. Individuals in these situations may be overwhelmed by the
discrepancy between their projected image and their awareness of
personal imperfections.
We have focused on perfectionism and risk in terms of certain
occupations, but it should be recognized more generally that perfectionism can become a destructive element in the culture of any
organization that places great pressure on their workers to be
perfect, and where admitting depression and psychological pain
jeopardizes ones job status. Data from measures of organizational
culture indicate that it is distressing to work in organizational
environments that promote the message that mistakes are not
acceptable and the only acceptable standard is attaining absolute
perfection. Preventive efforts should include an organizational
focus on reducing pressures to be perfect. When perfectionism
prevails as part of the culture and values of the workplace, it tends
to promote poorer performance rather than superior performance
(Gillett & Stenfert-Kroese, 2003) and it is linked with job dissatisfaction, poorer communication quality, role conflict, reduced
likelihood of staying, and a poorer perceived fit between the
person and the work environment (Balthazard, Cooke, & Potter,
2006; Rousseau, 1990).
Summary
In the current article, we presented evidence to support our
contention that perfectionism actually has a much greater role in
suicide than is currently appreciated. Unfortunately, Blatts (1995)
initial observations 20 years ago about the destructiveness of
perfectionism have not translated into the kind of public policies
and practices needed in order to protect vulnerable perfectionists
and their families. Several concepts and themes warranting further
attention and development were highlighted in the current paper,
including the role of a perfectionistic form of self-concealment in
suicide, and the ways in which perfectionism can increase the
likelihood of suicidal behaviors leading to death by suicide. Our
main purpose in writing this article was to address a growing
public health issue and magnify awareness of the role of perfectionism in suicide so that interventions can be designed and implemented before suicides occur. Many suicide experts include
perfectionism among the factors that heighten suicide risk, but its
importance still does not seem to be fully acknowledged.
Another key purpose in writing this article is that we hope it
serves as a further impetus for research and theory development on
the role of perfectionism in suicidality. It should be a relatively
simple matter to systematically incorporate an emphasis on perfectionism into existing research programs, such as psychological
autopsy research and long-term research assessing the impact of
related constructs such as hopelessness. There has been considerable research on perfectionism and suicide thus far, but it is evident
that much more research is needed. More importantly, it should be
relatively simple in clinical, counseling, school, and work settings
to more fully assess and evaluate perfectionism and associated risk
factors when seeking to determine whether a particular person is at

risk for suicide. The loss of human potential and the widespread
suffering among bereaved family members of perfectionists should
provide all the impetus that is required in order for more concerted
efforts to take place, both in terms of research and in terms of
practice.
References
Alaska Injury Prevention Center, Critical Illness and Trauma Foundation,
Inc., & American Association of Suicidology. (2007). Alaska suicide
follow-back study final report. Juneau, AK: Alaska Department of
Health and Social Services.
Ansell, E. B., Pinto, A., Crosby, R. D., Becker, D. F., Anez, L. M., Paris,
M., & Grilo, C. M. (2010). The prevalence and structure of obsessivecompulsive personality disorder in Hispanic psychiatric outpatients.
Journal of Behavior Therapy and Experimental Psychiatry, 41, 275
281. doi:10.1016/j.jbtep.2010.02.005
Apter, A., Bleich, A., King, R. A., Korn, S., Fluch, S., Kotler, M., &
Cohen, D. J. (1993). Death without warning? A clinical post-mortem
study of suicide in 45 Israeli adolescent males. Archives of General
Psychiatry, 50, 138 142. doi:10.1001/archpsyc.1993.01820140064007
Balthazard, P. A., Cooke, R. A., & Potter, R. E. (2006). Dysfunctional
culture, dysfunctional organization: Capturing the behavioral norms that
form organizational culture and drive performance. Journal of Managerial Psychology, 21, 709 732. doi:10.1108/02683940610713253
Baumeister, R. F. (1990). Suicide as escape from self. Psychological
Review, 97, 90 113. doi:10.1037/0033-295X.97.1.90
Becker-Weidman, E. G., Reinecke, M. A., Jacobs, R. H., Martinovich, Z.,
Silva, S. G., & March, J. S. (2009). Predictors of hopelessness among
clinically depressed youth. Behavioural and Cognitive Psychotherapy,
37, 267291. doi:10.1017/S1352465809005207
Beevers, C. G., & Miller, I. W. (2004). Perfectionism, cognitive bias, and
hopelessness as prospective predictors of suicide ideation. Suicide and
Life-Threatening Behavior, 34, 126 137. doi:10.1521/suli.34.2.126
.32791
Bell, J., Stanley, N., Mallon, S., & Manthorpe, J. (2010). The role of
perfectionism in student suicide: Three cases from the UK. Omega, 61,
251267.
Bergmans, Y., & Links, P. S. (2009). Reducing potential risk factors for
suicide-related behavior with a group intervention for clients with recurrent suicide-related behavior. Annals of Clinical Psychiatry, 21, 17
25.
Besser, A., Flett, G. L., & Hewitt, P. L. (2010). Silencing the self and
personality vulnerabilities associated with depression. In D. Jack & A.
Ali (Eds.), Silencing the self across cultures: Depression and gender in
the social world (pp. 285312). London, UK: Oxford University Press.
doi:10.1093/acprof:oso/9780195398090.003.0014
Bialosky, J. (2011). A history of a suicide: My sisters unfinished life.
Toronto, Canada: Atria Books.
Bibeau, L., & Dupuis, G. (2007). Dtresse psychologique, perfectionnisme,
insatisfaction de limage corporelle: Validation dun modle explicatif
de la problmatique suicidaire. Canadian Journal of Behavioural Science/Revue Canadienne des Sciences du Comportement, 39, 119 134.
doi:10.1037/cjbs2007_2_119
Blankstein, K. R., Lumley, C. H., & Crawford, A. (2007). Perfectionism,
hopelessness, and suicide ideation: Revisions to diathesis-stress and
specific vulnerability models. Journal of Rational-Emotive & CognitiveBehavior Therapy, 25, 279 319. doi:10.1007/s10942-007-0053-6
Blatt, S. J. (1995). The destructiveness of perfectionism. American Psychologist, 50, 10031020. doi:10.1037/0003-066X.50.12.1003
Blatt, S. J., & Zuroff, D. C. (2002). Perfectionism in the therapeutic
169
process. In G. L. Flett & P. L. Hewitt (Eds.), Perfectionism: Theory,

research, and treatment (pp. 393 406). Washington, DC: American
Psychological Association.
Boergers, J., Spirito, A., & Donaldson, D. (1998). Reasons for adolescent
suicide attempts: Associations with psychological functioning. Journal
of the American Academy of Child & Adolescent Psychiatry, 37, 1287
1293. doi:10.1097/00004583-199812000-00012
Brown, L. M., Bongar, B., & Cleary, K. M. (2004). A profile of psychologists views of critical risk factors for completed suicide in older adults.
Professional Psychology: Research and Practice, 35, 90 96. doi:
10.1037/0735-7028.35.1.90
Burns, D. D. (1980, November). The perfectionists script for self-defeat.
Psychology Today, 3, 4 52.
Centers for Disease Control and Prevention. (2010). 19972007 Incidence
and mortality web-based report. Atlanta, GA: Author.
Centers for Disease Control and Prevention. (2012). Understanding suicide: Fact sheet. Retrieved from http://www.cdc.gov/violenceprevention/
pdf/suicide-datasheet-a.PDF
Chang, E. C. (1998). Cultural differences, perfectionism, and suicidal risk
in a college population: Does social problem solving still matter? Cognitive Therapy and Research, 22, 237254. doi:10.1023/A:
1018792709351
Chang, E. C., & Rand, K. L. (2000). Perfectionism as a predictor of
subsequent adjustment: Evidence for a specific diathesis-stress mechanism among college students. Journal of Counseling Psychology, 47,
129 137. doi:10.1037/0022-0167.47.1.129
Chehil, S., & Kutcher, S. (2012). Suicide risk management: A manual for
health professionals (2nd ed.). Chichester, West Sussex: WileyBlackwell.
Chen, C. (2012). Perfectionism and suicide ideation: An assessment of the
specific vulnerability hypothesis and stress generation model (Unpublished masters thesis). University of British Columbia, Canada.
Cheng, S. (2001). Life stress, problem solving, perfectionism, and depressive symptoms in Chinese. Cognitive Therapy and Research, 25, 303
310.
Christiansen, E., & Larsen, K. J. (2012). Young peoples risk of suicide
attempts after contact with a psychiatric departmentA nested case
control design using Danish registry data. Journal of Child Psychology
and Psychiatry, 53, 16 25. doi:10.1111/j.1469-7610.2011.02405.x
Dean, P. J., & Range, L. M. (1996). The escape theory of suicide and
perfectionism in college students. Death Studies, 20, 415 424. doi:
10.1080/07481189608252790
Dean, P. J., & Range, L. M. (1999). Testing the escape theory of suicide in
an outpatient clinical population. Cognitive Therapy and Research, 23,
561572. doi:10.1023/A:1018728606568
Dean, P. J., Range, L. M., & Goggin, W. C. (1996). The escape theory of
suicide in college students: Testing a model that includes perfectionism.
Suicide and Life-Threatening Behavior, 26, 181186.
DiBartolo, P. M., Li, C. Y., & Frost, R. O. (2008). How do the dimensions
of perfectionism relate to mental health? Cognitive Therapy and Research, 32, 401 417. doi:10.1007/s10608-007-9157-7
DiBartolo, P. M., & Rendon, M. J. (2012). A critical examination of the
construct of perfectionism and its relationship to mental health in Asian
and African Americans using a cross-cultural framework. Clinical Psychology Review, 32, 139 152. doi:10.1016/j.cpr.2011.09.007
Donaldson, D., Spirito, A., & Farnett, E. (2000). The role of perfectionism
and depressive cognitions in understanding the hopelessness experienced by adolescent suicide attempters. Child Psychiatry and Human
Development, 31, 99 111. doi:10.1023/A:1001978625339
Dunkley, D. M., Blankstein, K. R., Halsall, J., Williams, M., & Winkworth,
G. (2000). The relation between perfectionism and distress: Hassles,
coping, and perceived social support as mediators and moderators.
Journal of Counseling Psychology, 47, 437 453. doi:10.1037/00220167.47.4.437
170
Dunkley, D. M., Zuroff, D. C., & Blankstein, K. R. (2003). Self-critical

perfectionism and daily affect: Dispositional and situational influences
on stress and coping. Journal of Personality and Social Psychology, 84,
234 252. doi:10.1037/0022-3514.84.1.234
Ellis, T. E. (2006). The study of cognition and suicide: Beginnings and
developmental milestones. In T. E. Ellis (Ed.), Cognition and suicide:
Theory, research, and therapy (pp. 1328). Washington, DC: American
Psychological Association. doi:10.1037/11377-001
Ellis, T. E., & Rutherford, B. (2008). Cognition and suicide: Two decades
of progress. International Journal of Cognitive Therapy, 1, 47 68.
doi:10.1521/ijct.2008.1.1.47
Enns, M. W., Cox, B. J., & Clara, I. P. (2005). Perfectionism and neuroticism: A longitudinal study of specific vulnerability and diathesis-stress
models. Cognitive Therapy and Research, 29, 463 478. doi:10.1007/
s10608-005-2843-04
Enns, M. W., Cox, B. J., & Inayatulla, M. (2003). Personality predictors of
outcome for adolescents hospitalized for suicidal ideation. Journal of the
American Academy of Child & Adolescent Psychiatry, 42, 720 727.
doi:10.1097/01.CHI.0000046847.56865.B0
Enns, M. W., Cox, B. J., Sareen, F., & Freeman, P. (2001). Adaptive and
maladaptive perfectionism in medical students: A longitudinal investigation. Medical Education, 35, 1034 1042. doi:10.1046/j.1365-2923
.2001.01044.x
Essau, C. A., Conradt, J., Sasagawa, S., & Ollendick, T. H. (2012).
Prevention of anxiety symptoms in children: Results from a universal
school-based trial. Behavior Therapy, 43, 450 464. doi:10.1016/j.beth
.2011.08.003
Flamenbaum, R., & Holden, R. R. (2007). Psychache as a mediator in the
relationship between perfectionism and suicidality. Journal of Counseling Psychology, 54, 51 61. doi:10.1037/0022-0167.54.1.51
Flett, G. L., & Hewitt, P. L. (2002). Perfectionism and maladjustment: An
overview of theoretical, definitional, and treatment issues. In G. L. Flett
& P. L. Hewitt (Eds.), Perfectionism: Theory, research, and treatment
(pp. 531). Washington, DC: American Psychological Association. doi:
10.1037/10458-001
Flett, G. L., & Hewitt, P. L. (2013). Disguised distress in children and
adolescents Flying under the radar: Why psychological problems are
underestimated and how schools must respond. Canadian Journal of
School Psychology, 28, 1227.
Flett, G. L., & Hewitt, P. L. (In press). A proposed framework for
preventing perfectionism and promoting resilience and mental health
among vulnerable children and adolescents. Psychology in the Schools.
Flett, G. L., Hewitt, P. L., Blankstein, K. R., & Gray, L. (1998). Psychological distress and the frequency of perfectionistic thinking. Journal of
Personality and Social Psychology, 75, 13631381. doi:10.1037/00223514.75.5.1363
Forintos, D. P., Sallai, J., & Rozsa, S. (2010). Adaptation of the Beck
Hopelessness Scale in Hungary. Psychological Topics, 19, 307321.
French, D. (2011). American legal education and professional despair.
Academic Questions, 24, 157166. doi:10.1007/s12129-011-9217-z
Freudenstein, O., Valevski, A., Apter, A., Zohar, A., Shoval, G., Nahshoni,
E., . . . Zalsman, G. (2012). Perfectionism, narcissism, and depression in
suicidal and nonsuicidal adolescent inpatients. Comprehensive Psychiatry, 53, 746 752. doi:10.1016/j.comppsych.2011.08.011
Friedlander, A., Nazem, S., Fiske, A., Nadorff, M. R., & Smith, M. D.
(2012). Self-concealment and suicidal behaviors. Suicide and LifeThreatening Behavior, 42, 332340. doi:10.1111/j.1943-278X.2012
.00094.x
Friedman, R. A. (2006). Uncovering an epidemicScreening for mental
illness in teens. The New England Journal of Medicine, 355, 27172719.
doi:10.1056/NEJMp068262
Froedge, C. (2006, March 8). Suicide numbers troubling. Jackson Hole
News and Guide. Retrieved from http://www.jhnewsandguide.com/
article.php?art_id470
Frost, R., & DiBartolo, P. M. (2002). Perfectionism, anxiety, and

obsessive-compulsive disorder. In G. L. Flett & P. L. Hewitt (Eds.),
Perfectionism: Theory, research, and treatment (pp. 341371). Washington, DC: American Psychological Association.
Frost, R., Marten, P., Lahart, C., & Rosenblate, R. (1990). The dimensions
of perfectionism. Cognitive Therapy and Research, 14, 449 468. doi:
10.1007/BF01172967
Gillett, E., & Stenfert-Kroese, B. (2003). Investigating organizational
culture: A comparison of a high and a low performing residential
unit for people with intellectual disabilities. Journal of Applied Research
in Intellectual Disabilities, 16, 279 284. doi:10.1046/j.1468-3148.2003
.00170.x
Graham, A. R., Sherry, S. B., Stewart, S. H., Sherry, D. L., McGrath, D. S.,
Fossum, K. M., & Allen, S. L. (2010). The existential model of perfectionism and depressive symptoms: A short-term, four-wave longitudinal
study. Journal of Counseling Psychology, 57, 423 438. doi:10.1037/
a0020667
Halpin, K., & Lester, D. (2001). Hopelessness and perfectionism. Psychological Reports, 88, 252. doi:10.2466/pr0.2001.88.1.252
Harter, S., Marold, D. B., Whitesell, N. R., & Cobbs, G. (1996). A model
of the effect of perceived parent and peer support on adolescent false self
behavior. Child Development, 67, 360 374.
Hawley, L. L., Ho, M. H. R., Zuroff, D. C., & Blatt, S. J. (2006). The
relationship of perfectionism, depression, and therapeutic alliance during
treatment for depression: Latent difference score analysis. Journal of
Consulting and Clinical Psychology, 74, 930 942. doi:10.1037/0022006X.74.5.930
Heisel, M. J., & Flett, G. L. (2004). Purpose in life, satisfaction with life,
and suicide ideation in a clinical sample. Journal of Psychopathology
and Behavioral Assessment, 26, 127135. doi:10.1023/B:JOBA
.0000013660.22413.e0
Heisel, M. J., & Flett, G. L. (2006). The development and initial validation
of the Geriatric Suicide Ideation Scale. The American Journal of Geriatric Psychiatry, 14, 742751. doi:10.1097/01.JGP.0000218699
.27899.f9
Heisel, M. J., & Flett, G. L. (2014). Do meaning in life and purpose in life
protect against suicide ideation among community-residing older adults?
In A. Batthyany & P. Russo-Netzer (Eds.), Meaning in existential and
positive psychology (pp. 303324). New York, NY: Springer. doi:
10.1007/978-1-4939-0308-5_18
Hewitt, P. L., Blasberg, J. S., Flett, G. L., Besser, A. Sherry, S., Caelian,
C. M., . . . Birch, S. (2011). Perfectionistic self-presentation in children
and adolescents: Development and validation of the Perfectionistic SelfPresentationJunior form. Psychological Assessment, 23, 125142. doi:
10.1037/a0021147
Hewitt, P. L., Caelian, C. F., Chen, C., & Flett, G. L. (2014). Perfectionism,
stress, daily hassles, hopelessness, and suicide potential in depressed
psychiatric adolescents. Journal of Psychopathology and Behavioral
Assessment. Advance online publication. doi:10.1007/s10862-0149427-0
Hewitt, P. L., & Flett, G. L. (1991). Perfectionism in the self and social
contexts: Conceptualization, assessment, and association with psychopathology. Journal of Personality and Social Psychology, 60, 456 470.
doi:10.1037/0022-3514.60.3.456
Hewitt, P. L., & Flett, G. L. (1993). Perfectionism and goal orientation in
impulsive and suicidal behavior. In W. McCown, M. Shure, & J.
Johnson (Eds.), The impulsive client: Theory, research, and treatment
(pp. 247263). Arlington, VA: American Psychological Association.
doi:10.1037/10500-013
Hewitt, P. L., Flett, G. L., Sherry, S. B., & Caelian, C. (2006). Trait
perfectionism dimensions and suicidal behavior. In T. E. Ellis (Ed.),
Cognition and suicide: Theory, research, and therapy (pp. 215235).
Washington, DC: American Psychological Association. doi:10.1037/
11377-010

Hewitt, P. L., Flett, G. L., Sherry, S. B., Habke, M., Parkin, M., Lam,
R. W., . . . Stein, M. B. (2003). The interpersonal expression of
perfectionism: Perfectionistic self-presentation and psychological distress. Journal of Personality and Social Psychology, 84, 13031325.
doi:10.1037/0022-3514.84.6.1303
Hewitt, P. L., Flett, G. L., & Turnbull-Donovan, W. (1992). Perfectionism
and suicide potential. British Journal of Clinical Psychology, 31, 181
190. doi:10.1111/j.2044-8260.1992.tb00982.x
Hewitt, P. L., Flett, G. L., & Weber, C. (1994). Perfectionism, hopelessness, and suicide ideation. Cognitive Therapy and Research, 18, 439
460. doi:10.1007/BF02357753
Hewitt, P. L., Newton, J., Flett, G. L., & Callander, L. (1997). Perfectionism and suicide ideation in adolescent psychiatric patients. Journal of
Abnormal Child Psychology, 25, 95101. doi:10.1023/A:
1025723327188
Hewitt, P. L., Norton, G. R., Flett, G. L., Callander, L., & Cowan, T.
(1998). Dimensions of perfectionism, hopelessness, and attempted suicide in a sample of alcoholics. Suicide and Life-Threatening Behavior,
28, 395 406.
Higgins, E. T. (1987). Self-discrepancy: A theory relating self and affect.
Psychological Review, 94, 319 340. doi:10.1037/0033-295X.94.3.319
Holden, R. R., Mehta, K., Cunningham, E. J., & McLeod, E. D. (2001).
Development and preliminary validation of a scale of psychache. Canadian Journal of Behavioural Science/Revue Canadienne des Sciences
du Comportement, 33, 224 232. doi:10.1037/h0087144
Horesh, N., & Apter, A. (2006). Self-disclosure, depression, anxiety, and
suicidal behavior in adolescent psychiatric inpatients. Crisis, 27, 66 71.
doi:10.1027/0227-5910.27.2.66
Horesh, N., Levi, Y., & Apter, A. (2012). Medically serious versus nonserious suicide attempts: Relationships of lethality and intent to clinical
and interpersonal characteristics. Journal of Affective Disorders, 136,
286 293. doi:10.1016/j.jad.2011.11.035
Hunter, E. C., & OConnor, R. C. (2003). Hopelessness and future thinking
in parasuicide: The role of perfectionism. British Journal of Clinical
Psychology, 42, 355365. doi:10.1348/014466503322528900
Hyatt, L. A. (2010). A case study of the suicide of a gifted female
adolescent: Implications for prediction and prevention. Journal for the
Education of the Gifted, 33, 514 535. doi:10.1177/
016235321003300404
Jacobs, R. H., Silva, S. G., Reinecke, M. A., Curry, J. F., Ginsburg, G. S.,
Kratochvil, C. J., & March, J. S. (2009). Dysfunctional Attitudes Scale
perfectionism: A predictor and partial mediator of acute treatment
outcome among clinically depressed adolescents. Journal of Clinical
Child and Adolescent Psychology, 38, 803 813. doi:10.1080/
15374410903259031
Jeglic, E. L., Pepper, C. M., Vanderhoff, H. A., & Ryabchenko, K. A.
(2007). An analysis of suicide ideation in a college sample. Archives of
Suicide Research, 11, 4156. doi:10.1080/13811110600897176
Johnson, J., Wood, A. M., Gooding, P., Taylor, P. J., & Tarrier, N. (2011).
Resilience to suicidality: The buffering hypothesis. Clinical Psychology
Review, 31, 563591. doi:10.1016/j.cpr.2010.12.007
Jones, J., Ramirez, R. R., Davies, M., Canino, G., & Goodwin, R. D.
(2008). Suicidal behaviors among adolescents in Puerto Rico: Rates and
correlates in clinical and community samples. Journal of Clinical Child
and Adolescent Psychology, 37, 448 455. doi:10.1080/
15374410801955789
Kawamura, K. Y., & Frost, R. O. (2004). Self-concealment as a mediator
in the relationship between perfectionism and psychological distress.
Cognitive Therapy and Research, 28, 183191. doi:10.1023/B:COTR
.0000021539.48926.c1
Kessler, R. C., Borges, G., & Walters, E. E. (1999). Prevalence of and risk
factors for suicide attempts in the National Comorbidity Survey. Archives of General Psychiatry, 56, 617 626.
King, R. A., Apter, A., & Zohar, A. (2007). Toward a typology of late
171
adolescent suicide. In L. Mayes, P. Fonagy, & M. Target (Eds.), Developmental science and psychoanalysis: Integration and innovation (pp.
313324). London, UK: Karnac Books.
Kral, M. J. (1998). Suicide and the internalization of culture: Three
questions. Transcultural Psychiatry, 35, 221233. doi:10.1177/
136346159803500203
Krug, E. G., Dahlberg, L. L., Mercy, J. A., Zwi, A. B., & Lozano, R.
(2002). World report on violence and health. Geneva, Switzerland:
World Health Organization.
Legha, R. K. (2012). A history of physician suicide in America. Journal of
Medical Humanities, 33, 219 244. doi:10.1007/s10912-012-9182-8
Lloyd, S., Schmidt, U., Khondoker, M., & Tchanturia, K. (2014). Can
psychological interventions reduce perfectionism? A systematic review
and meta-analysis. Behavioural and Cognitive Psychotherapy. Advance
online publication. doi:10.1017/S1352465814000162.
Meichenbaum, D. (2005). 35 years of working with suicidal patients:
Lessons learned. Canadian Psychology/Psychologie Canadienne, 46,
64 72. doi:10.1037/h0087006
Mller-Leimkhler, A. M. (2003). The gender gap in suicide and premature death or: Why are men so vulnerable? European Archives of
Psychiatry and Clinical Neuroscience, 253, 1 8. doi:10.1007/s00406003-0397-6
Moore, S. L. (1997). Meaning in life in suicidal older adults. Archives of
Psychiatric Nursing, 11, 29 36. doi:10.1016/S0883-9417(97)80047-7
Nobel, R., Manassis, K., & Wilansky-Traynor, P. (2012). The role of
perfectionism in relation to an intervention to reduce anxious and depressive symptoms in children. Journal of Rational-Emotive &
Cognitive-Behavior Therapy, 30, 7790. doi:10.1007/s10942-0110133-5
Nock, M. K., & Kessler, R. C. (2006). Prevalence of and risk factors for
suicide attempts versus suicide gestures: Analysis of the National Comorbidity Survey. Journal of Abnormal Psychology, 115, 616 623.
OConnor, R. C. (2007). The relations between perfectionism and suicidality: A systematic review. Suicide and Life-Threatening Behavior, 37,
698 714. doi:10.1521/suli.2007.37.6.698
OConnor, R. C., & Forgan, G. (2007). Suicidal thinking and perfectionism: The role of goal adjustment and behavioral inhibition/activation
systems (BIS/BAS). Journal of Rational-Emotive & Cognitive-Behavior
Therapy, 25, 321341. doi:10.1007/s10942-007-0057-2
OConnor, R. C., & OConnor, D. B. (2003). Predicting hopelessness and
psychological distress: The role of perfectionism and coping. Journal of
Counseling Psychology, 50, 362372. doi:10.1037/0022-0167.50.3.362
OConnor, R. C., OConnor, D. B., OConnor, S. M., Smallwood, J., &
Miles, J. (2004). Hopelessness, stress, and perfectionism: The moderating effects of future thinking. Cognition and Emotion, 18, 1099 1120.
doi:10.1080/02699930441000067
OConnor, R. C., Rasmussen, S., & Hawton, K. (2012). Distinguishing
adolescents who think about self-harm from those who engage in selfharm. The British Journal of Psychiatry, 200, 330 335. doi:10.1192/bjp
.bp.111.097808
OConnor, R. C., Whyte, M. C., Fraser, L., Masterson, G., Miles, J., &
MacHale, S. (2007). Predicting short-term outcome in well-being following suicidal behaviour: The conjoint effects of social perfectionism
and positive future thinking. Behaviour Research and Therapy, 45,
15431555. doi:10.1016/j.brat.2006.11.006
Ohtani, Y., & Sakurai, S. (1995). Relationship of perfectionism to depression and hopelessness in college students. Shinrigaku Kenkyu: The
Japanese Journal of Psychology, 66, 41 47. doi:10.4992/jjpsy.66.41
Orbach, I. (1997). A taxonomy of factors related to suicidal behavior.
Clinical Psychology: Science and Practice, 4, 208 224. doi:10.1111/j
.1468-2850.1997.tb00110.x
Orbach, I., Mikulincer, M., Stein, D., & Cohen, O. (1998). Selfrepresentation of suicidal adolescents. Journal of Abnormal Psychology,
107, 435 439. doi:10.1037/0021-843X.107.3.435
172
ORiley, A. A., & Fiske, A. (2012). Emphasis on autonomy and propensity

for suicidal behavior in younger and older adults. Suicide and LifeThreatening Behavior, 42, 394 404. doi:10.1111/j.1943-278X.2012
.00098.x
Owens, C., Lambert, H., Lloyd, K., & Donovan, J. (2008). Tales of
biographical disintegration: How parents make sense of their sons
suicides. Sociology of Health & Illness, 30, 237254. doi:10.1111/j
.1467-9566.2007.01034.x
Pacht, A. (1984). Reflections on perfection. American Psychologist, 39,
386 390. doi:10.1037/0003-066X.39.4.386
Peruzzi, N., & Bongar, B. (1999). Assessing risk for completed suicide in
patients with major depression: Psychologists views of critical factors.
Professional Psychology: Research and Practice, 30, 576 580. doi:
10.1037/0735-7028.30.6.576
Pisetsky, E. M., Thornton, L. M., Lichtenstein, P., Pedersen, N. L.,& Bulik,
C. M. (2013). Suicide attempts in women with eating disorders. Journal
of Abnormal Psychology, 122, 10421056. doi:10.1037/a0034902
Rasmussen, K. A., Slish, M. L., Wingate, L. R., Davidson, C. L., & Grant,
D. M. (2012). Can perceived burdensomeness explain the relationship
between suicide and perfectionism? Suicide and Life-Threatening Behavior, 42, 121128. doi:10.1111/j.1943-278X.2011.00074.x
Rasmussen, S. A., Elliott, M. A., & OConnor, R. C. (2012). Psychological
distress and perfectionism in recent suicide attempters: The role of
behavioral inhibition and activation. Personality and Individual Differences, 52, 680 685. doi:10.1016/j.paid.2011.12.011
Rasmussen, S. A., OConnor, R. C., & Brodie, D. (2008). The role of
perfectionism and autobiographical memory in a sample of parasuicide
patients: An exploratory study. Crisis, 29, 64 72. doi:10.1027/02275910.29.2.64
Rice, K. G., Leever, B. A., Christopher, J., & Porter, D. (2006). Perfectionism, stress, and social (dis)connection: A short-term study of hopelessness, depression, and academic adjustment among honors students.
Journal of Counseling Psychology, 53, 524 534. doi:10.1037/00220167.53.4.524
Rousseau, D. M. (1990). Normative beliefs in fund-raising organizations:
Linking culture to organizational performance and individual responses.
Group & Organizational Management, 15, 448 460. doi:10.1177/
105960119001500408
Roxborough, H. M., Hewitt, P. L., Kaldas, J., Flett, G. L., Caelian, C.,
Sherry, S., & Sherry, D. L. (2012). Perfectionistic self-presentation,
socially prescribed perfectionism, and suicide in youth: A test of the
perfectionism social disconnection model. Suicide and Life-Threatening
Behavior, 42, 217233. doi:10.1111/j.1943-278X.2012.00084.x
Sakurai, S., & Ohtani, Y. (1997). Relations of self-oriented perfectionism to depression and hopelessness. Shinrigaku Kenkyu: The Japanese
Journal of Psychology, 68, 179 186. doi:10.4992/jjpsy.68.179
Shneidman, E. (1993). Suicide as psychache: A clinical approach to
self-destructive behavior. Lanham, MD: The Rowman & Littlefield
Publishing Group, Inc.
Sorotzkin, B. (1998). Understanding and treating perfectionism in religious
adolescents. Psychotherapy: Theory, Research, Practice, Training, 35,
8795. doi:10.1037/h0087792
Stanley, N., Mallon, N., Bell, J., & Manthorpe, J. (2009). Trapped in
transition: Findings from a UK study of student suicide. British Journal
of Guidance & Counselling, 37, 419 433. doi:10.1080/
03069880903161427
Statistics Canada. (2010). Suicides and rate of suicide according to sex and
age. Ottawa, ON: Statistics Canada. Retrieved from http://www.40
.statcan.gc.ca/l01/cst01/hlth66a-eng.htm
Tangney, J. P. (2002). Perfectionism and the self-conscious emotions:
Shame, guilt, embarrassment, and pride. In G. L. Flett & P. L. Hewitt
(Eds.), Perfectionism: Theory, research, and treatment (pp. 199 215).
Washington, DC: American Psychological Association. doi:10.1037/
10458-008
Targum, S. D., & Kitanaka, J. (2012). Overwork suicide in Japan: A
national crisis. Innovations in Clinical Neuroscience, 9, 3538.
Trnblom, A. W., Werbart, A., & Rydelius, P.-A. (2013). Shame behind
the masks: The parents perspectives on their sons suicides. Archives of
Suicide Research, 17, 242261. doi:10.1080/13811118.2013.805644
Troister, T., & Holden, R. R. (2012). A two-year prospective study of
psychache and its relationship to suicidality among high-risk undergraduates. Journal of Clinical Psychology, 68, 1019 1027. doi:10.1002/jclp
.21869
Van Orden, K. A., Witte, T. K., Cukrowicz, K. C., Braithwaite, S., Selby,
E. A., & Joiner, T. E., Jr. (2010). The interpersonal theory of suicide.
Psychological Review, 117, 575 600. doi:10.1037/a0018697
Wang, K. T., Wong, Y. J., & Fu, C.-C. (2013). Moderation effects of
perfectionism and discrimination on interpersonal factors and suicide
ideation. Journal of Counseling Psychology, 60, 367378. doi:10.1037/
a0032551
Wei, M., Malinckrodt, B., Russell, D. W., & Abraham, W. T. (2004).
Maladaptive perfectionism as a mediator and moderator between adult
attachment and depressive mood. Journal of Counseling Psychology, 51,
201212. doi:10.1037/0022-0167.51.2.201
Wenzel, A., & Beck, A. T. (2008). A cognitive model of suicidal behavior:
Theory and treatment. Applied and Preventive Psychology, 12, 189 201.
doi:10.1016/j.appsy.2008.05.001
Wheeler, H. A., Blankstein, K. R., Antony, M. M., McCabe, R. E., &
Bieling, P. J. (2011). Perfectionism in anxiety and depression: Comparisons across disorders, relations with symptom severity, and role of
comorbidity. International Journal of Cognitive Therapy, 4, 66 91.
doi:10.1521/ijct.2011.4.1.66
World Health Organization. (2007). Suicide prevention (SUPRE). Geneva,
Switzerland: Author. Retrieved from http://www.who.int/mental_health/
prevention/suicide/suicideprevent/en/
York, J., Lamis, D. A., Friedman, L., Berman, A. L., Joiner, T. E.,
McIntosh, J. L., . . . Pearson, J. (2013). A systematic review process to
evaluate suicide prevention programs: A sample case of communitybased programs. Journal of Community Psychology, 41, 3551. doi:
10.1002/jcop.21509
Received May 14, 2014

Revision received July 26, 2014
Accepted July 26, 2014

The Destructiveness of Perfectionism Revisited Implications For The

Caricato da

Informazioni sul documento

Titolo originale

Copyright

Formati disponibili

Condividi questo documento

Condividi o incorpora il documento

Opzioni di condivisione

Hai trovato utile questo documento?

Questo contenuto è inappropriato?

Copyright:

Formati disponibili

The Destructiveness of Perfectionism Revisited Implications For The

Caricato da

Copyright:

Formati disponibili

Review of General Psychology

2014, Vol. 18, No. 3, 156 172

2014 American Psychological Association

The Destructiveness of Perfectionism Revisited: Implications for the

University of British Columbia

40 years of age (Centers for Disease Control & Prevention, 2010).

He was very deliberate. He was a perfectionist. I have been

Gordon L. Flett, Department of Psychology, LaMarsh Centre for Child

PERFECTIONISM AND SUICIDE

appearance of defect (p. 1005). Below, we discuss Blatts (1995)

still the case that conclusive studies remain to be done. It

FLETT, HEWITT, AND HEISEL

Contemporary Research on Multidimensional

and suicide use either the Multidimensional Perfectionism Scale

PERFECTIONISM AND SUICIDE

summarized 29 papers examining perfectionism and suicide risk

More Recent Research on Perfectionism and Suicide

Suicide and Unidimensional Perfectionism

Suicide and Multidimensional Perfectionism

FLETT, HEWITT, AND HEISEL

prescribed perfectionism plays a unique role in predicting suicide

Socially Prescribed Perfectionism and Unmet Social

Another study tested the roles of goal-reengagement and the

PERFECTIONISM AND SUICIDE

perfectionists who would prefer to maintain an image of being

Is the Role of Perfectionism in

FLETT, HEWITT, AND HEISEL

sized perfectionistic standards in their model of cognitive factors

spontaneously how their lost sons concealed their problems and

Reasons for Elevated Risk Among

Beware the Mask: The Overrepresentation of

PERFECTIONISM AND SUICIDE

These accounts are in keeping with our belief that perfectionists

self-presentation is identifiable and has a destructive influence

Perfectionism and Lethal Suicide Attempts

FLETT, HEWITT, AND HEISEL

Perfectionism and the Shame of Surviving

Conditions That Confer Added Risk:

with the planning component of suicide and a reported history of

PERFECTIONISM AND SUICIDE

Blankstein, Lumley, &

Chang & Rand (2000)

Donaldson, Spirito, & Farnett

Enns, Cox, & Clara (2005)

Predictors of Hopelessness Among

Dysfunctional Attitudes Scale (DAS)

DAS perfectionism was significantly

Perfectionism, Cognitive Bias, and

Dysfunctional Attitudes ScalePerfectionism Beck Hopelessness

DAS perfectionism was significantly

MPS (Hewitt & Flett, 1991) Beck

MPS (Frost et al., 1990) Beck

SPP was a significant predictor of

MPS (Hewitt & Flett, 1991) Beck

SPP was significantly correlated with

MPS (Hewitt & Flett, 1991) The

SPP was moderately correlated with

MPS- SPP subscale (Hewitt & Flett,

SPP was moderately correlated with

SPP was moderately correlated with

MPS (Hewitt & Flett, 1991) MPS

SPP was associated with hopelessness

MPS (Frost et al., 1990) Beck