Perfectionism in Youth: Understanding how Perfectionism Shows up in Treatment

The Importance of Distinction

Perfectionism is a familiar trait in many high-achieving adolescents and young adults.

But it’s important to distinguish between healthy striving and harmful self-pressure—especially in the treatment of anxiety and OCD.

Some teens use perfectionistic traits to set meaningful goals, stay organized, and push through challenges. Others feel crushed by fear of failure or not meeting expectations. Both patterns can look like “perfectionism,” but they function very differently in a clinical setting.

Adaptive Perfectionism

Adaptive perfectionism tends to support mental health and academic success.

It’s driven by internal motivation and a sense of self-efficacy. These teens may still feel pressure, but it doesn’t overwhelm them. Instead, they use their high standards to organize their lives and work toward goals.

Common traits of adaptive perfectionism:

  • Strong sense of responsibility
  • Goal-setting and persistence
  • Effective time management
  • High personal standards
  • Resilience after setbacks

These qualities often lead to better performance in school or extracurriculars—and they’re typically manageable in therapy unless they tip into rigidity or avoidance.

Maladaptive Perfectionism

Maladaptive perfectionism is more concerning.

It often comes from external pressure—real or perceived—and leads to emotional distress, procrastination, and avoidance. Teens with this presentation may over-identify with others’ expectations, doubt their abilities, and feel paralyzed by the fear of making mistakes.

Common signs of maladaptive perfectionism:

  • Preoccupation with what others expect (e.g., parents, teachers)
  • Excessive self-doubt and overthinking
  • Rigid, black-and-white thinking
  • Obsessing over past mistakes
  • Avoidance driven by fear of failure

In treatment, maladaptive perfectionism should be viewed not just as a symptom but as a maintaining factor—one that reinforces anxiety, OCD, or depression. Addressing it often requires cognitive restructuring, exposure work, and values-based interventions.

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Helping young clients understand the difference between healthy effort and harmful self-criticism is a key step toward building flexibility, self-compassion, and progress in therapy.

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About the Author

Dina Nunziato, PhD

Chief Clinical Officer

Dina has spent nearly two decades working with young adults in various clinical and educational settings. Dina specializes in cognitive behavioral treatment of anxiety and related disorders. Her research and publications include the use of evidenced-based mindfulness techniques to support anxiety management, academic success, and emotional wellbeing.