Treat “others expect me to be perfect” as a symptom, not a fact

No cost involved. The hard part is viewing this thought pattern as something that needs addressing rather than as an accurate reflection of others’ actual expectations.

Pooling several studies (meta-analysis): 45 studies, N = 11747, samples of undergraduates, medical students, community adults, and psychiatric patients, random-effects model. Below are weighted average correlations with suicidal thoughts. Perfectionistic concerns r = .28 (95% CI .24–.32; 42 studies, 7936 people). Perfectionistic concerns is a bundle including socially prescribed perfectionism, concern over mistakes, doubts about actions, and gaps between reality and standards. Socially prescribed perfectionism alone is also r = .28 (.25–.32, 30 studies, 3640 people). Perfectionistic striving r = .10 (.07–.13, 31 studies, 4588 people), a bundle of self-oriented perfectionism and personal standards. Parental criticism r = .20 (.11–.29). Then links to suicide attempts. Perfectionistic concerns r = .12 (.07–.17, 15 studies, 5275 people). Socially prescribed perfectionism r = .19 (.08–.29, 8 studies, 689 people). Then the follow-up part. After subtracting suicidal thoughts present at the start, socially prescribed perfectionism still moved in the same direction as later follow-up suicidal thoughts, modestly. Self-oriented and other-oriented perfectionism showed no link.

Smith MM, Sherry SB, Chen S, Saklofske DH, Mushquash C, Flett GL, Hewitt PL (2018). The perniciousness of perfectionism: A meta-analytic review of the perfectionism-suicide relationship. Journal of Personality, 86(3), 522–542. https://doi.org/10.1111/jopy.12333

This item is graded B because most included studies relied on single-time surveys, making it hard to establish temporal sequence. The correlation strength is moderate (r ≈ .28), accounting for only a few to ten percent of total variance. Since the outcomes measured are suicidal thoughts and attempts rather than actual mortality, the overall benefit is rated as limited due to reliance on surrogate endpoints. The authors themselves note that the data on perfectionistic concerns and suicide attempts may suffer from publication bias, with studies showing weaker or null results less likely to be published; even after accounting for such missing studies, the overall trend remains unchanged. This recommendation does not oppose setting high standards; rather, it emphasizes where those standards originate and whether failure to meet them leads to feelings of personal worthlessness. Similar to the idea discussed in Item 15 — viewing pessimistic expectations like “things will definitely get worse” as symptoms — this pattern can also be addressed clinically. If you or someone you know is experiencing suicidal thoughts, call 12356 immediately and remove any means of self-harm, as outlined in Section 1, Item 25. For guidance on how to respond when someone close expresses such thoughts, refer to Section 8, Item 15. Information on depression screening for children can be found in Section 30, Item 8.