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.

A comprehensive meta-analysis was conducted using data from 45 studies involving 11,747 participants — including undergraduates, medical students, community members, and psychiatric patients — analyzed via a random-effects model. The weighted average correlation with suicidal thoughts is as follows: for perfectionistic concerns (a composite of socially prescribed perfectionism, fear of making mistakes, self-doubt, and perceived gaps between personal performance and standards), r = .28 (95% CI .24–.32; based on 42 studies with 7,936 participants). Socially prescribed perfectionism alone also shows r = .28 (.25–.32; 30 studies, 3,640 participants). Perfectionistic striving — which reflects self-directed perfectionism and personal standards — has a lower correlation of r = .10 (.07–.13; 31 studies, 4,588 participants). Parental criticism correlates at r = .20 (.11–.29). Regarding suicide attempts, perfectionistic concerns correlate at r = .12 (.07–.17; 15 studies, 5,275 participants), while socially prescribed perfectionism shows r = .19 (.08–.29; 8 studies, 689 participants). Even after adjusting for pre-existing suicidal thoughts, socially prescribed perfectionism still shows a modest positive link to later increases in suicidal thoughts; no such link is observed for self-directed or other-oriented perfectionism.

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.