Perfection is the fleeting pause in time in which the final card gently settles into place in the towering pyramid - an extraordinary moment of pure, fragile beauty that captures the essence of everything we strive for, and naturally, cannot be sustained.
– Erika Belledent
Estimated reading time: 10 minutes
Perfectionism is a term I’ve heard used more and more over the last few years and while on the surface it can initially be misunderstood as rigid expectations and setting high standards, there’s a deeper complexity that’s worth exploring. In my psychotherapy practice, I’ve observed the pattern of how perfectionism manifests, particularly among high-functioning adults, and the distinct ways it interacts alongside neurodivergence. It’s a powerful, often exhausting force that shapes lives, and understanding it can spark a profound awakening, an acknowledgement of struggles that are sometimes invisible but deeply felt.
Uncoupling the notion of perfection and success
Perfectionism in high achievers almost never announces itself as perfectionism. It arrives as a reputation. At work, you may be the one who catches the error before the client does, who answers the email at 11pm so nobody is left waiting, who reads the room and adjusts before anyone even has to ask. You have calendars and prompts to remind family/ friends/ your partner/ or coworkers of upcoming events or what to pack (and you’ve got every ‘just in case’ object packed in yours). You may have even rehearsed what you’re going to say at a social gathering as you fidgeted with the third shirt change. From the outside, this reads as competence. From the inside, it’s a fifth revision of a document that was fine after the second, done with a clenched jaw, followed by three hours of lying awake replaying one sentence you wish you had phrased differently. “Are they judging me for that?” you wonder. It’s the uncertainty in whether or not you can hold it all together, but the idea of letting someone peek behind the scenes and know that you need help feels too vulnerable and risky. It almost feels laughable that people may have described you as “calm, cool and collected” when inside you feel anything but.
The body keeps a separate record from the performance review. Tension headaches that arrive on Friday afternoons and the Sunday scaries. Stomach trouble nobody can find a cause for. The kind of tiredness that a week off doesn’t touch, because the week off is spent catching up on everything the working weeks displaced. A 2025 Psychology Today article on perfectionism in high-achieving women describes exactly this pattern, including research suggesting that a large majority of high-achieving professionals use achievement to secure validation they did not reliably get earlier in life.
In my work I often hear the story of children across different generations who felt overlooked or invisible in their home, never asked how their day was, how they felt, and their thoughts and feelings and dreams were rarely discussed or considered important. Some received praise only after academic achievements or athletic accomplishments, but the sense of validation was fleeting because their parents' attention was not sustained long enough to make them feel truly seen or valued. Others, despite their best efforts and regardless of performance, recall the early festering of loneliness and how those feelings still affect how they see themselves and their motivation today. This isn’t said to blame parents, but to highlight the importance of a society that can support parents in understanding attunement and being able to show up for their children on a physical and emotional level. So, when I hear someone describe their symptoms before they describe their standards, that connection is usually the first thing worth naming out loud.
Difficulty accepting praise is one of the clearest signals. A woman who is genuinely good at her job will tell me about a promotion in the same flat voice she uses to describe a chore. Not false modesty. Something closer to a technicality: the promotion went to the version of her that never drops anything but sacrifices everything, and she knows what that version costs to maintain, so the credit feels misdirected. There may also be a sense of disbelief, discounting her own competency and awaiting to be caught for the fraud she feels herself to be. It’s the thought “if only they knew I actually don’t know what I’m doing… it’s not long now until I’m found out. They’re anticipating the fallout like a magician’s slipup, watching the crowd become disillusioned.
Perfectionism in high achievers can look like delivering on time while hiding what the delivery costs. In my practice, the repair is not as simple as dropping your standards but reframing the relationship and beliefs around mistakes and imperfection and connecting back to personal values. It’s worthwhile to explore reasonable expectations of yourself (and others) and differentiate whether something feels overwhelming because it’s not realistic or because there’s a lack of appropriate support.
When neurodivergence is in the mix, it’s also important to tease apart what someone deems a factor of their personality and what is an invisible symptom of neurodivergence. Are you lazy, or do you feel motivated with hopes and dreams and ideas of what you wish to accomplish but there seems to be an invisible barrier to getting up, starting, and following through on it? Perfectionism in ADHD often manifests as an overwhelming, nearly impossible standard driven by a deep fear of mistakes and a need to compensate for past struggles with executive dysfunction. It’s a relentless drive born from insecurity and likely a history of negative feedback, a desperate attempt to prove one’s worth in the face of internal doubt. Perfectionism and anxiety can be interdependent, as they both distill down to a difficulty in tolerating uncertainty or disappointment. The 2025 ADDitude article outlines the various ways perfectionism shows up in ADHD, including:
rigid all-or-nothing thinking
negative self talk
procrastination
self punishment
sensitivity to feedback
fearing social rejection.
What changes things is understanding where this drive comes from and letting the effort become visible, loosening the rule that says your worth arrives with your output.
Masking turns competence into a disguise, and then the praise lands on the disguise
Masking is the part people rarely have language for. It means running a continuous background process that monitors how you’re being perceived and corrects it: softening a request so it doesn’t sound demanding, rehearsing a question before a meeting so it sounds casual, scanning faces to check whether you have been “too much”, apologizing if your thought process felt all over the place. The problem is that the performance works. People who mask well get described as steady, reliable, low-maintenance, and each of those words quietly raises the bar for how much has to go wrong before anyone thinks to check in.
Masking can feel like a double bind. If the mask slips, you fear losing the respect you built. If the mask holds, no help ever arrives, because there is no visible evidence that help is needed. For those with neurodivergence, whether they are aware of its existence or not, the masking may have started so early it may feel difficult to differentiate from their true selves and identify their own needs. So the effort escalates, and the gap between how you are experienced and how you actually feel keeps widening. I have sat with plenty of accomplished people who could not name a single person in their life who knows what their average Tuesday actually feels like, much less has an idea of what the inside of their brain feels like.
What I say to that, more or less, is that you have been paid, promoted, and thanked for a version of yourself you cannot sustain, and both of those facts are true at the same time. You can hold two things at once here: the work is genuinely good, and the way you are producing it is costing you something real. Neither one cancels the other. Masking doesn’t just exist within the workplace. Socially, this can show up as having relationships that rarely break the surface, struggling to know what is appropriate to share and how, and feeling as though people don’t really know the true you. This can often lead to feeling unseen or misunderstood.
Why "just lower your standards" and "do it at 80%" keep failing
Lowering your standards is the most common advice high achievers receive, and it is the piece that almost never sticks. It fails because it aims at the output when the driver is an internal rule about worth. If, somewhere underneath, you believe that being valued is contingent on flawless delivery or giving every piece of yourself, then handing in something merely good is not a relaxed choice. It is a gamble with your standing, add in a nervous system that treats mistakes as threats. Of course you revise it one more time.
The lever that does move is visibility. Not lowering the quality, but letting other people see what quality costs you, and finding out what happens. That is where cognitive behavioural work and exposure earn their keep, because it turns a belief into something testable instead of something to argue with. What if someone sees the messy draft or the imperfectly worded email. What if you say "I need two more days" instead of producing the two days out of your own sleep. What if you let a colleague notice you are stretched.
Three experiments I like to start with, all small on purpose:
Send the version you would normally revise once more and write down beforehand what you predict will happen. Compare your prediction to what actually happens. This is called reality testing.
Ask for one thing in a week where you would normally absorb it and notice the gap between the dread beforehand and the response you get. Can we get curious about the story the dread is spinning for you?
Rest once without building a justification first. No earned rest, no productive rest. Just rest, followed by noticing what shows up emotionally when the justification is missing. For ADHDers rest may look a little different, so it can be helpful to discuss in therapy to gain clarity on what rest means for you physically, emotionally, and mentally.
When those experiments spike real distress, and they often do, distress tolerance skills from DBT are useful. The goal isn’t to feel calm about being seen mid-process. You are trying to stay in the room while it feels awful, long enough to collect evidence.
Undiagnosed ADHD often hides under a spotless work record
ADHD, in women particularly, is regularly missed because the compensation strategies work for years before they stop working. What can appear as over-optimization of daily tasks can actually be the result of ongoing struggles with time management, task initiation, and prioritization. If your brain feels unreliable in starting and finishing tasks, then anxiety and perfectionism can sub in as the energy and motivation. While the experience feels overwhelming and crippling it may feel like the only available method that works. Over-preparation covers for poor working memory and details that slip. Triple-checking covers for the one thing you genuinely forgot last time. Working late covers for the fact that focus finally arrived at 9pm. Perfectionism, in that context, is not a character trait. It is scaffolding, and it is expensive. A clinical write-up from Resilience Therapy on perfectionism and ADHD in professional women draws on 2024 research by Kelly and colleagues showing that women often go years or decades without appropriate recognition or support, in part because those sophisticated workplace strategies conceal the difficulty.
Not every perfectionist has ADHD, and I want to be careful here. Plenty of people hold impossibly high standards for reasons that have nothing to do with attention. But when someone describes exhaustion that scales with how much invisible administration their brain requires, when the scaffolding predates the career, when burnout arrives despite genuine interest in the work, it is worth asking whether we are treating perfectionism or treating the workaround. That question changes the plan. If the over-preparation is load bearing, taking it away without putting anything in its place is not supportive.
Where therapy starts when burnout arrives alongside a strong performance review
Therapy for burnout in high achievers does not start with productivity strategies, and it does not start with me telling you your standards are too high. It usually starts with what the perfectionism has been protecting. So I ask what it means to you, the moment you first learned that being impressive was the reliable route to being wanted and how safe that felt, and what it would mean now to be valued for something other than your reliability. The answers are almost never about work.
Strengths-based work matters here in a specific way. People who mask are fluent in their own shortcomings and illiterate in their own decency, so when I reflect a strength back, I do it with a concrete example rather than a compliment. Showing up for a family member's milestone without organizing the whole thing counts. Saying the honest sentence in a hard conversation counts. Noticing you were exhausted and going home anyway counts. These get dismissed as not-achievements precisely because no one graded them, which is what makes them worth pointing at.
Change, when it comes, is undramatic and easy to miss. You take a sick day without building a case for it. Someone asks how you are and you answer in one true sentence instead of a summary of your workload. You let a draft go out at good-enough and the ceiling stays up. Your standards, meanwhile, mostly stay where they are, because they were never the thing that needed fixing. The goal was never a less capable version of you. It was a version of you who can be known without first being impressive.
TLDR: Key takeaways
The effort is the hidden part, not the standards. Most of the work happens where nobody can see it, at a cost that is unsustainable.
Masking means praise lands on the performance, so the help you need never gets offered.
"Just do it at 80%" fails because it targets output instead of the perpetuating beliefs underneath it.
For some people, relentless over-preparation is compensation for undiagnosed ADHD rather than a personality trait.
Perfectionism can stem from deep rooted beliefs of a person’s self worth, alongside experiences of frequent negative feedback and lack of guidance during confidence building years.
Progress looks like resting without a justification attached, not producing less. It means exploring the values that are meaningful to you and comparing how behaviours align or don’t. It’s digging into the emotional work in asking yourself “what is this all for?”
Frequently asked questions
Is perfectionism a mental health diagnosis?
Perfectionism is not a diagnosis on its own. It is a pattern that shows up across anxiety, depression, ADHD, burnout, and eating difficulties, which is why it often gets treated as a target in its own right rather than a side effect.The practical implication is that you do not need to meet criteria for anything to bring it to therapy. Many people I work with come in because of exhaustion, low self-esteem, or a relationship strain, and the perfectionism surfaces three sessions later as the thread running through all of it. If the pattern is costing you sleep, health, or closeness, that is reason enough.How can I tell whether I am masking or just a private person?
Privacy is a choice you may feel neutral about. Masking is maintenance you cannot stop, and it usually leaves you tired after ordinary social contact rather than just after difficult contact.A useful test is what happens when the effort is unnecessary. If you find yourself managing your presentation with people who are already safe, close friends, a partner, a sibling, that is closer to masking than preference. Another signal is relief at cancelled plans followed by guilt about the relief. Privacy rarely comes with that second part.Will working on perfectionism make me worse at my job?
No. Most people find their quality stays steady while the hours and the dread around it drop, because a large share of perfectionistic effort goes into checking, rehearsing, and revising work that was already finished.What often does change is the shape of your ambition. People start declining projects they were only taking to prove something and pursuing ones they actually want. That can look like ambition shrinking from the outside, especially to a workplace that benefited from the old arrangement. In reality, this is you implementing healthier boundaries and allowing you to show up more authentically and to feel more connected and present in your work, your personal life, and in your own body and mind. As cliché as it may sound, it’s living in alignment with your values and organizing your time and energy based on what is important to you. It’s worth talking about directly in therapy, rather than being surprised by it.Should I get an ADHD assessment before starting therapy?
You do not have to choose an order. Therapy can begin right away, and if the pattern suggests ADHD, a formal assessment can happen alongside it rather than as a prerequisite.Assessment and therapy answer different questions. An assessment tells you whether a diagnosis fits, which matters for medication, accommodations, and often for how you understand your own history. It can help serve as an explanation, while therapy offers the exploration. Therapy addresses what the over-preparation has been holding up and what could hold it instead. In practice, many adults find the diagnostic clarity makes the therapy work more efficiently, because self-criticism has less to feed on.If this resonates with you or you recognize yourself in this, know that understanding and support is available, and I invite you to connect through a consult call. Connect with me by emailing at erika@inthemidstpsychotherapy.ca, scheduling through OWL portal, or call 289.216.7094
Written by Erika Belledent (Registered Psychotherapist)
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