“When I was in school the teachers told me ‘practice makes perfect’; then they told me ‘nobody’s perfect’ so I stopped practicing.” —Steven Wright, comedian
An interesting finding to emerge from the study of the mindsets of clinic-referred adults with ADHD was that perfectionism was the most frequently endorsed cognitive distortion.1 Perfectionism is typically associated with holding unrealistic performance standards that result in frustration when they are not met, at times being self-defeating, such as being late with a school assignment or report for work because it is not yet “just right.” Such high standards may be based on some objective measure, such as a grade or a ranking (or at least doing better than a “rival”), but subjective standards can be as pernicious to one’s sense of self and competence.
This finding in this clinical sample of adults with ADHD was initially surprising until squaring it with clinical experiences with those seeking cognitive behavior therapy (CBT). A distinction can be seen between front-end and back-end perfectionism, which goes beyond the study data but has utility in understanding why perfectionism was so prominent for adults with ADHD.2
Back-end perfectionism can be viewed as having extremely high, rigid standards for quality, details, and/or performance, akin to the classic definition of perfectionism above. This outlook leads to difficulties completing and submitting projects because they are not impeccable, often driven by a vague, gut-level sense that – “with just a little more time” – the product could still be better. Assignments or projects become tedious because every detail is seen as the one that, if it is not adequately crafted, will undermine the whole project. This outlook often leads to missing deadlines from problems letting go of a desire to devote more time and effort well beyond that required to produce a high-quality product in order to produce a flawless one or running out of time because trivial matters end up monopolizing time, effort, and energy.
On the other hand, back-end perfectionism also affects individuals who question whether their work meets a minimal acceptable standard. Thus, worries about whether an assignment will earn even a passing grade or the quality of a work project will be viewed as competent can make an already challenging undertaking seem desperate and agonizing.
For example, back-end perfection has sometimes arisen in cases of adults with ADHD who were granted extensions on work or school projects after falling behind on them. After making progress toward completion, these individuals still faced difficulties wrapping up the tardy projects as the adjusted deadline neared. Investigation into their task-interfering thoughts revealed assumptions with the theme that “My project must now meet an even higher standard due to having extra time to work on it.” No surprise, this self-imposed (and indeterminate) penalty only raised the stakes for the task and made it more difficult to persist and submit the final version. There is often more than a hint of guilt and shame associated with the very need for an extension in the first place, which both reflected and magnified self-doubts about the quality of one’s work meeting even minimal standards.
Front-end perfectionism, on the other hand, seems to be the more common variety in adult ADHD. This perfectionistic mindset manifests as rigid standards or preconditions that must be met in order to engage in a task or endeavor in the first place (e.g., “If circumstances are right, then I can perform the task.”), but there also exists a corresponding and self-distrusting conditional belief (e.g., “If circumstances are not just right, then I cannot perform the task.”). Clients with ADHD often describe putting off tasks because conditions (internal or external) are somehow not sufficient (e.g., “I’m not in the mood.”; “I’m too tired.”; “I got off to a late start.”; “The library looks full.”). In fact, there is some truth to these concerns, as adults with ADHD are more prone to distractions and a myriad of dissuading factors that others can more easily ignore; however, front-end perfection runs the risk of being overgeneralized and prompting maladaptive escape and avoidance. Insidiously, this and other “insufficiency” mindsets observed in adults with ADHD do not reflect the absence of one’s sense of capability for most tasks but rather the automatic reaction that “I know I can do this … but I do not trust that I can make myself do it right now,” which prompts escape.
Both styles of perfectionism magnify and are magnified by the core features of ADHD and interfere with seemingly straightforward to-do plans and larger endeavors. This interference typically results in procrastination and creates many of the common pain points in the lives of adults with ADHD. Adults with ADHD often describe an experience of setting out a reasonable plan for a task that nonetheless goes undone. There is often self-recrimination for falling into the pit of procrastination, yet again, beating themselves up for all the lost opportunities for tackling the task through the lens of hindsight. Of course, both foresight and hindsight are a safe distance from the point of performance, the critical pivot point for coping with ADHD.
For either type of perfectionism (but particularly the front-end variety), the cognitive shift in CBT works in concert with behavior change to find ways to break down and frame tasks, particularly steps for task initiation, such that tasks are believed to be “doable.” This shift might be achieved by questioning the notion that a tardy project will held to a higher standard due to an extension to prompt re-engagement in the case of back-end perfectionism (e.g., “My assignment only needs to be ‘good enough.’”). Modifying assumptions underlying front-end perfectionism might include the reframe that an individual has enough or sufficient energy and focus to initiate a task for a discrete time, even if they are not at their best (“I’m tired but I can re-read the last paragraph I wrote and work on the report for at least 15 minutes.”).
Both forms of procrastination can be viewed as means for dealing with anticipated emotional discomfort. In the case of front-end perfectionism, the discomfort will be minimized if someone is at their best, which will rarely be the case for anyone. In the case of back-end perfectionism, there is often a degree of discomfort associated with what can be seen as a hard-to-achieve outcome. This performance expectation may result from negative feelings associated with need an extension (and perhaps not making the best use of the extra time), or from past experiences of thinking something was "good enough," only to find out later it was not the case.
The discomfort associated with task initiation is normalized - no one is every "in the mood" to do work - and reframed as likely to be short-lived and bearable, with relief coming once the task is faced. A reframe is that facing the task is an investment in getting rid of those discomforting feelings by engaging in the smallest step that constitutes starting the task at hand, akin to wading into a swimming pool before swimming.
These modified outlooks address the extreme view in perfectionism that “everything must be perfect or else I cannot do the task at all.” Instead, thinking through one’s mindset, noting one's feelings, and setting a specific, actionable plan helps to promote engagement and the prospect of better outcomes and greater confidence.
1 Strohmeier et al. (2016). Assessment of the relationship between cognitive distortions, adult ADHD, anxiety, depression, and hopelessness. Psychiatry Research, 238, 153-158. doi: 10.1016/j.psychres.2016.02.034
2 Ramsay, J. R. (2020). Rethinking adult ADHD: Helping clients turn intentions into actions. American Psychological Association.