Perfectionists are people who not only want to be perfect; they also need to seem perfect. Several decades of global research on perfectionism have identified a host of worrisome realities. First, meta-analytic evidence indicates that perfectionism is on the rise among young people¹. Second, perfectionism is associated with mental health problems, but also with physical health issues and early mortality². Third, perfectionism is associated with heightened risk for suicide³, as illustrated by the results of a comprehensive meta-analysis³.

The perfectionistic person who is experiencing psychological pain is at a heightened suicide risk due to a confluence of correlated attributes and tendencies⁴. These include a proclivity to hide psychache behind a perfect front while also experiencing elevated hopelessness⁵; a tendency to all-or-none views and cognitive rumination; an unwillingness or inability to seek help; and a degree of planfulness that can turn suicidal urges and plans into completed suicides. Here the voracious information seeking of perfectionists may extend to accessing information on the Internet that enables them to perfect their suicide plans. The risk is especially high for the perfectionist who has attempted suicide and remains suicidal while grappling with the humiliation of having engaged in a failed attempt.

The role of perfectionism in suicide is to some extent in the public consciousness. We are all aware of the deaths of highly perfectionistic luminaries such as V. Woolf, S. Plath and E. Hemingway. Public awareness was heightened further when S. Blatt published his seminal paper on the destructiveness of perfectionism, detailing the lives and demises of three well-known highly self-critical perfectionists⁶. We can add the recent attention given to the suicides of famous people such as director T. Scott in 2012 and fashion designer L'Wren Scott in 2014, as well as highly publicized public inquests investigating the suicides of perfectionists such as N. Worrall and C. Dragun. Unfortunately, clinical case examples of deceased perfectionists continue to mount, including the deaths of people such as K. Spade, M. Evans and L. Breen (the emergency room physician who died as stressors mounted during the COVID-19 pandemic). Sadly, there is also no shortage of deaths due to suicide among perfectionistic adolescents⁷.

Constant additions to the above list are disconcerting, but just as troubling is the lack of evidence that research knowledge and public awareness of the role of perfectionism in suicide are being reflected in practice. Our informal survey of key organizations which provide lists of acknowledged suicide risk factors (e.g., the US Centers for Disease Control and Prevention) found little mention of the role of personality factors in general, and perfectionism in particular. More progress is needed immediately, because it is not hyperbole to state that many lives are in the balance. Education, training and heightened awareness are urgently needed.

Accordingly, we are issuing a call for a stronger proactive and comprehensive focus on perfectionism and its various elements in terms of their likely roles in suicide and suicidal tendencies. Perfectionism and its various facets merit extensive consideration and action when it comes to assessment, treatment and prevention of suicidal behavior.

It should be seen as a warning sign when someone known to be in psychological pain is also a perfectionist. Similarly, when a perfectionist with stressful experiences that should elicit psychological pain seems to be functioning exceptionally well on the surface, this too is a warning sign. In many of these instances, probing for suicide ideation and intent can be appropriate, along with an assessment of perfectionism using measures that have been linked empirically with elevated suicide ideation and risk. In adults, these include the Hewitt-Flett Multidimensional Perfectionism Scale, the Frost Multidimensional Perfectionism Scale (FMPS), and the Perfectionistic Self-Presentation Scale (PSPS), which have extensive evidence of reliability and validity. In younger people, dimensions of perfectionism can be assessed with the Child-Adolescent Perfectionism Scale and the junior version of the PSPS⁷. Also, the perfectionistic person with a recent suicide attempt should be closely monitored and frequently evaluated. Close evaluation is especially needed of the perfectionistic person brought to an emergency department due to being suicidal, but whose symptoms almost magically seem to disappear at the hospital.

All of the above applies to perfectionists from all backgrounds, but especially to people prone to burnout in exceptionally demanding jobs (e.g., doctors, lawyers). In general, people in roles that can provide experience in concealing symptoms behind a front should be closely scrutinized, in line with our conclusion that perfectionists are over-represented among people who commit a suicide that seems to take place without warning. The association between perfectionism and suicide needs to be examined from a perspective that involves careful consideration of life stressors and transitions. For instance, the work-obsessed perfectionist who is disquieted by and feels forced into retirement may also have heightened risk.

Our frustration about the lack of implementing knowledge and putting it into action is balanced by a modicum of hope. What accounts for this hope? First, by and large, perfectionism researchers are dedicated to making the world a better place, and this includes a commitment to sharing vital information with the public, including this topic. Second, there is mounting empirical evidence of the effectiveness of nuanced treatments addressing the complexities inherent in the perfectionism construct. A recent meta-analysis of 15 randomized control trials concluded that cognitive-behavioral therapy focusing on perfectionism is efficacious in reducing depression, anxiety and eating disorder symptoms⁸. However, a dynamic interpersonal approach to treatment may be preferred, especially for perfectionists who feel under pressure to meet extreme expectations imposed on them by others (i.e., socially prescribed perfectionism) and those with an excessive need to seem perfect that has been hidden behind a perfect front (i.e., perfectionistic self-presentation)⁹.

A strong case can be made for prevention, given that many perfectionists experiencing psychological pain tend to suffer in silence and never come into contact with potential treatment providers⁷. Specific themes that need to be highlighted in preventive efforts include promoting self-compassion to combat self-criticism; seeing oneself as learning and growing rather than fixed and defective; limiting excessive self-reliance; training in problem-solving and cognitive restructuring; and role-playing responses to mistakes and failures.

Prevention efforts should be broad and designed to heighten awareness among not only mental health professionals, but also parents and educators. Efforts should also include a targeted focus on people in roles, or training for roles, in which the pressure to be perfect and never make mistakes can seem unbearable (e.g., elite athletes, medical personnel, lawyers, architects). Prevention is also needed to counter the impact of settings that promote unrealistic and unrelenting pressure to be perfect (e.g., schools and communities where high achievement is prescribed and seems normative).

Treatment and prevention offer hope and promise for perfectionists in general, including people experiencing suicidal tendencies that may or may not be openly expressed.

完美主义者不仅想要完美，而且想要完美。他们还需要看起来很完美。全球数十年对完美主义的研究发现了许多令人担忧的现实。首先，荟萃分析证据表明完美主义在年轻人中呈上升趋势¹。其次，完美主义与心理健康问题有关，但也与身体健康问题和过早死亡有关²。第三，正如综合荟萃分析³的结果所示，完美主义与自杀风险升高相关³。

由于相关属性和倾向的综合作用，正在经历心理痛苦的完美主义者面临更高的自杀风险⁴。其中包括倾向于将心理隐藏在完美的外表后面，同时也经历着更高的绝望⁵；倾向于全有或全无的观点和认知反思；不愿意或无法寻求帮助；以及一定程度的计划性，可以将自杀冲动和计划转化为彻底的自杀。在这里，完美主义者对信息的贪婪寻求可能会延伸到访问互联网上的信息，使他们能够完善自己的自杀计划。对于那些曾试图自杀并在努力应对自杀失败的耻辱的同时仍保持自杀倾向的完美主义者来说，这种风险尤其高。

完美主义在自杀中的作用在某种程度上是公众意识中的。我们都知道 V. 伍尔夫、S. 普拉斯和 E. 海明威等高度完美主义的杰出人物的去世。当 S. Blatt 发表关于完美主义破坏性的开创性论文时，公众的意识进一步提高，该论文详细描述了三位著名的高度自我批评的完美主义者的生活和死亡⁶。我们还可以添加最近对名人自杀事件的关注，例如 2012 年导演 T. Scott 和 2014 年时装设计师 L'Wren Scott 的自杀事件，以及调查 N. Worrall 和 C 等完美主义者自杀事件的公开调查。 .龙枪。不幸的是，完美主义者去世的临床案例不断增加，包括 K. Spade、M. Evans 和 L. Breen（在 COVID-19 大流行期间因压力源增加而死亡的急诊室医生）等人的死亡。可悲的是，完美主义青少年因自杀而死亡的情况也不在少数⁷。

上述列表的不断增加令人不安，但同样令人不安的是，缺乏证据表明研究知识和公众对完美主义在自杀中的作用的认识正在实践中得到反映。我们对主要组织（例如美国疾病控制与预防中心）提供了公认的自杀风险因素清单进行了非正式调查，发现很少提及人格因素的作用，特别是完美主义。立即需要取得更多进展，因为毫不夸张地说，许多生命处于平衡状态。迫切需要教育、培训和提高认识。

因此，我们呼吁更加主动、全面地关注完美主义及其各种因素在自杀和自杀倾向中可能发挥的作用。在评估、治疗和预防自杀行为时，完美主义及其各个方面值得广泛考虑和采取行动。

当已知患有心理痛苦的人同时也是完美主义者时，这应该被视为一个警告信号。同样，当一个经历过压力的完美主义者表面上表现得异常出色时，这也会引起心理上的痛苦，这也是一个警告信号。在许多此类情况下，探索自杀意念和意图可能是适当的，同时使用与自杀意念和风险升高相关的实证措施来评估完美主义。对于成人，这些量表包括 Hewitt-Flett 多维完美主义量表、Frost 多维完美主义量表 (FMPS) 和完美主义自我呈现量表 (PSPS)，这些量表具有广泛的信度和效度证据。对于年轻人来说，完美主义的维度可以通过儿童青少年完美主义量表和初级版 PSPS ⁷进行评估。此外，最近有自杀企图的完美主义者应该受到密切监视和经常评估。对于因有自杀倾向而被送往急诊室但其症状在医院几乎神奇地消失的完美主义者尤其需要进行密切评估。

以上所有内容都适用于各种背景的完美主义者，尤其是那些在要求极高的工作中容易精疲力尽的人（例如医生、律师）。一般来说，那些能够在表面上隐藏症状的角色的人应该受到严格审查，这与我们的结论是一致的，即完美主义者在似乎毫无征兆地自杀的人中所占比例过高。完美主义和自杀之间的联系需要从仔细考虑生活压力源和转变的角度来审视。例如，痴迷于工作的完美主义者对退休感到不安并感到被迫退休也可能会增加风险。

我们对缺乏落实知识并将其付诸行动所感到的沮丧被一点希望所抵消。是什么造成了这种希望？首先，总的来说，完美主义研究人员致力于让世界变得更美好，这包括承诺与公众分享重要信息，包括这个主题。其次，越来越多的经验证据表明，细致入微的治疗方法对于解决完美主义结构固有的复杂性是有效的。最近对 15 项随机对照试验进行的荟萃分析得出结论，注重完美主义的认知行为疗法可有效减少抑郁、焦虑和饮食失调症状⁸。然而，动态的人际治疗方法可能是首选，特别是对于完美主义者来说，他们因满足他人强加给他们的极端期望而感到压力（即社会规定的完美主义），以及那些过度需要看起来完美但隐藏在不完美背后的人。完美的前台（即完美主义的自我呈现）⁹．

鉴于许多经历心理痛苦的完美主义者往往会默默承受并且从不与潜在的治疗提供者接触⁷ ，因此预防是有充分理由的。预防工作中需要强调的具体主题包括促进自我同情以打击自我批评；看到自己在学习和成长，而不是固定和有缺陷；限制过度自力更生；解决问题和认知重建的培训；以及对错误和失败的角色扮演反应。

预防工作应该是广泛的，旨在提高心理健康专业人员、家长和教育工作者的认识。努力还应包括有针对性地关注角色中的人，或角色培训，在这些角色中，追求完美和永不犯错的压力似乎难以承受（例如，精英运动员、医务人员、律师、建筑师）。还需要采取预防措施来应对那些提倡追求完美的不切实际和无情压力的环境的影响（例如，学校和社区规定了高成就并且似乎是规范的）。

治疗和预防为一般的完美主义者带来了希望和希望，包括那些可能有或可能没有公开表达的自杀倾向的人。