If you're a perfectionist, first of all...welcome. Pull up a chair.
A comfy chair. Not the one you sit in straight-backed and clenching your jaw while you push yourself to do all your work perfectly.
(Ask me how I know.)
Our culture loves perfectionists. We celebrate the employee who never takes a break, the parent who somehow volunteers for every school event while simultaneously making homemade organic dinosaur-shaped lunches, and the friend who always seems to have their life together.
From the outside, perfectionism looks impressive.
From the inside? It's exhausting.
And if you live with chronic pain, that constant pressure to perform may actually be keeping your nervous system stuck in a state of danger—and making your pain worse.
What Is Perfectionism, Really?
People often confuse perfectionism with simply having high standards, but they're actually very different.
Healthy striving says, "I'd like to do my best." Perfectionism says, *"If I don't do this perfectly, I've failed—and maybe I'm a failure too."*¹
Researchers describe perfectionism as setting unrealistically high standards while tying your worth to your performance and becoming intensely self-critical whenever you inevitably fall short.¹ It's less about excellence and more about fear.
Unfortunately, that fear doesn't stay in your head. It affects your whole body.
Perfectionism has been linked to higher levels of stress, anxiety, depression, burnout, and a variety of physical health problems.² Increasingly, research suggests it also plays an important role in chronic pain.
How Perfectionism Can Make Chronic Pain Worse
If you're a perfectionist with chronic pain, chances are you've had conversations with yourself that sound something like this:
"Just push through."
"One more thing."
"Everyone else can handle this."
"I'll rest after I finish everything."
(Spoiler alert: "Everything" is a mythical creature that never actually arrives.)
Research consistently shows that perfectionistic traits are associated with greater pain severity, disability, emotional distress, and poorer adjustment to chronic pain.³ There are several reasons why.
1. Perfectionism Keeps Your Nervous System on High Alert
Perfectionists spend an enormous amount of energy worrying about mistakes, disappointing people, or not measuring up.
The problem is that your brain isn't particularly picky about what counts as danger. Whether you're being chased by a bear or lying awake at 2:00 a.m. replaying an awkward conversation from Tuesday, your nervous system often activates the same stress response.
When your body spends enough time in that state, it begins expecting danger. And a brain that's expecting danger is much more likely to amplify pain signals.⁴
2. You Stay Tense Without Even Realizing It
Ever notice your shoulders slowly climbing toward your ears?
Or catch yourself clenching your jaw halfway through answering emails?
Or realize you've been holding your breath for the last ten minutes?
Perfectionists often carry chronic muscle tension because they're constantly bracing for the next demand, deadline, or problem to solve. Over time, that persistent tension contributes to pain, fatigue, headaches, and a nervous system that forgets what it feels like to relax.
3. We Ignore Our Bodies Until They Revolt
One of perfectionism's sneakiest tricks is convincing us that productivity matters more than our physical needs.
Hungry? Keep working.
Exhausted? Just one more email.
Your back hurts? Finish the project first.
Many perfectionists become experts at overriding their body's signals. Ironically, this pattern of overactivity may actually maintain or worsen chronic pain over time. We push through on the good days until we crash, recover just enough to get going again, and then repeat the whole cycle.
Sound familiar?
4. The "All-or-Nothing" Trap
Perfectionism doesn't do moderation very well.
If you can't exercise for an hour, why bother taking a ten-minute walk?
If you can't clean the whole house, why put away one basket of laundry?
If your pain flares after gardening, maybe you decide you'll never garden again.
This all-or-nothing thinking creates the classic boom-and-bust cycle. We overdo it when we feel good, completely shut down when we don't, and end up teaching our nervous system that our bodies are unpredictable and unsafe.
5. Fear Turns Up the Volume on Pain
Research has also found that perfectionistic tendencies are associated with greater pain catastrophizing and pain-related fear.⁶
When you're constantly worried about doing something wrong, making your pain worse, or permanently damaging yourself, your brain receives one loud message:
Danger!
And remember—your brain's number one job is to protect you. If it believes you're constantly in danger, it's more likely to produce protective pain. Not because your body is broken, but because your brain is trying—rather enthusiastically—to keep you safe.
It's Not Your Fault
Here's the part I wish every perfectionist could hear. You didn't wake up one morning and decide to become impossibly hard on yourself.
Perfectionism is almost always a coping strategy.
Maybe you grew up with a critical parent. Maybe mistakes didn't feel safe. Maybe you experienced trauma. Maybe you were the "good kid" who learned that achievement earned love or approval. Or maybe you simply had a highly sensitive nervous system that picked up every sigh, every raised eyebrow, and every hint of disappointment from the important adults in your life.
Your brain adapted the best way it knew how. It quietly concluded:
"If I'm perfect, maybe I'll be safe."
That strategy probably helped you survive. But now it may be keeping your nervous system stuck with the danger dial turned up to eleven. When the brain spends years scanning for threats, it can begin misinterpreting safe bodily sensations as dangerous—a hallmark of neuroplastic pain.⁷
Again... Not your fault.
Just a well-meaning brain that's become a little bit overprotective.
How Pain Reprocessing Therapy Helps Reduce Pain Caused by Perfectionism
If your brain is stuck in that overprotective loop, then Pain Reprocessing Therapy (PRT) can help. One of the things I love most about Pain Reprocessing Therapy (PRT) is that it doesn't ask you to try harder. It helps you learn to try softer, and create a sense of safety in your system.
Rather than constantly asking, "Am I doing this perfectly?" you gradually learn to ask, "Am I actually safe right now?" That simple shift can dramatically change how your brain interprets both stress and pain.
PRT also emphasizes self-compassion, which is one of the most powerful antidotes to perfectionism. Research has consistently shown that greater self-compassion is associated with lower perfectionism and greater emotional resilience.⁸ Instead of trying to shame yourself into healing, you learn to relate to yourself the same way you'd naturally respond to someone you love.
Along the way, you'll practice skills like Somatic Tracking, which teaches you to observe physical sensations with curiosity instead of fear, and Outcome Independence, which helps you let go of obsessively monitoring whether you're "doing healing right."
Ironically, the less you force healing, the easier your nervous system often finds it to heal.
Ready to Let Go of Impossible Standards?
As a recovering perfectionist myself, I completely understand how hard it is to loosen your grip.
I also know what it's like to live with chronic pain—and what it feels like to get your life back. After discovering Pain Reprocessing Therapy, my own chronic pain disappeared completely within weeks. That experience changed the course of both my life and my career, and it's why I became trained in PRT myself.
If you'd like to learn more about how I use Pain Reprocessing Therapy to help people reduce perfectionism and recover from chronic pain, I’ve written a lot about it over on my chronic pain page.
And if you're tired of feeling trapped by impossible standards, exhausted from trying to hold everything together, and wondering whether perfectionism is quietly fueling your pain, let’s talk.
I offer free consultation calls where we can explore your story, understand your nervous system, and begin turning down the danger dial together.
References
¹ Flett GL, Hewitt PL. Perfectionism in the Self and Social Context: Conceptualization, Assessment, and Association With Psychopathology. Journal of Personality and Social Psychology. 1991.
² When Perfect Isn't Good Enough. Antony MM, Swinson RP. When Perfect Isn't Good Enough: Strategies for Coping with Perfectionism.
³ Limburg K, Watson HJ, Hagger MS, Egan SJ. The Relationship Between Perfectionism and Psychopathology: A Meta-analysis. Journal of Clinical Psychology. 2017. (Includes chronic health outcomes and summarizes evidence linking perfectionism with poorer physical and psychological functioning.)
⁴ The Way Out. Gordon A, Ziv M. The Way Out: A Revolutionary, Scientifically Proven Approach to Healing Chronic Pain.
⁶ Randall, E. T., Palermo, T. M., Zhou, C., & Logan, D. E. (2018). Feeling the pressure to be perfect: Effect on pain-related distress and dysfunction in youth with chronic pain. The Journal of Pain 2018
⁷ Ashar YK, Gordon A, Schubiner H, et al. Effect of Pain Reprocessing Therapy vs Placebo and Usual Care for Patients With Chronic Back Pain. JAMA Psychiatry. 2021.
⁸ Neff KD. Self-Compassion: The Proven Power of Being Kind to Yourself. New York: William Morrow; 2011. (There is also a substantial body of peer-reviewed research by Dr. Kristin Neff linking self-compassion with lower perfectionism.)