Living Under Audit: Perfectionism, Gender, and the Body’s Vigilance
A Human, Historical Burden
Perfectionism is not a modern self-help concept or a charming personality trait; it is a long‑observed psychological struggle that can quietly govern how people think, relate to others, and exist in the world (Horney, 1950; Janet, 1903). Early psychologists like Pierre Janet and Karen Horney recognized perfectionism’s grip. Janet observed patients haunted by incompleteness, while Horney coined the “tyranny of the shoulds,” the relentless internal rules that sounded more like moral commandments, shaping perfectionistic suffering. Today’s research extends these insights, showing that perfectionistic concerns (e.g., fear of mistakes, harsh self‑criticism, and chronic worry about evaluation) are linked to anxiety, depression, obsessive–compulsive symptoms, disordered eating, and burnout in both women and men across cultures and age groups (Hewitt & Flett, 1991; Limburg et al., 2017; Smith et al., 2024). The specific forms this suffering often follow gendered lines: girls and women may be rewarded for being endlessly competent and emotionally attuned, while boys and men may be praised for invulnerability and achievement, even when the cost is internal collapse. Perfectionism thus emerges less as a harmless preference for order and more as a psychological and cultural structure (Ellis, 1962).
Perfectionism as Rigidity and Self‑Critique
Perfectionism is inherently self‑critical; it is not merely the wish to do well, but a rigid system of self‑evaluation in which standards are unreachable and non‑negotiable (Hewitt & Flett, 1991). People who struggle with perfectionism often discount objectively meaningful achievements, feeling chronically “behind,” “not enough,” or “one mistake away” from exposure and humiliation.
Perfectionism isn’t merely the pursuit of excellence for women or men. It is an all-encompassing inner stance shaped by fear of failure, vulnerability, and the deep need to be seen as worthy. It manifests through different expressions: self-oriented perfectionism with unattainable inner standards, socially prescribed perfectionism driven by external expectations, and other-oriented perfectionism that projects harsh standards onto others (Hewitt & Flett, 1991).
Perfectionists often live under the weight of constant vigilance. Every action becomes a test of value, every imperfection a threat to belonging. The result is not excellence but exhaustion, a chronic tightening of the nervous system, a collapse of curiosity, and an internal atmosphere ruled by judgment.
Self-Oriented Perfectionism
This form is experienced as an inner command wrapped in urgency: “Do more, do better, do without flaw.” Even achievements offer no rest, because the bar moves the moment it is reached. Behind it lies a fragile moral understanding. If I falter, I do not merely make a mistake. I become a mistake: for women, proving relational competence; for men, proving unyielding capability.Socially Prescribed Perfectionism
Here, the demand originates from the imagined gaze of others. Success becomes armor. Relationships turn into performance, and identity is shaped by anticipated evaluation. The nervous system stays alert, scanning for cues that approval might be revoked, women fearing they fall short as caregivers or colleagues, men dreading judgment as providers or leaders.Other-Oriented Perfectionism
This expression turns the same internal judgment outward. The intolerance for humanity, one’s own and others’, becomes a relational pattern. Critique replaces connection; control replaces curiosity, straining partnerships and teams across genders.
The Inner Critic and Self-Condemnation
Perfectionism carries an inner voice that monitors, corrects, and condemns, not only thoughts but the body’s rhythms. It tightens the breath, pulls the spine into rigid holding, and interrupts natural rest cycles. In Depth Psychology, this voice is understood as an internalized authority formed in early relationships. In Somatic Experiencing®, it is tracked not as an enemy but as an activation in the organism (Horney, 1950; Hewitt & Flett, 1991).
For many women, this can take the form of an internal voice that insists on being impeccably competent, emotionally available, and aesthetically acceptable at once. This impossible triple demand turns ordinary human limits into evidence of personal failure. For many men, the rigour of perfectionism may center more around being unshakeably capable, emotionally contained, and always “in control,” with vulnerability framed as weakness and hesitation interpreted as incompetence. In both cases, error becomes dangerous: not a moment of learning but a verdict on one’s worthiness and belonging (Limburg et al., 2017).
As a result, the nervous system remains mobilized against anticipated judgment or exclusion, and daily life takes place under a continuous internal audit. Success rarely brings peace; instead, it resets the bar, tightening standards and expanding the territory where one can “fail.” Because gender norms often shape what “failure” means, women may feel disproportionate shame when they cannot maintain relational harmony or caregiving roles perfectly, while men may experience intense self‑contempt when they falter in performance or decisiveness, even when circumstances would not justify such harsh conclusions.
Over time, this inner climate becomes austere and unforgiving: the self is monitored, not accompanied; evaluated, not cared for. Perfectionism thus functions less as motivation and more as an internal regime of control that drains spontaneity, playfulness, and the ability to feel fundamentally acceptable as a fallible human being (Horney, 1950)
Historical and Clinical Perspectives
Historically, clinicians across theoretical traditions have recognized perfectionistic dynamics as central to many forms of psychological distress, a pattern of internal demands, “I must never misstep; I must always perform; I must be exemplary,” that permits no room for error, ambivalence, or developmental process.
Contemporary perfectionism research further distinguishes between perfectionistic strivings (high personal standards and goals) and perfectionistic concerns (fear of mistakes, doubt about actions, self‑criticism), with meta‑analytic work showing that the latter are particularly linked to depression, anxiety, and suicidal ideation (Simon et al., 2025). Clinicians also note how gendered socialization threads through these structures: girls and women are more often socialized to internalize failure as a personal flaw and to keep distress “tidy” and self‑directed, while boys and men may be encouraged to convert inner doubt into externalized over‑performance, stoicism, or withdrawal, making their perfectionism harder to recognize as suffering. In both genders, the same pattern emerges: traits that initially support achievement (e.g., conscientiousness, persistence, attention to detail) slowly transform into mechanisms of collapse, as deadlines become punitive, rest feels hazardous, and sleep turns into a negotiation with the inner critic rather than a replenishing process.
Perfectionism appears across diagnoses: in obsessive–compulsive presentations, in restrictive eating and over‑exercise, in workaholic lifestyles, in scrupulous moral or religious observance, and in academic and professional overperformance that leaves little room for inner life. Importantly, the cultural backdrop often celebrates these patterns differently for women and men (e.g., applauding women’s “selfless dedication” and men’s “relentless drive”) while remaining essentially blind to the chronic hyperarousal, shame, and relational strain that accompany them. The clinical task, therefore, is not simply to reduce symptoms but to recognize how perfectionism intertwines with gendered expectations and to help patients disentangle their sense of worth from both performance and stereotypes.
The Hidden Cost: When Success Becomes Depletion
The first sign of perfectionism’s toll is often not a dramatic breakdown but quiet depletion. Sleep shortens or becomes restless, joy feels mechanical, and conversations become performances rather than encounters. The inner critic, once an anxious advisor, slowly takes the throne as sovereign, judging not only outcomes but motives, feelings, and needs.
For many women, this depletion appears in lives that look outwardly “successful”: caring for others, excelling at work, managing emotional labor at home, and still feeling that nothing is ever quite enough, body, output, parenting, or professional standing. For many men, the cost may be hidden behind long working hours, emotional distance, and the appearance of control; exhaustion, irritability, or somatic complaints can become the only “acceptable” languages through which distress speaks when tears and open fear feel forbidden.
When someone hears “You are too hard on yourself,” the perfectionistic mind may interpret it as yet another failure: not only are you failing your standards, but you are now failing at being gentle as well. Even invitations to self‑compassion can be conscripted into the perfectionistic project: be kinder, but perfectly kinder; rest, but excel at resting. Over time, relationships suffer: intimacy requires showing unpolished, uncurated parts of oneself, which feels dangerous when one’s existence seems to depend on maintaining a flawless façade.
Creativity narrows to what can be justified as “productive,” and play becomes frivolous rather than a legitimate expression of vitality. Gender roles frequently amplify this: women feeling guilty for saying no or setting boundaries, men feeling ashamed for admitting fear or the desire to step off the treadmill of endless achievement. Perfectionism, hence, often masquerades as a virtue, fueling success and discipline. Yet, its hidden toll emerges as exhaustion, anxiety, and a sense of never truly arriving.
Recent research indicates that among women, perfectionistic thinking is linked to increased dieting behavior, while for men, self-oriented perfectionism is associated with bulimic symptoms through increased perfectionistic thoughts (Boone, Soenens, & Braet, 2014)
The Cost, Reward, and Gendered Toll
Striving for perfection often demands relentless investments—late nights, missed gatherings, and constant vigilance—yet the returns rarely satisfy the deeper need for self-worth. Praise, predictability, and admiration act as reinforcers: each compliment, promotion, or positive evaluation temporarily validates the sacrifice and makes the next trade feel necessary.
This economy is not gender‑neutral: women may feel compelled to maintain both professional excellence and invisible labor at home (e.g., caregiving, emotional holding, social coordination) so that their perfectionistic economy operates on two currencies at once: performance and care. Men, by contrast, may be pressured to equate worth with material success, seniority, and stoic productivity, leading them to overinvest in work while underinvesting in emotional nourishment and relational depth. Clinicians repeatedly hear a similar realization from both women and men: “The success I fought for consumed the life I wanted to live.” The collapse is usually gradual rather than spectacular: accumulating insomnia, chronic worry, diminished pleasure, somatic symptoms, and a narrowed sense of self. Over the years, perfectionism often shifts from being one strategy among many to becoming the central identity: the person is no longer someone who strives; they are someone who believes they cannot afford not to strive.
At this point, stepping back or loosening standards feels less like a behavioural choice and more like an existential threat. Gender expectations can make renegotiating this economy particularly difficult: a woman who reduces her availability may be labeled selfish or “not a team player,” while a man who seeks a less demanding role may fear being seen as weak, unambitious, or unreliable. Recognizing this economy as structurally flawed rather than a personal failure is often the first step toward reclaiming a more livable balance between contribution, rest, and dignity.
Developmental Roots: Conditional Love and Early Gender Scripts
The developmental roots of perfectionism are diverse, but common themes appear in the narratives of both women and men. In many families, children absorb the belief that love and acceptance hinge on flawless performance: good grades, impeccable behavior, emotional composure, or taking on responsibilities beyond their age. Achievement was praised, and error, however small, received disproportionate focus, teaching the nervous system that belonging depended on staying ahead of disappointment. Over time, this lesson can evolve into a lifelong drive to meet impossible standards.
In many families, gendered expectations shaped the specific form this contingency took: daughters may have been rewarded for being helpful, kind, and high‑achieving “without causing trouble,” while sons may have been reinforced for being strong, autonomous, and “not too sensitive,” even when frightened or overwhelmed. In such contexts, perfectionism is not irrational; it is adaptive.
A child’s logic may sound like: “If I am exceptional, I will be safe; if I falter, I will be shamed, ignored, or abandoned.” Another developmental route occurs when early life success becomes a core identity: a child who excelled easily in school or sports enters more complex environments, where excellence is harder to achieve, and responds not by adjusting expectations but by avoiding situations in which they might feel ordinary or exposed.
In many families, children absorb the belief that love and acceptance hinge on flawless performance. Over time, this lesson can evolve into a lifelong drive to meet impossible standards.
For some women, this can lead to self‑selection out of visible leadership or competitive fields, not because of a lack of competence, but because the risk of imperfection feels intolerable; for some men, it can lead to grandiose overcompensation or withdrawal from challenges that threaten their “talented” self‑image.
In both patterns, relentless over‑pursuit or defensive withdrawal, the nervous system organizes around the prevention of shame rather than the pursuit of growth. An early vow: “If I remain stainless, I will not be abandoned,” a vow that later turns into an internal law even after the original environment has changed. Therapeutic work often involves locating these early rooms (e.g., classrooms, family gatherings, religious spaces) where perfection became a survival strategy and gently loosening the grip of those childhood conditions on the adult self.
Sibling Dynamics: Rivalry, Comparison, and the Seeds of Perfectionism
Perfectionism often takes root within the family system, especially through sibling relationships. Competition for parental attention, achievement-based comparisons, and the pressure to develop a unique identity can drive siblings to set increasingly high standards for themselves (Tesser, 1988; Dunn, 2015). Birth order and parental favoritism may amplify these dynamics: firstborns might feel compelled to be exemplary, while later-born children may strive to match or surpass their siblings’ successes (Sulloway, 1996). Gender expectations within families further shape these roles, with sisters and brothers absorbing distinct messages about what it means to be “good enough.” Sisters may compete over who embodies the “responsible carer” or “dutiful daughter,” while brothers vie for the mantle of “provider” or “achiever,” with parental favoritism amplifying the stakes. A “golden child” receives praise for effortless excellence, pressuring the other sibling to compensate through hyper-performance; conversely, the “scapegoat” sibling may develop perfectionism as a form of rebellion against perceived neglect. Over time, such patterns can underpin perfectionistic thinking, where self-worth hinges on outdoing, pleasing, or simply not falling behind one’s siblings (Adler, 1959; Flett et al., 2016).
Perfectionism and Workplace Bullying: From Victim to Perpetrator
Workplace bullying extends childhood relational patterns into professional life, where perfectionism creates both vulnerability and aggression. Research reveals perfectionists become double-edged targets: those with perfectionistic self-presentation, obsessed with concealing flaws and avoiding criticism, are significantly more likely to experience bullying victimization, particularly in high-stakes fields like nursing (Jang et al., 2025). Their hypervigilance to evaluation makes routine feedback feel like an attack, amplifying perceived hostility from colleagues or superiors.
Gender shapes these dynamics distinctly. Women perfectionists, conditioned for relational competence, face covert aggression (e.g., “you're too sensitive,” “not a team player”) when they cannot maintain impossible caregiving and performance standards simultaneously. Men encounter status attacks (e.g., “not leadership material,” “dropping the ball”), challenging their provider/invulnerable identities (Wei et al., 2024). Bullies exploit these insecurities, weaponizing deadlines and “perfection” demands to erode targets’ self-worth.
Paradoxically, perfectionists also perpetrate. Self-critical perfectionism and shame-proneness drive aggression to enforce standards or deflect personal exposure: “if I demand flawlessness from others, mine stays hidden” (Jang et al., 2025). High-standard perfectionism correlates with perpetration risk, especially when parental/sibling conditioning taught “outperform or be invisible.” (Roxborough et al., 2012)
This bidirectional cycle—from sibling rivalry's “outdo or be lesser” to office hierarchies’ “excel or be expendable”—encodes perfectionism systemically. Victims internalize bullying as personal failure, fueling self-criticism; perpetrators externalize their inner critic, harming others to soothe themselves. Healing requires naming this relational transmission: perfectionism is not solitary torment but a cultural contagion amplified by power imbalances (Hewitt & Flett, 1991).
Image via Unsplash by Anton Darius @thesollers
Somatic Organization: When the Body Learns to Brace
Perfectionism does not live only in thoughts; it embeds itself in the body as posture, breath, and muscle tone. Many individuals who describe an exacting inner critic also report chronic neck and shoulder pain, jaw tension, headaches, digestive issues, or a chest that feels as if it is holding its breath. The diaphragm tightens, the breath stays shallow and high, and the spine arranges itself as if under constant inspection.
Women may notice this bracing particularly in settings where they feel scrutinized for both competence and appearance, presenting at work, navigating academic spaces, or entering male‑dominated rooms where any misstep seems to confirm stereotypes about women’s abilities.
Men may experience somatic perfectionism in contexts where they feel required to embody toughness or invulnerability, such as athletic performance, demanding jobs, or leadership roles—tightening their bodies against any sign of fear, tenderness, or fatigue.
In Somatic Experiencing® and related body‑oriented therapies, such patterns are understood less as personal shortcomings and more as survival strategies that have become chronic: the body remembers moments when love felt conditional, when approval depended on not crying, not slowing down, not disappointing. Hypervigilance becomes somatic; even in quiet rooms, the organism remains prepared for evaluation and potential failure.
Over time, this chronic activation can contribute to functional somatic symptoms, real physical complaints without a clear medical explanation, especially in young people with high perfectionistic tendencies. Working with the body means inviting small experiments in safety: a fuller breath that is not immediately corrected, a softer jaw that does not lead to catastrophe, a slightly less rigid posture in a meeting or conversation. These experiments can be compelling when they consciously challenge gendered rules, allowing a woman’s body to take up more space without apology, allowing a man’s body to soften or slump without immediately “pulling himself together.” Gradually, the body learns that it can exist without constant self‑surveillance and that imperfection does not automatically mean danger.
Integrative Treatment: Toward Flexible, Embodied Living
In adulthood, this early learning becomes infrastructure for both women and men. The person wakes already bracing, even before breakfast, as the inner critic scans the horizon: What might go wrong? What must be done? What is not yet sufficient? Breath is shallow, not because the lungs are weak but because vigilance occupies the diaphragm. The spine stands on duty. The jaw closes around unsaid fear. Thoughts race not toward play but toward prevention. The moral atmosphere inside the psyche is austere. To err is to fall from dignity (Horney, 1950). Many perfectionists do not even call themselves perfectionists. They call themselves responsible, disciplined, exacting, or high-standard. They assume the high stakes are universal. They cannot imagine that others might wake without the inner demand to prove their right to exist.
Because perfectionism is multidimensional—cognitive, relational, somatic, moral—integrative treatment often proves most effective. Cognitive‑behavioural approaches, including targeted protocols for perfectionism, have demonstrated that modifying rigid beliefs, behavioural patterns, and self‑evaluation can significantly reduce perfectionistic concerns and associated distress (e.g., Hewitt et al., 1991; Wegerer, 2023). However, when gendered expectations go unexamined, cognitive work alone can inadvertently reinforce existing pressures, helping someone become more efficient at meeting impossible roles rather than questioning those roles themselves. Psychodynamic and relational therapies, including Dynamic‑Relational Therapy, address perfectionism as a relational defense, enabling patients to explore how they use flawlessness to secure connection or avoid shame, and how this plays out differently in women’s and men’s intimate, familial, and professional relationships. Somatic approaches such as Somatic Experiencing® or mindfulness‑based interventions bring the body into the therapeutic field, attending to breathing patterns, postural armour, and autonomic states that support perfectionistic vigilance. Attachment‑focused and narrative work invites patients to revisit life stories in which their value seemed conditional on performance, gender conformity, or early success, and to re‑author identity around deeper values instead. For women, this might include reclaiming the right to be competent without being endlessly accommodating; for men, it might mean reclaiming the right to be strong and capable while also being vulnerable, relationally available, and imperfect. An integrative, dignity‑centered treatment does not demand that patients relinquish excellence; rather, it seeks to dislodge excellence from fear so that striving becomes choice instead of compulsion. Over time, patients of all genders can learn to live with a more flexible inner posture: standards that stretch but do not crush them, bodies that participate in life rather than brace against it, and relationships where love is not continuously earned through performance.
Clinical Vignette: Different Faces, Shared Structure
A vignette can illustrate how perfectionism lives in both women’s and men’s bodies while wearing different social costumes. Consider Anna, a mid‑thirties academic whose life appears exemplary: frequent publications, well‑received lectures, and a carefully managed professional persona. Internally, she lives with chronic neck tension, muted breath, and an inner critic that reviews every sentence and facial expression; pauses feel like exposure, and rest feels suspicious. In therapy, she gradually notices how much of her striving is organized around not confirming stereotypes about women in her field, working harder to be beyond reproach because she anticipates being underestimated or scrutinized more closely than male colleagues. Over months, as she experiments with slightly less preparation, more honest communication about limits, and somatic practices that soften her posture, she finds that her world does not collapse when she is somewhat less than perfect. Now imagine Mark, a forty‑year‑old manager who works long hours, rarely shows emotion, and is admired for being “reliable” and “tough.” His body tells a different story: elevated blood pressure, tight jaw, insomnia, and episodes of chest tightness that medical tests cannot fully explain. Mark’s perfectionism revolves around being the man who never drops the ball, never needs help, and never lets colleagues or family see his uncertainty; his gendered superego equates softness with failure. In therapy, he begins to name fears he has never voiced, that if he slows down, asks for support, or admits confusion, he will lose respect and love. As he practices small acts of imperfection (e.g., delegating tasks, showing emotion with close friends), his body’s armour loosens, and he discovers that relationships can deepen rather than break when he is less polished. Anna and Mark’s stories differ in content but share a structure: perfectionism as a strategy to manage gendered expectations, protect dignity, and avoid shame, at the cost of bodily ease and authentic connection.
Why Depth and Gender Both Matter
Understanding perfectionism only as “high standards” overlooks its deeper roots in survival, identity, and culture. A depth‑psychological and somatic perspective shows how perfectionism encodes early vows about safety and worth, while a gender‑aware lens reveals how these vows are shaped and reinforced by societal scripts about what women and men must be to deserve respect and love. For women, this may mean constantly negotiating between expectations of brilliance and modesty, strength and softness, ambition and selflessness, creating a perfectionistic double bind that makes any choice feel partially wrong. For men, it may mean living under a mandate of emotional stoicism and professional dominance, where exhaustion, loneliness, and self‑doubt must be hidden behind competence and humour. When treatment or self‑reflection ignores these gendered pressures, individuals can mistakenly interpret their exhaustion as purely personal weakness rather than as a predictable response to structurally impossible demands. Recognizing perfectionism as a transdiagnostic process, one that cuts across symptoms and diagnoses, and across gender identities, opens space for more compassionate and precise care. Instead of asking “Why am I like this?” in a blaming way, people can begin to ask “What did I have to survive? What roles was I asked to play? And what might it be like to live in a body that no longer has to earn its right to exist?” For clinicians, leaders, and educators, a gender‑sensitive understanding of perfectionism can inform how expectations are communicated, how feedback is given, and how spaces are created where both women and men can risk being human rather than relentlessly exemplary. Perfectionism, then, becomes less a personal flaw and more a trace of a history that can be honoured, understood, and ultimately softened.
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