The term ‘Duck Syndrome’, coined by Stanford University, is used to describe the ability students have to remain calm when struggling with the pressures of studying in a competitive environment. In other words, like a duck appearing to glide calmly across the water, while beneath the surface it frantically, relentlessly paddles.
Given the pressure of good grades and high levels of performance that are expected, it comes as no surprise that perfectionist traits are high amongst medical and dental students. With this in mind, we’ve asked dentist and positive psychologist Mahrukh Khwaja, AKA Mind Ninja, to help. Here, she shares her top tips for helping you manage the perfectionism trap at university.
Introduction
Perfectionism is often correlated with decreased self-esteem, increased depression and anxiety, and unhelpful coping strategies (Grzegorek et al. 2004; Mehr et al. 2016).
A recent study involving 412 dental students in the UK found high levels of perfectionism (35%) associated with maladaptive coping strategies (such as alcohol misuse) and decreased mental wellbeing – specifically burnout and psychological distress (Collin et al. 2020).
What is perfectionism?
Simply put, perfectionism is setting unreasonably high standards for ourselves, and sometimes for others. It is the impossible quest to be perfect and without flaws.
The consequence of these unrealistic standards is that perfectionists are highly self-critical. Every flaw is scrutinised, ruminated upon and used to self-flagellate.
Do these types of thoughts or personality traits resonate with you?
- When I’m working on something, I can’t relax until it’s perfect
- I aim for perfection in my clinical work, and strive to be as perfect as I can be
- It makes me uneasy to see an error in my clinical work
- I dwell on my clinical mistakes
- I base my worth on my accomplishments
- I am goal-driven. I never feel satisfied and that there’s always more to do or accomplish
- Even when I succeed, I feel like it’s not enough and I could have done better
- Anything I do that is less than excellent will be seen as poor work by those around me
- I have high expectations for the people who are important to me
(List adapted from the Multidimensional Perfectionism Scale, Hewitt PL & Flett GL, 1990)
The psychology of perfectionism
The roots of perfectionist traits originate in childhood – from growing up with unrealistic expectations from caretakers to references in culture and media.
The belief that underpins perfectionism is that achievement and performance determines our self-worth, and there is a deep-rooted need to be liked, accepted and loved. There's often also a fear of not being good enough.
Perfection can be celebrated in society (for example, the success of great athletes) and is sometimes mistakenly confused with the pursuit of excellence. An individual with perfectionist traits strives to never make mistakes and is excruciatingly hard on themselves when they do.
The unforgiving nature of perfectionism results in us feeling worse rather than better. It also denies the very nature of being human, which is perfectly imperfect.
In a better world, culture would draw our attention to the first drafts and hidden labour of people behind the scenes. The challenge we have as adults is to find our own guides so that we are not at the mercy of the perfectionism trap.
The link between perfectionism and procrastination
Do you catch yourself delaying important tasks? Did you know that perfectionism and procrastination are linked?
In the procrastination-perfection avoidance loop, procrastination is not a case of poor time management or lack of motivation.
Beneath the learnt habit of procrastination lives the same perfectionist fear of not being good enough or failing. It is this fear that stops us from starting altogether.
A common theme when it comes to procrastination is that important tasks are seen as stressful. Thinking of completing them creates thoughts of not being good enough or meeting our own high standards. This is when the fear, anxiety and doubt creeps in.
Experiencing these negative emotions leads to avoidance, and we end up prioritising other tasks like scrolling through social media as a form of relief. We feel a sense of reward when our negative emotions are temporarily reduced – but soon enough our mind returns to the task and the avoidance loop continues.
Self-compassion: An antidote to perfection
Self-compassion is treating ourselves with the same kindness, care and warmth that we would naturally show a good friend (Neff, 2003). It’s also about treating ourselves in this way during periods of stress.
You could consider it almost a radical approach as a healthcare professional. Swapping perfectionism and self-criticism with an acceptance of our imperfections can help soothe us when something goes wrong – for example, if a patient complains.
By embracing this approach, we can stay connected to the present without getting stuck in negative thoughts about the past or swept up in anxiety about the future.
When it comes to self-compassion, one of the biggest challenges for medical and dental students is that patients also expect perfect systems, leaving little room for error. However, without self-compassion and an acceptance of our humanity, we run the risk of beating ourselves up for every mistake.
Given the importance of self-compassion, I will now explain how to use it to counteract self-perfection, nurturing a kinder, softer inner voice.
Using mindfulness to accept negative emotions and aid self-compassion
Negative emotions are to be expected in life. When we resist our natural emotions, often the pain of those feelings persists.
We may note that our attention wanders. We may also experience physical tension in our bodies, as well as feelings of worry and defensiveness.
So, how can mindfulness help us accept our emotions, rather than resisting them? How can it aid the self-compassion building process?
The mindfulness component of self-compassion allows us to know that we are suffering, enabling us to lean into a kinder response towards our pain. It is the first step towards self-compassion.
To increase your levels of self-compassion, try listening to these guided meditations:
Self-compassion with patients
The next time you notice feelings of stress or anxiety, try this process based on the three pillars of self-compassion.
1. Take a mindful deep breath
This is the first step towards working the self-compassion muscle!
Taking a deep breath helps us to make space for difficult things. When we are overwhelmed with our own thoughts, we are prone to getting swept up by their negative reactivity because we believe those thoughts to be true. We also minimise positive thoughts that come and go.
2. Remember that you are not alone in how you are feeling
This involves understanding that we all share a sense of interconnectedness. All humans make mistakes, are works-in-progress and experience adversities.
3. Use words and gestures of self-kindness
This means treating ourselves with warmth and acceptance when challenges arise. Instead of using a critical inner voice if things don’t go smoothly, self-kindness will allow us to foster a more comforting inner voice.
We may start to acknowledge the pain too. For example, you can say to yourself: “I’m so sorry you are experiencing this. I have your back and I’m here for you.” It may also involve soothing touch, such as squeezing our hand or arm.
Acts of self-compassion
Here are some practical examples of how we can offer ourselves self-compassion in our daily lives:
- Giving ourselves permission to be imperfect
- Giving ourselves a hug or a soothing squeeze of the arm when we feel stressed
- Saying no when we are at full capacity
- Working on setting boundaries
- Resting intentionally and scheduling in regular down time
- Allowing ourselves to feel and find healthy ways to express our feelings
- Paying attention to what brings us joy, and doing more of it
- Feeding ourselves with nutritious food
- Taking phone and screen breaks
- Going to bed early and practising good sleep hygiene
Final thoughts
Developing inner compassion takes time. Whether it’s focusing on our inner voice, practising mindfulness and meditation or making a conscious effort to act self-compassionately, we can better support ourselves by prioritising kindness.
Remember to give yourself permission to be imperfect. When ‘failures’ arise, remind yourself that you can learn lessons and keep improving. Reframe negative self-talk without judgement and remind yourself that with time and effort, you can train your brain to become more self-compassionate.
Part of self-compassion also involves asking for help and seeking support from family, friends and mentors. Working with patients, alongside preparing for exams and coursework, is tough. Use self-compassion to help you not only survive the stressors, but to thrive in them using the same kindness you would show a loved one.
References
Collin, V., O'Selmo, E., & Whitehead, P. (2020). Stress, psychological distress, burnout and perfectionism in UK dental students. British Dental Journal, 229(9), 605–614.
Khwaja (2023). Resilience and Well-being for Dental Professionals, Edition 1. Wiley and Sons Ltd.
Grzegorek, J. L., Slaney, R. B., Franze, S., & Rice, K. G. (2004). Self-criticism, dependency, sel-esteem, and grade point average satisfaction among clusters of perfectionists and non-perfectionists. Journal of Counseling Psychology, 51, 192–200.
Johnson, Edward, & O'Brien, Karen. (2013). Self-compassion soothes the savage EGO-threat system: Effects on negative affect, shame, rumination, and depressive symptoms. Journal of Social and Clinical Psychology.
Killham, M. E., Mosewich, A. D., Mack, D. E., Gunnell, K. E., & Ferguson, L. J. (2018). Women athletes’ self-compassion, self-criticism, and perceived sport performance. Sport, Exercise, and Performance Psychology, 7(3), 297.
Long, P., & Neff, K. D. (2018). Self-compassion is associated with reduced self-presentation concerns and increased student communication behavior. Learning and Individual Differences, 67, 223–231.
Mehr, K. E., & Adams, A. C. (2016). Self-compassion as a mediator of maladaptive perfectionism and depressive symptoms in college students. Journal of College Student Psychotherapy, 30, 132–145.
Neff, K. D. (2003). Development and validation of a scale to measure self-compassion. Self and Identity, 2, 223–250.
Shapiro, S., Astin, J., Bishop, S., & Cordova, M. (2005). Mindfulness-based stress reduction for health care professionals: Results from a randomized trial. International Journal of Stress Management, 12, 164–176.