As suicide is the worst outcome for those with ongoing mental ill-health, it makes sense to try to figure out all the factors that contribute towards a person wanting to take their own life. Beyond focusing on adverse life circumstances and events, research has also identified inherent character traits that raise an individual’s suicide risk. This article looks at two of the personality traits that have been linked with increased psychological suffering and suicidal ideation: perfectionism and neuroticism.
Perfectionism, mental illness, and suicidality
We probably all know someone with perfectionistic tendencies in at least one area of life. Maybe it’s their education, career, relationships, hobbies, health, appearance, or whatever. But then there are other individuals who are more like bona fide perfectionists – where it seems to be more like a constant, stable character trait. They’re the ones who seem to obsess over being exceptional in virtually every domain of life, striving to be their society’s spitting image of success across the board.
(Notice the word choice there: Image of success/happiness/perfection/fulfilment. The reality may be very different. More on this “self-oriented perfectionism” versus “socially prescribed perfectionism” later.)
Intuitively, it may come as little surprise that those who have never-ending preoccupations with a level of flawless excellence that is illusory and impossible to attain – let alone maintain – may possibly be susceptible to suffering from mental distress. Because their standards are so high, they are likely to be quite often disappointed in themselves and life (and other people). So, it may make sense that their self-imposed ideals and stress, perceived failures, and subsequent self-criticisms, along with any negative external appraisals, lead to depression and suicidal ideation.
But how much evidence is there to back this up? Psychologists have developed different scales and measures to test for perfectionism, including when examining it as a personality trait. And numerous studies over the decades have examined if and how perfectionism increases suicidality.
It’s handy to first differentiate between internally motivated versus externally motivated perfectionism. Because it does so, Hewitt and Flett’s perfectionism model, dating back to 1991, is still widely used in research today. In addition to other-oriented perfectionism (expecting others to be perfect), the model distinguishes between “self-oriented perfectionism” and “socially prescribed perfectionism.” The self-oriented type is characterised by the setting of lofty standards and goals for oneself based on the belief that perfection/achievement striving is positive. Socially prescribed perfectionism is probably more damaging to the self, as it stems from the belief that others expect you to be perfect and that you must be in order to be accepted by them. Naturally, you’re often going to feel as though you’re unable to meet these standards (because nobody can) and that, therefore, you are unacceptable to others.
So, in this model, one kind of perfectionism is more internally motivated – “I’ve met my own extremely high standards and achieved my lofty goals, so I am happy” – while the other depends upon external validation and recognition – “Other people see me as successful and perfect, so they accept me, so I am happy.”
Maladaptive perfectionism, as the name suggests, is pretty much any kind of perfectionism that causes more harm than good. It has been found to be detrimental to a person’s self-esteem. But this socially prescribed type of perfectionism – which may have its origins in parental rejection and invalidation – is especially damaging. Understandably, it has been connected with depression.
In fact, according to a systematic review of the psychological harms caused by perfectionism, maladaptive (toxic) perfectionism leads to all kinds of unnecessary distress. The piece states that unhealthily perfectionistic people are more susceptible to developing mental illnesses in the first place while finding it more difficult to overcome them.
So, we can see how maladaptive perfectionism can contribute to psychological illness and suicidality in a few ways. For instance, it can result in:
- More self-criticism
- Low self-esteem
- Shame
- Hopelessness and despair
- A false façade (and awareness of its falseness)
- Anxiety and obsessions (and clinical disorders, like OCD, social anxiety, eating disorders, etc.)
- Ruminations (e.g., over past mistakes, imperfections, and social criticisms)
- Stress from pushing oneself too far.
Regarding psychopathology in general, after examining 284 relevant studies, the authors of a 2016 meta-analysis call perfectionism – encompassing perfectionistic strivings and concerns – a “transdiagnostic factor” for a wide range of psychopathology, such as disorders and related symptoms and outcomes. That included self-harm and suicidal ideation.
Addressing suicide specifically, a 2007 study discovered much evidence linking “self-critical evaluative concerns perfectionism,” such as socially prescribed perfectionism, concerns over mistakes, self-criticism, and doubts over actions, with suicidality. Similarly, other work found correlations between self-criticism and suicidal ideation.
Now we can try to link perfectionistic self-criticism to Joiner’s interpersonal theory of suicide (there’s a book called Why People Die By Suicide that covers it). This model posits that for a person to die by suicide, they need to meet three conditions. Suicidal desire is created by the first two factors: “thwarted belongingness” combined with “perceived burdensomeness.” They lead to the desire to end one’s life. But for a person to have suicidal capability, a third condition needs to be met: the learned ability to hurt oneself, i.e., habituation to self-harm. (This explains why a prior history of self-injury is one of the greatest risk factors for suicide.)
How can toxic self-criticism lend itself to suicidal desire? Those affected by socially prescribed perfectionism believe that others hold incredibly high standards for them, and that interpersonal acceptance depends upon their meeting these standards. So, their critical self-evaluations may result in feelings that they will never truly be accepted (“thwarted belongingness”), and that their personal inadequacies make them a burden (“perceived burdensomeness”). And, of course, perfectionistically critical self-evaluations facilitate clinical depression and anxiety disorders, etc., and these conditions often increase feelings of isolation and burdensomeness.
Overall, it looks like maladaptive perfectionism (in particular, socially prescribed perfectionism) contributes to excessive self-criticism which contributes to suicidal desire.
Neuroticism, mental illness, and suicidality
For suicide prevention, why should we care about the personality domain/trait of neuroticism? Because it has been robustly associated with all the common mental health conditions. Highly neurotic people more easily, frequently, and intensely experience the so-called “negative” and painful emotions in response to stress. These feelings include the following:
- Anger/hostility (especially frowned upon in women)
- Irritability/frustration
- Sadness
- Despair
- Disgust
- Emptiness
- Shame
- Embarrassment
- Regret/guilt
- Self-consciousness
- Anxiety
- Fear
- Paranoia
- Envy/jealousy
- Loneliness
- Apathy
- Boredom, etc.
They are also likely to experience emotional lability, vacillating between these negative moods.
Unlike perfectionism, neuroticism is one of the broad personality domains covered by the Five Factor Model, aka the Big Five (which is maybe the most empirically validated personality taxonomy – unlike the MBTI or, god forbid I even mention, the Enneagram). But as a side note, although “perfectionism” is not measured by the Big Five, self-oriented perfectionism has been found to be correlated with the Big Five dimension of conscientiousness. Also, we can look at neuroticism as a wider construct, or examine each of its six individual facets, which are anxiety, angry/hostility, depression, self-consciousness, impulsiveness, and vulnerability.
These Five Factor dimensions are not binary things: people fall somewhere along the neuroticism spectrum, more than likely a bell curve, with a minority being extremely neurotic – and the other minority being extremely calm and chill. Moreover, though we’re looking at it as an inherent character trait (probably with some kind of basis in biology and genetics), adverse childhood experiences like emotional neglect and abuse, physical neglect and abuse, and sexual abuse may contribute to higher neuroticism in adulthood. Like virtually everything in mental health (and maybe health in general), it’s a combo of biological, psychological, and social stuff that contributes.
The sad reality is that not only are high general neuroticism scores tied to worse mental health, but to poor physical health (such as cardiovascular problems, irritable bowel syndrome, worse immunity, substance use), lower life satisfaction, and a shorter lifespan. And suicidality. For one example, this research suggests that greater negative-affect reactivity to life’s stressful days and events predicts worse physical health outcomes, and increased mortality and morbidity later in life. This is why this fundamental character trait has been viewed as having “enormous public health implications”.
Perhaps it’s not really that surprising, but studies have long associated heightened neuroticism with an array of psychological disorders. These include:
- Schizophrenia
- Bipolar disorder
- Depression
- Anxiety
- Social anxiety
- OCD
- Personality disorders
- And so on (maybe all of them).
Speaking more broadly and generally, it could be argued that mental health conditions – particularly, the ongoing, recurrent ones – arise from the temperament or trait of neuroticism interacting with some sort of life stressor, as mentioned above. Is that “mental illness” simplified? And, of course, researchers have proposed several different theoretical models to explain why neuroticism is so strongly connected to psychosocial disorders (which I won’t mention here because you’re probably uninterested).
Despite the fact that I love to litter my writing with numerous (too many) extracted quotes, I’ve consciously tried to avoid including too many here because I have perfectionistic tendencies. Nevertheless, I want to add this one, which sums things up nicely:
Neuroticism is a robust correlate and predictor of many different mental and physical disorders, comorbidity among them, and the frequency of mental and general health service use. Indeed, neuroticism apparently is a predictor of the quality and longevity of our lives.
The trait has long been linked with suicidal ideation and attempts (for example, here, here, and here). More recently, an insightful 2018 study titled “Neuroticism and suicide in a general population cohort: Results from the UK Biobank Project” examined data from over 380,000 participants involved in the UK Biobank Project to assess neuroticism’s association with death by suicide. These individuals were followed up after a 10-year period. Perhaps in a world first, the results were able to conclude that neuroticism is a risk factor for suicidal death, rather than only ideation and attempts. Interestingly, the neuroticism–suicidal death link was still significant for women (but not men) in their subsample even after adjusting for psychological disorders.
Backing up a lot of other similar investigations, the authors mention that the personality trait has been associated with psychiatric illnesses in general. Specifically, they say it’s a common component underlying affective disorders like depression and anxiety, which, as we probably know, heighten suicide risk on their own and in combination with other factors. Also interestingly, when discussing borderline personality disorder (“another strong risk factor for suicide”), they comment that perhaps the condition can be thought of as an extreme form of neuroticism – which would make sense, really.
Why else might the trait coincide with suicidal death? For one, the highly neurotic often cope with their emotions by using substances, like cigarettes, alcohol, and illicit drugs, and doing so has been linked with self-harm and suicide. Yet another factor that the paper brings up is that the mood instability seen in very neurotic people has also been connected to “psychological distress, depression, substance use, impulsivity, and suicidality”.
For these reasons and more, neuroticism is a public health concern likely playing a significant role in people’s suicidal ideation, attempts, and death (not to mention poorer physical health, and lower life quality and satisfaction – and shorter life length).
To sum all this up, it’s probably safe to say that when the personality traits of (maladaptive) perfectionism and/or neuroticism are fairly extreme, they can be considered risk factors contributing toward various kinds of mental distress, numerous psychological disorders, and increased suicidality. Thankfully, developing self-compassion and self-forgiveness can help those who are very perfectionistic or neurotic.
Monique Moate is a writer, editor, wife, cat mum, and night owl who enjoys writing about a wide range of topics. She cares about mental health awareness and destigmatisation.
