Fear of every slip, more than high standards, is usually the problem

Key takeaways

• A 2026 analysis of 307 studies with more than 82,000 college students found perfectionism rose from 1989 to 2024, with fear of mistakes and judgment climbing much faster than the drive for high standards.
• Across 43 studies, the worried side of perfectionism was clearly tied to burnout, while high standards on their own were not.
• Fear of mistakes predicted later binge-eating and purging symptoms in long-term studies, but for orthorexia, an unhealthy fixation on eating “correctly,” high standards themselves were the stronger link.
• A 2022 review of 15 randomized trials found that cognitive behavioral therapy for perfectionism cut perfectionism and eased depression, anxiety and eating-disorder symptoms.
• If food or exercise rules are taking over, the National Alliance for Eating Disorders helpline is 1-866-662-1235; in a crisis, call or text 988.

In May 2026, three psychologists in Britain published a review of 35 years of perfectionism research¹. They pooled 307 studies of more than 82,000 college students in the United States, Canada and the United Kingdom¹.

Perfectionism rose over that whole stretch. But since the early 2000s, one part of it has climbed much faster than the other: the fear of failing, the fear of being judged and the struggle to make decisions¹.

Lead author Thomas Curran of the London School of Economics called perfectionism “a public health risk,” linked to depression and anxiety¹. He also noted that the rise began before social media did¹.

Health is fertile ground for perfectionism, because there is always a cleaner diet, a longer workout, a better sleep score or one more supplement. Many people drawn to natural health hold high standards on purpose, and that’s a strength.

The research suggests the standards themselves usually aren’t the main problem. The trouble comes when every slip feels like a failure. This article shows how to tell the two apart and how to set standards that are high but livable.

Perfectionism is rising, and its anxious side is rising fastest

The 2026 study built on earlier work by Curran and Andrew Hill of York St John University in England¹².

Their 2019 paper in Psychological Bulletin covered 164 samples of 41,641 college students from 1989 to 2016². All three kinds of perfectionism the researchers measured went up².

The American Psychological Association summarized the size of those increases³:

• Demanding perfection of yourself rose 10%.
• Feeling that others demand perfection of you rose 33%.
• Demanding perfection of other people rose 16%.

The researchers pointed to rising competition in schools and economies as a likely driver, though they framed this as a pattern in the data, not proof of cause²³. The 2026 study added that slower economic growth went along with more striving, and rising inequality went along with faster-growing worry¹.

Keep the limits in mind. These studies cover college students in three countries, using self-report questionnaires¹². They show trends, not what any one person will experience.

Striving and fearing are two different things

For years, perfectionism researchers have split the trait into two parts¹⁴⁹.

Perfectionistic strivings are the drive to set and chase very high personal standards¹⁹. Perfectionistic concerns are the worried side: fear of mistakes, fear of being judged, and a nagging sense that what you do never measures up¹⁹.

The difference shows up again and again in health research.

In 2016, Hill and Curran pooled 43 studies with 9,838 people in work, sports and school⁴. The worried side of perfectionism had medium-to-large links with burnout⁴. High standards had small negative links or none at all⁴. And once the researchers stripped out the overlap with worry, high standards went along with clearly less burnout⁴.

A 2017 analysis by psychologists Sirois and Molnar pooled 13 samples with 4,991 people⁵. People high in perfectionistic concerns rated their own health worse, while those high in strivings rated it better⁵. Those links held up, though weaker, after the researchers accounted for people’s tendency toward negative moods⁵.

There may be a body-level piece, too. A Brock University lab in Canada reported that among 248 young adults, those who often had perfectionistic thoughts and felt stressed showed signs of more low-grade inflammation⁶. That’s one study, so treat it as early.

Where health perfectionism shows up: food, “clean” eating and exercise

Eating. A 2023 review in the Journal of Eating Disorders pooled 30 articles with 9,392 people⁷. Perfectionistic concerns had a modest link with binge eating, while strivings had almost none⁷.

Long-term studies point the same way. A 2019 review of 12 studies followed people over time and accounted for their earlier symptoms⁸. Concerns predicted later bulimic symptoms, meaning cycles of binge eating and purging, but strivings did not⁸.

“Clean” eating. Here the pattern flips, and it matters for natural-health readers. Orthorexia is a term for an obsessive focus on eating “healthy” or “correct” foods⁹. It isn’t a formal diagnosis in either of the two main diagnostic manuals, the DSM-5-TR and ICD-11⁹.

A 2024 review by York St John University researchers pooled 12 studies with 4,984 people⁹. Both sides of perfectionism were linked to orthorexia, but when the researchers separated them, only high standards predicted it⁹.

That suggests the drive to eat perfectly can become a problem by itself, even without much worry about judgment. Our article on becoming a natural health enthusiast covers orthorexia’s warning signs.

Exercise. A 2025 review of 7 studies with 3,117 people, average age about 22, found that both strivings and concerns went along with compulsive exercise¹⁰. That means exercise that feels driven rather than chosen. Most of the studies were snapshots in time, so they can’t show which came first¹⁰.

The pattern. Fear of mistakes is the more consistent danger. But in the areas closest to natural-health values, food purity and exercise, high standards can tip into rigidity on their own.

How perfectionism leads to quitting

Perfectionism doesn’t only push people too hard; it can also stop them cold.

Burnout is one route. In the 2016 review, the worried side of perfectionism tracked with burnout in work, school and sports⁴. A health routine run on fear can wear you out the same way.

All-or-nothing scoring is another. If a short walk “doesn’t count,” then a busy day means no walk at all. Our article on all-or-nothing thinking covers that trap in depth.

Official guidelines are friendlier than many perfectionists. The federal Physical Activity Guidelines say any amount of activity has some health benefits¹¹. They set a weekly range, 150 to 300 minutes of moderate activity plus muscle strengthening at least two days a week, rather than a daily quota¹¹. Our article on consistency explains why your heart counts the weekly total.

Self-check: is your health standard serving you?

This quick check was written for this article and isn’t a validated scale or a diagnosis. Score each statement: 0 for rarely, 1 for sometimes, 2 for often.

1. One meal off my plan makes the whole day feel like a failure.
2. I put off starting a habit until I can do it “properly.”
3. Meeting a health goal brings me relief more than joy.
4. I’d rather skip a workout than do a short one.
5. I spend more time researching the right way than doing anything.
6. My food rules have grown stricter over the past year.
7. I feel anxious when I can’t control what’s in my food, such as at a restaurant or a friend’s home.
8. I keep my routine even when I’m sick, injured or grieving.
9. I worry that others will judge me if I slip.
10. I hide what I eat or how much I exercise.

0 to 5: Your standards are probably working for you.

6 to 11: Some rules may cost more than they give. Try the worksheet below on your two strictest rules.

12 or more, or a 2 on item 8 or 10: Talk with a clinician or counselor. See “When to get help” below.

A good-enough standards worksheet

Rigid rules have one setting: perfect or failed. Livable standards have three levels.

• Floor: the minimum you’ll do on your worst day.
• Target: what a normal week looks like.
• Stretch: what you do when life is easy and you feel great.

Hitting the floor counts as a success. This is how some common rigid rules can be rewritten.

Rigid rule	Floor (worst day)	Target (normal week)	Stretch (great week)
“I exercise every single day.”	A 10-minute walk	150 minutes or more of moderate activity across the week, plus strength work twice11	A long hike or a new class
“I never eat sugar.”	Water or unsweetened drinks instead of soda	Most days without added sugar; dessert when it’s worth it	A month of baking sweetened with fruit
“Everything must be organic and homemade.”	One home-cooked meal a day, any ingredients	Mostly whole foods within my budget	A weekend batch-cooking session
“I need eight hours every night or I’ve failed.”	A regular wake-up time	A steady bedtime most nights	A screen-free hour before bed
“I can’t eat out because I can’t control the food.”	I choose the best option on the menu and enjoy the company	One shared meal out each week, no tracking	Trying a new cuisine with friends

To build your own, follow four steps:

1. Write the rule exactly as it sounds in your head. Words like “always,” “never” and “must” are clues.
2. Name what the rule protects. Usually it’s a real value: your heart, your energy, your family’s health.
3. Set the floor first. Make it small enough to do on a bad day.
4. Review after two weeks. If the floor feels easy every day, raise the target, not the floor.

Natural health was never meant to be perfect

Natural health, as many readers practice it, values balance, the seasons and listening to the body. A rule that ignores hunger, illness or a family celebration works against those values.

Self-kindness may help here. In a 2018 study of 541 high schoolers and 515 adults, perfectionism went along with depression, but the link was weaker in people who treated themselves with more compassion¹². That study was a snapshot, so it can’t prove that self-compassion protects anyone¹². Our articles on resistance to change and on recovering from setbacks cover self-compassion research in more depth.

Holding high standards with a light grip isn’t lowering the bar. It’s choosing the standard you can keep for decades.

What the evidence shows

Claim	Evidence rating	What it rests on
Perfectionism among college students rose from 1989 to 2024	Strong evidence	307 studies, 82,000-plus students in three countries, all self-report1
Perfectionistic concerns are linked to burnout	Strong evidence	43 studies, 9,838 people4
High standards alone are linked to burnout	Evidence says no	Small negative or no links in the same review4
Concerns are linked to poorer self-rated health	Strong evidence	13 samples, 4,991 people; correlational5
Concerns predict later bulimic symptoms	Promising but early	12 long-term studies8
Strivings predict orthorexia	Promising but early	12 studies, mostly surveys9
Perfectionism is linked to compulsive exercise	Promising but early	7 studies, mostly snapshots10
Perfectionism raises inflammation	Not enough evidence	One study reported by a university lab6
CBT for perfectionism reduces perfectionism and related symptoms	Strong evidence	15 randomized trials, 912 people13
Self-compassion buffers perfectionism’s link to depression	Promising but early	Two cross-sectional samples12

When to get help

Perfectionism is a trait, not an illness, but it can feed problems that need care.

Reach out to a clinician or counselor if:

• Your list of “allowed” foods keeps shrinking.
• You exercise through injury or illness, or feel panic when you miss a session.
• You binge, purge or hide your eating.
• Fear of doing it wrong keeps you from starting anything.
• You feel hopeless, worthless or persistently low.

Perfectionism responds to treatment. Cognitive behavioral therapy, or CBT, is a talk therapy that works on thoughts and habits together.

A 2022 review of 15 randomized trials with 912 people found CBT for perfectionism had medium-to-large effects on perfectionism itself¹³. It also eased eating-disorder symptoms and depression by a medium amount and anxiety by a small-to-medium amount¹³. The review looked at both self-help and face-to-face versions¹³.

For food, weight or exercise worries, call the National Alliance for Eating Disorders helpline at 1-866-662-1235¹⁴. Licensed therapists who specialize in eating disorders answer weekdays from 9 a.m. to 7 p.m. Eastern and can refer you to care¹⁴.

If you’re in distress or thinking about harming yourself, call or text 988, or chat at 988lifeline.org¹⁵. It’s free, confidential and open around the clock¹⁵.

Questions readers ask

The bottom line

High standards are part of what draws people to natural health, and they aren’t the main danger. The research points mostly at the fear of slipping up: it travels with burnout, binge eating, compulsive exercise and poorer health.

Keep your standards, but give them a floor, a target and a stretch. Count the good-enough days as wins. And if food or exercise rules start running your life, reach out. Asking for help is one more way of taking your health seriously.

Related reading

• Health tracking has a helpful dose, and past it, checking feeds worry
• Black-and-white thinking predicts regained weight, so learn to think in “mostly”
• A healthy identity supports good habits, while all-or-nothing food rules work against them
• Your heart counts the weekly total while your habits count the repeats
• A slip doesn’t erase your progress, but your reaction to it can

Sources

1. American Psychological Association. “Young Adults Are More Perfectionistic Than Ever Before” (news release on Curran T, Pose PM, Hill AP, “Perfectionism Is Accelerating Over Time: A Cross-Temporal Meta-Analytic Review of 35 Years of College Student Data,” Psychological Bulletin). May 28, 2026. apa.org
2. Curran T, Hill AP. “Perfectionism Is Increasing Over Time: A Meta-Analysis of Birth Cohort Differences From 1989 to 2016.” Psychological Bulletin, 2019;145(4):410-429. researchportal.bath.ac.uk
3. American Psychological Association. “Perfectionism Among Young People Significantly Increased Since 1980s, Study Finds.” News release, January 2, 2018. apa.org
4. Hill AP, Curran T. “Multidimensional Perfectionism and Burnout: A Meta-Analysis.” Personality and Social Psychology Review, 2016;20(3):269-288. researchportal.bath.ac.uk
5. Sirois FM, Molnar DS. “Perfectionistic Strivings and Concerns Are Differentially Associated With Self-Rated Health Beyond Negative Affect.” Journal of Research in Personality, 2017;70:73-83. doi.org
6. Brock University Developmental Processes in Health and Well-Being Lab. “Can Perfectionism Actually Affect My Health?” July 26, 2022. brocku.ca
7. Vicent M, Gonzálvez C, Quiles MJ, Sánchez-Meca J. “Perfectionism and Binge Eating Association: A Systematic Review and Meta-Analysis.” Journal of Eating Disorders, 2023;11. pubmed.ncbi.nlm.nih.gov
8. Kehayes IL, Smith MM, Sherry SB, Vidovic V, Saklofske DH. “Are Perfectionism Dimensions Risk Factors for Bulimic Symptoms? A Meta-Analysis of Longitudinal Studies.” Personality and Individual Differences, 2019;138:117-125. doi.org
9. Pratt VB, Hill AP, Madigan DJ. “Multidimensional Perfectionism and Orthorexia: A Systematic Review and Meta-Analysis.” Eating and Weight Disorders, 2024;29. ray.yorksj.ac.uk
10. Bills E, Muir SR, Stackpole R, Egan SJ. “Perfectionism and Compulsive Exercise: A Systematic Review and Preliminary Meta-Analysis.” Eating and Weight Disorders, 2025;30. pubmed.ncbi.nlm.nih.gov
11. U.S. Office of Disease Prevention and Health Promotion. “Top 10 Things to Know About the Second Edition of the Physical Activity Guidelines for Americans.” Updated November 19, 2025. odphp.health.gov
12. Ferrari M, Yap K, Scott N, Einstein DA, Ciarrochi J. “Self-Compassion Moderates the Perfectionism and Depression Link in Both Adolescence and Adulthood.” PLoS ONE, 2018;13(2):e0192022. pubmed.ncbi.nlm.nih.gov
13. Galloway R, Watson H, Greene D, Shafran R, Egan SJ. “The Efficacy of Randomised Controlled Trials of Cognitive Behaviour Therapy for Perfectionism: A Systematic Review and Meta-Analysis.” Cognitive Behaviour Therapy, 2022;51(2):170-184. researchportal.murdoch.edu.au
14. National Alliance for Eating Disorders. Helpline information (homepage). Accessed October 2026. allianceforeatingdisorders.com
15. 988 Suicide & Crisis Lifeline. “988 Suicide & Crisis Lifeline.” Accessed October 2026. 988lifeline.org