Many people don't know this, but in addition to a major in psychology, I also majored in music in college. I played piano from the time I was four until basically the day I graduated college.

At one point, I started to experience wrist pain while preparing for my final exams (performing by memory in front of a board of instructors who would grade me). I put a lot of hours into practicing for this and I remember not wanting to disappoint my teacher, who helped prepare me for it, or my parents who were expecting good grades.

Needless to say rest was not an option.

I pushed through the pain. I got an A.

Now I could figure out what was making my wrist hurt!

I went to the doctor. I did the physical therapy. I even practiced on left-hand-only pieces to give my right hand a break from playing.

Then, a cycle started. I would get really frustrated when my efforts didn't pay off. I'd push through the pain again to get back to my normal level of activity (I had things to do, after all!), but it was too fast for my wrist. It would hurt again, causing me to stop. I'd rest, get it slightly better, and start the push-through cycle all over again.

I'm laughing now realizing that I was even applying my perfectionism to recovering from chronic pain.

It was a long (LONG) time later that I realized that a better approach involved pacing. But boy, did I have a lot of work to do to chip away at my perfectionism and my need to be good enough, before I could even warm up to the idea of pacing.

I'm sharing this story because I wonder if you've experienced this too?

Reflection:

How much is a tendency toward perfectionism fueling your pain cycle?

I want to share here that women I speak with have different levels of insight (awareness) into how their perfectionism shows up for them. For example, many could catch themselves (even laugh at themselves) when they start getting wound up about something that isn’t exactly how they wanted it. They acknowledge this tendency readily when someone points it out to them. The ability to receive and then tolerate this kind of feedback on their tendencies is a good sign and what we as psychologists refer to as ego strength. You can learn from feedback when you have ego strength.

On the other hand, other women had a steeper hill to climb because they lacked this awareness into their desire for perfection, their unrealistic inner standards, or their unrealistic goals. They had a harder time with self-reflection, more resentment, and were more defensive when it was brought up. Their ability to receive and tolerate feedback around this topic was difficult for them and they were guarded.

Think about this awareness from a pacing perspective.

When you have awareness, you can intervene and break bad habits. You can begin to find new routines, build new connections in your brain, and take a different approach to building your ideal day. Though not easy at first, you can find the middle ground between the all or nothing and still feel “good enough”. When others point out those times that your perfectionism flared up again, you can have a good laugh and learn from it. You make a shift in your expectations, priorities, or goals for next time. That ego strength sets you up for positive coping-related changes related to chronic pain and eventually the ability to design a life that is bigger than your pain (even if imperfectly!).

For those women without the insight (yet) or ego strength (yet), a compulsive need to do things perfectly, stay busy, and push through exacerbates their pain. When they first develop some insight and try to reduce the compulsion to be perfect, they often experience significant tension and self-criticism. They become stuck in a place that is either high pain or high tension and self-criticism with a continued difficulty finding the middle ground. Often, the easiest route is to keep things the same, give into perfectionistic tendencies, become overly productive, and trapped in a cycle of push-then-crash.

In both scenarios, that “middle ground” can be hard to find through the fog of expectation, inner expectations, and unrealistic goals. There are barriers to sort through and it can be hard to reconnect with those things that are most important when the layer of perfectionism remains standing. Education here can be so helpful.

When we spend years in the clutches of perfectionism, it is associated with many adverse health outcomes, including unhelpful coping patterns around chronic pain. I have free Facebook group where I talk about the middle ground, perfectionism, chronic pain coping, and other topics related to pain management. I’d love for you to join us!