Perfectionism and Chronic Pain: When High Standards Become a Survival Strategy

This article considers perfectionism as one of several factors that may be associated with the persistence of chronic pain. Chronic pain is influenced by a range of interacting medical, neurological, psychological, and environmental factors, and experiences vary between individuals.

Perfectionism is often praised as a strength. It's associated with high standards, diligence, and responsibility, yet for many people living with chronic pain, perfectionism is not simply a personality trait; it's a nervous system strategy shaped by lived experience. Over time, this strategy can quietly contribute to the persistence and intensification of pain. Constant self-monitoring, fear of making mistakes, and an ongoing drive to get it right can keep the body in a state of heightened tension and vigilance. Rather than supporting wellbeing, perfectionism can maintain stress responses that make it harder for the nervous system to settle, rest, and recover.

Perfectionism as a survival strategy

Perfectionism rarely develops in a vacuum. For many people, especially those with histories of relational, developmental, or attachment trauma, it emerges as a way to stay safe. Being good, capable, or uncomplaining can reduce the risk of criticism, rejection, or abandonment. In unpredictable or emotionally unsafe environments, getting things right may have felt like the only form of control available. From this perspective, perfectionism is not self-focus or rigidity; it's about adaptation. The body and mind learn that vigilance, self-monitoring, and high performance are necessary for approval, belonging or survival. Over time, this attitude becomes ingrained, no longer requiring an external threat to remain active. The nervous system remains vigilant, continuously looking for mistakes, tension, or signs of failure.

The physical effects of perfectionism

Chronic pain is closely linked to how the nervous system processes threat and safety. Perfectionism keeps the system in a state of heightened arousal. The body stays tense, with muscles tightened, breathing shallow, and stress hormones elevated. This ongoing activation can increase pain sensitivity, reduce the body’s capacity to recover, and interfere with sleep, digestion, and immune functioning.

Perfectionistic individuals often push through pain rather than responding to it. Rest is often overlooked, delayed, or considered a reward only after being productive. Signals from the body are overridden in favour of meeting expectations, whether self-imposed or external. Over time, this pattern can worsen pain conditions, leading to flare-ups, fatigue, and a sense of feeling let down by one's own body. Importantly, the pain itself can reinforce perfectionism. When symptoms are unpredictable or invisible, people may strive even harder to appear functional, reliable, or normal (this one is super common!). This effort often comes at the expense of self-compassion and self-care.

The inner critic and pain amplification

Perfectionism is sustained by an internal critical voice that constantly evaluates performance. In chronic pain, this voice often turns against the body: "You should be coping better. Others manage more. You’re letting people down." These messages create shame and frustration, emotional states that further triggers the stress response. Research in pain psychology actually shows that fear, catastrophizing, and self-blame can amplify pain perception. When the body is viewed as an enemy or a problem to solve instead of a system striving for safety, pain tends to increase rather than decrease. Indeed, the nervous system responds not only to physical signals but also to emotional meaning, i.e. the interpretation the nervous system gives to an experience, not just what is happening physically.

The nervous system is constantly interpreting experiences by asking questions such as whether something is safe or threatening, whether the person feels overwhelmed or supported, and whether the situation resembles something difficult from the past. As a result, the same physical sensation such as pain (but also muscle tension, fatigue, or heart palpitations), can be experienced very differently depending on its emotional meaning. When the body interprets these sensations as a sign of danger (“Something is wrong,” “I can’t cope,” “This isn’t safe”), the nervous system may escalate stress responses, amplifying pain, tension, and exhaustion. When the sensations are interpreted as non-threatening or manageable (“This is uncomfortable but not harmful,” “I have support,” “I’ve been here before and I’m okay”), the nervous system is more likely to settle and regulate.

Identity, loss, and the breakdown of perfectionism

Chronic pain frequently alters one's sense of self. The roles previously maintained through efficiency and productivity might no longer be possible. For someone whose sense of worth has been built on being capable or dependable, this loss can be profound. Perfectionism may intensify as an attempt to regain control, or it may collapse into exhaustion, grief, and despair. This moment is often misunderstood as failure, when it is more accurately a turning point. The strategies that once ensured safety are no longer sustainable. The body, through pain, may be signaling the need for a different way of relating to oneself.

Letting go of perfectionism

Healing involves softening the rigidity with which standards or values are enforced, rather than abandoning them. This shift focuses more on fostering safety, flexibility, and responsiveness rather than simply striving to be imperfect. Learning to listen to the body without judgement is a crucial step. This may involve pacing, rest, and respecting limits, viewing them not as weaknesses but as wise decisions. It also involves challenging the belief that value and worth is dependent on productivity or stamina. In therapy, perfectionism is often approached through compassion rather than confrontation. When clients grasp why this pattern developed, shame transforms into insight. The nervous system can begin to relax when it no longer feels the need to justify its existence.

A new relationship with self

Chronic pain is alleviated not just by managing symptoms but by transforming one's relationship with oneself. Perfectionism thrives in isolation and self-scrutiny, while healing thrives through connections both within oneself and with others. Therapy that is trauma-informed and mind–body oriented can support this process by helping individuals notice how perfectionism lives in the body: the tight jaw, held breath, the constant alertness. Gradually, new experiences of safety allow the nervous system to shift out of survival mode. When the nervous system understands that rest and boundaries do not threaten a sense of belonging, pain might decrease, not because it has been eliminated, but because protective signaling is no longer necessary.

Conclusion

Perfectionism and chronic pain are often intertwined through the nervous system’s long-standing effort to stay safe. What appears as self-discipline or high standards may, beneath the surface, be a history of adaptation to threat. Chronic pain can be understood not as the body failing, but as the body asking for a different way of being. Healing begins when perfectionism is met with curiosity rather than criticism. In that space, the body may finally find enough safety to soften, and pain may gradually loosen its grip.

If this is something you’ve been affected by, please leave a comment below. If there’s something important you’d like to add, please do so. I'd love to hear from you.

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Dr. Ingela Thuné-Boyle is a licensed Practitioner Health Psychologist and a Doctor in Behavioural Medicine who specializes in improving the quality of life of people struggling with long-term health problems, chronic pain and trauma. She runs a private online (telehealth) practice at www.ingelathuneboyle.com. You can find out more about her background [here], and more about her approach to therapy [here].

📩 Contact: For therapy or other enquiries, you can contact her at info@ingelathuneboyle.com.

Please note: Advice given in this blog is not meant to take the place of therapy or any other professional advice. The opinions and views offered by the author is not intended to treat or diagnose, nor is it intended to replace the treatment and care that you may be receiving from a licensed physician or mental health provider. The author is not responsible for the outcome or results following their information and advice on this blog.