
In the first part of this two-part series, we dive into why high-achieving women often struggle with perfectionism, how early experiences shape these patterns, and what it really takes to finally breathe free of that constant pressure to be “perfect.”
In my therapy practice, I keep seeing this same story play out: ridiculously capable women who look like they’re crushing it on paper, but privately feel like they’re one mistake away from everything falling apart. Extreme perfectionism.
Take Rachel (not her real name – I’ve changed the details to protect privacy). From the outside, she’s thriving, but in our sessions, when she can finally drop the polished founder mask, she reveals how exhausting it feels to constantly prove herself.
“I feel like I’m playing this insane game of high-stakes Jenga,” she told me recently, looking exhausted despite her perfect Zoom backdrop. “Like if I pull the wrong block – miss one investor email, screw up one pitch – the whole thing comes crashing down and everyone finally sees I’m not actually qualified to be here.”
After 13 years of sitting with clients (and working through my own version of this), I’ve noticed something: This isn’t just about being ambitious or having high standards. That relentless drive to be perfect, to anticipate every possible problem, to never show weakness – it usually comes from somewhere deeper.
Where This “Not Good Enough” Story Really Starts
When Rachel opened up about her childhood, it was like hearing a story I’ve heard a hundred times in my practice. Her mom’s response to straight As? A quick glance and “What happened in Calculus?” (She got a 98%). Her dad was technically around but always buried in his laptop, barely looking up.
The message was pretty clear: being “good” wasn’t good enough to actually get anyone’s attention. Rachel figured out pretty quickly that maybe if she just achieved enough – got into the right college, landed the perfect job, started a successful company – someone would finally look up and really see her.
Research backs up what I’m seeing in the therapy room. Ko et al. (2019) found that growing up with inconsistent attention or validation often leads to perfectionism. Smith and Chen (2023) found nearly 70% of high-achieving professionals use achievement to secure the validation they missed growing up. It’s not just about being ambitious or driven. It’s about learning early on that love or attention was this scarce resource you had to compete for, and carrying that pattern right into your adult life.
How This Gets Hardwired Into Our System
Perfectionism literally rewires the brain’s alarm system. West’s (2023) research shows how early experiences that made us feel unsafe or not good enough leave our internal threat detector (technically called the amygdala) stuck in hyperdrive. That’s what happens in your brain when perfectionism takes over – every small mistake or criticism feels like a five-alarm fire.
I’ve started calling it the “achievement treadmill” in my practice because that’s exactly what it feels like – you’re running faster and faster, but you never actually get anywhere. Each accomplishment gives you maybe five minutes of relief before your brain starts screaming “What’s next? Better not mess this up!”
Recent research from Aloi et al. (2024) shows how we often internalize those critical voices from our past, installing their criticism as our brain’s default operating system. Once that system is running, it creates this endless loop of pushing ourselves harder while constantly seeking validation from others.
For Rachel, this showed up in every aspect of running her startup. Each investor meeting, team presentation, or product launch felt like her entire worth was on the line. During one particularly raw session, she completely fell apart after getting some mild feedback from an investor. It wasn’t even harsh criticism – just normal suggestions for improvement – but to her brain’s hyperactive threat system, it felt like everything was crumbling.
What Perfectionism Does to Your Body and Brain
The thing about perfectionism is that it doesn’t just stay in your head – it shows up in your body too. Rachel dealt with constant migraines, stomach issues, and the kind of exhaustion that even a week’s vacation couldn’t touch. But she kept pushing because that’s what the achievement treadmill demands.
Molnar et al.’s (2017) research mapped out how this works in our bodies. Perfectionism messes with our stress response system (specifically the HPA axis – the connection between our brain and stress hormones), flooding us with cortisol (our main stress hormone) and keeping our body’s alarm system permanently switched on. This explains why many perfectionists deal with chronic health issues – their bodies are literally stuck in emergency mode.
What Perfectionism Does to Your Relationships
The real kicker is how perfectionism messes with your relationships – at work and everywhere else. At work, Rachel struggled to trust her team, constantly double-checking their work. Moss’s (2021) research confirms this: perfectionists often struggle with delegation, feeling others’ mistakes reflect on them.
But it wasn’t just work. Her friends started noticing how she was pulling away. Grabbing drinks or weekend brunches became just another item to check off on her endless to-do list rather than actually enjoy. The irony? Perfectionism has this way of making you isolate right when you need your support system the most.
The Extra Weight of Being “the Only One”
For women in tech (or really any male-dominated field), perfectionism hits different. Thakur et al. (2023) found that women and marginalized groups face brutal double standards – having to be basically perfect to be seen as competent.
This gets even messier when you add social media to the mix. Hosseini et al. (2023) found that social media is particularly rough on ambitious women as it creates an endless highlight reel of other people’s successes that your brain uses as ammunition against you. Every “I’m excited to announce…” post becomes another reminder of how you’re somehow falling short.
The standards are already impossibly high when you’re the only woman in the room, or the only person of color, or both. You’re not just managing your own perfectionism – you’re carrying the weight of representation too. One false move feels like you’re letting down your entire gender or community.
In Part Two, we’ll explore practical tools, therapy modalities, and mindset shifts that can help you transform this pattern into something healthier and more sustainable.