For Clinicians: Is it Perfectionism? Or OCD?

Perfectionism is a trait so many of our clients have; whether its from trauma, unrealistic standards, or distorted narratives, we see this almost daily. Many clients come into therapy identifying as “perfectionists,” striving for flawlessness in work, relationships, or appearance. But what happens when this drive isn't just about high standards or high praise?

As therapists, it’s crucial to recognize when the driving force of perfectionism is actually OCD.

OCD in Plain Sight

OCD isn’t always about checking the locks, handwashing, or placing objects in a meticulous way. It can manifest in subtler, more internalized ways—such as perfectionism. Clients may obsess over getting things “just right,” whether it’s re-reading emails dozens of times, re-writing notes until they “feel” perfect, or mentally reviewing conversations to avoid having said something wrong.

If you are an EMDR therapist, this perfectionism may show up when a client is asked to rate a SUD and tehy want to make sure they report it “right” or a client who backtracks each session on whether or nto they chose the “right” target. Perhaps you have reassured your clients numerous times that there is no way to do EMDR or therapy “right,” and yet they continue to worry about this. 

These behaviors are not quirks of our clients and their perfectionism; they are compulsions aimed at reducing anxiety tied to intrusive thoughts or a feared possible self. The perfectionist in this context isn’t seeking excellence—they’re trying to avoid imagined consequences, shame, or a sense of incompleteness.

Why This Matters

Mislabeling OCD-related perfectionism as simply a “personality trait” can delay effective treatment because treatment for OCD differs significantly from approaches used for managing general perfectionism or anxiety. Many common approaches to treating perfectionism outside of the context of OCD can actually make OCD symptoms far worse. 

As clinicians, we can help clients differentiate between striving for excellence and being trapped in obsessive loops. By exploring the “why” behind perfectionistic behaviors, we can better assess whether OCD may be playing a role—and guide treatment accordingly. 

My training on EMDR for co-morbid OCD & PTSD will help you discern between symptoms and perceived traits, get to the driving force behind these behaviors, and teach you how to resource your clients effectively. You will also learn the Distancing Technique to create space between your clients and their OCD related thoughts, and the Phobia Protocol specifically for targeting OCD related symptoms.