Convey mindfulness, realistic expectations for ‘diabetes perfectionists’
Diabetes specialists want the people in their care to do their best to achieve health-related goals, but a perfectionist mindset can counterintuitively lead to worse outcomes and poor mental health, according to two speakers.
“Diabetes perfectionists” may set up exacting standards for themselves or may perceive unrealistic expectations set by others — for example, a significant other, a health care provider or social institutions. When goals are not met, a perfectionist mindset can contribute to feelings of failure and shame and lead to depression, eating disorders and other mental health issues, Kersti Spjut, PhD, a clinical psychologist and assistant clinical professor at Brigham Young University in Provo, Utah, said during a presentation at the Association of Diabetes Care & Education Specialists virtual conference.
Perfectionism is not being perfect, but rather believing that being perfect can prevent negative consequences.
“We know that we can't avoid all judgment, we can't avoid all pain, all shame, and so that's why perfectionism sets us up to fail,” Spjut said.
In addition, the stress of striving for perfection can make hitting diabetes targets even less likely. Glucose levels rise in response to stress, which in turn creates more stress for a perfectionist.
“You put the two together — diabetes and perfectionism — and the odds for needing mental health support increase quite a bit,” Spjut said.
Excess and avoidance
Diabetes care and education specialists should consider perfectionism when a person has an “over” mindset — over-researching, over-analyzing, over-working, over-stressing —Alexis Skelley, LISW-CP, LCSW, CDCES, owner and mental health therapist at Diabetes and Obesity Treatment Strategies in Myrtle Beach, South Carolina, said during the presentation.
“Diabetes itself sets the stage for perfectionism,” Skelley told Healio. “The framework for high or unrealistic expectations, feeling judged or shameful, these are built into the mechanisms by which we measure how well diabetes is controlled, such as blood glucose and HbA1c outcomes.”
Diabetes perfectionists often show up to every appointment, count every carbohydrate, check their blood glucose constantly.
Alternatively, they may avoid these behaviors to escape feelings of shame and failure when they do not meet targets.
“Perfectionism often presents itself as avoidance or procrastination of self-care and diabetes management responsibilities,” Skelley told Healio. “Many may identify this as general lack of concern and write it off as noncompliance. It is the hesitation to engage in something when you are not confident you will be able to achieve 'perfect' outcomes, which is so often the case in diabetes.”
Counter with compassion, realistic expectations
Health care providers should encourage a diabetes perfectionist to practice self-compassion, to recognize without judgment that diabetes is difficult to manage.
Say, “it’s not hard because you’re doing it wrong, it’s just hard because it’s hard,” Spjut said.
A second strategy is what Spjut called “dare to be average.” Suggest that a diabetes perfectionist from time to time consciously loosen their control, for example, with a “diabetes nap” in which they give themselves permission not to check blood glucose levels for an afternoon.
Encourage a growth mindset, which means one’s ability to manage diabetes can improve and become easier over time. Let the diabetes perfectionist know that “it's not the expectation that you change your whole life overnight or that you're perfect every time or for diabetes to consume your life,” Skelley said.
Finally, reinforce realistic expectations by distinguishing between optimal, acceptable and dangerous control behaviors. Let the diabetes perfectionist know that most people with diabetes do not meet optimal blood glucose targets as defined by the American Diabetes Association, and that reasonable targets can change with changing life circumstances.
Time in range may be a more helpful goal for a diabetes perfectionist, according to Skelley.
“This reinforces the fact that blood sugar targets should not be a prescription; rather it is a discussion and needs to be individualized for every person with diabetes,” Skelley said.