But conscientiousness gets easily out of control. He is over-regulated by unrealistic standards which often lead to procrastination, paralysis, indecisiveness and endless second guessing. Perfectionism often rests on the illusion that if one can perfectly manage and control one small, special sector of life, happiness and a life free of anxiety will surely follow. Hidden within it is often more than a hint of vanity, and a sense of superiority to one's fellows. In some perfectionists, there is also an attempt to win love from a hypercritical parent who always raised the bar every time the child achieved a goal.
Perfectionism turns out to be a significant negative prognostic indicator for depression.
These patients were also more likely to make suicide attempts. Perfectionism as a character trait is also associated with anxiety. When a hyper-conscientious perfectionist is speaking and his tongue comes upon a small imperfection on the inside of his cheek, he stops, and goes through a differential diagnosis, until he gets to some dreaded possibility, then can't get it out of his mind. Key to the therapy of these individuals is first realizing that their hypochondriacal concern is not some aberrant form of reasoning, misapplied by them. Rather, it is them doing what they do, all the time.