“Is there a healthy form of perfectionism? lessons from pediatric somatic symptom disorders”

Perfectionism is widely studied as a multidimensional construct with adaptive and maladaptive facets, yet its relationship with pediatric somatization remains underexplored. We examined perfectionism dimensions in 67 patients aged 8–17 years with functional headaches (n = 28) or functional gastrointestinal disorders (n = 39), assessed with validated measures of somatic symptoms (CSI-24), behavioral/emotional problems (CBCL), psychopathology (SAFA), and perfectionism (CAPS). Compared with the gastrointestinal group, headache patients showed higher scores on insecurity, compulsive symptoms, eating-disorder risk, and perfectionism-related domains (e.g., SAFA perfectionism: t(64) = − 2.47, p=.016; SAFA inadequacy: t(65) = − 2.55, p=.013) and higher self-oriented perfectionism criticism (CAPS SOP-criticism: t(65) = − 2.39, p=.020). In multivariable regression predicting child-reported somatic symptoms (CSI-24), anxiety (β = 0.354, p=.002), SOP-striving (β = 0.222, p=.035), and phratry (β = 0.254, p=.012) were significant predictors, explaining 43.6% of variance (adjusted R²=39.9%). These findings suggest that even the striving component of self-oriented perfectionism—often conceptualized as relatively adaptive—may relate to somatization in pediatric functional disorders. To capture this nuance, we discuss the distinction between perfectionism and excellencism, defined as flexible pursuit of high but attainable standards. Targeting perfectionistic traits may be clinically relevant in interventions for pediatric functional somatic symptoms.