What Is Atelophobia? 

Atelophobia is the fear of imperfection. People with this phobia have an overwhelming fear of making mistakes and normally set ridiculously high standards for themselves; they constantly look for errors in their work and are never satisfied with their accomplishments. This article explores phobias in general and provides insight into atelophobia, its causes, signs and symptoms, its diagnosis and management.

What is phobia?

Definition:

A phobia is an irrational, extreme fear of an object or a situation that rarely causes real harm or threat; the mere thought of the object or situation can induce massive anxiety and distress. The word “phobia” is derived from the Greek word “phobos” meaning “fear” and it generally follows a word that describes the source of fear. For example, acrophobia is the fear of heights; the word “acro” is derived from the Greek word “akros” meaning “highest”.

Types of phobias:

Phobias are categorised into two main groups:

1. Specific (simple) phobias: centres around a specific fear-inducing trigger like an animal (e.g. spiders), environmental element (e.g. deep water), or a certain situation (e.g. flying). These phobias often develop during childhood, and they decrease in severity with age.
2. Complex phobias: these types often develop in adulthood and are more crippling to the patient compared to specific phobias. Social phobia, the fear of social situations, is a common complex phobia. 

While specific phobias have different prevalence across sex and age, people assigned female at birth (AFAB) are more likely to be affected by specific phobias than those assigned male at birth (AMAB).¹ Phobias can occur at any age, and the fear of animals and of heights has the highest prevalence in the population followed by the fear of flying and closed spaces.²

Atelophobia

Atelophobia is the fear of being imperfect or incompetent. The name originates from the Greek word “ateles”, meaning “incomplete”. People who suffer from this phobia set unattainable standards for themselves and are extremely afraid of making mistakes, so they avoid being in any situation where there is a possibility of making mistakes; they focus on mistakes they have made in the past and are anxious about mistakes that they might make in the future.

What causes atelophobia?

A specific cause is not yet known, but hypotheses of how the association between the phobia trigger and the feelings of distress and panic are created have been proposed. For example, the pairing of an event that occurred in the patient’s life with an anxious feeling or seeing the fearful reaction of another person to the phobia trigger can create the association.³ Additionally, genetics and the environment surrounding the patient can play a causative role in atelophobia. In particular, the idea of what a “perfect life” is in the modern digital age might create a culture that is less tolerant of errors and imperfection and might cause a morbid fear of imperfection.⁴ 

What are the symptoms of atelophobia?

Phobias can cause psychological and physiological symptoms. People with atelophobia can experience the following :

• Depression and burnout
• Low self-esteem and distorted self-image
• Inability to take any criticism but are highly critical of their own work
• Cannot feel satisfied with their accomplishments, and they excessively look for mistakes in their work

People with atelophobia may also experience the following physiological signs and symptoms related to anxiety:

• Chills, shaking and sweating
• Stomach ache and nausea
• Hyperventilation (rapid breathing)
• Heart palpitations (pounding heart)

How is atelophobia diagnosed?

Phobias diagnosis is carried out by a mental health professional using an assessment tool that involves interviewing the patient about the condition. The International Classification of Diseases 11th Revision (ICD-11), developed by the World Health Organisation (WHO), is one assessment tool that the doctor might use.

The diagnosis is made when the patient shows:

• Irrational and overwhelming fear of the phobia trigger, paired with avoiding situations that can cause it
• A swift anxiety response (panic attack, crying, anger) after exposure to the fear-inducing situation.
• Anxiety associated with the fear trigger, or its anticipation that then interferes with the patient’s daily life
• Persistent signs that have lasted for over 6 months

The doctor might use other assessments to rule out any physical cause or any other mental health condition that can also lead to anxiety and panic attacks (e.g. obsessive-compulsive disorder OCD and post-traumatic stress disorder (PTSD))

Can atelophobia be treated?

Specific phobias are generally treatable. When left untreated, they can severely interfere with daily life. Some forms of management are:

Cognitive behavioural therapy (CBT):

Cognitive Behavioural Therapy (CBT) is widely used to treat many mental health disorders (e.g. depression and anxiety) and is also used as a first form of treatment for phobias. To date, it is still the most efficient intervention in the case of specific phobias.⁵

In CBT, the patient is taught to identify the negative thoughts and harmful beliefs that drive fear and they are taught techniques that can help them to replace these thoughts and beliefs with more positive behaviours that can then help the patient cope. This normally comprises multiple one-hour sessions with a specialised therapist, and it includes tasks and activities to be taken by the patients at home.⁶

Another widely used technique is exposure therapy. For exposure therapy, the therapist exposes the patient to the phobia trigger in a gradual, controlled way; it can start first by letting the patient think of the fear trigger, then show them pictures or mimic a certain situation that normally induces their fear. With time, the patient becomes desensitised to the fear-inducing element and develops a more realistic reaction when faced with it.

One-session treatment (OST):

This is a technique that was found to be as effective as CBT, but is more cost-effective and requires fewer sessions with the patient. Instead of the multiple sessions that are required for the CBT, this approach requires only two. These sessions include a one-hour session for planning, followed by a three-hour treatment session where the patient is exposed to the fear-inducing element multiple times in a gradual manner. This new technique was tested in children and young people with various types of specific phobias and showed promising results.⁶ 

Medications:

The previously mentioned interventions are generally efficient for treatment with no side effects. However, in some cases, the doctor might prescribe drugs that can manage the physical signs and symptoms of the panic attacks and anxiety associated with the phobia, of these:

Antidepressants: this includes the selective serotonin reuptake inhibitors (SSRIs) group that are used in the treatment of many mental health conditions, including phobias but can cause withdrawal symptoms so they should be stopped gradually under your doctor’s supervision.

Sedatives: these are drugs of the benzodiazepines group (e.g. Valium). They might be prescribed for a short period in a small dose to manage anxiety. Like antidepressants, these drugs can cause withdrawal symptoms, so they must not be stopped abruptly.

Beta-blockers: these drugs can slow down heart rate and are usually used for heart conditions (e.g. hypertension), but some can be prescribed to manage anxiety symptoms. Propranolol (Inderal) is a beta-blocker that can be used in these cases.

Other strategies

Many supplementary coping techniques can be helpful to mitigate the anxiety associated with phobias:

1. Breathing exercises: taking deep breaths can help the patient calm down.
2. Social connection: getting support from friends and family can help distract from harmful thoughts.
3. Exercise, such as walking or moderately intense aerobics, can help release the chemical messengers endorphins - natural pain killers - from the brain and can offer a good distraction from negative thinking.
4. Meditation: Another way of releasing endorphins that can help focus thoughts.  

Summary

Atelophobia is an irrational fear of imperfection characterised by people setting impossible, high standards for themselves, so they are never satisfied with their achievements and are terribly afraid of making mistakes, leading to the avoidance of any situation where making a mistake is possible. This phobia is associated with psychological symptoms like low self-esteem as well as physiological symptoms like panic attacks when facing or even thinking of situations where they are performing imperfectly. If left untreated, this phobia can impair daily life and lead to other mental health issues like depression.

The exact cause of atelophobia is not known, but genetics and the environment can play a role. This condition can be diagnosed by a mental health care professional asking questions related to the condition during an interview, and a diagnosis is made when the patient expresses an irrational, consistent fear associated with imperfection. While there are no specific ways to prevent it, atelophobia can be managed and treated using psychological therapies like CBT and prescribed medications in some cases; other coping mechanisms such as meditation can help as well.