closely relate to perfectionism. Although perfectionist athletes strive to succeed, they can be limited by their intense fear of failure and therefore not exert themselves fully or feel overly personally responsible for a loss. Because their success is frequently measured by a score or statistics, perfectionist athletes may feel excessive pressure to succeed. Medical complications Perfectionism is a risk factor for obsessive compulsive disorder, obsessive compulsive personality disorder, eating disorders, social anxiety, body dysmorphic disorder, workaholism, self harm and suicide, substance abuse, and clinical depression as well as physical problems like heart disease. In addition, studies have found that people with perfectionism have a higher mortality rate than those without perfectionism. A possible reason for this is the additional stress and worry that accompanies the irrational belief that everything should be perfect. Therapists attempt to tackle the negative thinking that surrounds perfectionism, in particular the "all-or-nothing" thinking in which the client believes that an achievement is either perfect or useless. They encourage clients to set realistic goals and to face their fear of failure. Since perfectionism is a self-esteem issue based on emotional convictions about what one must do to be acceptable as a person, negative thinking is most successfully addressed in the context of a recovery process which directly addresses these convictions. Impact on psychological treatment A number of studies suggest that perfectionism can limit the effectiveness of psychotherapy. Namely, perfectionism impedes treatment success across seeking, maintaining, and ultimately benefiting from help. Unfavourable attitudes and negative beliefs towards seeking help present a barrier to treatment among perfectionists. When they do attend treatment, perfectionists, especially those high in perfectionistic self-presentation, are more likely to experience initial clinical interviews as anxiety-provoking and appraise their performance as inadequate. Perfectionism can also affect treatment adherence. For example, a study demonstrated that other-oriented perfectionism is associated with treatment attrition. Further, treatment effectiveness may be compromised by perfectionists' tendency to present an image of flawlessness and avoid self-disclosures because of an excessive sensitivity to judgment and rejection. Most importantly, treatment success may be negatively impacted due to the interpersonal disconnection prevalent among perfectionists which is associated with a failure to develop or strengthen a positive therapeutic alliance. Narcissism According to Arnold Cooper, narcissism can be considered as a self-perceived form of perfectionism – "an insistence on perfection in the idealized self-object and the limitless power of the grandiose self. These are rooted in traumatic injuries