Back to School with Pain and Perfectionism
What to do when your child wants to be perfect, but feels tired and in pain all the time?
My teen is so stressed out this year! We tell her that we’re proud no matter what her grades, but she puts so much pressure on herself to earn all A’s and get into the best college. After school, she has sports and club activities. When she finally gets home, she barely eats dinner, and then stays up late completing homework and has trouble falling asleep. The next morning, I have to drag her out of bed, and she says she has a stomach ache. I’m torn- if she stays home, she’ll be more stressed about missing school and falling behind. But if she goes, she is nervous about being able to concentrate or needing to leave class.
Does this story seem familiar?
It can seem overwhelming when stress, pain, and sleep problems all worsen one another. How is your child ever supposed to feel better? How are they supposed to make it through school and achieve their dreams? It can be difficult for children, parents, and even therapists and doctors to know where to start.
However, the more we learn about how these patterns operate, the more effective our treatments can be.
New Research
A group of researchers (Clementi et al., 2021, published in Journal of Pediatric Psychology) sought to learn more about the interrelationships between stress, pain, and sleep. They gathered surveys completed by over 400 adolescents before they participated in chronic pain treatment programs. These youth had a variety of diagnoses, including headache, abdominal pain, and musculoskeletal (body) pain. All of the teens had been experiencing pain for at least a few months that was beginning to interfere with their lives.
The authors found that two types of perfectionism predicted sleep problems among these youth with chronic pain. Self perfectionism referred to when teens were harshly self-critical, but perceived that their pressure was internal. In other words, they recognized that they had high expectations for themselves. Socially prescribed perfectionism referred to when teens were also harshly self-critical, but perceived that their pressure was external, or that others had really high expectations for them. For teens with self-perfectionism, their perfectionism was associated with their sleep problems if their pain only mildly or moderately impacted their day-to-day functioning. For teens with socially prescribed perfectionism, their perfectionism was associated with sleep problems no matter whether their pain interfered with their functioning mildly or severely.
The authors highlight that appreciating that perfectionism and sleep problems are related is important for preventing a downward trajectory, especially among adolescents who have maintained a higher level of functioning. If teens continue down a path of pain, stress, and poor sleep, their functioning may begin to deteriorate. They may continue to compromise on sleep and self-care to pursue their goals, but as their pain and stress increase, it can get harder and harder to keep up.
Fortunately, these results may also hold key information for helping teens break out of this vicious cycle. Pain psychologists already have a keen understanding of how high stress and deficient sleep can trigger pain and maintain and worsen pain that is already there. Pain-focused cognitive-behavioral therapy (CBT) can help children and teens systematically work on their sleep and perfectionistic thinking, to find reasonable and sustainable strategies to feel better and get back on track.
How to Help Your Child with Pain
In the back to school season, parents and caregivers can help children and teens by:
Having open conversations about aspirations about the upcoming school year, and having regular check-ins
Working on setting goals that are in line with family values
Gradually adjusting sleep schedules
Modeling good sleep practices
Encouraging school attendance despite symptoms
Researching Section 504 plans or other health plan options with the school
If you are looking for more support, pain-focused CBT may be a good fit for your child or teen. To learn more, please reach out by clicking the Get Started button at the top of the page.