Alternative hypotheses

Compare mechanisms

Compare function, sequence, patient language, and treatment leverage. The aim is not to choose a label—it is to identify which hypothesis best explains this person’s pattern.

Ask this

Which pattern better explains the sequence, protective function, and consequences: avoidance or perfectionism?

Avoidance

Avoidance reduces distress in the short term but commonly maintains anxiety, trauma responses, functional impairment, and interpersonal narrowing.

BehaviourCognitionTrauma+1

Perfectionism

Perfectionism can drive achievement but may maintain anxiety, depression, shame, procrastination, avoidance, and burnout.

CognitionBehaviourAffect+1

Definition

AA pattern of keeping away from internal experiences, situations, people, or tasks that trigger distress or perceived threat.

BA rigid pattern of setting excessively high standards and linking worth, safety, or acceptability to flawless performance.

Core process

AThreat appraisal activates escape, safety behaviour, suppression, or disengagement, which prevents corrective learning and narrows coping options.

BConditional self-worth and threat appraisal attach high emotional cost to mistakes, uncertainty, or ordinary limitation.

Look for

AMissed appointments · Safety behaviours

BAll-or-nothing standards · Difficulty finishing

Patient language

A“I just avoid it”

B“If it is not perfect, it is a failure”

Maintaining cycle

AThreat cue -> anxiety -> avoidance -> relief -> threat belief remains untested

BHigh standard -> threat of mistake -> overcontrol or avoidance -> temporary relief -> standard remains rigid

Treatment leverage

ATarget the relief-maintenance loop and build tolerable approach behaviours.

BReduce the link between worth and flawless performance.

Check before using

AWithdrawal is mainly due to low energy, cognitive impairment, environmental barriers, or lack of opportunity.

BHigh standards are flexible, values-based, and not associated with significant distress or impairment.

Formulation language

Avoidance appears to reduce distress briefly, but it also prevents corrective experience and maintains the threat appraisal.

Open full guide

Formulation language

Perfectionism appears to protect against shame through high control, but it increases self-criticism and avoidance when standards cannot be met.

Open full guide

Browse the map Use both hypotheses

Alternative hypotheses

Compare mechanisms

Compare function, sequence, patient language, and treatment leverage. The aim is not to choose a label—it is to identify which hypothesis best explains this person’s pattern.

Ask this

Which pattern better explains the sequence, protective function, and consequences: avoidance or perfectionism?

Avoidance

Avoidance reduces distress in the short term but commonly maintains anxiety, trauma responses, functional impairment, and interpersonal narrowing.

BehaviourCognitionTrauma+1

Perfectionism

Perfectionism can drive achievement but may maintain anxiety, depression, shame, procrastination, avoidance, and burnout.

CognitionBehaviourAffect+1

Definition

AA pattern of keeping away from internal experiences, situations, people, or tasks that trigger distress or perceived threat.

BA rigid pattern of setting excessively high standards and linking worth, safety, or acceptability to flawless performance.

Core process

AThreat appraisal activates escape, safety behaviour, suppression, or disengagement, which prevents corrective learning and narrows coping options.

BConditional self-worth and threat appraisal attach high emotional cost to mistakes, uncertainty, or ordinary limitation.

Look for

AMissed appointments · Safety behaviours

BAll-or-nothing standards · Difficulty finishing

Patient language

A“I just avoid it”

B“If it is not perfect, it is a failure”

Maintaining cycle

AThreat cue -> anxiety -> avoidance -> relief -> threat belief remains untested

BHigh standard -> threat of mistake -> overcontrol or avoidance -> temporary relief -> standard remains rigid

Treatment leverage

ATarget the relief-maintenance loop and build tolerable approach behaviours.

BReduce the link between worth and flawless performance.

Check before using

AWithdrawal is mainly due to low energy, cognitive impairment, environmental barriers, or lack of opportunity.

BHigh standards are flexible, values-based, and not associated with significant distress or impairment.

Formulation language

Avoidance appears to reduce distress briefly, but it also prevents corrective experience and maintains the threat appraisal.

Open full guide

Formulation language

Perfectionism appears to protect against shame through high control, but it increases self-criticism and avoidance when standards cannot be met.

Open full guide

Browse the map Use both hypotheses