Introduction
Exam anxiety is a common psychological disorder among students, which can have significant adverse effects on their academic performance and mental health. This anxiety is usually associated with concerns about the negative consequences of failing exams and can lead to reduced academic performance and even metacognitive problems. One of the factors affecting exam anxiety is perfectionism. Perfectionism is an individual’s tendency to achieve high standards and avoid shortcomings. This personality construct can have adaptive (positive) and maladaptive (negative) forms. Adaptive perfectionism is associated with high but achievable standards, while unrealistic standards and excessive concern about mistakes characterize maladaptive perfectionism. 
The relationship between perfectionism and exam anxiety is a topic of much debate in psychological research. While many studies have shown that perfectionism can increase exam anxiety, the results are contradictory. Some studies have found no relationship between the two variables, and others have shown that the type of perfectionism (e.g. positive or negative) can affect the severity of exam anxiety.  The high number of studies conducted in this field highlights the need for a systematic review. This study thus aimed to review the results of previous studies on the relationship between perfectionism and exam anxiety. 

Methods
This is a systematic review and meta-analysis. International and national databases were searched for related articles published from 2011 to 2024, including Google Scholar, Web of Science, Science Direct, PubMed, Scientific Information Database (SID), Irandoc, Noormags, and MagIran. The studies with available full-texts and sufficient information to calculate effect sizes were included, and the studies that did not report a correlation between perfectionism and exam anxiety or had serious methodological weaknesses were excluded. Two authors independently reviewed the articles based on the inclusion and exclusion criteria, screened the articles based on titles and abstracts, and reviewed their full texts. Any disagreement between the two authors was resolved by consulting a third author. The 27-item PRISMA checklist was used to ensure the quality of studies included in the final analysis. Finally, 17 studies with 25 effect sizes were selected for the final analysis.
The Q test and I2 index examined heterogeneity between studies, and a random effects model was selected to present the results. Meta-regression and subgroup analysis were used to investigate the reasons for heterogeneity. Also, Egger’s test and the fail-safe N were used to assess the possibility of publication bias in the studies. CMA software, version 2 was used for data analysis.

Results 
The total number of students surveyed was 5957, ranging from 100 to 761 students. The meta-analysis results showed that the average combined effect size of the relationship between perfectionism and exam anxiety was r=0.18 (95% CI; 0.357%, 0.008%), estimated to be small according to Cohen’s criterion. Also, the subgroup analysis showed that the most significant effect size was related to the adaptive perfectionism variable (-0.465). The heterogeneity (I2 index) for other-centered perfectionism, self-centered perfectionism, general perfectionism, maladaptive perfectionism, and adaptive perfectionism was 91.64, 98.62, 95.63, 99.60, and 98.13, respectively (Table 1).


Examining gender as a moderating factor in subgroups, the results showed that the combined effect size for girls was r=0.50 (95% CI; 0.44%, 0.55%); for boys, r=0.21 (95% CI% 0.12%, 0.30%), and for the mixed subgroup, r=0.14 (95% CI; 0.12%, 0.30%).
Also, the subgroup analysis results based on participants’ age showed that, considering the negative slope of the regression line and its equation (Y=0.57-0.04X), there was an inverse and significant relationship between Fisher’s Z effect sizes and age, such that for every one unit increase in participants’ age, the Fisher’s Z effect sizes are reduced by 0.04 units. 

Conclusion
The findings indicated that perfectionism is related to exam anxiety. Perfectionists are interested in achieving higher standards. Perfectionist students constantly experience negative mental states and emotions before, during, and after the exam, which can increase anxiety. All-or-nothing thinking, a characteristic of these students, increases worry, excitability, and anxiety by intensifying the process of generalizing failures. The difference in effect size between girls and boys is also significant. Girls experience higher levels of exam anxiety due to their greater tendency towards perfectionism and higher sensitivity to negative evaluations. Some theories suggest that there are gender differences in men and women in their reactions to problems and issues, and the types of solutions they use to regulate emotions and deal with anxiety differ depending on the situation and type of problem. This finding is consistent with previous research showing that girls are more likely to use internal coping strategies, such as rumination and self-blame, than boys. The results of our study also showed that adaptive perfectionism is most strongly associated with exam anxiety. This type of perfectionism is associated with high but achievable standards and can act as a protective factor against exam anxiety. This study is important for understanding the relationship between perfectionism and exam anxiety in Iranian society. It can be used as a basis for future research in this field.

Ethical Considerations
Compliance with ethical guidelines
This is a meta-analysis study that did not involve human or animal samples. There was no need for a code of ethics.

Funding
This research was not derived from a thesis and did not receive any funding from public, commercial, or non-profit sector funding organizations.

Authors contributions
Design, review, and supervision: Abolfazl Farid; Writing, data collection, and interpretation: Maryam Ghanbari; data analysis: Seyyed Qasem Musleh.

Conflicts of interest
The authors declare no conflicts of interest.



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