Some folks are good at the former, others are good at the latter. The really good ones are comfortable with both.
A developer who can talk you through an entire stack and why specific tradeoffs were made on specific pieces of the architecture... yet hoards code on their box without committing, works on stuff without telling other people, and claims that things are progressed much further than they actually are. It's an ego and accountability problem.
Someone like this might prefer to refactor your entire stack multiple times, partly due to shiny-new-framework, and partly due to the lack of understanding that from a business perspective you often have to work with what you've got. I think it's less about perfectionism and more about inexperience with balancing business tradeoffs with technology.
There's a great series in Forbes specific to CTOs undergoing this "meltdown" [2]. In it, they mention a few warning signs including: never saying no, missing deadlines, low morale, and poor estimation of timelines.
[1] http://www.citoresearch.com/it-management/why-cios-and-ctos-...
[2] http://www.forbes.com/sites/danwoods/2013/08/26/avoiding-a-c...