Perfectionism in Eating Disorders

Defining Perfectionism

Perfectionism is a complex personality characteristic described as a relentless drive to achieve your absolute best while setting and striving for unrealistically high standards for your performance. This drive can also be fueled by the perceived expectation of perfection from others. The frequency and intensity at which you experience perfectionistic thoughts determine how problematic this characteristic might be for you or a loved one. Perfectionism can be general, which is when someone has the broad tendency to have unrealistically high standards, or it can occur in specific aspects of life, such as in work or school performance, relationships, writing, speaking, athletics, health, personal cleanliness, or physical appearance.

The Benefits and Drawbacks of Perfectionistic Tendencies

Perfectionism can have both positive and negative qualities. It is easy to imagine how the drive to improve oneself, strive for the ideal, and seek better performance can be a strength in many situations and can reward a person with achieving goals. However, it is when this drive turns into an unrelenting pursuit of ideal standards that leaves no room for error that it starts to become problematic. Goals can become overwhelming because your best is not good enough, and no matter what achievement is made, it is never sufficient. This type of perfectionism can lead to feelings of disappointment and distress, which, in turn, can lead to self-criticism and self-hatred. When normal setbacks do occur, they can leave you feeling worthless due to the unrealistic expectations. Not only does this have consequences for mental health, but also for physical health and well-being. Striving for perfection can lead to stress, a decrease in positive emotions (e.g., contentment, happiness, pleasure), and an increase in negative emotions (e.g., depression, anxiety). High blood pressure and cardiovascular disease are also more prevalent among perfectionistic individuals. Perfectionism that is associated with these negative consequences is called clinical perfectionism. Unsurprisingly, clinical perfectionism also leaves people vulnerable to developing other mental illnesses.

Signs of Clinical Perfectionism

You may be experiencing clinical perfectionism if you experience the following:

  • Critical thoughts about your own behavior.
  • Frequent and harsh self-talk about your performance.
  • Excessive preoccupations with how others are evaluating you.
  • An inability to feel satisfaction even after a job well done.
  • Not being able to complete projects.
  • Having significant concern over mistakes.
  • Often feeling like a failure.
  • Frequently feeling too overwhelmed to start a project.
  • Feeling anxious often, or most of the time.

Understanding how your level of perfectionism may be impacting your life is important because psychological treatment, such as therapy, can effectively disrupt ineffective perfectionistic tendencies. It is normal to endorse some of the symptoms listed above. However, if you find that the intensity or frequency of your thoughts and feelings are getting in the way of your relationships, productivity, and mood, it may time to seek support from a trained mental health professional.

Perfectionism in Eating Disorders

Research studies indicate there is a relationship between perfectionism and eating disorders. Several studies suggest that perfectionistic traits are usually present before eating disorders begin. A tendency toward perfectionism can lead a person to become overly invested in diet and weight goals as they work towards achieving the “perfect” appearance. When the ability to control eating, weight, and shape is used to determine self-worth, this can lead to disordered eating behaviors such as compulsively exercising, calorie counting, restricting, and purging. Any breaks in dieting rules or weight gain is seen as a failure. Body and weight checking are often used as a biased appraisal of performance, which frequently leads to more self-criticism. Focusing on unattainable goals can result in a loss of sense of self and an individual may begin to lose themselves in their eating disorder. Additionally, people who are perfectionistic may find themselves driving others away as the rigidity of schedules and goals, as well as obsessive or critical thoughts, can interfere with interpersonal relationships.

Treating Perfectionistic Tendencies in Eating Disorders

Perfectionism is not only treatable, but reducing perfectionistic tendencies is linked to eating disorder recovery. Researchers in the field have highlighted the importance of addressing perfectionism specifically stating, “interventions and/or experiences that help decrease perfectionism may be key to making full recovery attainable”. Thus, reducing perfectionistic tendencies is an important and necessary treatment target for many individuals with eating disorders. CBT-Enhanced is a treatment approach that was developed to treat eating disorders and it specifically works to target perfectionism as part of the intervention. CBT-E is the most well researched effective eating disorder treatments available.

Cognitive behavioral therapy (CBT) can also be used to target perfectionism outside of the context of eating disorders through challenging perfectionistic thoughts, such as all-or-nothing thinking and “should” statements. Clients learn to test perfectionistic beliefs and practice experiencing and effectively handling “failure” through behavioral exposures. Over time, patients can begin to learn that it is okay to relax their standards and start to live a more healthy and balanced life. They learn that their greatest fears related to not achieving perfection aren’t realized. CBT treatment that targets perfectionism has been found to reduce perfectionism in eating disorders and help with other symptoms such as anxiety and depression. It has also been shown to work in a variety of formats such as individual therapy, group therapy, guided self-help, and web-based interventions. Please see below for more information on self-help resources for decreasing perfectionistic tendencies.

Finally, self-compassion can be taught and used as a tool to break perfectionistic tendencies and can be a vital part of eating disorder recovery. Cultivating a mindset of self-compassion takes continuous effort and practice to combat self-deprecating thoughts and self-judgment. Re-wiring the brain to begin to intentionally incorporate thoughts related to self-acceptance and self-support can increase emotional and physical health. When we can celebrate progress made one small step at a time and accept our imperfections, we can live a more fulfilling and rewarding life.

Examples of Resources

There are several online resources that the general public can access to start to intervene with these problematic behaviors. For example, an internet resource offered through the Center for Clinical Interventions in Perth, Australia includes a self-help workbook that contains nine modules to help individuals understand how perfectionism may be interfering with their life and small changes they can make to improve their mindset.

 

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About The Author:

Shelby Ortiz, M.A. is a Clinical Psychology doctoral student at Miami University. Before matriculating into Miami University’s program, she worked as the research coordinator for The Renfrew Center where she investigated the efficacy of Renfrew’s eating disorder treatment program. She is currently a member of the Research on Eating Disorders and Suicidality (REDS) Laboratory, which is supervised by Dr. April Smith. Research in the REDs lab aims to reduce suicide-related mortality, particularly among individuals with eating disorders. Work in the REDs lab is supported by grants from the National Institute of Mental Health, National Science Foundation, and Department of Defense.

References:

Bardone‐Cone, A. M., Sturm, K., Lawson, M. A., Robinson, D. P., & Smith, R. (2010). Perfectionism across stages of recovery from eating disorders. International Journal of Eating Disorders, 43(2), 139-148.

Curran, T., & Hill, A. P. (2019). Perfectionism is increasing over time: A meta-analysis of birth cohort differences from 1989 to 2016. Psychological Bulletin, 145(4), 410.

Fairburn, C. G., Cooper, Z., & Shafran, R. (2008). Enhanced cognitive behaviour therapy for eating disorders (“CBT-E”): an overview. Cognitive Behaviour Therapy and Eating Disorders, 23-34.

Lowndes, T. A., Egan, S. J., & McEvoy, P. M. (2019). Efficacy of brief guided self-help cognitive behavioral treatment for perfectionism in reducing perinatal depression and anxiety: a randomized controlled trial. Cognitive Behaviour Therapy, 48(2), 106-120.

Wade, T. D., O’Shea, A., & Shafran, R. (2016). Perfectionism and eating disorders. In Perfectionism, health, and well-being (pp. 205-222). Springer, Cham.

Written – 2019