Perfectionism and eating disorders
Perfectionism is a personality trait characterised by the setting of unrealistic personal standards, being very self-critical if those standards are not met, an extreme preoccupation with mistakes, having doubts when considering personal achievements, and a significant emphasis on precision and organisation. Research has shown high perfectionism is linked with various types of mental illness, such as depression, anxiety, obsessive-compulsive disorder (OCD) and eating disorders.
There are three types of perfectionism, which are self-oriented perfectionism (SOP), other-orientated perfectionism (OOP) and socially prescribed perfectionism (SPP). SOP is where an individual has a strong motivation to be perfect and has very high self-expectations that are impossible to achieve, as well as cognitive distortions such as ‘all or nothing’ thinking. OOP is where a person believes it is important for others to be perfect. They will expect perfection from others and will be critical of those who fail to meet their high expectations. SPP is where a person believes significant others have unrealistically high standards for them, and that to be accepted by these others, they must meet these standards.
Although perfectionism may be seen as a desirable trait, since it is associated with having high standards, striving to succeed and being the best, it causes many problems too. For example, OOP can cause issues in relationships, where one partner is expecting the other to be perfect and is critical of them when they don’t live up to their standards. SSP can cause problems due to the pressure that comes with believing others will only value you if you are perfect, which can cause feelings of hopelessness. SOP is also troublesome, as someone has to manage an internal drive to be perfect all the time. SOP is particularly linked to eating disorders.
Perfectionism is a risk and maintaining factor for anorexia nervosa. Anorexia and bulimia are viewed as having a particular relationship to perfectionism, with both eating disorders frequently being direct expressions of perfectionism.
Perfectionism does not disappear when an individual is at a healthy stage of recovery from an eating disorder. It has been noted that there should be important guidelines on post-diagnostic treatment for anorexia, with carers needing to focus on how perfectionism traits continue to negatively impact the quality of life of people with a history of anorexia. Given the high relapse rates of this illness, the importance of this should not be underestimated.
It has been suggested that interventions that target perfectionism are an important part of making recovery from anorexia and bulimia attainable. Decreasing perfectionism can also help with feelings of depression and anxiety. Relaxing perfectionism is extremely difficult for someone with an eating disorder, however. There is a fear that if perfectionism is relaxed, a person’s whole life will become out of control. There is a fear of being imperfect, which is not acceptable. For example, if someone with an eating disorder doesn’t thoroughly clean their home, they may think they are lazy and worry others will think the same. This may lead to them feeling that they don’t deserve to eat and are not good enough as a person.
Seeking help to change a perfectionist’s thinking patterns and behaviours is very important when trying to overcome an eating disorder, since perfectionism can sustain the illness. Speaking with a counsellor can help you to firstly identify unhelpful perfectionist ways and then work with you to loosen their tight grip on your life. This can involve testing out beliefs you have about yourself and challenging perfectionist thinking patterns. It can be a frightening journey to embark on and the eating disorder within you will not want to be challenged in this way, but by building trust with your counsellor and realising how much your eating disorder takes advantage of your perfectionism to keep you unwell, you can start to see that life is so much more fulfilling without it.