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How Perfectionism Drives Eating Disorders

July 2, 2018 Eating Disorders
woman cutting small piece of one cucumber on a plate

By Sara Schapmann

Perfectionism and eating disorders have long been thought to go hand in hand. One study explored types of perfectionism and body image issues and why this combination can be so lethal.

Eating Disorders: A Double Dose of Perfectionism

In psychology, there are two types of perfectionism:

Adaptive

Adaptive perfectionism drives people to complete a goal, to strive for their best. This type of perfectionism isn’t always “bad.” It can be motivating as long as people don’t beat themselves up if they fall short of their goal, but instead derive satisfaction from their efforts and knowing they did their best.

Maladaptive

Maladaptive perfectionism is a rigid, unwavering need to achieve goals, even if they’re unrealistic. Anything less than the desired outcome is unacceptable. People with maladaptive perfectionism are at risk for depression and other issues when they don’t reach their goals.

In the study published in the Journal of Eating Disorders, researchers found that among almost 2,000 participants, those at most risk for developing eating disorders experienced forms of both adaptive and maladaptive perfectionism. Adaptive perfectionism was defined as high standards in achieving a body image goal. Maladaptive perfectionism was defined as a concern with others’ opinions of them and a fear of making mistakes.

The further away participants were from a healthy body mass index (BMI), the bigger the gap between their current weight and goal weight. In other words, participants who were either very thin or very heavy had the most unrealistic body images and weight goals. Furthermore, participants who desired the smallest body sizes were the most hypervigilant about not making mistakes and experienced much more self-doubt than healthy control participants. These are characteristics common in people with eating disorders, especially anorexia.

The takeaway:

The link between perfectionism and eating disorders is complex. Essentially, participants’ adaptive perfectionism (striving to reach an ideal weight) was not of the healthy variety and also fueled maladaptive perfectionism, which was compounded by issues like perfectionism in other areas of life beyond weight control.

Characteristics of Perfectionism and Eating Disorders

This isn’t the first research addressing perfectionism and body image issues. Many studies on eating disorders have raised red flags on this issue. Research shows people with eating disorders can have issues with perfectionism even before disordered eating begins and may continue to struggle with it once they’re in eating disorder recovery. Characteristics of perfectionism in people with eating disorders include:

Self-punishment

Eating disorders like anorexia and bulimia are forms of self-punishment by definition. People with bulimia punish themselves for binging by purging the food through vomiting or laxative abuse. People with anorexia punish themselves by restricting the calories they need to maintain a healthy weight and by using methods like over exercising, diuretics, laxatives or more restriction to deplete their bodies of calories.

People with eating disorders have an inner perfectionistic voice that berates them for the numbers on the scale, the “unneeded calories,” the model figure they haven’t obtained, and even things like that “dumb” thing they said out loud in class, a less than perfect work project, or a B on a school exam.

History of perfectionism

Some research shows people with anorexia and bulimia may begin struggling with perfectionism anxiety in childhood. One study found women who showed personality traits as children like perfectionism, being driven by rules, inflexibility, preoccupation with order, cautiousness and excessive doubt were 35 times more likely to develop an eating disorder than those without these traits. Another study examined childhood perfectionism and eating disorders in various forms of anorexia and found perfectionism almost always preceded the development of anorexia nervosa.

High achievers

People with eating disorders aren’t just perfectionistic about food and weight. Many hold themselves to extremely high standards in other areas of life (i.e., maladaptive perfectionism). People with anorexia feel especially driven to prove they’re the best at everything – from the best numbers on the scale to the best grades, the best job title, the best daughter, best friend, and it goes on.

Mental health disorders

People with anorexia and bulimia may have recurring, lifetime struggles with perfectionism anxiety, depression, avoidant personality disorder and obsessive-compulsive disorder. Perfectionism is a trait that often underlies these diagnoses.

Shame

There’s a lot of secrecy around eating disorders. People with eating disorders are hit with shame from all angles. They’re ashamed of their bodies; ashamed of behaviors like binging, purging, laxative use, food restriction and over-exercising; ashamed of their fear of gaining weight; and ashamed of how they believe others view them.

People with eating disorders may have underlying trauma and can be ashamed of its source – sexual, physical or verbal abuse, unhealthy attachment styles, and other difficult circumstances. And where there’s shame, there’s usually perfectionism. As shame researcher and author Dr. Brené Brown put it, “When perfectionism is driving, shame is always riding shotgun — and fear is the annoying backseat driver.”

Fear of failure

There’s a lot of fear and anxiety involved in perfectionism and body image issues. A symptom of perfectionism, fear of failure can feel paralyzing to people with bulimia, binge-eating disorder and anorexia. They don’t just fear they’ll fail to meet their ideal body weight, they fear failing in social situations, in relationships, in work and school efforts, in getting everything right. This fear can be so overwhelming that they may become isolated, not even attempting to be social, get a promotion, apply to graduate school, or follow otherwise healthy pursuits because the fear of trying and failing is too much to bear.

Control issues

People with eating disorders often have an intense fear of losing control. They fear being out of control with food and weight as well as in other areas of their lives like relationships and emotions. Disordered eating behaviors may give them a sense of control. The rest of life can feel chaotic and uncontrollable to them, but focusing on perfection around food and weight gives them a sense of control, even if short-lived.

Treating Perfectionism and Eating Disorders

Eating disorders are complicated issues to treat. Many times clients enter treatment with co-occurring mental health disorders like anxiety, depression, personality disorders and substance abuse. There can also be underlying trauma or attachment disorders. Examples of treatment approaches effective in addressing perfectionism and eating disorders include:

Dialectical behavior therapy (DBT)

A type of cognitive behavioral therapy (CBT), DBT is a collaborative approach between therapist and client. Drawing on mindfulness and CBT principles, DBT helps clients learn to better tolerate emotional distress, identify and build upon their strengths, regulate their emotions and develop healthy interpersonal skills. Research has shown DBT is an effective therapeutic tool in treating eating disorders and co-occurring mental health disorders like borderline personality disorder.

Acceptance and commitment therapy (ACT)

This approach uses mindfulness and behavior-change strategies to help people get in touch with their authentic selves.

Acceptance and commitment therapy:

  • Explores why past attempts at getting better didn’t work.
  • Helps people define their values and goals.
  • Encourages people to act in ways that are consistent with their values and goals.
  • Teaches people to accept emotions as natural experiences without judging or pushing them away.
  • Encourages people to make changes in line with their values and actively work to alter unwanted behaviors.

Research shows that ACT can be particularly helpful with the control issues that people with eating disorders experience.

Mindfulness

Mindfulness practices can help people stay in the present moment and learn “to sit” with difficult emotions. This can be useful for people with eating disorders who may unwittingly engage in binging, purging and restrictive behaviors to manage uncomfortable feelings. An analysis of research on eating disorders and mindfulness found that mindfulness may significantly reduce negative body image and emotions and improve self-acceptance.

Family therapy

People with eating disorders often have a number of interpersonal issues with family members. As with other issues like addiction, they may unknowingly take the role of the “sick” loved one. This is an attempt to keep the family together as they rally around them or distract from other issues causing family strife. Family therapy is an integral component of healing the underlying wounds of eating disorders. Some research even shows family therapy to be more effective than individual therapy in the treatment of anorexia.

Perfectionism and body image issues can be overcome. Some research shows that people treated in the first few years of the onset of disordered eating have an 80% likelihood of making a full recovery. With determination, self-compassion and eating disorder treatment, recovery is possible.

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