Perfectionism in People With Eating Disorders

Perfectionism is the tendency to hold unrealistically high standards. It has been linked to the development of eating disorders. In fact, one of the leading treatments for eating disorder, known as CBT-E (enhanced cognitive behavior therapy), focuses on addressing perfectionism.

Studies have shown that people with anorexia nervosa and bulimia nervosa have higher levels of perfectionism than people who don't have eating disorders. Perfectionism may also affect people who have binge eating disorder.

This article describes perfectionism and its relationship to eating disorders. It also discusses treatment strategies that can help.

What Is Perfectionism?

Perfectionism is a complex personality characteristic with no universally accepted definition. It is sometimes viewed as a personality trait or symptom. It can also be understood as a process.

Perfectionism can have positive and negative aspects. Having high standards can be an asset; in many cases, it can be helpful in attaining goals. However, perfectionism also exacts a cost and in the wrong situations, too much of it can be an impediment.

Aspects of Perfectionism

Clinical perfectionism has three aspects:

1. Extremely high standards: Perfectionists have standards and expectations that most people would consider extreme or unreasonable.
2. Self-worth tied to high standards: People with clinical perfectionism judge themselves according to their unrelentingly high standards.
3. Persistence despite detrimental outcomes: Clinical perfectionism is also characterized by continuing to aim for these standards despite consistently negative consequences.

Perfectionism doesn't necessarily affect every area of a person's life. In other words, they might display these tendencies in some areas and not others.

For example, some people are perfectionistic regarding school or work, but not around their homes. Others may be perfectionistic around their appearance, but not about their school or work performance.

Specific areas where perfectionism may occur include:

• Close relationships
• Health and personal cleanliness
• Leisure and athletics
• Neatness and aesthetics
• Organization and ordering
• Performance at work or school
• Physical appearance
• Speaking
  
• Writing
  

Perfectionistic Behaviors

People with perfectionism engage in certain behaviors that maintain their perfectionistic beliefs. These can include correcting others, excessive checking, excessive organizing, and list-making.

In addition, many people with perfectionism avoid doing certain things out of fear that they will not be able to meet their own standards. Examples of avoidance behaviors include failing to delegate, giving up too soon, indecisiveness, and procrastination. 

Perfectionism's Link to Eating Disorders

Perfectionism and eating disorders seem to be correlated, but the exact nature of the relationship is not clear. In other words, researchers don’t know if one causes the other or which comes first.

Some research indicates that people with eating disorders and perfectionism often displayed perfectionistic traits before their eating disorders began.

However, some researchers have found that when a more stringent definition of eating disorder recovery was used, perfectionistic symptoms were reduced to levels similar to those found in people without eating disorders. This suggests that interventions that target perfectionism may be helpful in the treatment of eating disorders.

Treatment

If relaxation of perfectionism is associated with a more complete eating disorder recovery, it deserves attention during treatment. There are a few different approaches that may be helpful for reducing perfectionist tendencies. Most of the research on the treatment of perfectionism has focused on cognitive behavioral therapy (CBT) approaches.

Cognitive Behavioral Therapy

CBT has been found to be successful in reducing perfectionism among people with and without eating disorders. It has also has been shown to reduce eating disorder symptoms as well as symptoms of other disorders including depression and anxiety.

People also learn to test perfectionistic beliefs through the use of behavioral experiments. This involves trying something that challenges their existing beliefs to see what happens.

For example, a person who believes that they would be too ashamed to ever have a friend over unless their apartment is totally and thoroughly cleaned up could test having a friend over when things are left out of place. A person could also test the belief that they must always be productive by scheduling time to sit in the park and people-watch.

Exposure Therapy

Having a problem with perfectionism is similar to having a phobia of being imperfect. Perfectionists feel terrified of making mistakes.

Treatment for this condition therefore also involves repeated exposure to situations where a person is unlikely to perform perfectly. Examples of exposure activities could include:

• Arriving late for an appointment
• Asking for help in a store
• Giving incorrect change when paying for something
• Sending out an email that includes a spelling or grammatical error
• Speaking in a meeting and losing your train of thought
  

Over time, with repeated exposure, people learn that it is safe to relax their standards and that nothing terrible happens when they do. The goal is to develop more healthy and balanced standards.

Will Treatment Help?

Given the link between perfectionism and eating disorders, it might help to recognize and address perfectionism. The following are questions suggested by one of the leading experts on perfectionism to assess whether one might need help for perfectionism:

• Are your standards higher than those of other people?
• Are you able to meet your standards? Do you get overly upset if you don’t meet your own standards?
• Are other people able to meet your standards? Do you get overly upset if others don’t meet your standards?
• Do your standards help you to achieve your goals or do they get in the way (e.g., by making you overly disappointed or angry when your standards are not met; by making you get less work done, etc.)?
• What would be the costs of relaxing a particular standard or ignoring a rule that you have?
• What would be the benefits of relaxing a specific standard or ignoring a rule that you have?

A Word From Verywell

If you or a loved one with an eating disorder display symptoms of perfectionism, you might want to seek help for these symptoms in addition to seeking treatment for the eating disorder. Successful CBT self-help programs for perfectionism include the book When Perfect Isn’t Good Enough and Perfectionism in Perspective, a free downloadable workbook.