How Does Perfectionism Perpetuate Eating Disorders?

By Natalie Doan, BAH, MSc Student in Public Health and Health Systems at University of Waterloo

The following statements are some perfectionistic beliefs about weight and diet:

“I ate X. I messed up my diet”

“Since I ate X, I may as well eat a lot of it because I already messed up”

“If I eat, I’ll lose control”

“If I gain some weight, I’ll keep gaining weight until I’m obese”

“You can’t get anywhere in this world unless you’re thin”

 If some of these beliefs resonate with you, you might be interested to learn that researchers have consistently demonstrated that a person’s perfectionistic beliefs about weight and diet can lead to eating-related problems, such as binge eating, purging behaviours, and excessive exercise (Antony & Swinson, 2009).

 High Standards or Perfectionism?

So, what is perfectionism, and how is it distinguished from a healthy desire to achieve high standards? A healthy desire to achieve high standards can be very appropriate, allowing for effective performance in one’s environment. However, perfectionism results when standards are high beyond reasonable reach or reason and cause compulsive strain towards impossible goals (Burns, 1980).

In any given person, their degree of perfectionism varies depending on the life domain. Common domains for perfectionistic behaviours to manifest include: work, school, health, cleanliness, physical appearance, organization, neatness, aesthetics, and athletics (Antony & Swinson, 2009). Perfectionistic beliefs can lead to behaviours of excessive checking, organizing, list-making, and correcting others (Antony & Swinson, 2009). Alternatively, they may manifest through avoidance behaviours such as quitting too early, indecisiveness, and procrastination. Despite the heavy reliance on these behaviours to prevent mistakes, perfectionism inevitably leads to a sense of failure for the individual. 

Perfectionism and Eating Disorders

How does perfectionism relate to eating disorders? Eating disorder pioneer Hilde Bruch once characterized young individuals with anorexia nervosa as embodying “every parent’s and teacher’s idea of perfection” and demonstrating “superperfection” (Bruch, 1978, p.59). Here in this early attempt to characterize anorexia, Bruch observed a relationship between perfectionism and eating disorders. Empirical research supports this association, as perfectionism is one of the most robust personality temperament associated with eating pathology; so much that it has been frequently described as a central feature of eating disorders (Hewitt, Flett, Ediger, 1995). In a transdiagnostic theory of eating disorders, Fairburn and colleagues (2003) asserted clinical perfectionism can maintain eating disorders, and the removal of perfectionism would facilitate change. Indeed, many Individuals with eating disorders have unrealistically high standards for appearance and thinness, as well as exceedingly high expectations in other various facets of life (Butterfield & Leclair, 1988). These unrealistic expectations are often accompanied with self-defeating thoughts and behaviours (Cohen, 2015). For example, individuals with eating disorders may have unrealistic and unhealthy goals on how they want their bodies to look, and may therefore develop rigid rules that result in the development and maintenance of restrictive, bingeing, and/or purging behaviours.

Perfectionism and Eating Disorder Recovery

Perfectionism is not only relevant in the development and maintenance of eating disorders, but also the treatment of eating disorders (Bardone-Cone et al., 2010). Perfectionism can manifest during eating disorder recovery when individuals have unrealistically high expectations for their recovery process. For example, a person in recovery may hold themselves to the expectation that they are only in recovery if they always abstain from bingeing, purging, and never deviating away from their meal plan. However, not meeting these very high expectations, especially in the beginning, can lead to major disappointment, a sense of failure, and self-defeating behaviours (Cohen, 2015).

Is there hope for perfectionism to subside after recovering from an eating disorder? In general, individuals who recovered from eating disorders have levels of perfectionism comparable to individuals with active eating disorders (Bardone-Cone, et al., 2007). However, when perfectionism was assessed across different stages of eating disorder recovery, it was found individuals who were fully recovered had slightly lower level of perfectionism than those with active or partially recovered eating disorders (Bardone-Cone et al., 2010). Therefore, levels of perfectionism may depend on the stage of recovery the individual is in. Luckily, recovery from both symptoms of perfectionism and eating disorders is possible.