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Perfectionism and Eating Disorders

 By Alexa Martinez, Office Intern,

Clinical Psychology Associates of N. Central Florida  All rights reserved

2121 N. W. 40th Terrace, Suite B                                                                                           
Gainesville Florida 32605

Ph: (352) 336-2888  Fax: (352) 371-1730                      Offices in Gainesville and Ocala                   

Nov. 15, 2015                                                                                                                           

Perfectionism is the tendency to pursue exceptionally high standards. This personality characteristic can both be adaptive and maladaptive. As an adaptive trait, itphotography all rights reserved Ernest J. Bordini, Ph.D. encourages individuals to strive towards their set goals.  However, it can be maladaptive when it is so severe that individuals become overly self-critical, lose a practical sense of time and purpose, or become distressed when they are unable to reach their high expectations. Perfectionistic tendencies can affect functioning in many different domains, such as in the workplace, academics, and athletics.  It can result in development of mental health issues or complicate treatment in a number of disorders, such as eating disorders or body dysmorphic disorders.
In conjunction with body dissatisfaction, perfectionistic patients often have an ideal weight and body shape they wish to achieve.  When this is not reached they may become overly self-critical and begin forming negative self-views. In a study of healthy female college students, Boone and Soenens (2014) studied the relationship between perfectionism and body dissatisfaction. Participants in the perfectionistic condition were asked to set high standards for 24 hours and those in the non-perfectionistic condition were asked not to strive for such high expectations. Results showed that those in the perfectionistic condition experienced more eating disordered symptoms, including restrictive eating, eating less fatty foods, and  reported more regret after eating. In other words, even in non-disordered individuals, setting perfectionistic standards increased perfectionism and body dissatisfaction.
As is often evident in those suffering from anorexia nervosa, patients strive for further thinness even if they have reached their initial goals. It can seem that it is never enough, and goals pathologically shift to more unrealistic concepts of perfection.  Not only are goals readjusted, but this can be accompanied by experience of feelings of shame, failure, and negative affect.  Maladaptive efforts to deal with this cycle of feelings and expectation often further fuel further unhealthy eating habits (Boone & Soenens, 2014).
Boone et al (2013) examined the relationship between perfectionism, body dissatisfaction and maladaptive schemas, which are “self-perpetuating, dysfunctional cognitive belief systems” (p. 45). These schemas can result from negative experiences with others in childhood that affect our thoughts and behaviors. Maladaptive schemas were found to be predominant in anorexic and bulimic patients compared to healthy individuals, and perfectionistic inclinations were used as coping mechanisms for these intrusive beliefs.  In eating disordered patients, body dissatisfaction emerged when self-criticism, prevalent in perfectionism, was applied to weight and shape. Perfectionism was found to be the mediator between a maladaptive schema and body image concerns.
Because perfectionism is likely an associated schema related to the maintenance of eating disorders, it likely is an important target of treatment intervention.  Hurst et al (2015) examined three anorexic patients undergoing Family-Based Therapy (FBT) and Cognitive-Behavioral Therapy with Perfectionism in Perspective (CBT-P). Before treatment in this set of patients, high levels of perfectionism hindered positive outcomes in recovery for anorexia. CBT-P reduced perfectionistic thinking and negative self-evaluations on weight and shape in all patients, with two of the patients undergoing partial remission and the last, with the shortest illness duration, achieving full remission.
Comorbidity, having concurrent diagnoses, is common in mental health patients. With eating disorders there are high rates of comorbid obsessive-compulsive disorder (OCD). Bernert et al (2012) studied the relationship of perfectionism and OCD in eating disorders.  The study examined 204 individuals diagnosed with bulimia or those with bulimic tendencies.  It was found eating disorder symptoms were associated with higher levels of perfectionism and obsessive-compulsive symptoms. Perfectionism statistically explained the comorbidity between these two disorders.  The authors felt that perfectionism represented a clinically important construct to assess in the presence, prevention, and treatment of these disorders” (Bernert et al., 2012, p. 234).
In healthy individuals and patients with eating disorders, perfectionistic thinking, perfectionistic personality tendency, and perfectionistic goals an impact on mental health and adjustment. For perfectionistic individuals, it’s important to monitor their thinking and behavior to prevent it from becoming maladaptive. Cognitive-behavioral approaches targeting excessive perfectionism have an important role to play in psychologist's efforts in the prevention and treatment of OCD and Eating Disorders.
Bernert, R. A.; Timpano, K. R.; Peterson, C. B.; Crow, S. J.; Bardone-Cone, A. M.; le Grange, D.; … Joiner, T. E. (2012). Eating disorder and obsessive compulsive symptoms in a sample of bulimic women: Perfectionism as a mediating factor. Personality and Individual Differences, Vol 54(2), Jan 2013, 231-235.
Boone, L.; Braet, C.; Vandereycken, W.; Claes, L. (2013). Are maladaptive schema domains and perfectionism related to body image concerns in eating disorder patients? European Eating Disorders Review, Vol 21(1), Jan 2013, 45-51.
Boone, L.; Soenes, B. (2014). In double trouble for eating pathology? An experimental study on the combined role of perfectionism and body dissatisfaction. Journal of Behavior Therapy and Experimental Psychiatry, Vol 47, Jun 2015, 77-83.
Hurst, K.; Zimmer-Gembeck, M. (2015). Focus on perfectionism in female adolescent anorexia nervosa. International Journal of Eating Disorders. No Pagination Specified.

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 2121 NW 40th Terr. Ste B,  Gainesville, FL 32605     (352) 336-2888                    www.CPANCF.COM    Offices in Gainesville and Ocala

Clinical Psychology Associates of North Central Florida offers Employee Assistance Programs to municipalities and employers in the North Central Florida Area.  We offer a range of services for employers included EAP programs, fitness for duty evaluations, supervisor training, and violence avoidance seminars.


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