Perfectionism and eating disorders

One of the things i discovered when i went into treatment was my perfectionism helps my ED keep control. Coming back into the world i’m trying to keep a check on my perfectionism. I’m trying at work to get my managers to understand that perfectionism in someone with an ED is a little more serious than someone who has perfectionist tendencies. One manager told me “i used to be a perfectionist, but i choose not to be, so i’m not”. She obviously had a level of perfectionism that was on a different scale to mine, and part of me is jealous that she can just turn it off. I’d love to. I’m doing better at keeping it in check, but it’s very, very hard.


“Understanding the quest for the “perfect body”: The links between perfectionism, body dissatisfaction, and EDs

Body dissatisfaction and body dysmorphia are some of the most frequently discussed symptoms of EDs. In his work on the “transdiagnostic model” of EDs, Christopher Fairburn asserts that these two features not only unite all of the different ED diagnoses but also are at the heart cause of the disorder. Although I don’t agree with everything about this assertion, body image issues affect many with eating disorders and can cause much suffering.

Most of the research on body image and EDs has focused on media inputs: the digitally altered models, the completely unrealistic beauty standards for both men and women. I won’t argue with anyone who asserts that these are very real and very harmful and no doubt contribute to our culture’s completely messed up attitudes towards food and weight. While media is definitely a factor, it doesn’t explain why some people get so hung up on body image and others really don’t. One possible answer is perfectionism. A study published last month in the new open access Journal of Eating Disorders by Tracey Wade and Marika  Tiggemann found that self-oriented perfection was a strong predictor of body dissatisfaction.

More on perfectionism

First, a little background on perfectionism. Researchers generally define perfectionism as “those who strain compulsively and unceasingly toward unobtainable goals, and who measure their self-worth with their productivity and accomplishment. Pressuring oneself to achieve such unrealistic goals inevitably sets the individual up for disappointment. Perfectionists tend to be harsh critics of themselves when they do not meet the standards they set for themselves.”

I’m kind of surprised that a picture of me did not accompany this definition.

There are several types of perfectionism, depending on who you ask. In this study, the researchers used two of the most common constructs of perfectionism. The first construct (Hewitt & Flett, 1991) looks at the intra- and interpersonal types of perfectionism and divides it into three categories: self-oriented perfectionism (“setting high [personal] standards for achievement and self-criticism for not meeting standards”), others-oriented perfectionism(“having high standards for other people that are unrealistic”), and socially-prescribed perfectionism (“perceiving that other people hold unrealistically high standards for the individual”). In research studies on EDs, scientists have found that perfectionism in general is a risk factor for EDs, and that self-oriented perfectionism is the strongest risk factor (Bardone-Cone et al., 2007).

The second construct the researchers used to evaluate perfectionism is the Frost Multi-Dimensional Perfectionism Scale (Frost et al., 1990), which evaluates the following 6 factors: “Personal Standards (setting high standards), Concern over Mistakes (negative reactions to mistakes and perceiving mistakes as failures), Doubts about Actions (doubting one’s own performance), Parental Expectations (parents setting high standards), Parental Criticism (parents criticising for mistakes), and Organisation (organisation and neatness).” As a side note, I’m curious how one’s own perfectionism might influence the effects of parental expectations and criticism (ie, perceiving higher expectations and levels of criticism than were actually there or intended). That being said, perfectionism has fairly strong genetic components, so it wouldn’t be unexpected for a perfectionistic kid to have perfectionistic parents (I did.)

{{The quotes in the above two paragraphs were taken from the Wade and Tiggemann study.}}

When researchers measured perfectionism in adolescents with the Frost MDPS and compared this to eating disorder symptoms, they found that the highest risks were found in the teens with BOTH high personal standards and high evaluative concerns (concern over mistakes, doubts about actions, parental expectations, and parental criticism) (Boone et al.,2010). In summary, both constructs of perfection appear to be elevated in people with EDs or ED symptoms, making these good choices to measure the relationship between perfectionism and body dissatisfaction.

What they found

The researchers surveyed 1083 women as part of the Australian Twin Registry, assessing them both by telephone interview (gathering basic demographics and administering the Eating Disorders Examination) and by a self-report questionnaire (the Frost MDPS). The women were also asked to select their current body shape from a series of silhouettes (below), as well as their ideal body shape. They were also asked about their desired and current BMI.


Body silhouettes, as seen in Bhuiyan et al., 2003, adapted from Stunkard, Sorenson, and Schlusinger.

The researchers found that the higher your level of perfectionism, the higher the discrepancy between your current body shape and your ideal body shape. As well, higher perfectionism was also independently associated with wanting a thinner body, regardless of your current body weight. In particular, the researchers identified three aspects of perfectionism that were particularly associated with body dissatisfaction: concern over mistakes, organization, and doubt about action. The strength of the associations were in that order, from strongest to weakest. The researchers concluded:

In terms of how perfectionism exerts an effect on body dissatisfaction, it may be that the highest levels of body dissatisfaction which can act as risk factors for the later development of disordered eating are associated with high levels of both organisation and a concern over mistakes that results in criticism of oneself as a person. To the degree that organisation indicates a need to exert control over the environment, those people high on organisational traits may display more extreme efforts to control body appearance. Any resultant failure to meet the desired standards in this domain results in self-criticism and negative affect which is suggested to be part of the vicious cycle that perpetuates unhelpful perfectionism.

It’s important to note that these were not subjects with eating disorders. They were normal, everyday women, so exactly how perfectionism and body dissatisfaction interact in clinical eating disorders may be slightly different. For another, these women were around 35 years old, so how these results apply to younger and older women, as well as men, remains to be seen.

The researchers note that focusing on perfectionism in ED prevention may be useful. I think this would be extremely beneficial, especially when compared to current ED prevention efforts.”

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