Perfectionism in Eating Disorders

BY: Hunna Watson, PhD

DATE: May 6, 2016

Are you a perfectionist? Do you know someone who is? Perfectionism is a personality trait that involves striving to high standards that may require tremendous focus and effort. Sometimes we think of perfectionism as being a characteristic of high-achievers, an athlete, a Nobel prize-winning scientist, or musical or social high achievers. Yet, perfectionism can and does have a darker side. Instead of being adaptive and helpful, perfectionism can sometimes lead to procrastination and fearing the worst, and has been strongly linked to health issues such as eating disorders, anxiety disorders, and depression.

A distinction is typically made between “adaptive” and “maladaptive” (i.e., unhealthy) perfectionism. Adaptive perfectionism is more likely a reflection of conscientiousness and involves striving for high personal standards, without a crippling self-critical inner voice if the standards are not met. Some scientists have started using the term “clinical perfectionism” to describe the unhelpful perfectionism that interferes with mental health, work, study, and relationships. People with this type of perfectionism set excessively and often unrealistically high personal standards, and base their self-worth strongly or even exclusively on reaching these standards. They are deeply concerned with mistakes and are overly self-critical.

The association between perfectionism and eating disorders has a long history. Hilde Bruch, a pioneer in the field who described eating disorders even before they were officially recognized, noted that patients she treated for eating problems were perfectionistic (Bruch, 1978). They set high demands on themselves and were praised for the excellence, enthusiasm, and helpfulness applied to work, athletics, families, or social causes. Yet she also described it as “inner misery”—she noted that high perfectionism perpetuated rigid, dangerous goals and behaviors around food and exercise. She insisted that if this unhelpful perfectionism was recognized early, it may avert the possible onset of an eating disorder.

Modern scientific research has consistently shown that maladaptive perfectionism is higher in people with eating disorders than in healthy comparison individuals. The desire to achieve unrealistic standards when it comes to body weight and shape, coupled with relentless pursuit of this goal can lead to engaging in behaviors that compromise health, mental functioning, and get in the way of regular daily life. For example, since many social activities involve shared meals, relationships with friends and family can be affected. A nourished brain is also essential for optimal school and work performance, healthy bones, for the heart to pump blood around the body, and for the immune system. Research has also shown that individuals who have these maladaptive perfectionist traits may have a more difficult time staying in and engaging in treatment (Bizeul, Sadowsky, & Rigaud, 2001; Lowe et al., 2001).

Importantly however, some treatments for eating disorders, such as cognitive-behavioral therapy, have been found not only to reduce eating disordered behaviors but also to reduce perfectionism, as well as symptoms of anxiety and depression. So, although maladaptive perfectionism is associated with eating disorders, the unhelpful thinking and behaviors that go along with this type of perfectionistic personality can be reduced. At least two self-help books have been published that reduced perfectionism in controlled scientific trials, and could be used in conjunction with treatment with a provider. Additionally, prevention programs for eating disorders have been devised that work to reduce unhelpful aspects of perfectionism in at-risk adolescents. If you are interested in learning more about perfectionism, or the self-help books mentioned above, you can find more information in the sources below marked with an asterisk.


*Antony, M. & Swinson, R. (2009) When perfect isn’t good enough: Strategies for coping with perfectionism. Oakland, CA: New Harbinger Publications. [self-help book]

Bizeul, C., Sadowsky, N., & Rigaud, D. (2001). The prognostic value of initial EDI scores in anorexia nervosa patients: A prospective follow-up study of 5-10 years. European Psychiatry, 16, 232-238.

Bruch, H. (1978). The golden cage: The enigma of anorexia nervosa. Cambridge, MA: Harvard University Press.

*Egan, S. J., Wade, T. D., & Shafran (2014). Cognitive behavioral treatment of perfectionism. New York: Guilford Press. [for clinicians]

Lowe, B., Zipfel, S., Buchholz, C., Dupont, Y., Reas, D. R., & Herzog, W. (2001). Long-term outcome of anorexia nervosa in a prospective 21-year follow-up study. Psychological Medicine, 31, 881-890.

*Shafran, R., Egan, S., & Wade, T. (2010). Overcoming perfectionism: A self-help guide using cognitive behavioral techniques. London: Constable & Robinson, Ltd. [self-help book]