Perfectionism in Anorexia Nervosa

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Perfectionism is the belief that a perfect outcome exists, can actually be achieved, and that it is a worthwhile pursuit.  When someone is unable to achieve this perfect state, it often results in self-criticism, an excessive concern for mistakes, and doubts about oneself and one’s abilities.  Eventually, perfectionism leads to be dissatisfied with oneself and with other people.

For people with anorexia nervosa, perfectionism has long been noted as a common personality characteristic.

Even over a century ago, the French physician Charles Lasegué described sufferers of anorexia as “ever on the watch for judgments concerning themselves, especially such as are approved by the family.”

Perfectionism in Anorexia Nervosa

In anorexia nervosa, perfectionism may fall into multiple categories:

  • Self-oriented perfectionism typically revolves around perfection in eating – eating the right things, the right number of calories, etc.  It may also include things like schoolwork, or obsessions with organization or doing things in a precise manner. 
  • Other-oriented or interpersonal perfectionism revolves around looking the right way, saying the right things, and generally building a façade so that other people think you are perfect.

Interestingly, research has shown that self-oriented perfectionism is associated primarily with anorexia, while interpersonal perfectionism is associated with eating disorders (including bulimia nervosa) as a whole.

Perfectionism Predates Eating Disorders

Current research indicates that many people suffering from eating disorders and struggling with perfectionism had the perfectionism traits before their eating disorders began.  

Interestingly, although many symptoms of anorexia nervosa lessen or even disappear after a person is in recovery and has gained weight back, perfectionism traits don't disappear.

Multiple research studies have shown that perfectionism continues to be significantly higher in people with anorexia nervosa than in the general population, even after recovery.

Because perfectionism doesn't go away, some researchers have speculated that it might be a personality trait that indicates a genetic tendency for anorexia. Even if the cause isn't genetic, it's important to recognize this link between perfectionism and eating disorders, because it might help to recognize or even prevent eating disorders.

What Does This Mean for People With Anorexia?

For people in recovery from anorexia, this research gives some insight into an issue that they may need to be aware of, and mindful of, throughout their lives. 

Perfectionism can be a source of stress and anxiety that can cause problems in work, school, and interpersonal relationships, in addition to issues with weight and eating.  As such, this may be an important area for those in recovery to continue working on and challenging themselves in.

Sources:

Bulik, C.M., Tozzi, F., Anderson, C., Mazzeo, S.E., Aggen, S., Sullivan, P.F. (2003). The relation between eating disorders and components of perfectionism. American Journal of Psychiatry, 160(2). 366-368.

Castro, J., Gila, A., Gual, P., Lahortiga, F., Saura, B., Toro, J. (2004). Perfectionism dimensions in children and adolescents with anorexia nervosa. Journal of Adolescent Health, 35(392-398).

Halmi, K.A., Sunday, S.R., Strober, M., Kaplan, A., Woodside, D.B., Fichter, M., Treasure, J., Berrettini, W.H., & Kaye, W. (2000). Perfectionism in anorexia nervosa: variation by clinical subtype, obsessionality, and pathological eating behavior. American Journal of Psychiatry, 157(11). 1799-1805.

Hewitt, P.L., Flett, G.L., Ediger, E. (1995). Perfectionism traits and perfectionistic self-presentation in eating disorder attitudes, characteristics, and symptoms. International Journal of Eating Disorders, 18(4). 317-326.

Srinivasagam, N. M., Kaye, W. H., Plotnicov, K. H., Greeno, C., Weltzin, T. E., & Rao, R. (1995). Persistent perfectionism, symmetry, and exactness after long-term recovery from anorexia nervosa. American Journal of Psychiatry, 152(11), 1630-1634.

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