I am a real perfectionist. People tell me I am too “hard on myself,” but I just like to do things well. I also have certain ideas about what my body should look like and specific goals about my weight. Will this interfere with my treatment?
Perfectionism refers to the tendency to expect a greater performance from oneself or others than is required for a given situation (Wonderlich 2002). As the term implies, perfectionists set extremely high (and unrealistic) standards for themselves. A growing body of research indicates that perfectionism plays an important role in a number of psychological disorders, including anorexia nervosa. In fact, recent studies suggest that perfectionism is one of the most common traits associated with eating disorders. Studies also suggest that perfectionism is both an antecedent risk factor for anorexia and that it appears to persist long after weight recovery from anorexia.
For some patients, the chronic, telltale traits associated with perfectionism may even indicate a more severe disorder known as obsessive-compulsive personality disorder, or OCPD. Symptoms of OCPD include excessive orderliness, severe inflexibility, extreme stubbornness, and preoccupation with rules and details. Although estimates of comorbidity vary greatly (from 3% to 60%), OCPD is one of the personality disorders shown to frequently co-occur with anorexia nervosa. When OCPD co-occurs with anorexia, long-term treatment will address symptoms of both disorders.
It is one thing to be a high-achiever and to want to give your best effort at essential tasks-this is true of many healthy individuals. However, the self-imposed standard of perfection seen in anorexia patients goes far beyond the adaptive qualities of a conscientious worker or a high achiever. Chronic perfectionism can actually interfere with a healthy attitude about oneself, hinder interpersonal relationships, and negatively affect mental health and well-being. Do any of these characteristics describe your own personality style: inflexible, preoccupied with rules and order, rigid, stubborn, insecure, overly cautious, self-critical, or terrified of making mistakes? Characterized as “neurotic perfectionism,” this personality style reflects an “all-or-nothing” mindset that can have a detrimental effect on your quality of life. In fact, instead of increasing self-esteem and a sense of competency, perfectionism often has the opposite effect, increasing feelings of inadequacy, worthlessness, and self-hatred. Perfectionism, therefore, sets a trap: The more it causes you to focus on being the “best” in everything, the more it makes you aware of your shortcomings. Susan Kano, author of Making Peace with Food, has this to say about perfectionism:
“[While] our search for perfection may sound like a positive thing-like a search for greatness, in truth a search for perfection is always a search for fault.” Perfectionism offers a vision of fulfillment and happiness, says Kano, but leaves us with a judgmental inner voice that repeatedly reminds us that we will never be “good enough.”
Perfectionism can be especially problematic when it creeps into the area of body image and weight. “If only I lose 10 pounds, then I will be pretty,” “I will be popular when I lose more weight,” “I will be happy with myself only when I am thinner.” These “if only” conditions may seem like commonly expressed sentiments, but for the person at risk for anorexia, thinking of this kind can perpetuate a dangerous cycle of self-disgust, self-deprivation, and unhealthy self-restrictions. Self-imposed restrictions can take on a more dangerous tone:
“I cannot eat today until I run 5 extra miles,” “I am not good enough unless I am the thinnest one of all my friends,” “If I eat anything today before dinner, I am a failure.” Many people in recovery from anorexia nervosa are also “recovering perfectionists.” In such cases, treatment will include attention to changing and adapting one’s thinking style so that it is more open, flexible, and self-accepting. In fact, studies show that increasing self-esteem and self-acceptance in treatment assures a better recovery outcome from anorexia. Your therapist and treatment team will help you move away from a place of self-judgment and self-criticism toward a more forgiving and peaceful self-appreciation. It will take time, but the journey toward self-acceptance is well worth the effort. Imagine having a positive outlook about yourself and your life; imagine quieting the “tapes” that play in your mind and seem to highlight your mistakes and faults; imagine feeling valuable and worthy of love. Such an achievement does not have to remain an “if only”-it is possible-you can learn to feel better about yourself, to accept yourself, and to put an end to the “if only’s.”
Sarah shares:
One of the hardest parts of my treatment was learning to let go of the unrealistic standards I had set for myself. Even when I did meet my stringent expectations, I convinced myself that it was only because I had set the bar too low; each time I “succeeded” at one of my self-destructive goals, my reward was to make my standards even higher. As you could guess, this mindset quickly deteriorated my mind and body, leaving me with a sense of hopelessness and self-hatred. In treatment, I discovered that my self-worth is not determined by the calories I restrict or the miles I run. As a “recovering perfectionist,” not only did I learn that my weight doesn’t establish my self-worth, I realized that the strength of my character is not determined by my grades in school, the number of community service hours I complete, or the amount of money I save. I am not a number, and no quantitative statement can determine my character. “Should” is a bad word to use when talking about your physical appearance-there is no one way that anyone “should” look and I’ve let go of judging myself based on who the world tries to tell me I “should” be
Diagnostic Indicators for Obsessive-Compulsive Personality Disorder (OCPD)
OCPD is defined as a pervasive pattern of preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency, beginning by early adulthood and present in a variety of contexts.
A partial list of associated behaviors may include:
• A preoccupation with details, rules, lists, organization, or schedules
• Perfectionism that interferes with task completion
• Over conscientiousness or inflexibility
• Reluctance to delegate tasks and an inability to work with others unless they submit to an exact way of doing things
• Rigidity and stubbornness
SOURCE: American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, 4th ed., Text Revision (p. 729). Washington, DC: Author.
Terms:
Antecedent – Preceding event or cause.
Comorbidity – The occurrence of more than one illness, disease, or diagnosable condition at the same time.
Perfectionism sets a trap: The more it causes you to focus on being the “best” in everything, the more it makes you aware of your shortcomings.
