Many people use the term “perfectionist” in a favorable way. They think of those who consistently push themselves, hold themselves to higher standards and strive to be the best.
Those people are actually “goal oriented.” Perfectionism is different. Perfectionism is a pathological personality trait that creates massive discomfort, interferes with social and emotional functioning, and negatively impacts overall health.
Understanding the difference between the two, particularly in terms of what motivates behavior, is paramount to success in treatment. The two traits may look similar at first, but a closer look reveals the truth. Where goal-driven individuals seek to accomplish things to enhance their lives, perfectionistic individuals are driven by fear of failure or by accomplishment because it defines their lives and personal worth.
Many individuals with eating disorders, particularly those with anorexia nervosa, are also perfectionists. In fact, research indicates that perfectionism substantially increases the risk of a person developing an eating disorder.
Setting the wrong goals
For those with eating disorders, no amount of weight loss or hours in the gym is good enough. Perfectionists with eating disorders frequently set and reach very measurable goals such as losing a certain amount of weight, working out a certain number of hours, or reaching a specific waist size. But accomplishing a goal often fails to make them feel better because they have a limited sense of worth yet believe an external marker will validate their worth. So they set a more challenging goal.
They think, “If I do THIS, life will be better.” And when life is not better once they reach 120 pounds, they don’t think, “Maybe the weight isn’t what’s making me miserable.” They think, “Maybe if I work harder and get to 110, then I’ll really feel good about myself.”
Social cues can feed into these damaging beliefs. Every day, multiple images insist that if you alter your physical appearance, then people will want to be with you, they will admire you, and you will have more worth. Advertising exacerbates these wayward beliefs. It’s easy for someone who lacks a sense of self-worth to buy into the idea that an external change will make them feel better internally.
For these individuals, success in therapy rests on helping them understand that they have intrinsic value. Period. Their value is separate from what they do. Nothing we do or don’t do adds to or takes away from our value as humans.
How to absorb positive messages
It’s a very hard concept for perfectionists to grasp, but little tricks or reminders can help them start to absorb positive messages that build up their internal value. Because perfectionists never think they are good enough, they tend to tear themselves down frequently. If every time they criticize themselves, even internally, they have to counter with something positive about themselves, they start to develop an awareness of their own goodness, their strengths and value. To make positive self-talk more of a habit, every time they cross a threshold into a building or a room they give themselves an affirmation. In the course of a day, they receive dozens of physical reminders to say or think something nice about themselves.
For primary care providers, therapists, pediatricians, trainers, nutritionists and others who work with individuals with eating disorders, understanding and addressing the specific challenges of perfectionists can significantly improve outcomes.
Treatment for anyone with an eating disorder must address the whole individual, not just the disorder. As with substance abuse, an eating disorder is often used as a mood-altering behavior, with roots that frequently go back to a core original trauma.
While getting the individual in treatment and eating again is critical to stabilization, it is really only the beginning of therapy. Ultimately, treatment will need to help individuals rebuild their sense of self and develop an awareness of their inherent value.