The Link Between Perfectionism and Eating Disorders

Perfectionism and eating disorders

Perfectionism is a personality trait often associated with eating disorders. Characterized by a relentless pursuit of high standards and the need for flawless performance in all areas of life, perfectionists prioritize success and accomplishments. They typically appear as though they have it all together – helpful, organized, proactive, detail oriented, always meeting goals and deadlines. They rarely disappoint people or let them down. 

There can be a dark side to perfectionism, however. When taken to an extreme, it can cause people to set unrealistic expectations and criticize themselves when they fall short. Due to core beliefs of unworthiness, perfectionists may experience feelings of inadequacy and hurt, or worry that without performing, all the positive feedback and validation will be taken away. When behavior is driven by a need to please other people and elicit external validation, it can result in obsessive compulsive behaviors to try to control everything and achieve a positive outcome. 

This can be especially dangerous if a preoccupation with perfection also extends to one’s body, which can evolve into an eating disorder. People with perfectionistic tendencies may feel a sense of control by limiting their food intake, obsessively exercising, or feeling guilt or shame when they “slip up” and eat more than they intended. A distorted body image and extreme behaviors to control weight can lead to significant physical and mental health consequences that can potentially be life threatening if not treated.

While treating eating disorders related to perfectionism can be challenging, a pivotal point often involves addressing the underlying perfectionistic tendencies. Many beneficial treatment modalities, including CBT (Cognitive Behavioral Therapy) and DPT (Dialectical Behavior Therapy), can help people identify and challenge perfectionistic beliefs, develop healthier coping mechanisms, and reclaim their thoughts, actions, and life.

Causes of Perfectionism

Perfectionism can develop in various ways, and many different factors can contribute. Some possible underlying causes include:

  • Parental expectations: If a child grows up with parents who have very high expectations for them and place a strong emphasis on achievement and success, they may internalize these values and develop a perfectionistic mindset.
  • Personal traits: Some individuals may be more prone to perfectionism due to their natural personality traits. For example, highly conscientious and detail-oriented individuals may be more likely to develop perfectionistic tendencies.
  • Trauma or abuse: In some cases, individuals may develop perfectionism to cope with trauma or abuse. They may believe that if they can achieve perfection in certain areas of their lives, they can control their environment and avoid further harm.
  • Cultural factors: Certain cultures may strongly emphasize achievement and success, which can lead individuals to adopt a perfectionist mindset.
  • Anxiety or other mental health conditions: Perfectionism may also be a symptom of anxiety or other mental health conditions. For example, individuals with obsessive-compulsive disorder (OCD) may feel compelled to achieve perfection in certain areas of their lives to manage their anxiety.

Perfectionism is likely the result of a complex interplay between genetic, environmental, and cultural factors, and it can develop in various ways depending on an individual’s unique experiences and circumstances. It’s typically something that evolves over time. It’s not just one incident or one influence that grows a perfectionist – it’s often many things that get reinforced. 

Disordered Behavior Is Often Masked by High Achievement

While striving for excellence is nothing to be ashamed of, if it feels as though nothing is ever good enough or rigid patterns of behavior become debilitating, it’s probably time to take a step back. Perfectionists might eventually run into a wall where their expectations are unmanageable, forcing them to find coping skills to manage their stress and anxiety – but people don’t always choose coping strategies that are beneficial or healthy for them. 

Sometimes it’s hard to identify issues, because perfectionists are often perceived as being very capable and successful. They can be reluctant to ask for help, because it conflicts with the image they have cultivated. 

Top fears of perfectionists include:

  • Failure
  • Disappointment
  • Abandonment
  • Rejection

Despite appearing to be successful, the issue lies in performance driven by anxiety and underlying fears. The outward appearance doesn’t match the dysfunction on the inside. Things that seem to be positive qualities may not be healthy in reality.


  • Overthinking/catastrophic thinking → looks like being prepared for anything.
  • Perfectionism → looks like being on time, organized and reliable.
  • Negative self-talk, constantly second-guessing and seeking validation from others  → looks like good teamwork and collaboration with other people.
  • Repetitive habits, obsessively double checking things → looks like being detail oriented.
  • People pleasing  → looks like being helpful and friendly.

The Price of Perfectionism

Always trying to be prepared and predict everything makes it impossible to be present in everyday moments. When the midbrain that is responsible for keeping us safe is constantly activated in a state of stress response, it’s harder to be logical and present. At some point, things become overwhelming, leading to the need to shut down and isolate – the opposite of performing. Unhealthy coping behaviors like eating disorders or substance use may arise to help manage the constant stress.

Short Term Symptoms:

  • Trouble concentrating
  • Weight loss
  • Panic attacks
  • Rash decisions
  • Irritability
  • Appetite changes (overeating due to stress or not eating much at all)
  • Sleep disturbance
  • Unhealthy coping with eating disorders, alcohol or drugs
  • Acute physical symptoms – headache, tension, heart palpitations, hypertension, upset stomach, vomiting

Long Term Impact:

  • Weakened immune system
  • Migraines
  • Digestion/IBS
  • Cognition/Memory
  • Hypertension
  • Chronic pain
  • Heart disease
  • Relationship strain

How Perfectionism Thrives in Eating Disorders

Research suggests that perfectionism plays a role in the development and maintenance of eating disorders by driving individuals to engage in extreme and unhealthy behaviors to achieve an unattainable standard of perfection. The levels of perfectionism found among people with anorexia nervosa, binge eating, and bulimia nervosa are higher than those without eating disorders.

A person with an eating disorder may exhibit perfectionism in the following ways:

  • Strict food rules: Perfectionism can lead to rigid thinking and an all-or-nothing approach to eating. People with eating disorders may have strict rules around what they can and cannot eat and may feel guilty or ashamed if they break these rules.
  • Excessive exercise: Perfectionism can also lead to an obsession with exercise and a belief that they must burn off every calorie they consume. People with eating disorders may feel like they must push themselves to the limit with exercise, which can lead to physical harm.
  • Black-and-white thinking: Perfectionistic individuals may engage in all-or-nothing thinking, meaning that they believe that they must be perfect in every aspect of their lives, including their eating habits. This can lead to rigid and inflexible eating behaviors that are difficult to maintain in the long run.
  • Fear of weight gain: Perfectionism can cause a preoccupation with weight and body shape, leading to a fear of gaining weight. People with eating disorders may have an intense fear of gaining weight, which can result in extreme dieting and unhealthy weight loss.
  • Self-criticism: Perfectionism often leads to harsh self-criticism and negative self-talk. People with eating disorders may have a constant internal dialogue criticizing their appearance, eating habits, and ability to control their weight. Perfectionistic individuals may have low self-esteem and believe they are only worthy of love and acceptance if they achieve their ideal body shape or size. This can lead to a cycle of unhealthy behaviors in which the individual must maintain their restrictive eating habits to feel good about themselves.
  • Control issues: Perfectionistic individuals may feel a strong need to control their environment, including their food intake. This can lead to a preoccupation with food and eating and an inability to eat in social situations or eat foods that are not deemed “healthy” or “safe.”

There isn’t a “perfect” way to eat or exercise, just as there is no “perfect” body. But perfectionism will convince people that there is, and they might harm their bodies in pursuit of that perfection. Perfectionism is exhausting, and spoiler alert: It doesn’t yield the desired results. In fact, perfectionism diminishes any external validation and connection because it doesn’t allow people to show up authentically and causes them to lose touch with who they are. Moreover, it disconnects them from their internal cues and their truth, making it much easier to internalize toxic messages from diet culture. Challenging these messages from diet culture and having an attuned approach to eating, movement, and self-care are essential in making peace with their inner perfectionist on their road to recovery.

It’s important to note that not all individuals with eating disorders will experience perfectionism, and not all individuals who experience perfectionism will develop an eating disorder. However, perfectionism can be a significant risk factor for developing an eating disorder, making recovery more challenging. Seeking professional help from a therapist or dietitian specializing in eating disorders can help address these issues.

Break the Pattern of Perfection and Get Help

Treating perfectionism-related eating disorders involves addressing the underlying perfectionistic tendencies and developing healthier coping mechanisms. There are ways to use it that are advantageous, where someone can learn to harness its positive aspects. Focusing on progress rather than putting all efforts into achieving perfection is a noble start. Practicing self-compassion, embracing faults, and seeking support are essential to healing.

Here are some ways in which addressing perfectionism can help with eating disorder recovery:

  • Changing rigid rules and beliefs about food: Perfectionism can lead to rigid thinking and an all-or-nothing approach to eating. By addressing perfectionism, people with eating disorders can work on changing their rigid rules and beliefs about food, which can help them develop a more flexible and balanced approach to eating.
  • Reducing anxiety and guilt around eating: Perfectionism can cause constant worry and fear of failure, leading to anxiety and guilt around eating. By addressing perfectionism, people with eating disorders can work on reducing their anxiety and guilt around food, which can make it easier to develop a healthier relationship with food.
  • Increasing self-compassion: Perfectionism often leads to harsh self-criticism and negative self-talk. By working on perfectionism, people with eating disorders can learn to be more self-compassionate and kind to themselves, which can help reduce shame and increase feelings of self-worth.
  • Improving body image: Perfectionism can cause a preoccupation with weight and body shape, leading to a negative body image. By addressing perfectionism, people with eating disorders can work on improving their body image and accepting their bodies for what they are.
  • Reducing the risk of relapse: Perfectionism can make it challenging to maintain progress and can increase the risk of relapse. People with eating disorders can develop skills and strategies for managing perfectionistic tendencies and preventing relapse by addressing perfectionism.

Remember, addressing any co-occurring disorder, such as perfectionism, is not a quick fix and often requires ongoing work and support. However, at Eating Disorder Solutions, our therapists, counselors, recovery coaches, and clinical staff specialize in eating disorders and other co-occurring disorders, providing tools and strategies for managing perfectionism in the context of eating disorder recovery.

If you’re struggling with your eating, you’re not alone. It’s okay to need more support and to reach out for help to ask for what you need. Call us today at 866-931-1185 or contact us online to learn more about our treatment options.


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