Perfectionism and Eating Disorders

Our culture is slowly shifting to become more accepting that women’s beauty comes in a variety of shapes and sizes. No longer is the pressure to be a super skinny female quite as demanding as evidenced by this amusing development: the Barbie doll – Little Miss Perfect Body – has gotten some stiff competition. The new Lammily doll is based on measurements researched by the Centers for Disease Control that represent the average 19-year-old female body. This makes the Lammily doll quite a bit heavier than Barbie. Kids can also buy stickers of cellulite, stretch marks, acne, freckles, moles, glasses, scars and a range of other “imperfections” that the child can stick to the doll’s skin giving her an even more flawed appearance! The doll’s slogan is “Average is beautiful!” This doll encourages a body-positive message that even normal human bodies can have imperfections that add to their unique beauty.

However, the inner pressure to be thin and perfect persists in many girls and women because it is psychological in nature. Many of the girls and women I have worked with at The New York Center for Eating Disorders are on a quest for the perfect body, the perfect size, the perfect diet, and the perfect work-out regime.

When we humans insist on perfection in our appearance, we are ultimately left discouraged and even in despair.

Perfectionism, Anxiety, and Eating Disorders: A Perfect Storm

By why would someone strive to be perfect if it harmed them psychologically and/or physically? The answer is that many people have strong feelings of anxiety, a sense of inner emptiness, or an obsessive-compulsive personality that leads them to organize their life around perfectionism.

Rituals, obsessive thoughts, and compulsive behaviors give them a channel and a vehicle to express their anxiety about life. Dieting/excessive exercise/emotional eating can add structure and meaning to one’s life.

This is why an anorexic or bulimic, for example, fights so fiercely to hold on to her illness, and why a compulsive overeater is afraid to give up her destructive eating patterns. Who would she be without emotional eating? What would give her life purpose? What is her authentic inner identity? All of these questions need to be worked through in therapy before she feels strong enough to cope with life without the safety crutch of disordered eating and perfectionism.

The role of anxiety in creating an eating disorder and how it fuels perfectionism is clearly illustrated in the case of one of my patients, Carol.* The very day her beloved father was diagnosed with terminal cancer, Carol decided to train to become a competitive bodybuilder! She had recently gotten divorced and was raising her children alone. Carol devoted the following year to rigid eating, a rigid workout schedule and won the final competition in her category. During this time her father died, and Carol reported, “I had no time to feel anything about his death because I was so involved in doing my own thing with the body building training.” Carol came to therapy after her competition ended and she was at loose ends about her life. Her father was dead, her children needed her, she was depressed, and she added with just a touch of humor, “Not only did I just lose my father, but since I can’t devote so much time anymore to my workouts, I’m also about to lose my six pack abs.” For Carol to heal her perfectionism and fixation with eating, she had to face her anxiety, fear, and emotions of loss. It is so much easier to hyper-focus on your barbells and your abs than on your life and its meaning which often may include pain. Carol is getting better – she has returned to a more normal eating plan and is facing her sadness without the prop of being a perfectionistic ultra exerciser.