The Link Between Perfectionism and Bulimia

There’s been significant research to validate the correlation between the personality trait of perfectionism and bulimia nervosa, although, the causality has been debated. A 2010 study in the International Journal of Eating Disorders showed that perfectionism plays a role in the “etiology, maintenance, and treatment of eating disorders.”¹

Are Perfectionists More Likely to Become Bulimic?

A recent study published in the journal, Personality and Individual Differences, found that perfectionists are much more likely to develop bulimia and that perfectionism can lead to increases in the illness as time passes.²

It took me years to understand – beyond an intellectual level – that perfectionism was a potent driving force behind my eating disorder. Even after starting recovery five years ago, I expended a lot of energy trying to assert total control over my food intake, which was my biggest threat for relapse and a hurdle in my journey towards wellness. I tried to eat the “right” amount at the “right” time, avoid “bad” foods and consume only “good” ones, and attain “perfect” mastery over my body weight. I wasn’t particularly concerned with being thin, but I was terrified of uncertainty, and my quest for control was born out of an attempt to make the world around me feel predictable and safe.

Control was at the heart of my illness. But due to the inherently disappointing nature of perfectionism, I was often left feeling dissatisfied and hopeless, while struggling to escape my disordered behaviors. Adjusting my unhelpful beliefs so as to gradually let go of perfectionistic tendencies became an integral part of my long-term recovery.

The Negative Effects of Perfectionism on Bulimia

Perfectionism can lead people with food-related mental illness to develop an extremely destructive, black and white approach to eating. I decided as a teenager that since I struggled to eat certain foods in moderation, I would undergo lengthy periods of severe restriction. Not being able to perfectly regulate my every bite, on the other hand, often justified a binge – too many slices of toast, an extra piece of cake, sometimes an extra bite of chocolate was reason enough.

For many bulimics, the most distressing symptom of perfectionism is purging. For me, this usually erupted out of a desire to rid myself of excess or undesirable foods, but most of all it became a way to appease the physical and psychological discomfort of eating the “wrong” things, or consuming more than I “should have.”

Letting go of perfectionism can be challenging for a lot of survivors. The idea of setting high standards doesn't necessarily conjure up negative associations, but rather it can be interpreted as a commendable quality. Like any characteristic, perfectionism is a spectrum, which can be both positive and negative, varying from person to person. For people with eating disorders, perfectionism often goes beyond "doing your best" -- it centers around unfeasible goals, where no outcome ever feels "good enough", and so, it's important for survivors in recovery to be honest with themselves about their intentions and motivations, and whether or not these are realistic and healthy.

Overcoming Perfectionism

Cognitive behavioral therapy (CBT) -- the leading treatment for adults with eating disorders – has been shown to be extremely helpful in restructuring perfectionistic self-talk.³ I’ve continued to use CBT to challenge the idealistic expectations that fueled my illness, in particular, the “should” statements, rigid thinking and incessant catastrophizing around food. CBT can allow people struggling with bulimia to catch their destructive thoughts before they flare up into emotions, which might lead to harmful actions. But there are various other tools with which to identify and disrupt this vicious cycle -- the first step is to recognize that perfectionism has become a problem.

Often people think that refraining from disordered behaviors equals recovery, but it’s just the tip of the iceberg. Over time, I realized that even after I’d entered into recovery and developed healthy eating patterns, I wasn’t fully letting go of the need to control, I was simply trying to control different things. I harbored unhelpful cognitions, such as the notion that consuming even a small amount of my “trigger foods” (i.e. foods that could lead to a binge) would necessarily cause a relapse. My perfectionism meant that the disorder continued to haunt me, lingering in the background, ready to be re-ignited, so, I took some time to focus on reframing my all-or-nothing thinking.

Using a powerful combination of psychological tools, including CBT, hypnotherapy, and meditation, I’ve learned to adopt a more mindful and moderate approach to life. Cognitive behavioral therapy and meditation, in particular, have helped me to exercise self-love and accept my vulnerabilities, weaknesses, and strengths, rather than living in fear every day, desperately grasping at control. Whenever I start to ruminate on whether or not I’ve overindulged or consumed something “bad,” I bring my awareness to the unnerving feelings and practice acceptance. This has become a ritual, like daily meditation. I continue to work on my perfectionist beliefs, learning how to be okay with uncertainty and imperfection.

In understanding the connection between perfectionism and bulimia, therapists may be able to improve treatment by targeting perfectionistic thoughts (e.g. self-criticism and having unrealistically high standards) and symptoms (e.g. purging), and hopefully psychologists can draw on these findings to devise preventative interventions for bulimia and psychoeducational programs that reduce the risk for future onset.

Sources

1. Bardone‐Cone, A. et al. “Perfectionism across stages of recovery from eating disorders.” International Journal of Eating Disorders. March 2010.
2. Kehayes, I-L. et al. "Are perfectionism dimensions risk factors for bulimic symptoms? A meta-analysis of longitudinal studies." Personality and Individual Differences. February 2019.
3. National Institute for Health and Care Excellence (NICE). Eating Disorders: Recognition and Treatment. Accessed May 30, 2017.