Perfectionism and Eating Disorders:

Are the two related?

Carrie Paulus

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11. Perfectionism: A Closer Look.

Ill. Perfectionism and Eating Disorders.

I. Introduction:

Many extreme pressures exist in modern society which directly affect a large number of the population to the point of extremity. In an age of high technology, rapid development, and intense social pressure, the pressure to be the best of the best prevails. Many people succumb to the pressure in a variety of ways, some beneficial, and some detrimental. Eating disorders such as Anorexia Nervosa and Bulimia Nervosa in part result from an intense pressure to achieve the perfect ideal body weight and physical appearance. Emphasis on being perfect begins early in childhood and continues to grow with age, sometimes so much that a personality takes on a perfectionistic drive affecting every aspect of daily life. Perfectionism is a common individualized personality trait which in part stems from this ardent cultural pressure. According to the Merriam Webster's Collegiate Dictionary, perfectionism is defined as "a disposition to regard anything short of perfection as unacceptable". Given this definition, is this trait, perfectionism, one that can be directly linked to those people who suffer from eating disorders?

II. Perfectionism: A Closer Look:

Setting high and demanding goals of achievement for oneself can be both a positive and negative experience. Yes, goals are important and essential in life to allow us to work for an ultimate high achievement. They give one purpose and drive. But what happens when this goal exceeds the normal realm of possibility to the point that it directly changes from a means for a self-actualizing strive for excellence to a neurotic, obsessive preoccupation with perfection? Roedell (1984) continues the argument that perfectionism can be looked upon as both positive and negative.

"in a positive form, perfectionism can provide the driving energy which leads to great achievement. The meticulous attention to detail necessary for scientific investigation, the commitment which pushes composers to keep working until the music realizes the glorious sounds playing in the imagination and the persistence which keeps great artists at their easels until their creation matches their conception all result from perfectionism. Setting high standards is not in itself a bad thing. However, perfectionism coupled with a punishing attitude towards one's own efforts can cripple the imagination, kill the spirit, and so handicap performance that an individual may never fulfill the promise of early talent."

(http://www.nexus.edu.au/teachstud/gat/peters.htm)

The focus of this paper is primarily centered on the negative repercussions which may accompany perfectionism. A perfectionist is likely to have learned early on in life that the level of achievement or accomplishment that one has achieved is the basis for how others value others. Therefore, he or she might have learned to value him/herself on the basis of other people's approval. His/her self esteem could be based primarily on external standards which could leave him/her vulnerable and sensitive to other people's opinions and criticisms. Perfectionism may be in itself a means of defense against the criticism of others. (http://www.odos.uiuc.edu/Counseling-Center/perfecti.htm) Many negative thoughts, beliefs, and feelings can accompany perfectionism, and it is these feelings which can often lead to other more serious distortions in perception and other forms of disorder. Perfectionism fosters emotions such as a fear of failure as a sign of lack of personal worth, fear of making mistakes as a sign of failure, and the fear of disapproval as a sign of not being accepted by others. In addition, accompanying perfectionism is all-or-none-thinking, the idea that if an accomplishment is not perfect, the person is worthless, an overemphasis on "shoulds" that serve as a rigid set of rules to live by which often overshadows the persons own wants and desires, and finally, the belief that others are easily successful with minimal effort, few errors, emotional stress, and maximum self-confidence, while all efforts on their own part are inadequate. (http://www.odos.uiuc.edu/Counseling-Center/perfecti.htm)

Hewitt and Fiett (cited in Silverman 1995, p.3) identify three components to perfectionism: "self-oriented (unrealistic standards for self), other oriented (unrealistic standards directed towards others), and socially prescribed (belief that others have perfectionistic expectations and motives for oneself)." http://www.nexus-edu.au/teachstud/gat/peters.htm Hewitt and Fiett's research links self-oriented perfectionism with clinical depression as well as other-oriented perfectionism with anti-social and narcissistic personality disorders.

Others viewing perfectionism as having more negative effects are Burns (cited in Parker & Adkins, 1995, p-173) and Pacht (cited in Parker & Adkins, 1995, p. 173). Burns sees perfectionists as "people who strain compulsively and unremittingly toward impossible goals and who measure their own worth entirely in terms of productivity and accomplishment." Pacht sees perfectionism as "the striving for that nonexistent perfection that keeps people in turmoil and is associated with a significant number of psychological problems." Research has linked perfectionism to disorders such as depression, migraine, personality and psychosomatic disorders, type A coronary-prone behavior and suicide, as well as eating disorders such as anorexia and buli'mia nervosa.

(http://www.nexus.edu.au/teachstud/gat/peters.html)

Ill. Perfectionism and Eating Disorders

So how does perfectionism affect eating disorders such as anorexia or bulimia nervosa? Anorexia nervosa, for instance, is a psychosociological disease which affects primarily young and healthy adolescent girls at the onset of puberty often as they come out of high school and enter college, a period characterized by the emergence of adulthood and the separation from parents. (Bruch, 1978, and Hsu, 1983) Over the past two decades, the incidence of anorexia nervosa has risen to alarming proportions. According to the DSM -111-R, (1987), the number has increased to 12-1 girls out of every 100 have a strong chance of developing the disorder which is characterized by the refusal to maintain body weight over a minimal normal weight for age and height; intense fear of gaining weight or becoming fat even though underweight, a distorted body image, and amenorrhea, the cessation of the menstrual cycle. (http://www.pgi.edu/hagopian.htm)

Although the possible links to anorexia nervosa as well as bulimia nervosa are multi-faceted, a major component contributing to the development of eating disorders is the sociocultural pressure for women to be perfect in physical and intellectual states. According to Levenkron, (1982, p. 4), eating disorders can be linked a "stylistic breakdown resulting from cultural pressure, since it amounts to a pathological exaggeration of society's message to women" which associated thinness and beauty with social, sexual, interpersonal, and professional success. (http://www.pgi.edu/hagopian.htm) In addition, with the feminist movement two decades ago, the pressure for women's achievement and competition has skyrocketed. Interestingly, heightened competitiveness and over-achievement are personality traits found among many patients with anorexia nervosa. (Romeo, 1986) (http://www.pgi-edu/hagopian.htm)

IV. Research studies.

Many studies have attempted to link perfectionism with eating disordered patients. For instance, many studies have been performed to research the relationship of personality traits and disorders such as obsessive-compulsive disorder and perfectionism.

For instance, Rothenburg (1990) conducted a study regarding the prevalence of obsessive-compusive disorder among eating disordered adolescence in an effort to further understanding of the centrality of obsessive-compulsive symptomatology and dynamisms and their relationship to adolescent conflict and development. Social pressures of conformity with the ideal of feminine thinness especially prevalent during the adolescent period interact with obsessive-compulsive predispositions to produce eating disordered behavior. According to Rothenburg, obsessive preoccupations with food, ruminative calorie counting, ritualistic behavior regarding food, laxatives, vomiting, combine with an underlying focus of obsessive-compulsive control and a sado-masochistic orientation to the body and point towards an obsessive-compulsive disorder. As patients with eating disorders are notoriously secretive and misleading, Rothenburg carried out a diagnostic assessment of such patients with eating disorders in intense treatment in a long-term treatment facility. He compared this group with a control group randomly selected from the remainder of the hospital patient population. He found that obsessive-compulsive manifestations of rumination, ritualistic behavior, excessive cleanliness, excessive orderliness, perfectionism, miserliness, rigidity, scrupulousness, and self-righteousness were all significantly associated with the eating disordered patient group. According to his findings, the current eating disorder picture appears to be a modern form of obsessive-compulsive disorder beginning during the adolescent period.

Another study of similar investigation by Pigott, Altemus, Rubenstein, Hill, Bihari, L'Heureux, Bernstein, and Murphy (I991 ) explored the potential overlap of symptoms of eating disorders in patients with obsessive-compulsive disorder. The researchers administered a structured, self-rating scale, The Eating Disorder Inventory, to 59 outpatients at an obsessive-compulsive disorder clinic and to 60 sex-matched normal volunteers. The EDI has previously been validated as a reliable measure of the specific cognitive and behavioral dimensions of the psychopathology typical of patients with eating disorders. The scores of patients with obsessive-compulsive disorder and of healthy comparison subjects were compared those of 32 female inpatients with anorexia nervosa or bulimia nervosa who had also been given the inventory.

Researchers found that the patients with obsessive-compulsive disorder scored significantly higher than the healthy comparison group on all eight subscales of the ED[: drive for thinness, bulimia, body dissatisfaction, ineffectiveness, perfectionism, interpersonal distrust, interoceptive awareness, and maturity fears. Compared to the healthy subjects, males with obsessive-compulsive disorder had more symptoms than female patients with obsessive-compulsive disorder. The scores of female patients with obsessive-compulsive disorder fell midway between those of the 32 female patients with eating disorders and those of the 35 female normal subjects. Conclusions were made that suggested that the patients with obsessive-compulsive disorder display significantly more disturbed eating attitudes and behavior than healthy comparison subjects. In addition, they also share some of the psychopathological eating attitudes and behaviors that are common to patients with eating disorders.

Other research has focused more indepth on the actual trait of perfectionism and its relationship to eating disorders. Four important studies stand out.

First, Slade, Newton, Butler, and Murphy (1991) performed an experimental analysis of perfectionism and dissatisfaction. A questionnaire measure of Perfectionism and General Dissatisfaction (the SCANS) together with the Eysenck Personality Questionnaire and measures thought to gauge aspects of perfectionistic thinking were administered to a mixed group of 148 subjects, including 25 eating disordered patients. Perfectionism appears to be associated with a tendency to deny personally deviant behavior and to present oneself in the best possible light. General Dissatisfaction was correlated significantly with Neuroticism, Introversion, and Psychoticism, thus appearing to be related to a combination of 'neurotic introversion" and 'personality deviance'. It is also associated with a tendency to be under-inclusive, that is to find difficulty in ruling out irrelevant stimuli when forming categories. These results show the characteristic traits often found in patients with eating disorders.

A second study by Hewitt, Fiett, and Ediger (1995) focused more on the direct association between several dimensions of perfectionism and measures of eating disorder symptoms, body image, and appearance of self-esteem on college students. A sample of 81 female university studentscompleted the Multidimensional Perfectionism Scale, The Perfectionistic Self-Presentation Scale, the Eating Attitudes Test, the Bulimia Test, the Body Image Avoidance Questionnaire, and two measures of self-esteem. Researchers found that whereas self-oriented perfectionism was related only to anorexic symptoms, the social facets of perfectionism, especially socially prescribed perfectionism and the perfectionistic self-presentation dimensions, were related to eating disorder symptoms as well as body image avoidance and self-esteem. These findings support the usefulness of differentiating personal and interpersonal dimensions of perfectionism as well as trait versus self-presentational aspects of perfectionism in investigating personality, attitudes, and behaviors related to eating disorders.

A third study performed by Bastini, Rao, Weltzin, and Kaye (1994) focused more on perfectionism in anorexia nervosa. They began on the notion that although it has been well accepted that most patients with anorexia nervosa are perfectionistic, little work has been done to characterisize this behavior. In this study, researchers assessed anorxics with two new multi-dimensional instruments that were designed to measure multiple aspects of perfectionism. Both scales confirm that underweight, malnourished patients with anorexia nervosa are perfectionistic. More importantly, elevated perfectionism scores persisted after weight restoration. Anorexics experienced their perfectionism as self-imposed and not as a response to other's expectations. Researchers concluded that perfectionism is a dimension of the rigid, obsessive behaviors that may contribute to resistance to treatment and relapse in anorexia nervosa. Thus, the scales used may be beneficial in assessing response to treatment.

Finally, an important study done by Srinivasagam, Kaye, Plotnicov,et al. (1995) looked more acutely at the aspect of persistent perfectionism after weight restoration. Researches looked as 22 subjects who had recovered from anorexia nervosa with the requirement of having been at normal weight with restored menses regular for more than one year. These subjects were compared to 16 healthy women using the Eating Disorders Inventory, the Frost Multidimensional Perfectionism Scale, and Yale-Brown Obsessive-Compulsive Scale. The recovered anorexic patients had significantly higher scores than the comparison women on the measures of perfectionism on the EDI and on overall perfectionism on the Frost scale. In addition, the recovered patients had higher scores on the Yale-Brown scale, with target symptoms suggesting that may had specific concerns for symmetry and exactness. Researchers concluded that certain characteristics of anorexia nervosa, such as a need for order and precision, persist after good outcome and recovery, thus. posing the question of whether these behaviors are traits that contribute to the pathogenesis of this illness.

V. Conclusion.

Much of the research confirms assumptions that rigid and controlling personality traits such as perfectionism are highly correlated with people afflicted with eating disorders. These personality dimensions such as perfectionism and obsessive-compulsive traits are often the result of intense sociocultural pressures which drive our modern, fast paced society. The pressure to be perfect can sometimes be overwhelming, especially in the area of physical appearance. Females especially feel a pressure to have the perfect body weight and it is this pressure that contributes to the ritualized and obsessive attitude toward eating that leads to serious illness associated with eating disorders such as anorexia and bulimia nervosa. It is important to look at and continue to investigate the idea that perfectionistic traits do not stop once the person has recovered their normal weight but continue to affect their daily lives. More evidence in this area may help us learn how to pinpoint these perfectionistic tendencies before they develop into extreme behavior as a means to target eating disorders before they occur.

References

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