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The Many Faces of Perfectionism

Reprinted from Eating Disorders Today
By Nancy Zucker, Ph.D.

Rebecca walks into my office wearing her perfectionism like a badge of honor. As the session progresses, however, it becomes clear that the weight of this badge is unbearable. These divergent effects speak to the complexity of perfectionism, a characteristic often attributed to individuals with eating disorders and their families. The purpose of this article is to explore the nature of this characteristic and its role in the development of an eating disorder.

The Dual Nature of Perfectionism
What do we mean by the term perfectionism? Although some experts define it in such simple terms as a "striving for flawlessness" (Flett and Hewitt 2002), perfectionism is a complex quality which has both negative and positive elements. First, to help understand why this feature can be maladaptive, let's consider how it may develop.

Perfectionism is usually derived from a variety of sources and it is most likely a combination of these sources that leads to its development. For example, imagine that you had a parent who was extremely perfectionistic. Every time they did something "wrong," they criticized themselves mercilessly. It's not hard to imagine that you would learn the lesson, "making mistakes is really bad." What if you were surrounded by media messages inferring that, "people will like you more if you have the perfect body, the perfect smile, the perfect skin.....?" You would then learn that, "being perfect makes people like you." If your life felt chaotic, you might feel safer by forming rules for yourself. In this case, rigid rules, the essence of negative perfectionism, would be reinforcing (Flett, Hewitt et al. 2002). Finally, there is increasing evidence that elements of perfectionism may actually have a genetic component. Thus, it is evident that there are many paths to perfectionism, some of which make "perfect" sense. Once present, however, the negative consequences can be stifling.

As mentioned earlier, perfectionism can take either a healthy or a destructive form. Individuals who exhibit its more healthy form set and work towards realistic goals. These goals take into account the person's strengths, desires, and current physical, emotional and mental states. Although failure to achieve a goal is met with disappointment, the experience does not threaten their identity or confidence. In this way, goals are modifiable based on feedback. Thus, when a "healthy perfectionist" who wants to get "all A's" in school gets a "B," they might be disappointed, but will use the experience as an opportunity for learning.

In contrast, individuals with the negative form of perfectionism exhibit the opposite characteristics. Goals are extreme, rigid, and inflexible. Rather than taking individual preferences and strengths into consideration, "negative perfectionists" often set goals according to external standards or impossible internal standards. When these goals are not achieved, the individual's sense of identity is threatened and they feel like a failure. As a result of getting a "B" grade in school, their self-talk might be, "I failed on this test, therefore, I am a failure." One of the critical elements of this state, then, is forming rigid standards of performance that do not consider or adapt to the individual as a person.

"Rebecca was furious-at herself. She had vowed she would run 3 miles, but her legs didn't want to cooperate. She would push on anyway. After all, 3 miles was the goal. And why was she so gosh darn hungry? How annoying when the scale didn't read what she thought it should this morning and yet her body wanted food. How lazy she must be! And then there was her mood. She felt off today. . . but she can't let anyone know. They might think less of her if they knew she had down days."

Negative Perfectionism and Identity
By keeping the focus on goals that are rigid, unrealistic or externally derived, negative perfectionism can affect the process of developing a sense of "who you are"-in other words, your identity. To illustrate, think about the relationship between a caring parent and a child. Among many tasks, a caring parent attends to a child's hunger and fatigue, pays attention to emotional displays and teaches how to manage and learn from those emotions, encourages exploration and the initiation of new activities, and sets appropriate limits and boundaries. In many ways, forming a sense of identity parallels this process. In fact, acting as a caring parent towards ourselves helps us to learn "who we are." When an individual learns to turn her attention inward, listen and responds to her needs and emotions, explore new opportunities, and learn appropriate personal boundaries, she learns about herself--her likes, dislikes, limits, and preferences. She will then be more able to set flexible, realistic goals based on personal preferences, abilities and situations.

However, the attitudes of a negative perfectionist are not those of a caring parent. Setting rigid rules without regard to needs, imposing standards without taking into account preferences and desires, imposing limits without considering one's natural state of being-these processes all defy the development of a positive relationship with oneself. Perhaps equally important, these standards interfere with learning about who we ARE. How can we learn about ourselves if we ignore what is going on inside of us? How can we set meaningful or attainable goals if we don't know what is personally fulfilling or realistically within our reach? Is it any wonder that perfectionists have tied their identities to accomplishments since they have not come to know who they really are?

Perfectionism and Eating Disorders
So, what is the connection between perfectionism and eating disorders? An eating disorder is an example of negative perfectionism played out in its most destructive form. In this case, the rigid, inflexible rules apply to eating habits, appearance, and body weight regulation, the effects of which are varied and pervasive. The physical consequences, such as low body weight and poor nutrition, affect concentration and motivation. Interests narrow, energy wanes, and the desire for self-exploration deadens. Also, such rigid rules regarding what, when and how much to eat interfere with learning to read hunger and satiety (fullness) cues, a fundamental part of self-care. The ultimate effect is that barriers to learning more about oneself are erected at many levels of functioning--from the satisfaction of basic internal needs to the expression of external interests, desires, and goals. Not surprising that, for many individuals, an eating disorder becomes the identity. The rigidity of the perfectionism has succeeded in halting the acquisition of self-knowledge.

So how does one go about improving this situation? According to this model, we believe that addressing perfectionism requires teaching an individual how to tune in and respond to her wants, needs, and limits. This, in turn, allows her to adapt her "rules of living" to be more flexible. Like a healthy perfectionist, her guidelines then become more adaptable. Such guidelines provide feedback and opportunities for learning rather than the rigid, stifling laws of a negative perfectionist.

Bibliography
Flett, G. L. and P. L. Hewitt (2002). Perfectionism and maladjustment: An overview of theoretical, definitional, and treatment Issues. Perfectionism : Theory, research, and treatment. G. L. Flett and P. L. Hewitt. Washington, D.C., American Psychological Association.

Flett, G. L. and P. L. Hewitt, et al. (2002). Perfectionism in children and their parents: A developmental analysis. Perfectionism: Theory, research, and treatment. G. L. Flett and P. L. Hewitt. Washington, D.C., American Psychological Association.

The Author
Nancy Zucker, PhD. is an assistant professor in the Department of Psychiatry at Duke University Medical Center and is the director of the Duke Eating Disorders Program. Her area of research and clincial interest involves helping parents feel confident in the task of parenting.

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