Perfectionism and Eating Disorders

Introduction

            Perfectionism is personality trait in which perfectionists set excessively high personal standards for his/her own achievements. As a result, this excessively high standards result in behavioral psychopathology where perfectionistic cannot overcome those demanded standards for oneself. In the end, they have critically self-evaluation by the presence of failure in life events (Hewitt & Flett, 1991b). On the other hand, anorexia nervosa (AN) is an eating disorder where the its symptomology has perfectionistic characteristics. In literature, several reports show that perfectionism play major potential role in the etiology, maintenance and psychopathology of eating disorders (EDs) (Subha & Elizabeth, 2013; Sutandar‐Pinnock, Blake Woodside, Carter, Olmsted, & Kaplan, 2003). For example, anorexia nervosa (AN) as an eating disorder mostly seen in women result in major reduction in food intake to have perfect weight, body and shape. They reduce intake of food to have approval in society as well as they set highly unrealistic standards where they cannot overcome. In the end, they become underweight with impairment in physical health (Wilson, 1999).

            There are several reports in literature that proves the link between perfectionism and EDs. In this report, it was aimed to collect several research that analyzes the role of perfectionism in EDs by providing examples and comparisons.

The Multidimensional Perfectionism

            At the beginning of perfectionism research, two forms of perfectionism were described such as normal and neurotic (Hamachek, 1978). In both neurotic and normal perfectionism, individuals have excessively higher standards however, neurotic perfectionism differ from normal perfectionism where it included psychopathology. In neurotic perfectionism, there is dissatisfaction with unrealistic excessive standards which result in unhealthy form of perfectionism. These descriptions further changed into maladaptive and adaptive perfectionism with similar situation. From maladaptive perspective, unattainable ideal are tried to be achieved by perfectionistic. However, in adaptive form of perfectionism, motivation of perfectionists drives to reach their goals. Apart from those descriptions, it was considered that perfectionism has multidimensional point. Three dimensions of perfectionism was proposed as self-oriented, socially-prescribed and other oriented (Hewitt & Flett, 1991a). Self-oriented perfectionism (SOP) describes the perfectionistic behavior where unrealistic higher standards set by oneself influence self. However, in socially prescribed perfectionism (SOP), perfectionistic standards are driven by perfect expectation of others. In other oriented perfectionism (OOP), perfectionists have unrealistic expectancies to others, in the end, he/she has perfectionistic motivations.

The Nature of Eating Disorders (EDs)

            EDs are health problems in which psychopathology of disease seriously influence on patient’s life. Two types of EDs are named as anorexia nervosa (AN) and bulimia nervosa (BN). As a serious mental disorder, in AN, distorted cognitions about body shape and weight occurs by the reduction of food intake. Two types of AN are as follows: restricting subtype and binge eating subtype. Patients in restricting subtype performs calorie restriction, while in binge eating subtype, they engage in binge eating and purge not to gain weight. People with AN, have excessive exercise, food restriction and vomit activities with a fear of gaining weight (Subha & Elizabeth, 2013). In BN, self-induced vomiting and bingeing characteristics were observed to prevent weight gain.

Measurement of Multidimensional Perfectionism and EDs

            Different researches use distinct scales in the assessment of perfectionism and EDs. For example, multidimensional perfectionism is assessed multidimensional perfectionism scale (MPS). The evaluation of SOP, SPP and OOP is done by MPS-H which is 45 item scale that scores multidimensional perfectionism according to some assumptions (Hewitt & Flett, 1991b). In addition to this scale, MPS-F is the 35 items questionnaire which evaluates the multidimensional perfectionism (Frost, Marten, Lahart, & Rosenblate, 1990). For EDs, several measurements were invented. For instance, Eating Disorders Inventory (EDI) measures AN and BN related psychopathology (Garner, Olmstead, & Polivy, 1983). Another scale for EDs is Yale-Brown-Cornell Eating Disorder Scale includes eight items which measures abnormal eating disorders in patients (Mazure, Halmi, Sunday, Romano, & Einhorn, 1994).

Research on Perfectionism and Eating Disorders

            Current literature suggests a lot of report that finds link between perfectionism and EDs.

In an old 2003 report, study aimed to find consequences of perfectionism in AN. Patient with AN took at least four weeks of inpatient treatment by hospitalization. During six to twenty-four-month treatment period, patients answered different eating disorder evaluation scales.  Following treatment, their perfectionism scores were evaluated. In the end, individuals having EDs show highly perfectionistic treats even after treatments. Additionally, robust perfectionists have difficult time to complete the treatment. Authors conclude that rigidity in thinking makes worse the course and treatment of the disease. Therefore, having psychological change in those individuals became difficult (Sutandar‐Pinnock et al., 2003).

            In another study, researchers investigated link between multidimensional perfectionism, EDs symptomology and appearance of self-esteem in college students. As a result, they found that EDs are connected to SPP and appearance of self-esteem. They proposed that disordered eating behavior are directed by others. Their motivation of study is that perfectionistic sit herself on center to get to be acceptable by others where her perfectionistic behaviors develop. Authors also note that, OOP has linkage with increased body image avoidance. They explain this situation by having perfectionistic feelings about one’s body image might result in needing of others to be perfect. They also link perfectionistic style in individuals with EDs are relatively have poor self-esteem and self-presentation (Hewitt, Flett, & Ediger, 1995).

            One research was conducted to find relation between EDs and components of perfectionism. In this study, authors found the increased scores in perfectionism especially in its concern over mistakes component. Concern over mistakes can be interpreted as negative consequences of mistakes in failure. This component was especially higher in individuals with EDs. In addition to this, doubt about actions component is also correlated in individuals having EDs. Doubts about actions component evaluates ability to manage the tasks in perfectionism. In the end, authors concluded that perfectionism are emerged as a result of EDs. Individuals having EDs negatively judge themselves by their mistakes in failure. They also note that there must be other mental disorders that they did not evaluate and limitations may arise (Bulik et al., 2003).

            In more recent research, cognitive behavioral group intervention was used to target perfectionism in anorexics. The main purpose of research was to find effectiveness of group intervention by targeting perfectionism in adults with AN. Cognitive behavioral therapy was utilized to change aberrant psychopathology occurring in mind of perfectionists. By means of cognitive behavioral therapy, abnormal thoughts and as well as perfectionistic unrealistic standards of patients are tried to be reduced. Authors observed the rigidity in intervention in individuals having low body weight. As a result, the effectiveness of therapy reduced. Reduction in perfectionism helps to change individuals with increase in their life quality (Lloyd, Fleming, Schmidt, & Tchanturia, 2014)

Conclusion

            In this brief report, the role of perfectionism on EDs was discussed. Basically, perfectionism has multidimensional structure that closely linked to EDs, especially AN. In perfectionism, individual set excessive high standard themselves and this situation is similar in AN. Generally, anorexics have so rigid perfectionism that, this situation creates major problem in treatments. Apart from that, self-prescribed perfectionism has strong association with AN where abnormal eating behavior of individuals are directed by others. As a result, in order to get acceptance and approval from surrounding environment, perfectionistic reduce his/her own food intake and AN develops.

            When the dimensions of perfectionism were considered, adults with eating disorder have strong fear of their mistakes where concern over mistakes component of perfectionism strongly associated with disordered eating. Lastly, perfectionists with eating disorder might be treated via cognitive behavioral intervention, even though their perfectionistic thoughts are so rigid. However, since changing the mind of perfectionist is too hard, this situation have impact on intervention on therapies.

            Several research, of course includes some limitations in terms of having sample homogeneity and bias. Apart from that, in spite of being serious problem, current literature provides several examples understanding basic nature of EDs behind perfectionism.

            Consequently, this review has compared basic evidences and examples from literature. The more we know about EDs and perfectionism, the better we change the negative results arise from the disease psychopathology.

                                                           References    

Bulik, C. M., Tozzi, F., Anderson, C., Mazzeo, S. E., Aggen, S., & Sullivan, P. F. (2003). The relation between eating disorders and components of perfectionism. American Journal of Psychiatry.

Frost, R. O., Marten, P., Lahart, C., & Rosenblate, R. (1990). The dimensions of perfectionism. Cognitive therapy and research, 14(5), 449-468.

Garner, D. M., Olmstead, M. P., & Polivy, J. (1983). Development and validation of a multidimensional eating disorder inventory for anorexia nervosa and bulimia. International Journal of Eating Disorders, 2(2), 15-34.

Hamachek, D. E. (1978). Psychodynamics of normal and neurotic perfectionism. Psychology: A Journal of Human Behavior.

Hewitt, P. L., & Flett, G. L. (1991a). Dimensions of perfectionism in unipolar depression. Journal of abnormal psychology, 100(1), 98.

Hewitt, P. L., & Flett, G. L. (1991b). Perfectionism in the self and social contexts: conceptualization, assessment, and association with psychopathology. Journal of personality and social psychology, 60(3), 456.

Hewitt, P. L., Flett, G. L., & Ediger, E. (1995). Perfectionism traits and perfectionistic self-presentation in eating disorder attitudes, characteristics, and symptoms. International Journal of Eating Disorders, 18(4), 317-326.

Lloyd, S., Fleming, C., Schmidt, U., & Tchanturia, K. (2014). Targeting perfectionism in anorexia nervosa using a group‐based cognitive behavioural approach: a pilot study. European Eating Disorders Review, 22(5), 366-372.

Mazure, C. M., Halmi, K. A., Sunday, S. R., Romano, S. J., & Einhorn, A. M. (1994). The Yale-Brown-Cornell eating disorder scale: development, use, reliability and validity. Journal of Psychiatric Research, 28(5), 425-445.

Subha, M., & Elizabeth, V. (2013). EATING DISORDER-AN ALARMING HEALTH PROBLEM. Asian Journal of Pharmaceutical and Clinical Research, 1(1).

Sutandar‐Pinnock, K., Blake Woodside, D., Carter, J. C., Olmsted, M. P., & Kaplan, A. S. (2003). Perfectionism in anorexia nervosa: A 6–24‐month follow‐up study. International Journal of Eating Disorders, 33(2), 225-229.

Wilson, G. T. (1999). Cognitive behavior therapy for eating disorders: Progress and problems. Behaviour Research and Therapy, 37, S79-S95.