Understanding Perfectionism and Eating Disorders

Perfectionism is often misunderstood as a positive trait, something that motivates achievement or reflects strong values. But in the context of eating disorders, perfectionism rarely functions that way. It tends to manifest as chronic self-evaluation, a persistent fear of falling short, and an internal pressure to avoid mistakes at any cost. Rather than pushing someone forward, it can trap them in patterns that feel impossible to break.

Understanding Perfectionist Traits

Perfectionism is not a single trait; it includes two broad dimensions: 

• Perfectionistic strivings: Involve the pursuit of high standards and can appear productive or even adaptive in certain environments.
• Perfectionistic concerns: Reflect a deeper preoccupation with failure, mistakes, and how one is perceived. They tend to be more emotionally damaging, especially when they involve harsh self-judgment or anxiety about not meeting internal expectations.

In eating disorders, perfectionism is often closely tied to a concept called clinical perfectionism, where self-worth becomes dependent on meeting rigid, often unrealistic standards. This is not limited to food or appearance; it can influence how someone approaches their relationships, education, work, and even recovery itself. What makes it clinically relevant is the persistence of distress and self-evaluation, even when those standards are clearly causing harm.

Research has consistently found associations between perfectionism and eating disorders, though much of it reflects diagnostic limitations. Many studies disproportionately include participants with anorexia or bulimia diagnoses, with less representation of binge eating disorder or other specified feeding or eating disorder (OSFED). Even so, perfectionism has emerged as a common factor across diagnoses, particularly when it takes the form of self-criticism and shame rather than goal-setting or high standards alone.

Perfectionism and the Persistence of Eating Disorders

Perfectionism does not just influence how eating disorders develop; it also shapes how they endure. When high standards shift from being motivating to being mandatory, they can turn daily eating habits and exercise routines into rigid rules that feel non-negotiable. This internal pressure often drives secrecy and self-surveillance, creating a fear of deviating from what has been set as “acceptable.” What starts as an attempt to manage distress or achieve control can become a cycle of self-criticism, where even small lapses feel like personal failures rather than natural fluctuations.

This same perfectionism can also interfere with recovery. Many people approach healing with the same unrelenting standards that once applied to food or appearance. They may hide setbacks, avoid talking about relapse, or feel that progress only counts if it is linear and complete. Recovery itself can begin to feel like another test of discipline, one that cannot be failed. When self-worth becomes tied to how well someone “does” treatment, the process of getting better can feel unsafe or impossible.

Perfectionism, therefore, sustains eating disorders both by reinforcing symptoms and by undermining the flexibility needed for change. Recognizing this dynamic can help people understand why letting go of rigid patterns is so difficult and why imperfect progress is still progress.

Addressing Perfectionism in Recovery

Treating perfectionism in the context of an eating disorder often requires a specific focus. While general therapy approaches may help with anxiety or depression, perfectionism can continue to operate beneath the surface unless it is named and addressed directly. One approach, cognitive behavioral therapy for perfectionism (CBT-P), has shown promise in helping people identify the patterns that keep them stuck in self-critical loops. It doesn’t ask people to lower their standards; it helps them understand where those standards came from. And it asks what happens when they’re not met and how those reactions affect emotional well-being.

Other approaches, like self-compassion work, can also be helpful, especially in softening the edges of shame or body image distress. But self-compassion alone is often not enough when perfectionism is deeply ingrained. Telling someone to be gentle with themselves does little if their internal rules insist that gentleness is failure. What’s more effective is helping people notice how rules show up across situations, and gradually build tolerance for not getting it right.

Redefining Progress in Recovery

Perfectionism does not have to be eliminated for recovery to be possible. But it does have to lose some of its authority. Progress cannot mean meeting a new set of flawless expectations. It has to include ambivalence and the reality of not always knowing what comes next. People in recovery often report feeling like they’re performing wellness rather than experiencing it. They worry about slipping up or appearing less put-together than they want to be. They worry about disappointing their loved ones and sometimes even their treatment teams. But healing does not require polish; it requires presence.

Redefining progress means recognizing that success is not always visible, neat, or immediate. It means understanding that the fear of being imperfect is not a reason to stay silent. And it means learning to value the ability to keep going.

Alexandra Perkinson, LMHC

Alexandra (Alex) Perkinson began in the field of mental health as a therapist specializing in addictions, eating disorders, and trauma. She has worked in various treatment settings and levels of care throughout the United States and abroad and now serves as the Chief Operating Officer of ‘Ai Pono Hawaii Eating Disorder Treatment Center on Maui, Hawaii and Central Coast Treatment Center in San Luis Obispo, CA.