Stretching beyond the ideals of an over-achiever, a perfectionist creates a situation in which they can’t ever meet their own expectations or standards. In some cases, this can lead to anxiety, depression, self-hatred, and even the loss of identity, according to Alison Locklear, LCSW, Senior Eating Disorders Therapist at Penn Medicine Princeton Center for Eating Disorders.
“Most perfectionists realize that they can’t ever be perfect, but that doesn’t stop them from trying,” says Locklear. “It’s really more about chasing a feeling than the pursuit of perfection. That feeling is different for each perfectionist – it can range from a sense of control or safety to feeling competent, loved, or respected.”
When a perfectionist is introduced to unachievable body image or body culture ideals, it can be a recipe for the development of an eating disorder. Perfectionists may immediately try to meet these standards, and then continue to raise the bar.
“Perfectionism and an eating disorder play off of each other, because the eating disorder itself is a perfectionist,” explains Locklear. “An eating disorder always raises the bar but never allows an individual to meet it, and it can emotionally bully anyone who doesn’t attain its impossible standards.”
During treatment for eating disorders, patients sometimes exhibit treatment perfectionism. They may strive to be fully compliant during treatment, but then a mistake after discharge can lead to relapse, because most perfectionists can’t tolerate mistakes.
“Sometimes mistakes are the most important part of treatment,” says Locklear. “A bad day or week doesn’t define who someone is as a person, and patients need to do the hard work to challenge these beliefs. It’s also important for providers to set a tone that celebrates vulnerability while managing their own emotional responses in order to truly meet patients where they are.”
Because perfectionism is both common and detrimental in those with eating disorders, the Princeton Center for Eating Disorders team has developed several initiatives to specifically address it.
RO-DBT Group
Based on the treatment philosophy and workbook developed by psychologist Thomas Lynch, PhD, Princeton Center for Eating Disorders has created a weekly psychoeducation group centering on radically open dialectical behavior therapy (RO-DBT). RO-DBT was initially created for overcontrolled styles of emotion and interpersonal expression (with traditional DBT created for undercontrolled styles).
RO-DBT is beneficial for those with perfectionist tendencies, as it aims to create more flexibility in thinking, greater openness to new situations, and an improved ability to express emotions. It’s overarching goal is to create “a life worth sharing,” recognizing that genuine social connection and the ability to be socially flexible can improve overall mental health. The group is currently available for adult patients, with an adolescent curriculum in development. It focuses heavily on mindfulness skills, practicing openness, and even incorporating therapeutic play that helps activate social safety – such as asking patients to say their names in a monotone voice, and then to do the same while raising their eyebrows and smiling.
Challenging Perfectionism Group
Available to child and adolescent patients, the weekly Challenging Perfectionism Group focuses heavily on CBT skills. Young patients explore the ways perfectionism interferes with life and learn to challenge thought distortions. In one exercise, patients write a letter to their treatment team describing what would happen if they weren’t perfect in treatment – giving them the opportunity to consider and confront their fears.
Challenging Perfectionism Art Therapy Group
According to Allied Clinical Therapist Shea Andrews, art is an ideal way to challenge perfectionism, because it’s about exploring where the process leads rather than seeking a perfect result. In the Challenging Perfectionism Art Therapy Group, Andrews incorporates process painting, inviting patients to choose colors they may not like without thinking about what they’ll select next. To ease the need for control, she may recommend using a non-dominant hand, creating a piece of artwork as a group, splattering paint, or setting erasers aside. (Patient artwork pictured above).
“Both art and life can be messy, but that’s part of the beauty,” says Andrews. “We create an inviting, safe place
to explore that.”