Perfectionism in Eating Disorders: Treatment Guide

Perfectionism makes eating disorders worse and harder to treat. Here's what you need to know and how to get help:

Key Points	Details
Main Issue	Perfectionism + eating disorders create rigid food rules and impossible body standards
Warning Signs	- Zero flexibility with food - Black/white thinking about eating - Harsh self-criticism - Obsessive food/exercise control
Treatment Options	- CBT therapy (66% success rate) - Mindfulness practices - RO-DBT therapy
Getting Help	- Find eating disorder specialist - Start therapy sessions - Build support network

Quick Facts:

Women are 3x more likely to develop eating disorders
41% face setbacks in first 18 months
Early treatment works better

Need Help Now?

Text "ALLIANCE" to 741-741
Call 988 for immediate support
National Eating Disorders Helpline: 1-800-931-2237

This guide walks you through spotting signs, getting treatment, and staying in recovery. We'll show you step-by-step how to break free from perfectionist patterns that keep eating disorders going.

Let's be clear: You don't have to figure this out alone. Help is available, and recovery is possible.

How Perfectionism and Eating Disorders Connect

Clinical perfectionism isn't just about high standards - it's when those standards take over your life. People with clinical perfectionism base their entire self-worth on meeting extreme goals. They can't shake off small mistakes and don't enjoy their wins because they're too busy looking for flaws.

Here's what it looks like in real life:

They judge themselves based on strict rules
Small mistakes feel like huge failures
Success doesn't feel good because they spot every tiny flaw
They keep pushing even when it's harmful

When perfectionism meets eating disorders, it creates specific patterns:

Behavior	Impact on Eating Disorder
Food Rules	Making strict lists of "allowed" and "forbidden" foods
Exercise	Feeling forced to burn off every eaten calorie
Weight	Setting impossible weight goals
Body Image	Never-ending self-criticism
Meal Planning	Over-controlling portions and calories

"Perfectionism can be closely tied to shame, which, at least for me, was a core feature of my eating disorder and mental health struggles as a whole." - Jamie Drago, Equip Peer Mentor

Research points to three main ways perfectionism shows up in eating disorders:

Type	How It Shows Up
Self-Directed	Extreme rules about food, weight, and exercise
Social	Worry about others judging eating habits or body
Physical	Chase for an impossible "perfect" body

A study of 193 anorexia patients found something important: Those with high perfectionism ate less, felt worse about themselves, and struggled more with anxiety and depression.

"While many people may assume that a restrictive eating disorder like anorexia may be most associated with perfectionism, I think it's important to recognize that perfectionism can actually be a factor in any eating disorder." - Jamie Drago, Equip Peer Mentor

It's a two-way street: perfectionism can kick off eating disorders, and eating disorders can make perfectionism worse. Breaking free means tackling both issues head-on.

Spotting the Signs

Let's break down what happens when perfectionism meets eating disorders. These patterns show up in specific ways:

Area	What to Look For
Food Behaviors	- Making strict "good" vs "bad" food lists - Hiding when eating - Following exact food routines - Avoiding meals with others
Exercise	- Pushing through workouts when sick or hurt - Getting anxious about missed workouts - Obsessing over calories burned
Body	- Stepping on the scale multiple times daily - Looking at body parts over and over - Strong fear about gaining weight
Mind	- Seeing food choices as only right or wrong - Being harsh on yourself about eating - Feeling bad after eating

Here's what to ask yourself:

Ask This	It's a Problem If You Say "Yes"
Do you feel bad after eating?	Shows unhealthy thoughts about food
Must you exercise no matter what?	Shows too much control
Do small food "mess-ups" wreck your day?	Shows perfectionist patterns
Are you hiding how you eat from others?	Shows shame and control issues

"People often feel nothing is enough. They're never satisfied, never feel good enough, and can't enjoy what they've done." - Susan Albers, PsyD

When to Get Help

Talk to a doctor if:

Your food rules run your life
Food and weight thoughts won't stop
You notice physical problems:
- Throat pain
- Teeth issues
- Stomach pain
- Heart concerns

Body Signs	Mind Signs
Swollen neck glands	Can't eat without stress
Damaged teeth	Food thoughts take over
Stomach burning	Fear of eating near others
Heart issues	Deep eating shame
Weight shifts	Stuck in food rules

Don't wait to get help - early treatment works better. If you see these signs, reach out now.

Treatment Methods

Here are the 3 main therapies that help with perfectionism in eating disorders:

Treatment Type	Main Focus	Key Benefits
CBT	Changes perfectionist thoughts and actions	- Stops binge-eating and purging in 42% of cases after 5 months - 66% reach remission with CBT-E
Mindfulness	Builds present-moment focus	- Helps with bulimia, anorexia, and binge-eating - Less self-criticism
RO-DBT	Opens up emotional expression	- Better social connections - Less rigid thinking

CBT Methods

CBT helps you change your perfectionist thinking patterns. Here's what happens in CBT:

Your therapist works with you to:

Break down strict food rules
Track what you eat
Practice eating foods you avoid
Create goals you can actually reach

"While a number of different CBT approaches are available for the treatment of perfectionism, future studies should examine which interventions work best for different patient types." - Melanie Wegerer, Department of Psychology, University of Salzburg

Using Mindfulness

Mindfulness shifts your focus from perfect outcomes to the present moment. It's that simple.

The practice includes:

Paying attention to right now
Simple breathing exercises
Basic meditation

Research shows students who tried Mindfulness-Based Cognitive Therapy (MBCT) got these results:

Lower perfectionism scores
More self-kindness
Better mindfulness skills

RO-DBT Basics

RO-DBT helps you open up about your feelings. Here's what it does:

Makes it easier to connect with others
Helps you let go of strict rules
Shows you how to be more flexible

"Eating disorders are serious conditions that can affect their mental and physical health, relationships with others, and ability to enjoy life." - Fiona Yassin, Founder and Clinical Director at The Wave Clinic

Want the best results? Here's what to do:

Choose a therapy that matches your situation
Keep showing up
Use what you learn every day
Tell your therapist when something's not working

Daily Coping Tips

Here's how to deal with perfectionism in simple steps:

Setting Better Goals

Let's make goals you can actually hit:

Goal Type	What Doesn't Work	What Works
Food	"No more sugar ever"	"I'll eat one veggie at dinner"
Exercise	"2-hour workouts daily"	"15-minute walk today"
Recovery	"Get better right now"	"Try one coping skill"

Changing Negative Thoughts

Here's a simple way to spot and fix those perfectionist thoughts:

1. Catch Your Thoughts

Write them down when they pop up. Note what triggered them. Keep it simple with a small notebook.

2. Look at the Facts

Compare your thoughts to reality. Would you judge your friend this harshly? Write down what's actually true, not what your perfectionist brain says.

"Perfectionism often involves harsh self-criticism and a lack of self-acceptance. Developing self-compassion is crucial in overcoming perfectionism in binge eating." - Dr. Nina Savelle-Rocklin, Author and Psychoanalyst

Being Kinder to Yourself

Here are some self-care moves that work:

Time	Activity	Result
5 min	Play uplifting music	Less anxiety
10 min	Journal your thoughts	See thought patterns
15 min	Sit in quiet	Lower stress

Make It Work:

Pick activities that help YOU feel good
Put sticky notes where you'll see them
Step away when things get tough
Do something nice for yourself each day

"Learning how to take notice of our needs and make an action towards meeting those needs can be uncomfortable." - Katie Bendel, LMSW, Alumni/Family Liaison for Eating Recovery Center

Your recovery path? It's YOURS. Some days will be tough. That's just part of it.

Making Recovery Work

Here's what works for eating disorder recovery:

Goal Type	What to Include	Example
Daily	Small steps	Eat 3 meals at set times
Weekly	Check-in tasks	Send meal photos to dietitian
Monthly	Progress steps	Add one new food each week

The SMART method helps you stay on track:

Specific: "Eat at 8 AM" beats "Eat more"
Measurable: Count your meals
Attainable: Take baby steps
Relevant: Focus on what helps recovery
Time-bound: Set clear dates

"Meeting clients where they are builds trust and creates eating patterns that stick." - Meg Salvia, MS, RDN, CDE

Breaking Free From Food Rules

Let's turn strict rules into flexible habits:

Old Pattern	New Approach
Exact meal times	+/- 30 minutes
Same foods only	One new food weekly
Exact portions	Rough estimates

"Want to beat an eating disorder? Practice flexibility." - Jenni Schaefer, Author

What Works:

Share meal photos with your team
List your food choices (no judging!)
Make meal plans you can change
Track ALL progress, not just setbacks

Your meal plan should HELP you recover. If it doesn't? Talk to your team and switch things up.

Getting Professional Help

You'll need expert support to overcome perfectionism and eating disorders. Here's what works:

One-on-One Therapy

You'll meet with an eating disorder specialist for 50-minute sessions, once or twice per week.

Treatment Phase	What Happens
Starting Out	Your specialist checks your perfectionism and eating habits
Middle Work	You learn better ways to cope and think
Final Steps	You practice being flexible and build your strength

"Work with therapists who specialize in eating disorders - you need and deserve that level of expertise." - Sarah Davis, Certified Eating Disorder Specialist

Support Networks

Recovery works better with help from others:

Who Helps	How They Help
Family	Support during meals and daily life
Group Members	Share stories and tips with others in recovery
Care Team	Your providers work together for you

Need help finding treatment? Call the National Alliance for Eating Disorders: 866-662-1235 (9 AM - 7 PM EST, Monday-Friday).

Medicine Options

Your treatment might include:

Care Type	When It's Right
Residential	You need around-the-clock support
Partial Hospital	You can live at home but need daily help
Intensive Outpatient	You need several sessions each week

"I see people recover every day. You can too." - Melissa Spann, PhD, LMHC, CEDS-S

Ready to Start? Do This:

Pick a certified eating disorder specialist
Ask about their perfectionism experience
Check your insurance coverage
Book your first visit
Write down your questions

Need help NOW?

Text "ALLIANCE" to 741-741
Call 988 for instant support

Staying on Track

Studies show 41% of people recovering from anorexia nervosa face setbacks within 18 months. But here's the thing: setbacks don't mean failure. Let's look at what works.

Spot Problems Early

Here's what to watch for (and what to do about it):

Warning Sign	What to Do
Missing meals	Jump back to your 3 meals + 2-3 snacks
Food/weight worries pop up	Tell your support person NOW
Those "perfect" thoughts come back	Pull out your therapy tools
Feeling overwhelmed	Get help before it snowballs

When something feels off:

Write down what set it off
Pick up the phone (your support team wants to help)
Schedule a therapy check-in
Stick to your meal plan (even when it's hard)

"Learning how to recover from an eating disorder takes time, and you'll need talented treatment professionals to help you on your journey." - Jacquelyn Ekern, MS, LPC

Make It Stick

What to Do	How to Do It
Daily Basics	Eat at set times, take care of yourself
Keep Connected	Talk to your team, show up at support groups
Stay Alert	Use tools like EAT-26 to track how you're doing
Clean Up Social	Delete stuff that bugs you, follow recovery wins

Here's what works:

Drop the perfect recovery myth
Show up for therapy
Practice those coping skills
Build your support squad

"Perfectionism can be a dangerous and unnecessary challenge throughout your continued sober journey." - Hawaii Island Recovery

If things get rough:

Text "ALLIANCE" to 741-741
Call your therapist
Use your backup plan
Remember: Slips happen. They're not the end.

Track your day:

Check This	Ask Yourself
Food	Did I eat what I planned?
Coping	Did I handle stress without old habits?
Help	Did I reach out when I needed to?
Self-Care	Was I on my own team today?

Bottom line: Recovery's a journey, not a race. Keep moving forward.

Women's Specific Issues

Women deal with eating disorders and perfectionism at much higher rates than men. Here's what the data shows:

Issue	Statistics
Diagnosis Rate	3x more likely than men
Age of Onset	Typically 18-21 years
Total Affected	Up to 20 million American women
Bulimia Rate	2-3% of women
Binge Eating	3.5% of women
Anorexia Rate	0.5-1% of women

What's behind these numbers? A few big factors:

The non-stop flood of social media images
Tying self-worth to weight
Major life changes affecting body image
Never-ending pressure about looks

"It's a complex interaction between the biology of being female, the biology of being female at puberty, as people go through that phase of life, and the cultural factors." - Douglas Bunnell, PhD, Chief Clinical Officer at Monte Nido Eating Disorder Treatment Centers

The Body Image Battle

Let's look at the stats:

Factor	Impact on Recovery
Body Image Issues	16% of eating disorder behaviors
Perfectionism	14% of disorder patterns
College Women	16-25% show binge eating
Teen Girls	44% show eating issues

What helps? A complete support system:

Teams of health pros working together
Focus on healing body image
Setting limits with social media
Learning to handle perfectionist thinking

For women who are pregnant, here's what to watch for:

Warning Signs	Action Steps
Weight gain fears	Medical monitoring
Diet attempts	Nutrition guidance
Body changes anxiety	Mental health support
Perfectionist thoughts	Regular check-ins

"Research consistently shows perfectionism to be elevated in people with eating disorders and people recovering from eating disorders." - Margot Rittenhouse, MS, PLPC, NCC

Need support? Connect with eating disorder specialists and women's health experts who can build a plan just for you.

Next Steps

Here's how to start your recovery:

Step	Action	What You'll Get
Medical Check	Schedule a physical exam	Your personalized treatment roadmap
Find Support	Call eating disorder experts	Professional guidance from the start
Start Treatment	Book therapy sessions	Help with food and perfectionism
Track Progress	Use assessment tools	Clear view of your recovery path

Need Help Now? Call These Numbers:

National Eating Disorders Association: 1-800-931-2237
Beat Eating Disorders (UK): 0345 643 1414
Butterfly Foundation (AUS): 1800 33 4673

"Perfectionism is a self-destructive and addictive belief system that fuels this primary thought: If I look perfect and do everything perfectly, I can avoid or minimize the painful feelings of shame, judgement, or blame." - Brené Brown, Author of The Gifts of Imperfection

Your Treatment Will Include:

Personal therapy
Food planning help
Health checks
Group support

Here's what to expect:

Recovery isn't a sprint - it's more like learning to walk again. Some days you'll move forward, others you might step back. That's normal. Your body and mind need time to adjust.

"You can accomplish great things without having to feel the tenacious pressure that your life worth primarily depends on your high performance." - Karen Geren, Counselor

Do These Things Every Day:

Eat at set times
Write down good moments
Sleep enough
Talk to your support people
Take care of yourself

You CAN break free from perfectionism and eating issues. Pick up the phone and make that first call - it's the biggest step you'll take.

Perfectionism in Eating Disorders: Treatment Guide

How Perfectionism and Eating Disorders Connect

Spotting the Signs

When to Get Help