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Starving for Perfection: The Link Between Anorexia and Perfectionism
May 3, 2011
In a world filled with the media’s projection of the “ideal” body, abnormally thin celebrities and models, and the rage to have the newest hot commodity, people are now bound to feel the need to be perfect in every possible way. Today’s advertisements are being used to portray women as being strikingly thin as well as successful and to promote the “magic” pill that insures major weight loss. Adolescents and young adults are thus pressured to reach these “perfect” bodies by any means necessary, which can lead to anorexia. Anorexia is not just a disorder that affects a person mentally and physically; it also can become a routine and lifestyle for certain people. However, in reality, no one can really be perfect, “but anorexics think they should be” (Livai 2007). Although, there is not a clear cause for anorexia, many studies link people with certain characteristics and personality traits as candidates susceptible or prone to having anorexia. Perfectionism is a personality disorder described as “a tendency to place excessive emphasis on precision and organization, the setting of and striving for unrealistic personal standards, critical self-evaluation if these standards are not reached, excessive concern over mistakes, and doubts about the quality of personal achievements” (Castro- Fornieles et al., 2007, p. 562). Thus, according to new findings, there is an apparent link between anorexia and perfectionism. Through intensive research and study, hopefully a way can be found to prevent the start of anorexia from the beginning or before it is too late. Therefore, it is crucial to define the connection between anorexia and perfectionism in order to see its complexity and grasp the risk behind it.
Anorexia nervosa is an eating disorder in which a person refuses to eat or has a very restricting diet that they follow in order to maintain an intentional body weight below fifteen percent of what is considered a healthy body weight for a person’s age and height. People with anorexia are affected both mentally and physically. What starts out as normal diet and exercise, turns into a crucial limit of food intake and detrimentally low weight and dangerous weight loss (WebMD Medical Reference from Healthwise, 2009).This drastic weight loss is a sign of control and once it is conquered, anorexics usually keep going adding things like diet pills, extreme exercising, laxatives, diuretics and other sources to induce a loss of appetite which results in more weight loss almost to the point of starvation. Anorexia can begin to affect how a person interacts socially, cause one to become obsessed with food and rituals, cause hair loss, dental problems, amenorrhea (in women), fatigue, low body temperatures, and bone density loss (WebMD Medical Reference from Healthwise, 2009). The causes of anorexia are unknown, but researches are looking into all factors that may contribute to it (psychological, behavioral, mental, personality traits, etc.). However, media’s advertisement of beautiful, thin, successful people can cause people to want to live in the “satisfying, awarding” life of being thin. There are two types of anorexia: restricting and binge/purge type. The restricting anorexic tends to eat very small meals with few calories in order to maintain body weight; the binge/purge type anorexic tends to eat abnormally large amounts of food for an anorexic (i.e. an average amount of food, a cookie, etc.) and then purges (i.e. vomiting, excessive exercise, etc.) in order to get rid of the excess calories (http://www.anad.org/get-information/about-eating-disorders/anorexia-nervosa/).
Tying the Knot between Anorexia and Perfectionism
According to new studies, people who have trouble handling their own mistakes are more susceptible to gaining an eating disorder, like anorexia. A study involving 1000 female twins in 2003, aged 25-65, used standardized tests and interviews to study the link between perfectionism and anorexia. Researchers claim that perfectionism is a personality trait in which people excessively criticize themselves. They also need to have a abnormal sense of approval and are deeply infatuated by their mistakes to the point of obsession. If they fail to get these things, then they feel like failures. Researchers were able to connect the negative emotions over mistakes and personal failure in a perfectionist as a direct link to anorexia (WebMD Medical Reference from Healthwise, 2003). Cynthia Bulik, PhD, of the Virginia Institute for Psychiatric and Behavioral Genetics at Virginia Commonwealth University stated that "these findings tell us that there may be something unique about perfectionism that sets up a person for being at risk for anorexia”. Thus, it can become possible to detect some stages of anorexia before they occur by helping a perfectionistic person reconsider their unrealistic goals. If not caught early on, people will become wrapped up inside their goals that are unattainable and may begin to develop an eating disorder to reach the goal. Considering that a perfectionist is not fully satisfied and has imagined fallacies, it is clear why many anorexics start as perfectionists. Eating food to a perfectionist may be the deterrent into getting the perfect body or fitting into the smallest dress: the act of eating is for failures in their mind. It can start as dieting, but can end up as a restricting anorexic. Although not yet proven, it is clear how one can depict that anorexia may be one of the branches off the tree of perfectionism.
Recent Scientific Studies Show a Possible Link Between Anorexia and Perfectionism
Numerous studies have seen the possibility of the existence of perfectionism in anorexics. Both studies below interpret how perfectionism can influence anorexia and how it is common among anorexics.
Dr. Katherine Halmi et. al, conducted a study of 322 women who had a history of some type of anorexia nervosa (restricting, binge eating/purging, or purging) with women who did not in 2000. The study was used to show if there was a phenotypic trait of perfectionism within the anorexic women (Halmi, Sunday, et. al, 2000, pgs. 1799-1805). The researchers used the following measures in order to better understand the women involved:
--Multidimensional Perfectionism Scale (MPS): MPS is a self-report questionnaire that measures the six features of perfectionism (concern over mistakes, personal standards, parental expectations, parental criticism, doubts about actions, and organization) and gives an overall perfectionism score.
--Eating Disorder Inventory-2 (EDI-2): This is another scale that measures perfectionism but is specifically used for people with eating disorders.
--Yale-Brown Obsessive Compulsive Scale: A reliable and valid interview generates a symptom checklist for both current and lifetime symptoms, then process-oriented questions are asked about the obsessions and about the compulsions.
--Yale-Brown-Cornell Eating Disorder Scale: Another interview type tool that assesses core preoccupations and rituals that are related to food, eating, exercise, and the subject’s weight and body.
The results from the Multidimensional Perfectionism Scale were significantly higher for the people with anorexia than it was for the people without. Also, the scores for the anorexia women for the Eating Disorder Inventory-2 (subscale of perfectionism) were exceedingly above the scores for the normative data that was collected. Furthermore, the total score for the MPS and EDI-2 were highly correlated. The results show that perfectionism is more than likely a variable associated with anorexia as a phenotypic trait. Halmi concluded that “the extent of perfectionism was directly associated with the severity of victims' anorexia nervosa” (Livai 2007).
Though the results showed the relationship between anorexia and perfectionism, they may have been skewed. The women involved in the study were from the same area, so it may have been part of their environment to be perfect. Also, the interviews conducted could have been full of lies and bias due to the interviewer and the interviewee. Even though these cases can be likely (very rare), the results seemed very accurate and valid.
Three years later Dr. Cynthia M. Bulik et al. conducted another study with an older group of female-female twins. These subjects, all born between 1934-1974, were collected from the Virginia Twin Registry. Questionnaires containing 12 items from the MSP were sent to the following individuals (Bulik, Tozzi, et al., pgs.366-368). Also, many of the subjects took part in an interview. The researchers used the answers to these completed questionnaires and interviews in order to calculate the odds ratios for the links amongst perfectionism subscale scores and psychiatric disorders in the 1,010 female twins who participated. Out of all the seven psychiatric syndromes tested (anorexia nervosa, bulimia nervosa, depression, alcohol abuse, anxiety disorder, panic disorder, and miscellaneous phobia), within the MSP, the “concern over mistakes” subscale section was found most prominently in the individuals with anorexia nervosa. Moreover, other results of perfectionism measured in anorexics were the subscales that emphasize “doubts about actions”. After evaluating, it is apparent that these acts of perfectionism are present within anorexics. Hence, the researchers were able to conclude that perfectionism was more prominent in the eating disorders than the other psychopathy disorders. However, researchers also concluded that the investigation was limited because it was not prospective, and thus, perfectionism cannot be seen as the true cause of anorexia but is in many anorexics.
Certain limitations must be considered with all studies. For example, most of the questionnaires and interviews that were used are solely based on the answers of the patients and their honesty. Nevertheless, the recent studies and researches have given evidence of a clear correlation between anorexia and self-oriented perfectionism.
Anorexia nervosa is an eating disorder that has recently been on the rise. People with anorexia (mainly females) are not able to see their true selves and their health is becoming detrimental. It is best to detect the signs of anorexia before it is too late. According to these studies, it may be possible that people with perfectionistic traits are susceptible to anorexia; thus, it can be detected from early on and hopefully prevented. Additionally, caregivers should be aware of the signs of anorexia (rapid weight loss, amenorrhea, hair loss, etc.) within perfectionistic people. Hopefully, in the near future, the etiology of anorexia will rise and will be able to be cured, but scientists are still doing research on the relationship between perfectionism and anorexia because the two do seem to go hand-in-hand. However, only through more research and future studies can more knowledge be provided about it.
“Anorexic Illustration”. Image from Google Search Images. Retrieved from http://my.hsj.org/Schools/Newspaper/tabid/100/View/frontpage/editionId/7726/NewspaperId/607/Default.aspx
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. Am J Psychiatry, 160, 366-368.
Castro-Fornieles, J., Gual, P., Lahortiga, F., Gila, A., Casula, V., Fuhrmann, C., Imirizaldu, M., Saura, B., Martinez, E., & Toro, J. (2007). Self-oriented perfectionism in eating disorders. International Journal of Eating Disorders, 40, 562-568.
Halmi, K.M., Sunday, S. R., Strober, M., Kaplan, A., Woodside, D.B., Fitcher, M.,
Treasure, J., Berrettini, W. H., & Kaye, W.H. (2000). Perfectionism in anorexia nervosa: variation by clinical subtype, obsessionality, and pathological eating behavior. Am J Psychiatry, 157.11, 1799–1805.
Livai, E. (2000, November 17). Perfectly skinny. Retrieved from http://talentdevelop.com/articles/perfectskinny.html
WebMD Medical Reference from Healthwise. (2009). Anorexia Nervosa. Retrieved from http://www.webmd.com/mental-health/anorexia-nervosa/anorexia-nervosa-topic-overview
WebMD Medical Reference from Healthwise. (2003). Perfectionism Linked to Eating Disorders: Concern Over Making Mistakes May Increase Risk. Retrieved from http://www.webmd.com/news/20030205/perfectionism-linked-to-eating-disorders
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