Q & A: Perfectionism and Personality

Q: I know that “perfectionism” has been closely associated with eating disorders in several studies, but I’m also aware that this trait can refer to many different qualities in different people. Are any particular features of perfectionism and associated personality features most strongly linked to eating disorders? ( JA, Philadelphia)

A: In recent years, perfectionism has received considerable attention, both from the psychological and the biological perspective, and researchers have been studying this trait in relation to eating disorders developmentally and genetically. A recent study from London by Anderluh and co-workers showed that various childhood obsessive-compulsive characteristics contributed significantly to the odds of developing an eating disorder. The risk of developing a disorder increased almost seven times for each of the features that were present (Am J Psychiatry 160:242, 2003). Their way of thinking about perfectionism and associated features offers a useful framework. The specific childhood features linked to subsequent eating disorders included perfectionism and rigidity in particular. Perfectionism was ascertained in relation to behaviors present in at least two specific life domains such as schoolwork, self-care (grooming), looking after her room, hobbies, caring for pets, part-time job or housework. Rigidity was measured by inflexibility in adjusting to moves and changes, and by being rule-bound in areas such as planning, persistence, and complying with rules set out by parents and teachers. Less important but still notable, excessive doubt and cautiousness and a drive for order and symmetry were also associated with the subsequent development of eating disorders. Asking about these characteristics individually will most likely increase patients’ abilities to better describe their pre-eating disorder traits.

—J.Y.