Chasing Perfect: How Perfectionism Fuels Eating Disorders in Adults

Perfectionism and eating disorders in adults: how the pressure to be perfect fuels disordered eating. Discover dietitian support for health, healing, and recovery

Have you ever felt like you needed to be perfect to be accepted, successful, or even worthy? That constant striving for flawlessness might seem like a motivator, but research shows it could be more harmful than helpful—especially when it comes to our relationship with food and body image.

A recent systematic review and meta-analysis by Stackpole and colleagues sheds light on a powerful and often overlooked driver behind eating disorders in adults: perfectionism (1). This review, published in Eating Behaviors, included 25 studies and over 10,000 participants, confirming a strong and consistent link between perfectionism and eating disorder symptoms in adults. This wasn’t the first study to point in that direction, but its comprehensive nature makes it a significant addition to the field.

Perfectionism: More Than Just High Standards

Perfectionism isn’t just about aiming high. It’s characterised by a harsh inner critic, fear of failure, and the belief that nothing is ever good enough (2). According to Frost and colleagues, perfectionism can be broken down into several components, such as concern over mistakes, doubts about actions, and perceived expectations from others (3). The review by Stackpole et al. confirmed that maladaptive perfectionism—those negative, self-critical aspects—are especially associated with eating disorder symptoms (1).

Maladaptive perfectionism often leads to rigid dietary rules, obsessive calorie tracking, excessive exercise, and extreme body image concerns. When perfectionism intersects with appearance-related pressures or low self-esteem, it becomes a toxic combination that may trigger or perpetuate disordered eating behaviours (4).

Social Pressures and Perceived Judgement

One important subtype is socially prescribed perfectionism—the belief that others expect you to be perfect. Research has consistently shown that this form of perfectionism is highly associated with bulimia and binge eating behaviours (5). People with this belief system may use food as a coping mechanism for the stress of not meeting perceived expectations or to escape self-criticism.

In contrast, self-oriented perfectionism—a more internally driven form—is often linked to restrictive eating and anorexia nervosa (6). These individuals may engage in extreme dieting and exercise to maintain a sense of control or to prove their worth through discipline.

Why Focus on Adults?

Most discussions around eating disorders centre on teenagers, but eating disorders in adults are increasingly recognised. Adults often face unique pressures—workplace performance, parenting, relationship demands—and perfectionism may not fade with age. In fact, some studies suggest that these traits intensify over time or become more ingrained (7).

The review by Stackpole et al. helps shift the focus toward adult populations, where early-life perfectionistic traits may have gone unaddressed and silently contributed to years of disordered eating (1).

What This Means for Treatment

These findings highlight a crucial point: to treat eating disorders effectively, we must go beyond food and weight. Targeting perfectionistic thinking patterns is essential.

Cognitive behavioural therapy (CBT), especially CBT for perfectionism, has been found effective in reducing maladaptive perfectionism and associated behaviours (8). These interventions help individuals challenge black-and-white thinking, reduce the fear of making mistakes, and develop a more flexible, self-compassionate mindset.

Mindfulness and self-compassion-based therapies also show promise, helping individuals break the cycle of self-criticism and disordered behaviours (9). By addressing the root causes—not just the symptoms—clinicians can help clients create lasting change.

Importantly, the review by Stackpole et al. calls for future research to distinguish between perfectionism subtypes when assessing or treating eating disorders (1). Tailored approaches may be far more effective than generalised treatment.

Final Thoughts

This study serves as a compelling reminder that the roots of disordered eating are complex. Perfectionism is not just a personality quirk—it’s a serious psychological trait with strong links to disordered eating, especially in adults.

You don’t have to be perfect to be healthy. You don’t have to look a certain way to be enough. Understanding the deeper “why” behind eating patterns can unlock more compassionate, sustainable healing. If you’re a clinician, researcher, or someone who struggles with perfectionism and eating, the message is clear: look beyond the food, and into the beliefs driving it.

References 

1. Stackpole R, Greene D, Bills E, Egan SJ. The association between eating disorders and perfectionism in adults: A systematic review and meta-analysis. Eat Behav. 2023;51:101769. doi:10.1016/j.eatbeh.2023.101769

2. Shafran R, Cooper Z, Fairburn CG. Clinical perfectionism: A cognitive-behavioural analysis. Behav Res Ther. 2002;40(7):773–91.

3. Frost RO, Marten P, Lahart C, Rosenblate R. The dimensions of perfectionism. Cognit Ther Res. 1990;14(5):449–68.

4. Bardone-Cone AM, Wonderlich SA, Frost RO, Bulik CM, Mitchell JE, Uppala S, et al. Perfectionism and eating disorders: Current status and future directions. Clin Psychol Rev. 2007;27(3):384–405.

5. Hewitt PL, Flett GL. Dimensions of perfectionism in unipolar depression. J Abnorm Psychol. 1991;100(1):98–101.

6. Boone L, Soenens B, Luyten P. An empirical typology of perfectionism in early-to-mid adolescents and its relation with eating disorder symptoms. Behav Res Ther. 2014;52:137–42.

7. Egan SJ, Wade TD, Shafran R, Antony MM. Perfectionism as a transdiagnostic process: A clinical review. Clin Psychol Rev. 2011;31(2):203–12.

8. Lloyd S, Schmidt U, Khondoker M, Tchanturia K. Can psychological interventions reduce perfectionism? A systematic review and meta-analysis. Behav Cogn Psychother. 2015;43(6):705–31.

9. Kelly AC, Carter JC. Self-compassion training for binge eating disorder: A pilot randomized controlled trial. Psychol Psychother. 2015;88(3):285–303.