Looking back, Equip Peer Mentor Jamie Drago says her perfectionistic tendencies far predated her eating disorder. But growing up, she would have never described herself as someone striving for perfection. “I actually would have described myself more as ‘wishing I could be a perfectionist,’” she says. “I felt ‘lazy,’ ‘average,’ and ‘not very good at things,’ and I have always really struggled with procrastination.”

It wasn’t until Drago’s first therapist informed her that procrastination can be a symptom of perfectionism that she started to realize how her self-imposed, impossibly high standards were affecting her mental health. “I always felt like I needed to be on a quest of self-improvement, and that if I wasn’t excelling at everything under the sun it was because I wasn’t trying hard enough or I didn’t ‘want it badly enough,’” she says. Reflecting now from a place of recovery, Drago sees that this kind of negative self-talk fueled her shame, and her eating disorder by extension.

While no one specific personality type is most prone to developing an eating disorder, experts have long known that perfectionism is associated with them. Perfectionism, which is often defined as the tendency to hold oneself or others to extremely high or flawless levels of performance, is considered a common trait among those struggling with anorexia, bulimia, and binge eating disorder (BED).

Understanding the connection between perfectionist qualities and disordered eating behaviors can help you identify early warning signs in yourself or a loved one and get the support you need. Here’s why perfectionists are more likely to get eating disorders—and what to do about it.

How personality traits play into eating disorders

Eating disorders are complex illnesses rooted in biological, psychological, and social risk factors and triggers. They never have one single cause. That said, there are certain contributing factors that can elevate a person’s risk of developing an eating disorder including genetics, family history—and personality. Defined as “the relatively enduring patterns of thoughts, feelings, and behaviors that reflect the tendency to respond in certain ways,” personality traits aren’t inherently positive or negative. Rather, they have the potential to shape a person in different ways, contributing to their interests, values, strengths, emotional patterns, and more.

When it comes to eating disorders, researchers have identified certain personality traits that may play into the development and maintenance of anorexia, bulimia, BED, and other diagnoses. One 2016 systematic review and meta-analysis asserted that neuroticism, avoidance motivation (a desire to avoid stressful or unpleasant things), and perfectionism often show up in those diagnosed with eating disorders. While having these personality traits doesn’t guarantee someone will develop an eating disorder, they can make people more vulnerable to them.

“Temperament traits are present from birth, and they stick with a person throughout their life. When someone experiences internal or external stressors, those temperament traits may then get expressed in the form of eating disorder behaviors,” says Equip Director of Program Development, Tana Luo.

These innate tendencies can be harmful when channeled toward disordered behaviors, but they often serve a protective purpose. “Eating disorder behaviors may reduce someone’s experience of distress, which then makes it more likely that they will continue to engage in those behaviors,” Luo says. “So, those harmful expressions of their temperament get strengthened over time.”

The link between perfectionism and eating disorders

While perfectionism can manifest in many different ways, the core characteristics (extreme ambition, fear of failure, extremely high standards) do tend to overlap with many of the traits observed in those with eating disorders. “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,” Drago says. “Some people may constantly feel the need to be ‘doing more,’ ‘doing better,’ ‘pushing harder.’ This can show up in a number of eating disorder behaviors, with never feeling like we’ve done enough.”

Luo says that people who are perfectionistic may be highly self-critical and may overemphasize what they perceive to be mistakes, which can ultimately result in disordered behaviors. “These tendencies, coupled with external stressors—like societally imposed appearance standards—may contribute to the development and maintenance of eating disorders,” she says.

Drago experienced this firsthand, with her self-doubt and self-criticism contributing to the symptoms she eventually developed. “If a person feels like they aren’t ‘good at anything,’ it can be common for restrictive eating disorder behaviors to become a thing they might feel ‘good at,’ which can be a tricky cycle to get out of,” she says. “On the other side of the coin, I also experienced instances of binging behaviors, where it felt like I was rebelling against my own perfectionism, only to feel the shame afterwards that reinforced restrictive eating disorder thoughts, and the cycle continued.”

Which eating disorder diagnoses are most associated with perfectionism?

Perfectionism isn’t exclusive to any one eating disorder, but research shows the strongest link with two in particular: anorexia and bulimia. “Both are characterized by an overvaluation of weight and shape, so people who have a natural tendency to strive for high standards and be fearful of ‘failing’ to meet those standards may be at increased risk for both,” Luo says.

However, research has also found perfectionism to be closely associated with binge eating itself, meaning it could also be linked to binge eating disorder, anorexia binge-purge subtype, and other disorders that involve bingeing. Drago also points out that those struggling with orthorexia—which isn’t technically considered a diagnosis but includes disordered behaviors—may exhibit more overt perfectionistic qualities. “Almost across the board, perfectionism will show up in some amount in orthorexia, because the thoughts about food are really based around ‘perfect’ eating and ‘perfect’ choices,” she says.

“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,” Drago says.

How eating disorder treatment can help you use perfectionist qualities for good

Despite its ability to contribute to eating disorder behaviors, perfectionism isn’t inherently negative. In fact, perfectionists have been found to have higher levels of conscientiousness and motivation, and are often high achievers. It’s only when these perfectionistic tendencies are channeled into maladaptive behaviors, that they can contribute to mental health challenges. So is there a way to harness perfectionism for good, rather than allowing it to contribute to unhealthy thoughts and behaviors?

According to Luo, cutting-edge eating disorder treatments are doing just that. “A new treatment, Temperament-Based Therapy with Support (TBT-S), is based on the notion that individuals can harness their natural temperament traits to help them recover,” she says. “The idea is that temperament traits in themselves aren’t good or bad, but they can show up in helpful or harmful ways.”

In Drago’s case, treatment empowered her to channel her perfectionistic traits into more effective modes of expression. She says this was among the greatest skills she learned in her recovery process. “With a trusted provider, I went through a list of all of the traits I felt like I had—the ones I thought were strengths and the ones I maybe wished I didn’t have,” she says. “Then, we went through the list together and brainstormed what word I would use if that trait were being expressed in a more helpful way.”

When the time came to evaluate the word “perfectionism,” Drago was able to see how that trait could be channeled in a more productive way by expressing it as “high attention to detail,” “thoroughness,” or “dedication” when it came to things that brought her joy and enhanced her life. “When my perfectionist trait is being expressed in a less productive way, that’s actually when it fueled my eating disorder rigidity, or when it comes out as ‘laziness’ because it drives my procrastination or task paralysis,” she says.

Luo says this ability to harness personality traits for good is the purpose of TBT-S and other forms of comprehensive eating disorder care—and the results can be life-changing. “Treatment can help people figure out how their traits can be used to stop meeting their eating disorder's goal and instead meet their own goals, like building a life worth living outside of an eating disorder,” she says.

Is it perfectionism or an eating disorder?If you’re worried that your perfectionism is becoming harmful, we’re here to help.

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