Perfectionism in Eating Disorders

完美主义 - 持有不切实际的高标准的趋势 - 已涉及饮食障碍的发展和维护。临床完美主义是干预的主要目标认知行为治疗（CBT-E），患有饮食障碍的成人的主要治疗方法。研究表明患者神经性厌食症和bulimia nervosa比对照科目更高的完美主义。患者的研究尚未逐步研究binge eating disorder。根据Bardone-Cone及其同事（2010年），“完美主义似乎在饮食障碍的病因，维护和治疗中发挥作用”（第139页）。本文将界定完美主义，描述其与饮食障碍的关系，并讨论治疗策略。

What Is Perfectionism?

Perfectionism is a complex personality characteristic with no universally accepted definition. It is sometimes viewed as a personality trait or symptom. It can also be understood as a process. Perfectionism can have positive and negative aspects. Having high standards can be an asset and in many cases, it can be helpful in attaining goals. However, perfectionism also exacts a cost and in the wrong situations, too much of it can be an impediment. The perfectionism associated with psychological problems is problematic and has been referred to asclinical (or dysfunctional) perfectionism。

Clinical perfectionism has three aspects:

1. The continuous expectation that you or others meet high standards that, given the circumstances, other people consider extreme or unreasonable.
2. Judging your self-worth largely on your ability to strive for and achieve these unrelenting high standards.
3. Continuing to aim for these standards despite consistently negative consequences.

People can exhibit perfectionism in certain domains of their lives and not in others. For example, some people are perfectionistic regarding school or work, but not around their homes. Others may be perfectionistic around their appearance, but not about their school or work performance. Specific domains of perfectionism that have been identified in the literature include:

• 工作或学校的表现
• Close relationships
• Leisure and athletics
• Neatness and aesthetics
• Organization and ordering
• Writing
• Speaking
• Physical appearance
• Health and personal cleanliness

具有完美主义的人们从事某些行为，以维持他们的完美主义信仰。完美主义的行为包括您可能做的两件事以及您可能避免做的事情。

Behaviors that perfectionists might do include:

• 过度检查
• Excessive organizing
• Listmaking
• Correcting others

In addition, many people with perfectionism avoid doing certain things out of fear that they will not be able to meet their own standards. Examples of avoidance behaviors include:

• 太快放弃了
• Indecisiveness
• Avoiding tasks
• Failure to delegate
• Procrastination

Many people with clinical perfectionism find that it negatively affects their social relationships, mental health, and/or physical health.

Perfectionism’s Relationship to Eating Disorders

完美主义和饮食失调似乎correlated, but the causality is not clear–we don’t know if one leads to the other or which comes first. Some research indicates that people with eating disorders and perfectionism often displayed perfectionistic traits之前their eating disorders began.

然而,Bardone-Cone和他的同事们发现when a more stringent definition of eating disorder recovery was used, perfectionistic symptoms were reduced to levels similar to those found in patients without eating disorders. These researchers write, “From this perspective, interventions and/or experiences that help decrease perfectionism may be key to making full recovery attainable. However, it could also be that the temporal ordering is reversed, with attaining full eating disorder recovery (with eating disorder symptomatology at levels comparable to those with no history of an eating disorder) being what permitted the relaxation of perfectionistic standards and attitudes.”

Clinical perfectionism is described as one of four key factors that maintain eating disorders, according to Fairburn, the author of CBT-E. Research shows perfectionism is related to poorer prognosis after admission for anorexia nervosa and with higher treatment drop-out.

治疗

If relaxation of perfectionism is associated with a more complete eating disorder recovery, it deserves attention during treatment. Most of the research on the treatment of perfectionism has focused on cognitive behavioral therapy (CBT) approaches. CBT treatment for perfectionism has been found to be successful in reducing perfectionism among both patient and nonpatient populations. It has also has been shown to reduce eating disorder symptoms as well as symptoms of other disorders including depression and anxiety.

适用于完美主义的CBT治疗涉及挑战挑战性的思想，如全部或无所事事和“should” statements. It involves identifying overgeneralizations and double standards. Patients also learn to test perfectionistic beliefs through the use of behavioral experiments. For example, a patient who believes he would be too ashamed to ever have a friend over unless his apartment is totally and thoroughly cleaned up could test having a friend over when things are left out of place. A client could test the belief that she must always be productive by scheduling time to sit in the park and people-watch.

Having a problem with perfectionism is similar to having a “phobia” of being imperfect–you are terrified of making mistakes. Treatment for this condition therefore also involves repeated exposure to situations in which you are unlikely to perform perfectly. Examples of exposure activities could include:

• Arriving late for an appointment
• 发送包含拼写或语法错误的电子邮件
• Speaking in a meeting and losing your train of thought
• 在商店寻求帮助
• 支付某些东西时给予不正确的变化

随着时间的推移，通过重复曝光，患者了解到，放宽标准是安全的，并且在他们这样做时不会发生任何糟糕的事情。目标是培养更健康和平衡的标准。

治疗有帮助吗？

Given the link between perfectionism and eating disorders, it might help to recognize and address perfectionism in you or a loved one. The following are questions suggested by one of the leading experts on perfectionism (Antony 2015) to assess whether one might need help for perfectionism:

• 您的标准高于其他人的标准吗？
• Are you able to meet your standards? Do you get overly upset if you don’t meet your own standards?
• Are other people able to meet your standards? Do you get overly upset if others don’t meet your standards?
• Do your standards help you to achieve your goals or do they get in the way (e.g., by making you overly disappointed or angry when your standards are not met; by making you get less work done, etc.)?
• What would be the costs of relaxing a particular standard or ignoring a rule that you have?
• What would be the benefits of relaxing a specific standard or ignoring a rule that you have?

In Summary

如果您或亲人具有饮食失调展示完美主义的症状，您可能希望为这些症状寻求帮助，除了寻求饮食障碍的治疗。成功的CBT自助计划的完美主义包括这本书当完美不够好和完美主义在观点中, a free online downloadable workbook.