Perfectionists more likely to develop bulimia, new research

Bulimia nervosa is a common and life-threatening eating disorder. About 275,000 Canadian girls and women will have bulimia at some point in their lives. They will eat large amounts of food, often secretly, and then prevent weight gain by vomiting, fasting or exercise.

Most sufferers of bulimia are female. About two per cent of them die every decade. And around a fifth of those deaths about are due to suicide. Uncovering the multiple factors leading to bulimia nervosa is therefore very important, especially as the causes are largely unknown.

As a professor in Dalhousie University’s department of psychology and neuroscience, I research personality traits and eating disorders. As a clinical psychologist, I also assess and treat eating disorders and associated problems, including perfectionism.

My lab just published the most complete research study investigating the link between the personality trait of perfectionism and bulimia nervosa to date. Our results clearly show perfectionists have higher odds of developing bulimia and are at greater risk for developing the disease as time passes.

Building on this research, therapists may be able to improve treatments for some bulimic clients by focusing on their underlying perfectionism as well as their symptoms.

Harsh self-criticism

Perfectionism involves striving relentlessly for flawlessness and holding unrealistically high standards for oneself and others.

Perfectionists are rarely satisfied with their performance and engage in harsh self-criticism when their efforts fall short of perfection.

To get a more comprehensive picture of whether perfectionism leads people to develop bulimia nervosa, we conducted a thorough literature search that identified 12 longitudinal studies involving a total of 4,665 participants.

We then analyzed results from these 12 studies using statistical means. Most of our participants were female (86.8 per cent) and included adolescents, undergraduates and adults from the community, with an average age of 19 years.

We showed perfectionism predicted increases in bulimia nervosa, even after controlling for baseline levels of the condition. This suggests perfectionists are at risk for developing more bulimia nervosa as time passes.

In fact, our results indicate perfectionism is centrally important to the personality of people who go on to develop bulimia.

Previous research has already shown that external pressure from family, friends and media can contribute to the disease by fostering a desire to attain an “ideal” weight and shape. But the link between perfectionism and bulimia has never before been extensively explored.

A dog-eat-dog world

Perfectionism is linked with relationship problems and feeling sad. Perfectionists may turn to food to cope with sadness brought on by their lack of connection to other people.

Symptoms of bulimia (e.g., binge eating) may also offer perfectionists a temporary escape from pressure and self-criticism.

It’s a dog-eat-dog world today. We have controlling and hyper-competitive helicopter parents. And in society at large, self-interest and winning are emphasized. Rank and performance matter more than ever. These are conditions where perfectionism is likely to develop. So, we may see more and more perfectionism-linked cases of bulimia nervosa emerge.

Our results suggest treating perfectionism as early as possible may help to stop the development of bulimia nervosa. It is time to go beyond entirely symptom-focused treatments. Building on our research, clinicians may want to assess and to treat both bulimic symptoms (e.g., vomiting) and underlying perfectionism (e.g., self-criticism).

Bulimia nervosa usually lasts for more than eight years before symptoms go away. About 25 per cent of people with the condition develop chronic, hard-to-treat symptoms that last for many years. And affected people often develop other problems such as tooth decay and depression.

Clearly, more research is needed to understand and defeat this disease.