100% or Failure – How striving for Academic Perfection can be linked-to Eating Disorders in Teenagers
Mable* is 17.
She explains to me how she measures herself by numbers.
Her favourite numbers are 10 and 100. Ten represents the 10 out of ten that indicates a perfect score on a short test.
One hundred represents the only acceptable mark in an exam.
Anything that is not 10 or 100 equals failure.
Mable, like many of the other young girls that I talk to, files anything less than perfect as an indication of how imperfect and problematic her world is.
When “Good enough’ is far from Good Enough
It’s a big word.
Let’s take a moment to think what failure may mean for each of us.
The work failure may evoke a feeling or a memory. It may bring back thoughts of an old ballet exam, a resit in maths or a relationship that didn’t work out. Many adolescents view bumps in the path or ‘failures’ as an opportunity for learning and growth. Others ruminate.
Occasionally Teenagers and Young Adults may be significantly more preoccupied with ‘failures’ or areas where they feel less than perfect.
Perfection can become obsessive in nature. Critical, harsh judgements of anything less than perfect follow.
Adolescents preoccupied with perfection can often become rigid in their thinking. Teenagers can focus on single aspects or multiple areas to achieve perfection.
Academic perfection; the A-plus student and perfection in appearance have been linked in several studies.
Teenagers with extremely black and white thinking, led by a desire for perfection often present in residential treatment for young people.
Perfection -v- Imperfection. My Imperfect Self
Thoughts of a perfect score, a perfect body or a perfect smile can become obsessive and debilitating.
Teens in this group fear failing. For them, imperfection is more than a moment in time; it is an open wound.
An internal injury that can lead to further harsh behaviours, giving rise to a critical and judgemental internal voice. Pushing themselves harder, longer and striving for a world where imperfection does not exist.
Young people, punish themselves by restricting or bingeing, lack of sleep, purging, extreme expertise and burning the candle at both ends. The schedule of checking, working and rechecking can become relentless.
Families and friends may notice as they strive to achieve unrealistic goals and the almost impossible.
The message that they readily internalise is that they are ‘not good enough’, that they are ‘bad’, ‘unworthy’ or broken in some way.
‘Perfectionism’ is often described as a need to do something ‘perfectly’.
Extensive research indicates that perfectionism is a vastly more complex personality trait; which drives for increasingly high standards, chronic dissatisfaction and extreme pressure on the individual, combined with an extremely negative reaction to perceived failure, doubts in one ability, sensitivity to anticipated criticism and ultra-high expectations.
An ever-decreasing cycle of ‘nothing is quite good enough’.
Academic success is an area where many young people may feel an element of performance anxiety or stress.
The importance of academic success can vary not only for the young person studying but within the family, society and culture. The pressure that teenagers and young adults experience will almost certainly be derived from a combination of these external and environmental factors, together with personality traits and genetics.
Young adults who believe that ‘getting it right’ is about perfection struggle with the concept of being ‘good enough’.
That’s a heavy load to carry.
Perfectionism is difficult to manage, replaces enjoyment and ultimately can take over a young person’s life.
It some cases, perfection can take life. Suicidal thoughts and gestures are more likely in children and young people who develop obsessive behaviours, eating disorder, highly sensitive and emotionally unstable.
Parents, teachers and families may notice that a young person is striving for something more than a good result.
It may be that homework is reworked many times, somewhat unnecessarily, or that artwork is crumpled and placed in the bin.
Disgust at the perceived poor quality of their work may seem unreasonable to families looking in (or maybe encouraged).
Exams with exceptional grades in the eyes of peers may be viewed in a very different way by a perfectionist. The focus may shift to exactly what was wrong rather than the undisputed fact that the majority was right.
The missing 5 or 10% could feel overwhelming and feel like a complete disaster.
As the internal pressure increases, the missing 5% or 10% can lead to self-punishment through self-harm, restrictive eating, self-hate and feeling that life is no longer worth living. Isolation, depression and anxiety replace any joy in achievement.
The ‘Good Child’
Young children often receive praise or acknowledgement from family and teachers for high achievements. Some children learn to ‘need’ this acknowledgement to feel “special’ or loved within the family.
The traits of perfectionism develop early on in childhood. Children who require a great deal of external validation and who are sensitive to perceived criticism from others may begin to strive for perfection in order to prevent themselves from feeling ‘bad’.
Children can develop a fear of failure or fear of disapproval.
Children and teenagers may strive to be the ‘good’ child, the best, the successful one or the gifted sibling. They begin to use achievement and perfection as a means of assessing their self-worth. Young children who are particularly sensitive to this environment may begin to build their self-esteem upon the feelings that they experience in these moments of achievement and perceived success. A decision can be made at that moment that becomes a life decision,
The delicate balance between feeling worthy loved and accepted or unworthy, forgotten and rejected begins.
Anxiety, stress and depression can sometimes follow with the negative self-worth experienced should these young people not do as well as expected.
Perfection and Eating Disorders can go hand in hand
As we strive to understand emotional instability, psychological distress and mental health concerns, we can correlate perfectionism in childhood and adolescence with the development of eating disorders.
Understanding the risks and protective factors is essential in preventing and changing the course of life long and life-endangering psychiatric conditions.
The very same emotions that drive academic success in obsessively high achieving students can also lead to the development of eating disorders.
New research at Monash University has provided much-needed insight into the development of Eating Disorders in this group of young people.
Students who identified having ‘strong positive’ emotions when they achieved in the school setting, described disordered eating when they experienced ‘negative emotions’.
The study investigated the link between academically driven emotions and positive self-worth and the later effects on the development of eating disorders.
To retain exemplary standards, avoid failure and maintain the strong positive emotions, young people must attain a degree of control over themselves, others and their environment.
The difficulties that we outlined in early childhood are compounded. Rigidity and black and white thinking can follow. Punishment for failure can be increasingly harsh, delivered by the greatest internal self-critic.
Punishment of the self may lead to the withdrawal of self-care, love and relationships, basic needs or the beginning of a regime of restricting pattern.
Weight, Body Image and Perfection. Body Dysmorphic Disorder
Teenagers and young adults identified as academically high-achievers are predisposed to similar ‘positive emotions’ in the areas of weight, body shape and appearance.
The perfectionist is seen in the academic arena, perfectly translates perfection derived from self-image to self-worth.
The now-familiar feelings of reward, control and punishment well established.
Teenagers and young people diagnosed with Anorexia Nervosa and Bulimia Nervosa score significantly higher on the perfectionism scale than their peers in controlled studies.
Whilst the body of research undoubtedly links high academic achievement derived through the pursuit of perfection with the development of eating disorders in adolescents, there is also a great deal of hope.
Traits and characteristics of perfectionism are noted to respond well to early intervention in treatment. CBT-e, D.B.T. and I.F.S. are evidence-based psychotherapeutic interventions than can be seen to address the issues surrounding perfectionism, eating disorders, control and an internal ‘rule book’.
How can parents help with rigid thinking?
As parents, we would like our teenagers to feel ‘good enough’. We would like to see them feeling confident, with great self-esteem.
We would like to see our young people feeling content in the body that they inhabit.
Parents can help young people at home. The most important first step is to talk with your teenager about perfectionism.
Parents can explain in age-appropriate language how striving for perfectionism can hold us back from trying and exploring new things.
- Encourage your teen to see the ‘Grey’ area and move away from black and white thinking patterns. We can think and feel two things at the same time. We can balance them and stay in the grey zone.
- Avoid setting rigid routines at home. Experiment with impromptu trips or activities. Avoid setting strict times or over-scheduling activities.
- Encourage your teen to give themselves a positive self-talk or ten! Encouraging gratitude lists at bedtime, seeing the beauty in everyday events and having a daily list of things that they love about themselves.
- Encourage realistic thinking. Teens with perfectionist traits can often ‘catastrophic events. Develop good communication that leads to exploring the reality of each potential problem. Make it a family or team discussion to explore solutions.
- Ignore negative self-talk. Replace it with a validation that the young person is seen and heard whilst reframing in a neutral or positive statement.
- Praise the process not the result. Praise great thinking and rational feelings. Let them know when they handle a tricky situation well. Set priorities that reflect the time available. Help them to take breaks when needed. Have plenty of options available to break from studying or focused tasks. Take a walk outside, wash the dog or make up a family dance; anything to distract and change direction.
- Avoid over-scheduling and accounting for every hour of the week. Your teenager will benefit from being bored at times. They do not need every evening and weekend full of back to back activities.
- Take advice from the professionals. With early signs of Eating Disorders appearing in preteens, early intervention is essential. Children as young as eight are developing behaviours that are cause for concern.
- Find a psychotherapist, Psychologist or Psychiatrist who has experience in early intervention in young people. Dr Rasyid Sulaiman, Medical Director at The Wave Clinic, advises that Children and Teenagers exhibiting signs and symptoms of Eating Disorders or Obsessive and Compulsive Disorders should be assessed by a Mental Health Professional as soon as possible.
- Give plenty hugs. Be spontaneous. Be creative and most importantly show authentic love and feeling for the child or teen – not the achievement or event.
Mable, the names and identifying information in this article have been changed to protect the anonymity of the young people involved.
Fiona Yassin is the International Clinical Director at The Wave Clinic. Fiona is a Fellow of A.P.C.C.H., a member of F.D.A.P. and I.A.E.D.P. Currently studying C.E.D.S., Fiona is an Accredited Clinical Supervisor (U.N.C.G.) and Accredited Child and Family Trauma Professional.
With a specialist interest in Eating Disorders and Borderline Personality Disorders, currently enjoying advanced training in the Psychiatry for Women throughout the Lifespan, Massachusetts Psychiatry Department. The Wave Clinic provides residential and outpatient consultations for Children, Teenagers, Young Adults and Families.
Dr Rasyid Sulaiman is a Consultant Psychiatrist and Medical Director at The Wave Clinic.
Suggested reading for Parents:
The Perfectionism Workbook for Teens: Ann Marie Dobosz. M.A. M.F.T. (available on Amazon and Kindle)
The Mindfulness and Acceptance Workbook for Teen Anxiety: Activities to Overcome Fears and worries Using Acceptance and Commitment Therapy (Instant Help book for Teens): Sheri L. Turner. PhD. Christopher McCurry. PhD. Mary Bell. M.S.W. R.S.W.
Suggested Reading for Professionals:
Intuitive Eating. 4th Edition. A Revolutionary Anti-Diet Approach: R.D. Triboloe, Evelyn. M.S. F.A.D.A. Resch, Elyse. M.S. R.D. This is an excellent book for those working with Young People and Eating Disorders. Required reading for C.E.D.S. exams, it is an invaluable source of information and is a much-needed test for any clinicians office.