Treating Perfectionism in Eating Disorders


It’s normal for young people to have goals that they want to achieve. Aims and targets can help teenagers and adolescents to feel motivated and form a sense of direction in life. As with all of us, they may sometimes feel disappointed if these aims aren’t met.

However, when these standards become too high or start to define a young person’s sense of self-worth, it can begin to affect their well-being.

They may start to see themselves as a failure unless they reach certain, often unattainable goals and struggle to value themselves for who they are. These thought patterns can contribute to anxiety, depression, eating disorders, and other mental health conditions.

Young people living with eating disorders often experience underlying issues of perfectionism. They may want to have a certain, ‘ideal’, body shape or weight and feel like a failure if their perceived body shape is different. Young people may turn to diet restriction, binging and purging, over-control, and other behaviours as a way to cope with their thoughts and emotions.

For many teenagers and adolescents, overcoming perfectionism is an important part of lasting recovery. At the Wave, we address perfectionism with a range of therapeutic approaches specifically tailored to the unique needs of young people, including RO-DBT (radically open dialectical behaviour therapy).

We combine clinical care with education, experiences, and life skills development, helping young people to grow in self-esteem, build plans for the future, and follow their passions and dreams.

What Is Perfectionism?

Perfection isn’t a simple concept to define. People who struggle with perfectionism usually strive for very high or unattainable standards and place their self-worth in reaching them. Perfectionism can be rooted in a young person’s own standards or standards placed upon them by others, such as parents or teachers.

Researchers often distinguish between adaptive and maladaptive perfectionism. Adaptive perfectionism is when someone’s perfectionist standards don’t cause harm to their well-being, and may even have a positive effect. This might happen when a young person feels satisfied when they reach their goals but don’t experience emotional distress if they miss them.

On the other hand, maladaptive perfectionism causes young people significant distress. Maladaptive perfectionism often involves a strong fear of failure that drives teenagers and adolescents to achieve certain goals. When these aims are not met, young people may struggle to cope, feeling worthless and unable to recognise all the ways that they are valuable.

What Causes Perfectionism?

Perfection is rooted in the belief that your self-worth is based on what you achieve. Many young people develop perfectionism thinking because of their experiences growing up. They may have:

  • experienced rigid, high, or unrealistic expectations from their parents
  • had highly critical parents
  • received excessive praise for their achievements

Perfectionism can be related to black-and-white thinking, when someone sees themselves (and others) as either all good or all bad. Black-and-white thinking often develops in young people who experience distressing or traumatic childhoods, preventing them from forming a cohesive understanding of the world around them.

What Is the Relationship Between Perfectionism and Eating Disorders?

Eating problems are not just about food. They’re often caused by difficult emotions, feelings, and thoughts that are hard to cope with. Young people may use food as a way to deal with, or find temporary relief from, these feelings. However, these behaviours don’t help to overcome underlying issues in the long term – and usually make them worse.

Researchers have found that many young people who have eating problems also struggle with perfectionist thinking. Disordered eating is associated with both adaptive and maladaptive perfectionism and studies have consistently shown that perfectionism is a risk factor for eating disorders, including anorexia nervosa and bulimia nervosa.

Scientists use different models to try and understand and explain how eating disorders develop and are maintained. The transdiagnostic model of eating disorders is based on the idea that disordered eating is often rooted in underlying issues of clinical perfectionism, core low self-esteem, mood intolerance and/or interpersonal difficulties.

Within this framework, researchers suggest that young people’s over-evaluation of shape and weight interacts with their perfectionist thinking. Teenagers and adolescents may try to achieve a certain, often unattainable, body shape or weight, and feel afraid of not reaching this standard. They may develop a fear of gaining weight and repeatedly check their bodies or weigh themselves to see whether they are meeting their standards.

Young people with eating disorders are often self-critical and experience low self-esteem. They tend to evaluate themselves negatively and are likely to feel like they haven’t reached their aims and goals. This can make them take even greater steps to try and meet their standards, maintaining disordered eating behaviours. 

Exploring Perfectionism and Overcontrol

Perfectionism thinking can cause young people to try and control themselves and their behaviours. Perfectionist standards often require things to be a certain, specific way. Young people may become preoccupied with controlling themselves and their environment to try and reach or maintain the conditions that they need to reach their goals.

What Is Overcontrol?

Overcontrol happens when self-control becomes maladaptive, harming a person’s well-being and causing persistent distress. Self-control describes the inhibition of urges, behaviours, impulses, and desires in order to reach certain goals.

While some level of self-control is necessary for someone to form stable relationships with other people and pursue things that matter to them, too much self-control can lead to isolation, loneliness, and mental health conditions like depression, eating disorders, and OCD.

Overcontrol and Eating Disorders

Among teenagers and adolescents with eating disorders, overcontrol often takes the form of strict diets, eating schedules, and other behaviours involving food. They may only eat in certain settings, such as by themselves or inside their house. They may limit the kinds of foods that they eat or the amount of food they consume in one day. 

Research has found that people with eating disorders who struggle with perfectionism and overcontrol are more likely to experience anxiety or depression alongside disordered eating. Overcontrol is also associated with a longer stay in eating disorder treatment programs.

Towards a Better Future: Treating Perfectionism, Overcontrol, and Eating Disorders

For young people living with eating disorders, everyday life can feel impossible. Eating disorders are serious conditions that can affect their mental and physical health, relationships with others, and ability to enjoy life.

The good news is that eating disorders are treatable. While recovery isn’t easy, effective support can help young people to address the issues underlying their behaviours and maintain meaningful and lasting recovery.

At The Wave, we understand that full recovery requires young people to develop a secure sense of self where they believe in their abilities, follow their passions, and value themselves unconditionally. Our core elements of treatment support young people to explore different directions in life, reconnect with themselves, and develop the skills they need to follow their dreams.

Our transformative recovery programs for eating disorders include:

  • Talk therapy, including interpersonal therapy, RO-DBT, and group therapy
  • Alternative therapies such as dance therapy, art therapy, and mindfulness
  • Trauma-focused treatment
  • Yoga and meditation
  • Nutritional programs
  • Family therapy
  • Gardening groups
  • Vocational courses

What Is Radically Open Dialectical Behavioural Therapy (RO-DBT)?

What Is Radically Open Dialectical Behavioural Therapy (RO-DBT) is an innovative, evidence-based treatment method that helps young people to overcome issues of overcontrol. 

RO-DBT is rooted in a philosophy of radical openness, a principle based on openness, flexibility, and social connectedness. Radical openness is a way of being as well as a state of mind.

It describes a journey of exploring the unknown and learning from the world around us, remaining open to what others can teach us. It requires us to challenge even our most firmly held beliefs, actively addressing the parts of our lives that we find difficult or uncomfortable so that we can learn and grow.

RO-DBT centres around the idea that the way we communicate with others is fundamental to personal change. Efforts to suppress or control our emotional expression – or to communicate a different emotion to the one we are experiencing – can cause other people to see us as inauthentic, leading to further distress. By learning to express ourselves authentically, we can increase our social connectedness and well-being.

Through RO-DBT, young people who struggle with over-control can learn to express their inner urges, feelings, and desires more freely, helping them feel connected with others and part of a community.

These social relationships lay the foundations for growing self-esteem, confidence, security, and general well-being, supporting young people to overcome and recover from mental health concerns including eating disorders, loneliness, and depression.

Research has shown that RO-DBT effectively helps people to cope with their emotions and increase their psychological flexibility – that is, their ability to be in touch with the present moment and respond to it in a productive way. Other research has found that RO-DBT effectively reduces eating disorder symptoms among individuals with anorexia nervosa and decreases levels of emotional distress.

The Wave: Specialist Recovery Programs for Young People

The Wave Clinic is a specialist mental health treatment centre, dedicated to making a difference in the lives of young people. The Wave is a Global Centre of Excellence for the treatment of eating disorders, setting the standard for recovery programs around the world.

Our programs offer a whole-person approach focused on full recovery and lasting growth, Combining exceptional clinical care with education, social responsibility, and a gap year experience, we support young people to reconnect with themselves, rediscover their love of life, and plan fulfilling futures.

We focus on building life advantage, guiding young people through a journey where they can flourish as their true selves and learn the skills they need to follow their dreams.

If you have any questions about our programs or how to start the admissions process, reach out to us today. We’re here for you.

Fiona - The Wave Clinic

Fiona Yassin is the founder and clinical director at The Wave Clinic. She is a U.K. and International registered Psychotherapist and Accredited Clinical Supervisor (U.K. and UNCG).

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