Perfectionism is often a major contributor to eating disorders.
When people hear the word perfectionism, they sometimes think of someone who is highly motivated, ambitious, or simply trying to be the best version of themselves. But clinically, perfectionism tends to be more complicated than that.
Perfectionism is often about self-worth becoming conditional: I am okay if I achieve enough, perform well enough, look a certain way, never make mistakes, never disappoint people, never appear vulnerable. In the context of eating disorders, perfectionism can show up in countless ways — rigid food rules, body ideals, compulsive achievement, fear of mistakes, difficulty resting, feeling like you always need to “have it together,” or harsh self-criticism when you inevitably fall short of impossible standards.
There are many different ways therapists may approach perfectionism in eating disorder treatment. Here are some of my go-to approaches.
Perfectionism doesn’t develop in a vacuum.
Many people have internalized cultural messages about what it means to be successful, valuable, productive, disciplined, attractive, or “good.” These messages are often deeply tied to larger systems of oppression - including patriarchy, white supremacy, anti-fatness, and ableism - that promote rigid ideals about what a worthy life should look like and who gets seen as valuable. We’re often taught that if we’re struggling, it’s a personal failure. That if we aren’t thriving, productive, thin, accomplished, always emotionally regulated, or constantly improving ourselves, we’re somehow to blame.
Part of therapy can involve examining and unlearning these messages. Where did your ideas about success, worthiness, discipline, achievement, or “having it together” come from? Which of these beliefs genuinely align with your values - and which ones were inherited from a culture you don’t actually agree with?
Understanding where perfectionism comes from can create space to loosen its grip.
Perfectionism often develops in response to unmet relational needs.
For some people, it grows out of family environments that placed heavy emphasis on achievement, image, or external perception. For others, it develops in relationships where their worth felt tied to what they could do for other people rather than who they were internally. Sometimes perfectionism emerges in childhood environments where you were responsible for managing other people’s emotions, meeting impossible expectations, or minimizing your own needs.
In these contexts, perfectionism isn’t just a personality trait - it’s a survival strategy. Therapy can involve exploring how perfectionism may have protected you at different points in your life, while also looking honestly at how it may no longer be serving you now.
Letting go of perfectionism can be scary. If perfectionism has been part of your life for a long time, you may wonder: Who would I even be without this? One common fear is that if you stop being perfectionistic, you’ll stop working toward your goals altogether.
In my clinical experience, I haven’t found that letting go of perfectionism leads to people becoming unmotivated or directionless. Often, goals become more attainable when they are driven by values, curiosity, meaning, or genuine desire, rather than fear, shame, or the need to prove worthiness.
For some people, particularly neurodivergent folks, perfectionism may also function as an important coping strategy. You may rely on anxiety, fear, urgency, or perfectionistic standards to compensate for executive functioning challenges or to get things done. That can be a valid adaptation. But it also may not be sustainable long-term and can contribute to burnout.
If this resonates with you, therapy doesn’t have to be about abruptly taking away a coping strategy that’s helping you survive. Instead, it can involve collaboratively exploring other ways of supporting motivation, structure, and follow-through that are more sustainable and compassionate.
One approach therapists sometimes use is helping clients gradually experiment with letting go of perfectionistic behaviors.
This idea comes from exposure-based approaches: giving your brain opportunities to learn, in safe and collaborative ways, that you can tolerate doing things differently - and that you can still be okay without relying on perfectionism.
We might look at how perfectionism shapes your behaviors and identify small, manageable steps toward more flexibility. Examples might include:
These experiments aren’t about forcing yourself to stop caring. They’re about building evidence that perfectionism may not be as necessary for safety, belonging, or success as your brain has learned to believe.
Perfectionism often develops from a very human desire: the desire for connection. We want people to see us as competent, responsible, hardworking, capable, dependable. And sometimes we do experience connection through being admired for those qualities or having our efforts recognized.
But perfectionism can also make closeness harder. It can be difficult to truly know someone who never shows mistakes, uncertainty, needs, or vulnerability.
Perfectionism may make it harder for others to offer support. It can make it harder for people to know what’s actually going on beneath the surface. Sometimes it can even make it difficult for others to ask you for support - because asking for help can feel unsafe with someone who appears never to need help themselves.
Therapy can be a space to explore the real relational costs of perfectionism without judgment and to experiment with new ways of showing up in relationships.
Mindfulness can also be a helpful tool for addressing perfectionism. Broadly speaking, mindfulness involves practices that help us become more aware of our thoughts, emotions, sensations, and experiences without immediately judging or reacting to them.
Perfectionism often pulls us away from the present moment. It keeps us focused on past mistakes, future fears, imagined worst-case scenarios, or how we are being perceived by others. It can disconnect us from our internal experience. Mindfulness practices can help redirect attention back to the present and reconnect us with what’s happening inside.
Meditation is one form of mindfulness, but mindfulness can be much broader than meditation. My approach isn’t about prescribing one “right” way to practice mindfulness. It’s about collaborating to identify approaches that are accessible, flexible, and supportive of your specific needs, goals, and nervous system.
Perfectionism in eating disorders is rarely just about “wanting to do well.” More often, it’s deeply connected to survival, belonging, trauma, identity, culture, relationships, and the complicated ways we learn what it means to be worthy.
Addressing perfectionism isn’t about lowering your standards or giving up on your goals. It’s about creating a life where your worth is not dependent on flawless performance - and where pursuing your values doesn’t require constant fear, rigidity, or self-punishment.
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