Words with Wisniewski: Research Review – Focus on Perfectionism in Female Adolescent Anorexia Nervosa

By Lucene Wisniewski, PhD

Hurst, K., & Zimmer-Gembeck, M. (2015). Focus on perfectionism in female adolescent anorexia nervosa. The International Journal of Eating Disorders, 48(7), 936–941.

Anorexia nervosa (AN) is a difficult illness to recover from for a number of reasons. First and foremost, it’s life-threatening and secondly, the treatments available do not yield high success rates and are in need of improvement.

Therefore, some researchers are experimenting with ways to improve our ability to better treat individuals suffering from AN.

One group of researchers is looking at a way to potentially augment current evidence-based treatment by directly addressing the obsessional thoughts, and impaired cognitive and behavioral inflexibility that are exhibited by many with AN. These obsessions and inflexibility are thought to be associated with rigidity and perfectionism and appear to be independent of starvation.

In this current study, perfectionism was defined as “personally prescribed or socially derived irrational and rigid expectations and exceedingly high standards of self-performance.”

The researchers chose to focus on addressing these issues. Previous research has indicated that an initial high level of perfectionism interferes with positive outcomes after AN treatment and is associated with treatment dropout.

The current clinical case report described the response of three girls who were being treated with Family-Based Treatment (an evidence-based treatment for eating disorders), along with a nine-session module focusing on perfectionism.

The nine-session module, “CBT perfectionism in perspective,” was developed from evidence-based psychological treatment for perfectionism. The aim of the module was to assist the individual to set more flexible and achievable personal standards and to reduce the negative impact of perfectionistic thinking.

The nine modules included information, worksheets, and suggested exercises or activities to be completed in session and/or at home.

What researchers discovered

The inclusion of the targeted CBT perfectionism modules appeared to decrease the levels of perfectionism and inflexible and rigid thinking. Patients reported an increased capacity to perceive making mistakes as an opportunity for new learning, rather than perceived failure or “not being perfect.”

Future research will need to be conducted to see how this impacts the treatment of AN over a long period of time. However, based on these positive results, The Emily Program has implemented this CBT perfectionism perspective module into our programs to further help our patients.

Are you a perfectionist?

Take the following test and find out if perfectionism is a problem for you. Answer the statements below with either True, Somewhat True, Somewhat False, or False to learn more.

• Nothing good comes from making mistakes.
• I must do things right the first time.
• I must do everything well, not just the things I know I’m good at.
• If I can’t do something perfectly then there is no point even trying.
• I rarely give myself credit when I do well because there’s always something more I could do.
• Sometimes I am so concerned about getting one task done perfectly that I don’t have time to complete the rest of my work.

If you have answered most of the above questions with True or Somewhat True, then perfectionism might be something you want to work on. Talk to your Emily Program therapist about our treatment for perfectionism.

The Emily Program offers FBT as one of the proven therapies in our adolescent eating disorder treatment programs. In addition, we offer the CBT Perfectionism in perspective augmentation to those who need it.