VCU study links perfectionist trait and eating disorders

By Lorraine Cichowski and Cynthia Bulik

RICHMOND, Va. – In the largest study of its kind, a team of researchers at Virginia Commonwealth University has identified a significant and unique link between the perfectionist's concern about making mistakes and a tendency to have anorexia and bulimia.

The finding, published today in The American Journal of Psychiatry, moves researchers a step closer to identifying a genetically influenced trait that might predispose a person to eating disorders. The results are particularly noteworthy because they uncover a trait that appears to be uniquely associated with the serious eating disorders anorexia nervosa and bulimia nervosa, says Cynthia M. Bulik, Ph.D., who led the team of researchers at the Virginia Institute for Psychiatric and Behavioral Genetics at VCU.

Although anyone can develop an eating disorder, women are at higher risk.

"Until recently, it hasn�t been clear whether the link between perfectionism and eating disorders is unique, or if perfectionism is also associated with the development of other psychiatric problems, such as anxiety disorders, depression and substance abuse," says Bulik, professor of psychiatry. "These findings tell us that there may be something unique about perfectionism that sets a person up for being at risk for anorexia and bulimia nervosa."

Perfectionism is a personality style marked by a tendency to be overcritical of one�s own performance. Perfectionists are differentiated from high achievers by their tendency to be driven by fear of failure rather than a goal to achieve. They also have an excessive need for approval from others and a great concern about making mistakes.

To explore the association between components of perfectionism and seven common psychiatric disorders, the researchers recruited 1,010 female twins, aged 25-65 and registered with VCU's Mid-Atlantic Twin Registry. The researchers used standardized tests designed to measure perfectionism and personal interviews to look for links between perfectionist traits and major depression, alcohol abuse or dependence, anxiety disorder, panic disorder, phobia, anorexia nervosa and bulimia nervosa.

Bulimia is characterized by episodes of binge-eating (eating unusually large amounts of food in a short time and feeling out of control), compensatory behavior such as self-induced vomiting and laxative abuse and over-concern about body shape and weight. Anorexia is characterized by starvation, compulsive exercising and often by the absence of menstrual cycles.

The study found that negative reactions to mistakes and the tendency to interpret mistakes as failures were significantly and uniquely associated with the presence of anorexia and bulimia. The concern about mistakes was not associated with other psychiatric problems. It was the only perfectionist trait found by the study apparently to be unrelated to other psychiatric disorders.

"Most patients and their parents say that perfectionism goes back to before they developed an eating disorder," Bulik says. "Also, many women continue to be perfectionists even after they recover from anorexia and bulimia. So perfectionism may be a trait that places an individual at risk for developing these potentially devastating illnesses.

"And now we know that being overly concerned about making mistakes is one particular perfectionist trait to watch. Young girls who are highly perfectionistic and punish themselves unduly for perceived failures can be helped to learn how to give themselves a break and set more realistic goals. This also could help them develop more realistic body image standards as well and perhaps prevent them from developing such extreme weight loss behaviors."

The research was funded by the National Institutes of Health through its National Institute of Mental Health and the National Institute on Alcohol Abuse and Alcoholism.