As I continue to work in the therapeutic space of disordered eating and eating issues, I remain skeptical of the emphasis on the eating behaviors themselves. What I’ve found, time and again, is that eating issues are largely couched in a number of emotionally-rooted issues, including anxiety, concerns about control, phobias and fears, low or externally-based self-esteem and self-worth, and the big-ticket winner: perfectionism.
For many of us that have struggled with eating issues, the emphasis on our weight and shape is just one small component of a much larger picture. Weight and shape concerns fit into the larger context of perfectionism, in which we place significant value on approaching everything in our lives in the “right” way, whenever possible. Because “right” is a rather ambiguous and moralistic term, our assumptions of what is “right” are routinely dictated by the social structures surrounding us, including our families and communities, and more broadly, the media and popular culture. This impacts our views on how our bodies “should” be, of course, but also on how we approach our daily lives. For example, it’s my belief that, because work ethic and selflessness are both prized cultural values for women in American culture, many of my female clients that strive for perfectionism report working very difficult jobs for low pay, or working 12 – 14 hours per day, or making substantial personal sacrifices in the name of their careers (or all three of these things). For male clients, it seems that the work ethic value remains, but the emphasis shifts from selflessness to earning power. In both cases, because perfectionism is a hole with no bottom, individuals rarely report that they’ve done enough or worked enough or made enough, no matter the enormity of their personal sacrifices.
Perfectionism also colors one’s view of what constitutes “healthy eating,” another cultural value that we strive to achieve by approaching food the “right” way. Since the cultural landscape is always changing regarding what constitutes a “healthy” diet, we sometimes desperately shift from one diet to another according to what is being touted as the most correct – this applies to alternative diets, of course, like vegetarianism, veganism, keto, and paleo approaches, but also more generally to the labelling of some foods as “good” (kale was the token hero food for years, for example), and others as “bad” (sugar, of course, is today’s ultimate bad guy, though for some time fats were in the lead). What many of us label as clean eating or a disciplined approach to food is often actually veiled orthorexia, a condition that manifests obsessive symptoms in pursuit of a “healthy” diet. Many sufferers of orthorexia are crippled with anxiety and fears around eating, though they many not identify these symptoms as unusual, because they are routinely celebrated in American culture.
For the reasons discussed above, it can be difficult to spot perfectionism at the heart of issues with eating because it is not identified as a problematic value in our culture. We often need to wait until the symptoms of perfectionism spring to the surface: crippling anxiety, insomnia, obsessions and compulsions, controlling behaviors, and, of course, issues with eating, among others. It can often be confusing to individuals seeking support for these symptoms because their symptoms are demonized while their perfectionistic behaviors are praised. This is why it is essential that the link between the two is recognized, and that both are addressed in one’s self-work in therapy.
My hope is that the role that some of our problematic cultural values, like perfectionism, will be challenged routinely by therapists (and healthcare providers, and educators, and parents, etcetera) in order to reach the root of the symptoms springing from them. Should the larger culture remain unchallenged, the problems will likely persist, despite our best therapeutic efforts.