Perfectionism, Eating Issues, & Cultural Values.


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. 


Useful Information

Some frequently asked questions and useful answers.

Online therapy works in the same way as in-office therapy, but is done online, similar to a Skype or FaceTime conversation. Clients are able to have sessions from home, work, or any other convenient location. We meet with clients using a HIPAA-compliant secure platform.

Online therapy allows you to work with us from the comfort of home, or any private location of your choosing. For some, the screen provides an added layer of comfort that makes the challenging work of being vulnerable in therapy a little easier.

Online therapy also creates the unique opportunity for you to work with us without the constraints of proximity! The practice was born in Keene, New Hampshire, but has since grown to service clients anywhere in Massachusetts, Pennsylvania, Connecticut, Vermont, New Jersey, Florida, and New Hampshire.

Online therapy is a great option for clients that travel for work, for college students that go home during the summertime and do not want a break in their sessions, and for anyone with a challenging or inconsistent day-to-day schedule. It is an excellent choice for clients seeking a therapist with a particular specialty that they are unable to find support for locally. Some of our clients report that online therapy makes the vulnerability element of therapy a bit less intimidating.

No. For some clients with more complex symptoms or safety concerns, having a local therapist that is readily available is important in case of crisis or the need for a higher level of care. Online therapy is also a challenge for clients that do not have access to a private, quiet space to be “in session” for the hour, or for those that do not have adequate internet connectivity.

There are several reasons why we don’t accept insurance. The most important are:

Confidentiality. Insurance companies require that your information be shared with them in order to pay for services. We prefer that clients’ information is kept as confidential as possible.

The pressure to diagnose. Insurance companies require that clients are given a mental health diagnosis in order to pay for therapy. We have found that many clients benefit from therapy, but do not meet criteria for a diagnosis. Not using insurance allows clients to access therapy without being given a mental health diagnosis.

Flexibility and freedom. Insurance companies dictate the length and number of sessions they will authorize, as well as when a client is no longer eligible for the benefits of therapy. Because we do not work with insurance panels, you and we can collaborate to determine your individual needs regarding session length, frequency of sessions, and when to terminate therapy.

While we do not accept insurance, many clients choose to submit receipts to their insurance companies to receive reimbursement via out-of-network benefits. We are happy to provide these receipts for you! Please check with your insurance company for details on your benefits.



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