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Rigid Food Rules in Eating Disorders: Is Perfectionism to Blame?

I remember cutting baby carrots into 6 pieces. Rushing home to eat because I wasn’t “allowed” to eat after 7 pm. Eating the exact portion size–no more, no less. (Oh the rules. I don’t miss them.) Rigid food rules are very common among eating disorder sufferers. These rules can be about anything: the foods you are allowed to eat, how you are allowed to eat them, the time you are allowed to eat them, and so on.

But where do they come from? Why do some individuals have more rules and more ritualistic behaviours than others?

It is a complex question, but a recent study suggests that perfectionism might play a role. Specifically, the authors explored the idea that perfectionism mediates adherence to food rules in disordered eating behaviours. In order words, food rules might be a way in which perfectionism “expresses itself” in eating disorders.

Why perfectionism?

Perfectionism has been identified as both a risk factor and a maintaining variable for disordered eating symptoms. In a prospective study, individuals with severe anorexia nervosa who scored highly on perfectionism at pretest had poorer prognoses, as indicated by assessments 5–10 years later (Bizeul, Sadowsky, & Rigaud, 2001). […] [I]ndividuals with eating disorders appear to hold themselves to exceptionally high personal standards but may be less concerned about living up to socially prescribed ideals.

In Fairburn and colleagues’ influential transdiagnostic cognitive–behavioral theory of the development and maintenance of eating disorders (Fairburn, Cooper, & Shafran, 2003), over-evaluation of eating, weight, and shape interacts with perfectionistic standards for achievement and self-control to drive the development and maintenance of eating disorder symptoms.

Previous studies have shown that self-imposed food rules may lead to even more preoccupation with food, “setting the stage for more rigid adherence to these rules” and “increasing the likelihood of binge eating” when the temptation is too strong. This might set up a positive feedback loop, whereby rules lead to dietary restraint, which leads to bingeing (or at least, rule breaking), which might lead to more rigid rules and increased preoccupation with forbidden foods and more chances of rule-breaking and “splurging.”

To test the idea that perfectionism mediates food rules in disordered eating, Amanda Brown and colleagues at Emory University recruited 48 female undergraduate students and had them complete a battery of questionnaires about eating behaviours, intuitive eating, body dissatisfaction, self-esteem, perfectionism, and food rules.

To assess adherence to food rules, the authors developed their own 14-item questionnaire that included items: “I eat what I believe to be the right portion size, even when it is not satisfying”, “I feel disappointed in myself when I “spurge” on food I typically do not ea or avoid.”, “I feel the need to follow food rules or diet plans that dictate what, when, and/or how much to eat.”

The participants were between 18-35 (average age: 19) and were racially diverse (67% Caucasian, 19% Asian, 8% Black or African-American, 10% Hispanic or Latino, and 6% Mixed Race or Other).

After all the questionnaire’s were completed, Brown and colleagues analysed the data and found that adherence to food rules was significantly related to self-oriented perfectionism, but NOT other-oriented or socially-oriented perfectionism.

Perfectionism comes in three flavours: self-oriented, other-oriented, and socially-oriented. Self-oriented perfectionism “involves critical self-scrutiny and holding unrealistic, self-imposed personal standards.” Other-oriented and socially-oriented perfectionism is “based on the need to achieve high standards imposed by other people or by society at large.”

Previous studies have shown that individuals with eating disorders appear to hold themselves to very high standards but are less concerned with living up to the standards of others or of society.

Brown and colleagues:

These data support the notion that disordered eating attitudes and behaviors may be largely driven by individuals’ self-imposed high standards. High levels of self-oriented perfectionism may lead individuals to rigidly interpret guidelines for healthy eating and to adhere strictly to these guidelines. Once established, rigid food rules likely become more restrictive and prohibitive, leading to greater preoccupation with food and eating, less intuitive eating, and increased symptoms of disordered eating. While the current data do not address the developmental trajectory of perfectionism, food rules, and disordered eating, they support the hypothesis that adherence to food rules may be a key mechanism by which self-oriented perfectionism leads to eating pathology.

Brown et al suggest that when it comes to treatment, interventions aimed at challenging the patients’ rules (such as exposure to rule breaking without having the option to restrict or purge) may lessen the rigidity of the patients’ beliefs (for example, that eating X will lead to weight gain). This seems to be something that is done routinely, no?

While I think that’s important, I think it is also important for patients to develop an understanding of why they feel the need to enact rigid food rules and what are the positive psychological aspects of following those rules. I think having a deeper understanding of that (as opposed to just focusing on reducing the behaviours) would benefit the patients in the long-run. What are the positive & beneficial aspects of food rules that perpetuate the disorder, and how can they be replaced or ameliorated? 

Keep in mind that this was a small study in a private university that enrolled non-clinical participants. It remains to be seen whether these findings are representative of the clinical population. Moreover, the study used a newly developed and not-yet well verified assessment of adherence to food rules. Finally, I’ve done lots of questionnaires, including some of the ones utilized in this study, and um, let’s just say it is a pretty rough measure of things, as far as I’m concerned. Our memories are not stable or accurate, and it is difficult to switch from thinking “in the last week” to “in the last three months” to “in the last 3 weeks,” as many of these questionnaires do.

Despite the limitations, this study provides some preliminary evidence that adherence to food rules might be one way through which perfectionistic traits (particularly self-oriented perfectionism) leads to the development and maintenance of eating disorder behaviours.

Brown, A., Parman, K., Rudat, D., & Craighead, L. (2012). Disordered eating, perfectionism, and food rules Eating Behaviors, 13 (4), 347-353 DOI: 10.1016/j.eatbeh.2012.05.011

Written by Tetyana

Tetyana is the creator and manager of the SEDs blog. She has an MSc in Neuroscience from the University of Toronto. Tetyana is passionate about science communication and knowledge translation. To get in touch, use the ‘Contact’ form on the website.

Discussion

12 Responses to “Rigid Food Rules in Eating Disorders: Is Perfectionism to Blame?”

  1. I used to plan binges for certain days (often a three-day-fast-one-day-binge cycle). My binge day started at the stroke of midnight. I was not allowed a crumb until then. So I used to sit in bed, surrounded by a mountain of food, eagerly watching the hands on my watch creep round.

    And yes, I’m a perfectionist. I’m an uber-Virgo. I create rules for myself and I have to follow them. Am not so societally influenced.

    The charts I wrote (in secret code) to keep myself on course are online here:
    http://www.lesbian-crushes-and-bulimia.com/bulimia-charts

    Posted by Natasha Holme | February 25, 2013, 6:11 PM
    • Yeah, I’ve known of people who’ve had specific binge/purge days and those kind of rules, you know, by the hour/minute. In retrospect, it is so odd but not at the same time, I must admit.

      Posted by Tetyana | February 27, 2013, 12:16 AM
      • I got down to a really slim weight by starving off [xx lbs]. So once I’d got there, I was so frustrated for food that bingeing was Heaven. To return to the same weight took three days of fasting … after which, I was so frustrated for food that bingeing was Heaven. … And so it continued.

        [Tetyana’s note: I edited out the weight #’s because 1. it might be triggering for some and 2. I think the actual numbers are irrelevant to the main point.]

        Posted by Natasha Holme | February 27, 2013, 8:18 AM
  2. I’m always sort of personally fascinated by this topic – I have a LOT of very rigid “food rules” that I logically know are silly or ridiculous but that I still adhere to. It’s even more pronounced now in “recovery” than it was while my AN was progressing and spiraling downward. And I’ve read other things like this that link this rigidity to the perfectionism thing, and I can see that link…but what’s interesting to me, regarding myself, is that I have never been anything approaching “perfectionist” in any other area or time of my life. Not in school, not at my jobs, not with chores, etc. Not that I slacked off or sucked at those things, just that I never cared about getting all As or doing tasks just exactly right. I certainly worried about failing at things or letting people down (teachers, bosses, etc) but not to any sort of…manic degree.

    I would never have applied the term perfectionist to myself, nor would anyone who has known me. Yet I cling to my food rules so so strongly. I know that should be one of the things I tackle in recovery, and my nutritionist has agreed that eventually I need to try to break out of that shell and allow some variations to my rules (what time I eat, how quickly, in what order, etc)…but for now it still feels like allowing myself the comfort of the rules helps me to be okay with recovery as a whole. I don’t know if that’s bad or not.

    Anyway, blah blah. :P

    Posted by Alison Rose | February 25, 2013, 6:45 PM
    • You raise an important point, which is that that perfectionism is just part of the picture. It explains some percentage of the variance we see in, you know, the behaviour we label as “adherence to food rules”, but it certainly doesn’t explain all of it. It is not a 1:1 relationship.

      Posted by Tetyana | February 27, 2013, 12:34 AM
  3. I stronly relate, because while they aren’t as strong as they used to be, I’ve been ruled by the rigid food rules too for a long time. Throughout life from early childhood, things had to be eaten in a certain order, I could only eat with a certain sized spoon, things had to be cut into fours etc. I think for me, it’s more like an OCD thing than a perfectionist thing because I’m not really perfectionist. As I fell down the rabbit hole into full blown ed the rules got a lot stronger. To disobey felt like the end of the world, felt like i would absolutely die. I think following the rules brought me great comfort too. “If I do x, then everything will be alright.” Rationally I was well aware that many of my rules were pointless, but the feeling of everything being in control and that it was ‘going to be alright’ was the only thing that kept me going at times and it’s what I miss the most today.

    Posted by Fiona | February 26, 2013, 7:51 AM
    • ” I think following the rules brought me great comfort too. “If I do x, then everything will be alright.””

      OMG. So this. Very much. The comfort that comes from familiarity and not having to worry. Like…you know that eating X food in Y way at Z time is safe, whereas changing any element – even while logically knowing it would probably be just fine – makes you think it just might possibly not be safe, and gets scary and worrisome and then you start fretting and stewing…gaaahh. Anyway, yes to all of your comment.

      Posted by Alison Rose | February 26, 2013, 6:32 PM
    • Yes, definitely, OCD and anxiety are other factors that contribute to this. No doubt.

      Perhaps, then, what contributes to these food rules and adherence to them is not so much perfectionism for many, but OCPD (obsessive compulsive personality disorder)? OCPD seems to include a lot of the components that you both (Fiona & Alison) mention.

      Posted by Tetyana | February 27, 2013, 12:37 AM
      • I certainly think that could be part of it for me. Other OCD-ish things crept up as my AN progressed – germphobia for one thing, and also severe trichotillomania. Neither of these things were big things before my ED came back (the germ thing a little bit but nothing like it got) and as my weight went down and down, those things went up and up.

        Posted by Alison Rose | February 27, 2013, 2:22 AM
      • The strange thing is that even though I knew it made absolutely no sense at all, it was my WHOLE LIFE that I felt was going to be alright and ‘fixed’. Not just my body or my food fears or whatever – my whole life. The people who hurt me would go away and/or leave me alone. I’d get back things I lost (ability to study/dance/work/etc) I’d be happy etc… I knew it was irrational, and yet, that’s the feeling I got from adhering to my rules. My whole world was upside down but this ED was going to be the solution to it all. And when I broke those rules, it was all tumbling down again. One bite of the wrong thing or at the wrong time, could tear my entire world of shaky card towers down.
        I don’t know enough about OCPD to know if that fits under that. I do know it’s magical thinking, all or nothing thinking.. and nuts, totally nuts :)

        Posted by Fiona | February 27, 2013, 3:18 AM
  4. I used to have a rule that I could only eat foods starting with C. I don’t know how that started, I think it was completely arbitrary- it was just a way to make myself feel less anxious by reducing the variety of options I had when I was trying to make decisions about what to eat. I have definitely been called a perfectionist since I was about 5 years old, but only in some areas of my life. As my ED got worse the perfectionism extended to more and more areas of my life, for example neatness when I’d never worried much about it before. Rules kept me safe, and I miss that quite a bit.

    Posted by bets | March 7, 2013, 5:50 PM

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