Pressures to be perfect are normalised in modern society. We are constantly besieged with images of perfect health, perfect diet, and perfect bodies. Social media platforms (e.g., Instagram) are plagued with gym workouts, health foods, and images of “perfect” aesthetic beauty. Attempts at achieving a perfect healthy lifestyle can come at a cost, however. One concern is that these attempts are contributing to the rise of compulsively healthy eating, known as orthorexia.

UK hospital admissions for eating disorder treatment have risen by 84% during the last 5 years. Eating disorders are characterised by unhealthy relationships with food, weight, and shape. These relationships are often coupled with dysfunctional exercise habits. Eating disorders such as anorexia nervosa and bulimia nervosa involve a fear of weight gain and body dissatisfaction. Anorexia differs from bulimia as it involves dietary restraint and significantly low body weight. Bulimia involves reoccurring episodes of binge eating that are coupled with compensatory behaviours.

Other specified feeding or eating disorders (OSFED) are defined as feeding or eating behaviours that cause clinically significant disturbance in an individual's thoughts, feelings, and behaviours, but do not meet the criteria of other eating disorders. Avoidant restrictive food intake disorders (AFRID) do not usually involve distress about the body, but individuals suffering from AFRID fail to meet appropriate intake/energy needs. Because energy balance is not met, weight loss, nutritional deficiency, and problems with social and mental functioning can occur. Researchers have collectively classified orthorexia as a subtype of AFRID.

Orthorexia

Orthorexia is a pathological fixation with correct nutrition that leads to physical ill-health and psychosocial malfunctioning. Popular commentary describes orthorexia as the pursuit of a perfect diet. It is characterised by rigid and inflexible patterns of eating that are self-imposed and strictly controlled. Orthorexia is not yet recognised as a clinical eating disorder in formal diagnostic criteria. However, arbitrary diagnosis depends on the duration of symptoms that an individual experiences, typically six-plus months.

Perfectionism and disordered eating

Personality can make someone susceptible to experiencing disordered eating. Personality traits describe how an individual thinks, feels, behaves, and relates to others. Perfectionism is a personality trait characterised by setting excessively high standards and being extremely self-critical. Perfectionists strive for flawlessness. Perfectionism is recognised as a risk factor in disordered eating.

Perfectionists are vulnerable to disordered eating because they set unrealistic standards to achieve eating and weight ideals and are highly self-critical when these standards are not met. Perfectionists see anything less than perfect as a failure. Striving to be perfect or obtain a perfect diet can be an attempt at gaining control. Here, a perfectionist’s sense of control is likely to be driven by feeling out of control in other areas of life.

Perfectionism and orthorexia

Evidence has confirmed that perfectionism is a key factor in the development and maintenance of orthorexia. Our latest research looked at the effects of “perfectionistic self-presentation” and “trait perfectionism” in predicting orthorexia over time. Perfectionistic self-presentation is the need to portray a perfect image of oneself while hiding imperfections. Trait perfectionism is a more ingrained why of thinking that is centred around the need to be perfect.

The results of our research found that both perfectionistic self-presentation and trait perfectionism predicted orthorexia across time. However, when we looked at perfectionistic self-presentation and trait perfectionism alongside one another, trait perfectionism was more important. This means that individuals who need to be perfect and experience extreme self-criticism when they are not perfect are most likely to develop orthorexia. Perfectionism, then, is a key variable in predicting orthorexia over time.

What can we do about it?

To prevent a further rise in levels of perfectionism and orthorexia we must learn to be compassionate toward ourselves. We must learn to let go of unattainable goals and look beyond the need for dietary control. Self-compassion is a tool to help us develop self-kindness and be willing to challenge and alleviate distorted ways of thinking and feeling. A compassionate mind will allow us to then change unhelpful eating patterns and realise that we can have dietary goals that are achievable, without the mental health cost.

Self-compassion is not something we learn once and master. It is a lifelong journey. It is a choice to be concerned for the well-being of the self. Self-compassion is proven to reduce the self-aspects of perfectionism. This in turn may protect us from developing disordered eating such as orthorexia. It may also buffer the effects self-defeating behaviours and encourage us to adopt safer eating practices.