New Study Finds Self-Criticism to be a Risk Factor for Bulimia in Adolescents

Perfectionism is multi-dimensional, including evaluative concerns (EV) and personal standards (PS) of perfectionism. “Whereas PS perfectionism is primarily defined by the setting of high standards per se, EC perfectionism is primarily defined by self-critical features such as concern over mistakes and doubts about actions,” said Liesbet Boone, faculty member of the Department of Developmental, Social and Personality Psychology at Ghent University in Belgium. “Both clinical accounts and empirical studies suggest that perfectionism is strongly involved in the development and maintenance of eating disorder (ED) symptoms.” In a recent study, Boone attempted to address two specific questions relating to perfectionism and eating problems. “Do both PS and EC perfectionism have unique relations with ED symptoms? Or is only EC perfectionism uniquely associated with ED symptoms?” asked Boone.

Boone and her colleagues evaluated 559 adolescents over a period of two years. They assessed their levels of perfectionism and eating problems and found that EC perfectionism was the most significant factor that contributed to disordered eating, and specifically, to bulimia. “This finding suggests that being overly critical of one’s own behavior and performance increases the risk to experience bulimic symptoms two years later,” said Boone. “In addition to the direct association between EC perfectionism and increases in bulimic symptoms, we found that EC perfectionism also had an indirect association with increases in bulimic symptoms through perceived pressure to be thin and body dissatisfaction.”

Boone believes her findings have clinical implications that could help target treatment for adolescents at risk for disordered eating. “By focusing exclusively on a reduction of perceived pressure to be thin and thin-ideal internalization, the source of these harmful socio-cultural orientations may not be addressed such that these orientations and their related symptoms reappear later. We argue that the long-term effectiveness of interventions may be increased by specifically addressing the role of PS and EC perfectionism.” She added, “Programs could, for instance, incorporate modules to diminish evaluative concerns and self-criticism and to lower the tendency to set very high standards in general and standards in the domain of weight and shape in particular.”

Boone, Liesbet, Bart Soenens, and Caroline Braet. “Perfectionism, Body Dissatisfaction, And Bulimic Symptoms: the Intervening Role of Perceived Pressure to Be Thin And Thin Ideal Internalization.” Journal of Social and Clinical Psychology 30.10 (2011): 1043-068. Print.

© Copyright 2011 by By Noah Rubinstein, LMFT, LMHC, therapist in Olympia, Washington. All Rights Reserved. Permission to publish granted to

The preceding article was solely written by the author named above. Any views and opinions expressed are not necessarily shared by Questions or concerns about the preceding article can be directed to the author or posted as a comment below.

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  • Gaye Sprague

    Gaye Sprague

    December 16th, 2011 at 7:26 PM

    You know, I think that we ought to do more to teach our girls that the kind of perfectionism that they seek can only be achieved through starvation and airbrushing. Now does that sound like the life that they would want to lead?

  • James


    December 17th, 2011 at 7:34 AM

    When did we all begin to tell ourselves that the ideal is perfect? I know that we all wish to do and be our best, but does that mean that is has to be perfect? No. And these kids internalize this from a very early age and think that this is the only way that they can be liked and accepted. And the bad thing is that most of us feed into that. I want to teach my sons and daughter that it is ok to not be perfect, that none of us are perfect and never will be. But just try hard and do your best, that is what most of us wish to see and to achieve.

  • alex h

    alex h

    December 17th, 2011 at 10:42 AM

    There are plenty of people who are self critical and who do not develop an eating disorder. What happens to trigger that in others?

  • Nate


    December 18th, 2011 at 4:24 AM

    If the sense of perfectionism is to eat right and eat healthy while consuming enough quantity of foods then there would be no problem.The reason why this perfectionism is seen to encourage eating disorders because the sole idea of perfectionism when it comes to eating for most young people is to keep the weight off and somehow not put it on at all, not eating healthy!

  • Maddie


    December 18th, 2011 at 6:31 AM

    It kind of goes without saying that the more critical one is of oneself then it is only going to be a natural progression to more and more destructive behavior. These are people who are not thinking clearly, are only thinking about the self loathing and hatred that they feel about their bodies or whatever other issues are going on in their lives and this is how they have chosen to act this out. Pretty sad once they get into that kind of cycle and then can’t find the way to break out of it.

  • Elsa Grantham

    Elsa Grantham

    December 18th, 2011 at 11:15 PM

    Concerns over mistakes and doubts about behaviors are commonplace. Heck, I wish teens realized how often adults have them and that’s it’s not only them that suffer that! You have to work on facing the world in such a way that you can shine and be confident, not hide in the shadows. Talk to anyone you trust as soon as possible and find alternative coping mechanisms.

  • Luke T.

    Luke T.

    December 19th, 2011 at 12:26 AM

    Gee who would have thought. Isn’t a major problem with your personal body image or image of your own self something like the #1 leading cause of any kind of eating disorder? That’s not exactly a new study unless they haven’t read an article on the subject in the last thirty years!

  • mackenzie l.

    mackenzie l.

    December 19th, 2011 at 12:40 AM

    @Luke T. : You hit the nail on the head. I read about a decade ago that anorexics and bulimics tend to be perfectionists. Those researchers wasted bucketloads of money there that could have gone towards the treatment of a girl or boy actually gripped by such a condition. This study is nothing new.

  • avril


    December 19th, 2011 at 6:08 AM

    You have to look at the criticism that bulimics feel from the worls around them too. I think that we can all remember someone telling us that we wuld be so much prettier if. . . Maybe those with eating disorders always heard that they would be prettier, happier, whatever if only they would lose weight. So they turned to bulimia as their mean to achieving that and also feeling like they were making someone else happier too. This is something that they feel like they have control over. So while I do think that it is vital to realize that bulimics are hard on themselves and that alot of this activity stems from that it is also important to be a little more mindful of the words that we say to these young people too. They take so much it to heart and this can end up being very detrimental to their overall health.

  • Vince.L


    December 19th, 2011 at 1:26 PM

    Isn’t self-criticism a good thing that can quickly turn into something bad?Yes, it sure is.N if someone does not know where to stop criticizing d self then he or she will face problems not only in eating issues but in anything else too.

  • Marcia N

    Marcia N

    December 20th, 2011 at 5:20 AM

    It is also about trying to be this perfect picture, you know. It is not just about how they look on the outside but trying to be this model of perfection to everyone else too. These are girls who are trying too hard to be all things to all people and it is hard to explain to a young girl that this is just an impossibility. You can’t make everyone happy, so the best thing to do is to focus on and concentrate on yourself. When you make yourself happy then it is bound to trickle down and make others happy too.

  • Sara Boyce

    Sara Boyce

    December 20th, 2011 at 8:08 PM

    I beg to differ. Not everyone who is a perfectionist picks up an eating disorder, and not everyone with an eating disorder is a perfectionist. It is common for the two to overlap yes, but you’re overlooking the crux of this: what do we do to prevent it? Tell girls off for having an eye for detail and the persistence to get it right because they might end up puking dinner into the toilet some day?

    What we need to know is how to use that information in practical terms to aid prevention.

  • Jenny Roland

    Jenny Roland

    December 20th, 2011 at 8:12 PM

    @Sara Boyce: That’s right. You can’t punish a positive personality trait or a negative one. Perfectionism can go either way depending on the overall situation, and that’s the problem. Young people are easy to confuse, and punishing them for trying to do something right or constantly warning them about the risks of perfectionism leading to an ED doesn’t seem right.

    We push them to excel and be the best they can be…hey, maybe that’s the problem right there that plants the seed.

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