Perfectionism and Shame in Anorexia in Middle-Aged Women

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When I was anorexic and continued to be readmitted to eating disorder units, there was one phrase that ran through the community of patients. I’m not sure if the staff was aware, although I wouldn’t be surprised if they’d heard it as well: "The perfect anorexic is a dead anorexic.”

There were several traits we all had in common. We were all perfectionists who felt we could never live up to an idealized version of ourselves. The perfectionism almost always started in school (some patients recalled traits even earlier) as we strove for perfect grades and chastised ourselves if we fell short. We often had one or more parents who were demanding and even abusive in some way — verbally, emotionally, physically, or sexually.

One study found that “participants spoke about striving for perfectionism in all areas of life. They inevitably found that this always led to failure and shame as they were not able to be perfect.”

My father was verbally and emotionally abusive, especially when he was intoxicated. He was extremely intelligent and knew just what to say that would sting the most. Words hurt. So did words never uttered. Until he died, I never heard you are good enough.

Since I developed anorexia later in life as an adult, I was always on eating disorder (ED) units with adults and when we talked, I heard a lot of women verbalizing their feelings of not being good enough at their jobs and a constant fear of being let go. Taking time off was so anathematic to us that we were willing to put our lives at risk until we were practically forced to take a medical leave of absence.

The same study quoted above reported that “shame really drove the need to be ‘perfect’ as this was perceived as the only way to alleviate the overwhelming feelings of shame.”

The older I got the more shame I felt at not being able to recover and put anorexia behind me for good. The shame was tied to perfectionism; I was unable to be a “perfect anorexic” when I relapsed. I figured I should have had enough practice by now, but there were always those who were thinner than I was. I would sit on the unit and surreptitiously steal glances at these women, wishing I was them. Additionally, when I was still working my job suffered as the malnutrition took its toll. I thought I should be special and be able to overcome the cognitive and physical effects of starvation.

It was difficult being in my forties and being with other patients in their twenties. I know the common belief is that we can all learn from each other, but the truth is we had little in common; I found it hard to relate to them and they to me.

Nurse paractitioner Kirsten Brook, writing in Eating Disorders Review, stated, “It is difficult and uncomfortable to go to a treatment center where most patients are younger than 35. Many adults in mid- or later life feel uncomfortable participating in such group sessions. Thus, many older adults are not well suited for treatments geared specifically to teens and younger adults. Shame may then paralyze older adults, isolating them further and preventing them from seeking help.”

Physical and mental recovery from an eating disorder are two different things. Someone can be weight-restored for years, maintaining their weight, but still struggle with body dissatisfaction or body dysmorphia and the urge to restrict. It can take years to get anorexia out of our heads.