Brian Pollack, LCSW, CEDS-C
Brian is the Founder and Clinical Director of Hilltop Behavioral Health, a boutique eating disorder specialty practice in Summit, NJ. He is one of the few male master’s-level Certified Eating Disorder Specialists in the country, with expertise in FBT, male clients, athletes, and muscle dysmorphia. He hosts the Minding Men podcast and serves as an adjunct professor at Yeshiva University.
Learn more about Brian →If you have ever stayed up past midnight rewriting an email, refused to leave the house with one wrinkle in your shirt, or felt your stomach drop over a B+ on a paper you actually worked hard on, you already know what perfectionism feels like from the inside. It does not always look loud. Sometimes it looks like the highest performing person at the office, the most reliable friend in the group, or the parent who never seems to drop a ball. Underneath that polished surface, there is often a quiet, exhausting voice insisting that nothing you do is ever quite enough.
As a Certified Eating Disorders Specialist, I sit with that voice every day. I hear it in the way clients talk about themselves, in the rules they have built around food, and in the sleepless nights spent rereading texts they already sent. Perfectionism is one of the most common threads in my practice, and one of the most misunderstood.
On a recent episode of Nourish and Empower, the podcast we are proud to sponsor, the conversation captured something I want every client and family to understand. Striving for your best and chasing perfect are not the same thing. Your best changes day to day. Your best on Monday after eight hours of sleep looks very different from your best on a Tuesday running on caffeine and stress. Perfect, by contrast, is a fixed standard that rarely accounts for being human.
What Perfectionism Actually Is
Clinically, perfectionism is more than a personality quirk. Researchers usually describe it across two dimensions: perfectionistic strivings (setting very high personal standards) and perfectionistic concerns (harsh self criticism, fear of mistakes, and worry about how others will evaluate us). A 2024 systematic review and meta analysis of 416 studies and more than 113,000 adults found that perfectionistic concerns showed moderate, consistent correlations with anxiety, depression, and obsessive compulsive symptoms (Callaghan et al., 2024, Cognitive Behaviour Therapy). The part of perfectionism that hurts most is not the high standards themselves. It is the punishing relationship many people develop with those standards.
This matters because perfectionism rarely travels alone. It tends to show up alongside anxiety, OCD, and eating disorders, which is why researchers now consider it a transdiagnostic process: a single underlying pattern that fuels several conditions.
Why I See This So Often in Eating Disorder Recovery
If you or someone you love has struggled with food, you may already sense the connection. Eating disorders thrive on rules. Numbers on a scale. Calorie counts. The “right” foods, the “right” times, the “right” body. For someone wired toward perfectionism, those rules can feel less like illness and more like discipline.
The research supports what I see in session. A 2023 systematic review and meta analysis of 95 adult studies found that both perfectionistic strivings and perfectionistic concerns were significantly associated with eating disorder symptoms, and the authors concluded that perfectionism functions as both a risk factor and a maintaining factor for eating disorder pathology (Stackpole, Greene, Bills, & Egan, 2023, Eating Behaviors).
The same team examined younger populations and found similar patterns. In a meta analysis of 39 studies and nearly 14,000 children and adolescents, higher perfectionism was significantly associated with greater eating disorder symptoms (Bills, Greene, Stackpole, & Egan, 2023, Appetite). A sobering finding for any parent who has wondered whether the pressure they sense in their child is “just personality.”
A separate meta analysis on binge eating found that perfectionistic concerns showed a small to moderate relationship with binge eating, even though binge eating is often misread as a “lack of control” rather than a perfection driven cycle (Vicent et al., 2023, Journal of Eating Disorders).
Translation: when a client cannot tolerate “imperfect” eating, what we are often treating is not just a relationship with food. It is a relationship with self worth that has been outsourced to a number, a behavior, or an outcome.
The Hidden Cost: A Punishment Loop
One of the things the Nourish and Empower hosts named so well is the punishment piece. Perfectionism is not just a high bar. It is a high bar followed by an internal consequence when the bar is missed. Studied for six hours and got a B? You should have studied for eight. Ate something outside the rules? You will compensate tomorrow. Said the wrong thing at dinner? Replay it on a loop until 3 a.m.
Over time, that loop wears people down. It is one reason perfectionism is now considered a transdiagnostic process that can complicate treatment for eating disorders, anxiety, and depression when it is not addressed.
What Helps (And What Does Not)
As a clinician, all of us are not trying to take away anyone’s drive or ambition. Those are gifts. What we are trying to do is loosen the grip of the punishment loop and help clients rebuild a sense of self worth that is not contingent on flawless performance. A few of the tools we lean on most:
- Naming the rules. Many clients do not realize how many tiny perfection rules they follow until we map them out together. Wrinkled shirts. Mismatched socks. The “right” amount of food. Awareness is the first crack in the armor.
- A graded approach. Borrowing from exposure work, we sort situations by how charged they feel: comfortable, willing to explore, and not yet. Then we practice tolerating “imperfect” in the comfortable zone first and slowly work outward.
- Separating worth from output. Much of my work is helping clients notice when they are equating their value with a grade, a weight, a clean kitchen, or how many people they made smile that day. You are not your performance. You are not your plate.
- Inviting support people in. Family and partners often see the perfectionism before the person does. When loved ones can gently reflect what they notice, without shame and without rescue, real change becomes possible.
A Final Word
If any of this is resonating, hear something I tell my clients often: you do not have to be perfect to be loved, to be safe, or to be enough. Your best is allowed to look different on different days. Resting counts. Trying counts. Falling short counts. You are still worthy in all of it.
If you want to sit with this idea longer, I really do recommend listening to the full Nourish and Empower episode that inspired this post. It is honest, warm, and full of moments that will leave you feeling less alone. And if perfectionism is tangled up with food, body, or your mental health in ways too heavy to carry on your own, please reach out. At Hilltop Behavioral Health, my team and I specialize in exactly this kind of work, because healing happens here, and you deserve to feel that for yourself.
I will be writing more soon on questions that come up most in this work: how families can support a loved one without slipping into pressure, what recovery from perfectionism really looks like, and the quiet ways diet culture preys on perfectionistic minds. If today’s post spoke to you, I hope you will come back for those too.
