Drew Westen, Ph.D.

Jennifer Harnden-Fischer, Ph.D.


Drew Westen points out that anorexia nervosa can be associated with personality pathology centering on perfectionism.

His research disclosed that one category of anorexia patients had axis II pathology that centered on the following traits:

TABLE 1. SWAP-200a Items That Best Described Eating Disorder Patients in the High-Functioning/Perfectionistic Personality

Is articulate; can express self well in words. 3.09

Tends to be conscientious and responsible. 3.05

Tends to be self-critical; sets unrealistically high standards for self and is intolerant of own human defects. 2.61

Expects self to be “perfect” (e.g., in appearance, achievements, performance, etc.). 2.53

Tends to elicit liking in others. 2.35

Tends to be preoccupied with food, diet, or eating. 

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Is empathic; is sensitive and responsive to other peoples’ needs and feelings. 2.29

Is able to use his/her talents, abilities, and energy effectively and productively. 2.28

Has moral and ethical standards and strives to live up to them. 2.13

Appreciates and responds to humor. 2.10 Enjoys challenges; takes pleasure in accomplishing things. 1.98

Tends to feel guilty. 1.98

Is psychologically insightful; is able to understand self and others in subtle and sophisticated ways. 1.96

Has the capacity to recognize alternative viewpoints, even in matters that stir up strong feelings. 1.87

Is capable of hearing information that is emotionally threatening (i.e., that challenges cherished beliefs, perceptions, and self-perceptions) and can use and benefit from it. 1.86

Is creative; is able to see things or approach problems in novel ways. 1.76

Tends to be energetic and outgoing. 1.69

Finds meaning in belonging and contributing to a larger community (e.g., organization, church, neighborhood). 1.56

Tends to express affect appropriate in quality and intensity to the situation at hand. 1.55

Tends to be competitive with others (whether consciously or unconsciously). 1.54

Is able to assert him/herself effectively and appropriately when necessary. 1.52

Tends to be anxious. 1.48

Is able to find meaning and fulfillment in guiding, mentoring, or nurturing others. 1.46

Is capable of sustaining a meaningful love relationship characterized by genuine intimacy and caring. 1.44


Anorexia is a disorder that is fundamentally rooted in a dissociated lack of awareness of needs — i.e., the individual’s lack of awareness of hunger or alimentary needs.  In that sense, anorexia seems related to schizoid disorder in that schizoid disorder centers on a dissociated lack of awareness of social needs.

Does my failure to take up the practice of law center on my anxieties relating to perfectionism — my need to be perfect?

Assuming this to be so creates an interesting linkage between my lack of social adjustment and my lack of occupational adjustment.  Perhaps my need to be perfect hinders my occupational adjustment just as my  dissociated lack of awareness of social needs (my schizoid tendencies) hinders my social adjustment.

Is there a hidden relationship between both my lack of social adjustment and my lack of occupational adjustment centering on an interrelated cluster of anxieties centering on perfectionism and a dissociated lack of awareness of needs?