A influência do perfeccionismo na comorbidade do transtorno obsessivo-compulsivo e transtornos alimentares: uma revisão narrativa

Abstract

This narrative review brings together 39 articles published between 2005 and 2025 on the relationship between OCD and EDs and analyzes the role of perfectionism in the comorbidity between Obsessive-Compulsive Disorder (OCD) and Eating Disorders (EDs), as well as its impact on maladaptive or pathological avoidance. Perfectionism is identified as a common and relevant psychological trait in individuals with OCD and EDs and manifests itself in two main dimensions: perfectionistic preoccupation (focus on avoiding mistakes and harsh self-criticism) and perfectionistic striving (striving for high standards). Perfectionistic preoccupation is more associated with symptoms of anxiety and cognitive rigidity, while perfectionistic striving can be adaptive in some contexts. This trait contributes to symptom severity, fueling obsessive-compulsive (OC) behaviors related to eating, weight, and body image. The high prevalence of OCD in patients with EDs is well documented, and this comorbidity is associated with factors such as impulsivity, rigidity, and perfectionistic traits. This relationship suggests that both disorders share etiological mechanisms, such as personality traits and obsessive thought patterns. Perfectionism often leads to pathological avoidance, where individuals avoid situations that might expose their flaws or challenge their high standards. This avoidance manifests in behaviors such as extreme dietary restriction, social isolation, and obsessive ritualization around food. Maladaptive avoidance not only perpetuates symptoms but also hinders treatment, creating a cycle of anxiety and behavioral rigidity. OCD symptoms, such as obsessions and compulsions, are often exacerbated by perfectionism. Individuals with high levels of perfectionism tend to have greater difficulty controlling intrusive thoughts and compulsive behaviors, which intensifies the symptoms of both disorders. This interaction reinforces the need for therapeutic approaches that consider perfectionism as a central factor. Studies suggest that therapeutic interventions should address perfectionism and maladaptive avoidance to improve treatment outcomes for OCD and EDs. Techniques such as cognitive behavioral therapy (CBT) can help patients challenge perfectionistic beliefs, reduce avoidance behaviors, and develop healthier coping strategies. Furthermore, screening for perfectionism and OC symptoms can be helpful in early identification of at-risk individuals. Perfectionism plays a crucial role in the comorbidity between OCD and EDs, influencing symptom severity and perpetuating patterns of maladaptive avoidance. Understanding this dynamic is essential to developing more effective and personalized interventions that address both the cognitive and behavioral aspects of these disorders. Future research should further explore underlying mechanisms and consider cultural and individual factors to improve diagnosis and treatment.