Apparently I Have A "Perfectionism Disorder"

Beyond Before & After is a bi-weekly column devoted to discussing living without dieting, in a body that demands attention. 

I saw my therapist last Friday.

Besides being my therapist, Dr. W is also my psychiatrist. This puts her in the unique position of knowing not only the dirty secrets of my past, but also the laundry list of medications that I take (or don’t).

In addition to my snotty, tear-drenched confessions, our appointments always include a rundown of my physical health, an opportunity to discuss feelings of suicidal ideation, and ultimately a contract to keep myself safe — a "promise" that I will seek resources before I seek death.

It’s a weird way to end an appointment designed to improve your mental health.

Last week, during the health review segment of the visit, we talked about my period. My period has been gone since February 2nd. For those of you not keeping track of the months, that makes five, all of them sans red river of Life-Blood.

To be clear, I’m not complaining about not having a period; I'm just complaining that I don't know where it went.

On the list of physical/emotional health problems I'm experiencing — besides the period thing, and the promising not to kill myself thing — is a chronic ankle injury.

Twenty months ago, I fell down my stairs. I slipped at the top of stair three, and when I finally landed on stair 11, my right foot was facing a direction that feet are not anatomically designed to face.

I thought I might die, which is saying a lot for a woman who once had a baby on her kitchen floor.

My husband drove me and my westward-facing ankle to the ER (presuming typical ankle orientation is north), where they did an X-ray, gave me one Percocet (still in the foil-sealed wrapper), and sent me home with crutches, an ACE bandage — and an air cast (AKA: two pieces of plastic held together with Velcro).

Twenty months ago.


Last Friday, my therapist/psychiatrist told me that I have a “perfectionism disorder”:

Dr W: You have disordered perfectionism.

Me: You don’t say? Well, I’ll be darned.

She told me that my “perfectionism disorder” prevents me from seeking appropriate medical care (case in point: ankle, period), because I see illness as weakness, and weakness as imperfection, etc. etc. — like she knows what she's talking about.

After telling me that my “perfectionism disorder” prevents me from seeking appropriate medical care, my psychiatrist/therapist told me that she was going to issue a challenge. A challenge to actually complete the blood work I should have completed three months ago. A challenge to make an appointment with my midwife (to Nancy Drew The Case of the Missing Period). A challenge to retrieve my broke-ass ankle MRI results.

Because I have a perfectionism disorder and don’t want my psychiatrist/therapist to think I am incapable of following directions, I did the three things she told me to do.

As of this writing, I still have a strip of gauze covering the blood-draw site on my inner-arm, where a lady in purple latex-free gloves vacuum extracted six (not small) vials of blood from my Cephalic vein.

And next week, my midwife will peer into the eye of my cervix by way of a sterile speculum.


I don’t know how much I weigh. Let’s just say, for the sake of this discussion, A Lot.


As for the MRI — well, I’m not a radiologist, but I think “degenerative disease” is bad. Nothing with the word “degenerative” in it is likely to be positive. My foot probably isn’t going to fall off, but it’s also probably not going to work correctly without some help.

“Help” may mean a cast or surgery — I’m not sure which — and I won’t know until my follow-up appointment with the foot doctor guy. I won’t miss the foot doctor guy follow-up appointment because of the aforementioned perfectionism disorder.

I am capable of following directions.

Even if that means I’m going to have to endure claustrophobic cast anxiety for six weeks. Or have some bolts put in there, effectively turning my ankle into Frankenstein and making me a TSA pat-down target for the rest of my life.

I guess my “perfectionism disorder” only delayed the inevitable. Unadvisable course of action. (By the way.)

In addition to my absent menstrual cycle and my crumbling joints, I have “severe Plantar Fasciitis,” which is fancy-doctor-talk for, “my foot hurts real bad.” Another thing the “perfectionism disorder” has prevented me from seeking treatment for.

So far, “perfectionism disorder” is only causing problems.

Malfunctioning Body: 3

Perfectionism Disorder: 0



Besides exploiting my suffering for the sake of the Internet, I’m also an RN.

Besides being an RN, I was Valedictorian of my nursing school class.

(The Valedictorian thing has nothing to do with this. I just like to say it because that GPA was made of blood and tears and stacks of stale peanut butter sandwiches.)

In nursing school, you learn how the Krebs Cycle works, how to calculate a Glasgow Coma Scale score (15 = good, 3 = real bad), how to use Vick’s Vapo Rub under your nose to keep the most putrescent smells from causing you to hurl your breakfast of coffee and a stale donut on a patient, and anatomy.

And when you learn about anatomy, and the bones that keep our skin-bags upright, you learn about the joints that are most important for said upright skin-bag mobility.

And yes, that includes the ankle.

Without your ankle you actually cannot stand upright (unless you have a prosthesis or crutches or are good at hopping).

I enjoy walking on two legs. In fact, I prefer two legs to almost any other of my available limb configurations used for motion.

For this reason, I am more than just mildly concerned about my degenerating ankle.

That’s 1,017 words to say: I like my ankle. I probably should do some things to help it heal. One of those things might be losing weight.


Every pound of weight on your body equals four pounds of weight on your lower joints. That’s science (physics, specifically).

I don’t know how much I weigh. Let’s just say, for the sake of this discussion, A Lot.

I definitely weigh the most I’ve ever weighed, and I know this because I definitely wear the biggest size of clothing I’ve ever worn. I can still buy the XXL in Target’s women’s section (barely) and I’m right at the tippy-top of the Gap size chart, which means all the cute stuff is gone by the time I realize it exists, and most of the dresses in my size area about as attractive as the plastic shipping bag they come in.

That’s what I know.

I also know that my ankle knows I weigh the most I ever have, because it hurts and it reminds me every time I move. It hurts to get up and down. It hurts to climb the stairs I fell down 20 months ago. It hurts a lot when I fall down the stairs.

It did not used to hurt.

I also know, because of the nursing school thing and the physics things I mentioned above, that weighing less would be beneficial. Which is to say, losing weight would improve my ankle, and my life.

Saying I need to "lose weight" frightens me — it challenges my identity. If I am not a radical fatty, what am I?


Body acceptance is complicated. What are we "accepting?" If we accept our size, do we also accept the parts of being that size that cause us discomfort? If I want to change my body to achieve greater mobility, comfort, even health, am I going to be kicked out of the club for defection? It often feels like an all or nothing pursuit.  

Team Fat or Team Skinny? The public demands an answer.

"Body Acceptance" has become more than just the meaning of those two words. It’s bucking the system, banishing diet culture, loudly proclaiming that our bodies are ours to fill with with what we please, dress in what we please. Rules be damned. This can make it a quick course change from "I accept and appreciate my body for what it does, in whatever form it does it" all the way to "I refuse to change this body because to do so is to succumb to the external pressure that screams YOU AREN'T GOOD ENOUGH."

It’s a weird place to be, at the intersection of body positivity and wanting to lose weight because I want my ankle to not fall apart.

But I’m there.

And I’m also recovering from an eating disorder.

My weight-loss journey(s) — of which there are many — have been “successful” by scale standards (though illness is hardly success), in large part, because I am disordered, which is to say I arrived at “thin” by way of simply not eating.

And, because I have lost and gained and lost and gained my body weight several times over, to be standing here on my disintegrating ankle, knowing weight-loss would make a difference in my recovery, and feeling unsure of how to attain this in a way that is anything but disordered, is confusing — to put it mildly.

I’m having a lot of Feelings about it.

So I’m going to ask for your support while I try to repair what’s broken while still remembering what isn't broken. If you want to join me, I’m going to offer you my support in return.

No Fitbit or #fitfam. No My Fitness Pal. No weigh-ins. No measurements. No calorie-counting.

Just me, developing a new (slightly more woo) relationship with my disintegrating body and my disordered mind.  

Meet back here in two weeks. K?

Want to follow my journey? Join in? Cheer me on? Cry with me?

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And drink your water.


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