What Perfectionism Actually Costs
The behaviors nobody names, why vet students are primed for them, what they look like, and how to get help — without shame
BEFORE YOU READ
This article covers eating disorders, skin picking and hair pulling, non-suicidal self-harm, and related compulsive behaviors. It is written for every Scrub, not only those currently struggling. These conditions are more prevalent in high-achieving, perfectionist environments than in the general population, and naming them is how we make it possible for people to get help. If you recognize yourself in any of this, this article has resources. If you recognize someone else, this article gives you language. There is no shame in any of this. There is only information and support.
You got into vet school because of traits that are genuinely exceptional. The discipline to maintain a competitive GPA through a rigorous undergraduate curriculum. The drive to pursue a goal that most people around you did not fully understand. The capacity to hold yourself to a standard that exceeds external requirements. The ability to perform under pressure.
These are the same traits that make vet students vulnerable to a specific cluster of compulsive and disordered behaviors. Not despite those traits — because of them. The perfectionism that produces excellence in academic performance is the same mechanism that, under sustained pressure and without sufficient coping resources, produces disordered eating, compulsive self-regulatory behaviors, and the kind of self-punishment that goes far beyond critical self-reflection.
This article is about the other side of the traits that got you here. Not to pathologize them, they are genuinely valuable, but to name the risks so that you can recognize them in yourself and in the people around you before they become entrenched. The earlier these patterns are addressed, the more completely they respond to treatment.
The perfectionism that produced your GPA and the behaviors this article describes come from the same psychological source. Both are true. Neither one defines you. One helps you become an excellent veterinarian. The other is worth addressing early.
The Perfectionist Profile: Strengths and Vulnerabilities
Perfectionism is not a unitary construct. Researchers distinguish between adaptive perfectionism (high personal standards with resilience to failure, ability to learn from mistakes, and realistic self-assessment) and maladaptive perfectionism (high standards combined with harsh self-evaluation, excessive concern about mistakes, doubt about one's actions, and parental or social expectations that feel impossible to satisfy).
Vet students are selected heavily for the former — and commonly develop elements of the latter under the sustained pressure of professional training. The transition point is often the first major failure: the first failed exam, the first clinical mistake, the first time the gap between self-expectation and performance becomes undeniable. How a student's nervous system responds to that gap — with learning and course-correction, or with punishment and shame — determines a great deal about the trajectory of their first year.
Perfectionism is a significant predictor of eating disorder risk
Bardone-Cone et al., International Journal of Eating Disorders 2010
A meta-analysis of 77 studies found that perfectionism — particularly the socially prescribed subtype (believing others expect perfection from you) — was one of the strongest predictors of eating disorder pathology across all subtypes. The mechanism: perfectionist standards applied to the body produce the same response as perfectionist standards applied to academic performance — a relentless drive toward an ideal that recedes as you approach it.
Veterinary students show elevated disordered eating rates
Nett et al., Journal of Veterinary Medical Education 2015
Studies of veterinary students report rates of disordered eating behaviors including restriction, compensatory behaviors, binge eating, excessive exercise, orthorexia, are significantly higher than the general young adult population. The combination of high academic stress, limited time for self-care, the physical demands of clinical training, and the perfectionist culture of the profession creates conditions where food becomes a domain of control when other domains feel uncontrollable.
OCD-spectrum disorders are more prevalent in high-achieving populations
Foa & Franklin, Journal of Clinical Psychiatry 2001
Multiple epidemiological studies have found elevated rates of OCD and OCD-related disorders — including body-focused repetitive behaviors (BFRBs) such as skin picking and hair pulling — in high-achieving, perfectionist individuals. The proposed mechanism: the same intrusive-thought and compulsion-suppression cycle that underlies OCD is related to the hyper-monitoring of performance that characterizes adaptive perfectionism in extreme form.
Eating Disorders: What They Are and What They Are Not
Eating disorders are not about food. They are about control, self-worth, emotion regulation, and the translation of psychological distress into a behavioral domain that feels manageable. This is why they are particularly common in high-pressure professional training: when control over grades, clinical performance, and academic standing feels uncertain, control over food intake becomes a reliable regulatory mechanism.
The major presentations
Anorexia nervosa: restriction of food intake resulting in significantly low body weight, with intense fear of weight gain and distorted body image. The highest mortality rate of any mental health condition and up to 10% of those affected die from the condition directly or from suicide. Not a diet gone too far. A serious medical and psychiatric illness.
Bulimia nervosa: cycles of binge eating (consuming large amounts of food in a discrete period with a sense of loss of control) followed by compensatory behaviors (purging, excessive exercise, fasting). Body weight may be normal, making it less visible than anorexia. Often associated with shame, secrecy, and significant impairment in social and academic functioning.
Binge eating disorder: recurrent binge eating without regular compensatory behaviors. Associated with significant distress. The most common eating disorder in the general population. Not a failure of willpower, a pattern driven by emotional dysregulation and the neurobiological reinforcement of the binge cycle.
Orthorexia: obsessive focus on 'healthy' or 'clean' eating that becomes so rigid it impairs social functioning, physical health, and quality of life. Not formally classified as an eating disorder in DSM-5 but well-documented and clinically significant. Common in high-achieving individuals who redirect perfectionist standards into nutritional behavior.
Avoidant/restrictive food intake disorder (ARFID): significant restriction of food intake not driven by body image concerns, but by sensory sensitivity, fear of choking, or aversion to certain food properties. Can coexist with anxiety disorders.
Eating disorders are not about food. They are about control, self-worth, and emotion regulation expressed through a behavioral domain that feels manageable when other domains feel chaotic. This is why professional training programs with high unpredictability create elevated risk.
Body-Focused Repetitive Behaviors: The Conditions Nobody Names
Body-focused repetitive behaviors (BFRBs) are a group of habitual self-grooming behaviors that become repetitive, automatic, and difficult to control. They include excoriation disorder (skin picking / dermatillomania), trichotillomania (hair pulling), onychophagia (nail biting to the point of damage), and related behaviors. They are classified in the DSM-5 as OCD-related disorders.
BFRBs are significantly more prevalent than most people realize — affecting an estimated 2–5% of the general population, with higher rates in anxiety-prone, perfectionistic individuals. They are also among the most under-discussed mental health conditions because of shame and because many affected individuals do not realize that what they are doing is a treatable condition rather than a personal failing or bad habit.
Excoriation disorder (skin picking)
Excoriation disorder involves repetitive picking at skin — pimples, scabs, perceived imperfections, to the point of causing tissue damage, scarring, and significant psychological distress. Episodes can last minutes to hours. Many people report a sense of tension before the behavior and relief or pleasure during it. Most people pick at areas they can reach without looking like the face, arms, chest, back. Disguising the evidence (makeup, long sleeves) and shame about the behavior are common.
The neurobiological mechanism: BFRBs activate the same reward circuitry as other compulsive behaviors, which is a dopamine release in the striatum during the behavior produces temporary relief from anxiety. Over time, the behavior becomes conditioned: anxiety triggers the behavior automatically, and the behavior temporarily reduces the anxiety, which reinforces the pattern. This is not moral weakness. It is operant conditioning.
Evidence-based treatment: habit reversal training (HRT) is the first-line behavioral intervention and it involves awareness training (recognizing triggers and early signs of the behavior), competing response training (substituting a physically incompatible behavior), and social support. Cognitive behavioral therapy addresses the underlying anxiety and perfectionism. N-acetylcysteine (NAC), a supplement that modulates glutamate in the OFC/striatal pathway, has shown efficacy in randomized controlled trials for excoriation disorder and trichotillomania.
Trichotillomania (hair pulling)
Trichotillomania involves compulsive pulling of hair from the scalp, eyebrows, eyelashes, or other body areas, resulting in noticeable hair loss. Like skin picking, it is associated with tension before pulling and relief after. Many people pull automatically while concentrating — while studying, watching a screen, or doing repetitive tasks. Common sites: top of head, eyebrows, eyelashes. Evidence-based treatments: HRT, ACT (acceptance and commitment therapy), NAC supplementation.
BFRBs are not bad habits. They are OCD-spectrum disorders driven by the same compulsion-relief cycle that underlies other compulsive behaviors. They respond to specific evidence-based treatments. The TLC Foundation (bfrb.org) has resources specifically for people in high-stress academic environments.
Non-Suicidal Self-Injury: What It Is and What It Means
Non-suicidal self-injury (NSSI) is direct, deliberate injury to body tissue — most commonly cutting, burning, hitting, or scratching, without suicidal intent. It is more common than most people know, particularly in young adults under sustained emotional stress. Research in medical and professional training programs consistently finds higher rates than in comparable age-matched general population samples.
NSSI is not the same as suicidal behavior. People who engage in NSSI are not typically trying to die. They are trying to manage overwhelming emotional pain through physiological means — the physical sensation interrupts emotional flooding, triggers endorphin release that temporarily reduces distress, and provides a sense of control over the body when emotional states feel uncontrollable. It is a coping strategy. An insufficient one, but a coping strategy with a neurobiological mechanism.
This matters because the clinical response to NSSI disclosure should not be alarm or judgment — it should be the same response you would give to any patient presenting with a maladaptive coping behavior: curiosity about what distress the behavior is managing, information about more effective alternatives, and connection to appropriate support. Most people who disclose NSSI report that the response of the first person they told was the determining factor in whether they sought further help.
WHAT TO SAY IF SOMEONE DISCLOSES TO YOU
'Thank you for telling me. That took courage. I’m not going to freak out. Can you tell me more about what’s been going on?'
What not to say: 'Why would you do that to yourself?' / 'You need to stop immediately.' / 'That’s so scary.' / Any response that centers your reaction rather than their experience.
After listening: 'Would you be open to talking to someone who specializes in this? I can help you find someone.' The Crisis Text Line (text HOME to 741741) and the 988 Lifeline can help identify local resources.
Other Perfectionism-Related Conditions to Know
Compulsive exercise
Exercise addiction or compulsive exercise is increasingly recognized as a behavioral pattern associated with perfectionism and eating disorder risk. Characteristics: exercising despite injury, illness, or exhaustion; significant distress when unable to exercise; using exercise to compensate for food intake; exercise as a primary anxiety management strategy to the exclusion of other coping mechanisms. Common in physically active, high-achieving individuals. Not easy to identify in a culture that praises exercise. Assessment: the Compulsive Exercise Test (CET) is a validated screening tool.
Body dysmorphic disorder (BDD)
BDD is an OCD-spectrum disorder characterized by preoccupation with one or more perceived defects or flaws in physical appearance that are not observable or appear slight to others, combined with repetitive behaviors (mirror checking, reassurance-seeking, skin picking at perceived flaws, excessive grooming) in response to appearance concerns. BDD causes significant distress and impairment. It responds to CBT and SSRIs. It is significantly underdiagnosed because shame prevents disclosure.
OCD and OCD-spectrum disorders
Obsessive-compulsive disorder affects approximately 2–3% of the population and is significantly more common in high-achieving, perfectionist individuals. In vet students, OCD themes often center on contamination (handling sick animals, fear of pathogen exposure), responsibility (fear of making a clinical error with serious consequences), and symmetry/order. The first year of clinical training — when genuine responsibility for patient outcomes begins — often activates latent OCD concerns. First-line treatment: ERP (exposure and response prevention therapy) and SSRIs.
How to Get Help: Resources Without Shame
The following resources are specific to each condition discussed. All are reputable, evidence-based, and accessible without judgment. Save the ones that apply to you or someone you know.
FULL RESOURCE LIST
Eating disorders: National Alliance for Eating Disorders | Helpline: 1-866-662-1235 | allianceforeatingdisorders.com | Free referrals to evidence-based treatment providers
Skin picking / hair pulling / BFRBs: TLC Foundation for Body-Focused Repetitive Behaviors | bfrb.org | info@bfrb.org | Find a therapist trained in HRT for BFRBs
Self-harm / crisis support: Crisis Text Line: text HOME to 741741 | 988 Suicide and Crisis Lifeline: call or text 988 | To Write Love on Her Arms: twloha.com
OCD / OCD-spectrum: International OCD Foundation | iocdf.org | Find an ERP-trained therapist | NOCD app (teletherapy for OCD and related conditions)
Body dysmorphic disorder: BDD Foundation | bddfoundation.org | International OCD Foundation BDD resources: iocdf.org/bdd
General mental health / your school: Your school’s student counseling center | Psychology Today therapist finder: psychologytoday.com/us/therapists | AVMA Wellbeing: avma.org/wellbeing
If you are unsure which resource fits: your school counseling center can help identify the right kind of support for your specific situation. That is what they are there for.
The Last Thing
These behaviors and conditions are more common in veterinary students than most people know, less visible than they deserve to be, and more treatable than they feel from the inside. The students who get help early — who name what is happening before it becomes entrenched — recover more completely and more quickly than those who wait until the behavior is severe.
The traits that made you competitive enough to get here are real. So is the cost they can carry. Both things are true. The profession needs people like you — high-achieving, driven, deeply committed to excellence. It also needs you to survive and stay well enough to become the veterinarian those traits are building.
You trained to recognize when a patient’s body is doing something it cannot stop on its own and needs support. Extend that same clinical recognition to yourself. Without shame. Without hesitation. With the same competence and directness you will bring to every patient you will ever treat.
You trained to recognize when a patient’s body is doing something it cannot stop on its own and needs support. Extend that same clinical recognition to yourself. Without shame. Without hesitation.
Scrub Squad · Day 7 of 99 · Body
This article is part of the Scrub Squad 99-day program from Vet Candy. Free for every first-year vet student.
If you are in crisis, please reach out: 988 (Suicide and Crisis Lifeline) | Crisis Text Line: text HOME to 741741 | SAMHSA: 1-800-662-4357
