I thought of one more example of these perfectionistic types of thinking thing that I thought might be useful.
A long time ago I was working with a 30 year old woman who, in addition to her eating disorder, had a life-threatening and eventually probably terminal medical condition. Between the toll the disease itself took on her and the chronic medical treatment she was forced to undergo, she was left perpetually exhausted and weak.
A running theme in our conversations was the difficulty of living with a rather large set of rules and thoughts she had for herself about what she "should be doing each day."
We had talked about these "rules" in myriad ways, and tried to counter them and/or change or moderate them. Nothing had worked very well and the "rules" persisted, and in fact, intensified over time.
The rules had to do with activities or chores she thought were her responsibility- cleaning, shopping for the household, paying bills, etc- and she was very, very mad at herself for not "perfectly" achieving all of them every day. It didn't matter if she managed to do one or two or some of them- nothing less than ALL of them had to be done for it "to count." She acknowledged that even if somehow (not that it was humanly possible, even by her own admission) she did complete every single one of the chores in a day and did them perfectly, she figured it still wouldn't count as good enough, since she'd likely come up with something else she additionally should have done also.
In one particular session I happened to ask my client how much of her rules were based on "thoughts about what she should do," how much of them were based on what she was truly physically capable of doing in a day, and how she might differenciate between those two things.
She gave me that incredulous look that I've grown accustomed to from clients, the one where they think I'm being ridiculous and/or asking a really dumb question. I've learned over the years that the look generally is an indication that we've stumbled upon something worthwhile.
So, it turned out that, no surprise, the rules were 100% based on what she thought she was supposed to do, and 0% based on the reality of her health and physical capacity. Her physical capability was "irrelevant" in the decision making process as far as she was concerned.
As we continued to talk about this she began to realize why the rules had been so hard for us to address and alter. They served a purpose for her, annoying and dismaying as they were each day.
"As long as I'm focused on all the things I'm supposed to be doing, and the fact that I'm failing at them every day, I'm not really in the moment. I'm not really exposed to the reality of my life, my illness my eating disorder, how unhappy and scared I am every day."
This is a pretty clear illustration of how perfectionistic thoughts, although they can be horrible to live with, seem to "help" in a strange way. They can "distract" someone from what he/she might really be feeling and thinking about.
In this client's case, the reality of her illness and what it meant for her life- all that she'd lost as a result, and the fact that she, in all likelihood knew the cause of her own death and that her life would be relatively brief- was too much for her to bear.
Remaining focused on "failing every day" at her chores was awful, really awful. It also was less awful than facing her real daily life.
Over time this client and I worked to help her gather the courage she needed to come to grips with her illness. It wasn't easy, of course. And her perfectionistic rules for chores didn't just disappear. But understanding why they were so tenacious in her life made them easier to bear. She could learn to have compassion for herself- when she had a thought about not doing all her assigned chores, she could say, "ok, I know this really comes from a place of fear and I need be try to be gentle with myself about it.