Perfectionism And Addiction: Dual Diagnosis

Medically Reviewed by Johnelle Smith, M.D. on July 5, 2021

People that are perfectionists may be at an increased risk of addictive behavior. In a recovery setting, therapy that addresses perfectionism may help with addiction recovery and mental health moving forward.

Co-Occurring Perfectionism And Addiction

Although perfectionism is not an official mental health diagnosis, a person that has high standards for their appearance, performance, or life, in general, may struggle with substance use.

Because perfectionists tend to set high standards for themselves, a misstep or departure from their idea of “perfect” may be met with an extreme reaction.

Sometimes, this constant negative feedback reaction and self-critique can make substance use and addiction appear to be a more attractive alternative to continually “failing” to meet high standards.

Find out more about co-occurring mental health disorders and addiction

What Is Perfectionism?

Though not an official diagnosis, perfectionism is a mindset where self-imposed or external pressures place high standards which can cause extreme disappointment, feelings of judgment, and self-loathing when “failure” occurs.

People that identify as perfectionists tend to be highly competitive and self-critical.

In one model of perfectionism, people with external social pressure to be perfect feel a deeper need to win approval through actions or appearance.

When any form of failure inevitably happens, it can be very difficult to manage strong feelings of self-doubt, anxiety, and depression.

Signs of perfectionism include:

  • seeking the approval of others
  • setting exceedingly high standards
  • feeling a deep need to be perfect/not show weaknesses
  • being deeply self-critical
  • feelings of shame, depression, or worthlessness when “failure” occurs

The Link Between Perfectionism And Drug And Alcohol Abuse

People that exhibit characteristics of a perfectionist may begin to resist the negative feelings associated with failing to meet expectations.

For some, substance use and addiction may be a coping mechanism to ease the fear of failure.

Others may simply find a life of substance use more fulfilling than that of constantly trying and “failing” to be perfect.

It may be difficult to recognize a substance use disorder in somebody with perfectionism, as many perfectionists may drive away loved ones when they experience feelings of failure.

Signs of drug or alcohol abuse may include:

  • big changes in appearance or hygiene
  • engaging in risky behavior
  • detaching from friends or family
  • disengaging from preferred activities
  • new, strange behavior
  • sudden mood changes
  • lying about drug use or hiding evidence of substance use
  • drinking or taking drugs for regular daily function
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What Causes Co-Occurring Addiction And Perfectionism?

The exact link between addiction and perfectionism is not known. Still, the thought patterns of both addiction and perfectionism can perpetuate each other.

People that are perfectionists may exhibit “the best or nothing” mindsets that cross into addiction. People that have addictive thought patterns re-enforce perfectionistic tendencies.

The same feelings of shame associated with a perfectionist that has “failed” to any degree may lead the same person to use substances to cope.

Other perfectionists may use substances in an attempt to improve functions or reduce anxiety about the potential for failure.

What Are The Most Effective Treatments?

For people with perfectionism, the drive to recover from addiction in a “perfect” way may interfere with progress towards sobriety.

Many people that view the road to recovery as a competition – either internal or external – may fall into patterns of substance use when “perfection” is not attained. Perfectionism is a risk factor for relapse.

In general, individual therapies can help with elements of perfectionism and addiction that co-occur. Pharmaceutical interventions can help with physical discomfort that can occur during substance detox.

Family And Individual Therapy

Cognitive-Behavioral Therapy (CBT): On an individual basis, a person in treatment will work with a therapist to learn tools to best address stressors and consider their environment in a way that inspires growth instead of fear.

Through CBT, a person can learn to recognize thought patterns that influence both addictive behavior and perfectionistic tendencies. They can learn to reframe and revisit old perceptions of perfection and failure.

Family Therapy: When external pressure for perfection is prominent in a person’s presentation of perfectionism, it can be helpful to bring the family in to create better communication and improved interpersonal dynamics.

Prescription Medications

For people with a strong dependence on substances, a medically supervised detox may be necessary.

As appropriate, pharmaceuticals may be used to ease symptoms of withdrawal that can be both highly unpleasant and in some cases, dangerous.

Medications that may be used to ease withdrawals in inpatient and outpatient settings include:

  • naltrexone
  • buprenorphine
  • methadone
  • benzodiazepines (as appropriate)

Finding Dual Diagnosis Treatment For Perfectionism And Addiction

For people with addiction and perfectionism, treatment can often help address the roots of addiction along with the physical and emotional results of substance abuse.

If you or a loved one is struggling with addiction and faces the stressors of a perfectionist, then an integrated treatment program may help.

Talk to one of our treatment specialists to learn more about the right dual diagnosis treatment program for your needs. We’re here to help – call today to get started.

This page does not provide medical advice. See more

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Medically Reviewed by
Johnelle Smith, M.D. on July 5, 2021

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