Perfectionist traits — higher self-criticism, and unrealistic standards leading to isolation — are associated with severe alcohol use disorder (AUD), according to the first study directly comparing patients with AUD to a healthy control group. Perfectionist people strive for unrealistic performance standards and are prone to self-criticism. These goals generate feelings of failure, and, if they can’t attain the standards they believe others expect of them, social disconnection. Perfectionism is known to increase vulnerability to stress and depression, but its role in severe AUD has not been fully investigated. Some evidence suggests perfectionist young adults drink less frequently than their peers. Some other studies showed that perfectionism co-occurs with high impulsivity and reduced impulse control, factors involved in AUD, and perfectionist people may self-medicate with alcohol in an attempt to overcome social anxiety or feelings of inadequacy. For the study in Alcoholism: Clinical & Experimental Research, researchers in Belgium explored associations between perfectionist traits and severe AUD.

Investigators worked with 65 adults with severe AUD who were undergoing inpatient detoxification and 65 healthy adults matched for sex and age. The participants filled out questionnaires evaluating three dimensions of perfectionism. Self-oriented perfectionism involves exaggerated performance standards set for oneself (e.g., “One of my goals is to be perfect in everything I do”). Socially-prescribed perfectionism is generated by others’ perceived expectations (e.g., “People expect nothing less than perfection from me”). Other-oriented perfectionism involves setting high standards for others (e.g., “I have high expectations for the people who are important to me”). The researchers also evaluated participants’ depressive symptoms, state anxiety (transient anxiety experienced in a specific situation), and trait anxiety (anxiety that generalizes to a person’s broad experience). The researchers used statistical analysis to look for links between these factors.

Patients with severe AUD reported higher depressive symptoms and trait anxiety. They also demonstrated higher self-oriented and socially-oriented perfectionism than the controls, though the two groups were similar in other-oriented perfectionism. Severe AUD was related to unrealistic personal standards and increased sensitivity to other people’s expectations, even after accounting for the role of depressive symptoms and anxiety, but not to being demanding of others. This is consistent with what is known about self-related and interpersonal factors in severe AUD, such as reduced self-esteem, a tendency to self-blame, and a divergence between people’s ideal and actual selves. Perfectionist people might perceive an exaggerated gap between their own high standards and alcohol-related consequences, fearing academic or professional failure. The study findings also suggest that self-oriented perfectionism in severe AUD is higher among men and people with more education. They also support previous evidence that perfectionism is associated with less daily alcohol consumption in moderate drinkers.

In view of the potential role of perfectionism in developing and maintaining severe AUD, it may be a valuable treatment target, researchers concluded. They recommend additional investigation of the varying dimensions of perfectionism in AUD, including whether high perfectionism reduces treatment effectiveness, and the causal links between perfectionism, impulsivity, and self-blame.