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He ignores his rapid heartbeat, headache, and growing sweat stains on his shirt. With his eyes darting across the computer screen and fingers tapping rapidly, he feels a thrill of satisfaction thinking about how quickly he’s completing the reports for his boss. That night, he has trouble shutting his mind off, and after a sleepless night, the next days he pops an extra little blue pill to stay awake and be productive at work.

Stories like these are becoming more common as cognitive-enhancement drugs (or “smart pills”) become increasingly popular with adults without attention deficit hyperactivity disorder (ADHD).

Long abused in high schools and colleges, more adults are abusing the prescription pills to get a handle on their busy lives, sleep less, or gain an edge at work.

“We are definitely seeing more [ADHD drug addiction] than one year ago, more than two years ago, especially in the age range of 25 to 45,” Dr. Kimberly Dennis, the medical director of Timberline Knolls, a substance-abuse treatment facility, told the New York Times.

Why are an increasing numbers of adults looking for productivity in a pill? In today’s competitive economy, many people are looking to gain an edge on their competition and keep up with their lifestyle. This desire to do and deliver more is seen both in college, as students become fixated on achieving top grades while maintaining a part-time job or active social life—and in the working world, where many driven employees see ADHD drugs as the only way to contend with their peers.

It’s easy to write off smart pill abuse as the unfortunate-but-necessary secret weapon of high-achievers. But it’s often the sign of a much deeper internal struggle with perfectionism.

There’s a fine line between high-achievement and perfectionism, healthy and unhealthy

Perfectionism—in small doses—has its benefits. Especially in school and at work, it can motivate people to set their standards high and strive to deliver great work and ideas. Yet, just like anxiety and stress, which can be motivating to some extent, being too much of a perfectionist will hurt you.

The key difference between high-achievers and perfectionists is in the underlying motivation: healthy high-achievers have an internal drive, while perfectionists are driven by external pressures, like fear of failure. This external motivation to succeed and avoid criticism is linked to depression, anxiety, shame, and guilt.

Maria Pascussi, a self-proclaimed recovering perfectionist, figured out that her mission to over-achieve was coming from a negative place. “I over-achieved for most of my life from a place of fear, inadequacy, and self-doubt…I controlled, perfected, and achieved to the point of exhaustion,” she told the audience during a Ted Talk.

Anxiety and perfectionism feed into each other until you’re paralyzed or exhausted

Perfectionists blow the risks of being wrong out of proportion and this deep fear of failure leads to anxiety. This anxiety, in turn, serves as a signal to work frantically—for example, pulling all-nighters to study during college—until they’re physically exhausted or mentally burned out.

Perhaps ironically, a perfectionist’s obsession with avoiding failure or disappointment can actually slow them down.

Perfectionists procrastinate starting projects for worry it won’t be outstanding, waste a lot of time making work perfect, and often miss deadlines. Anxiety and worries about work or school leads to trouble sleeping, a cycle of procrastination, more worry, and longer work hours.

High stress and anxiety coupled with unchecked perfectionism can lead to harmful behaviors

More than hindering success, perfectionism can predispose people to addiction and other mental illnesses. And ADHD drugs feed directly into perfectionists’ desire to work better and faster. Telling of the dangers of perfectionism and pressure to be successful, a National Survey on Drug Use and Health report found the greatest proportion of ADHD drug users were students at private and elite universities.

Taking ADHD pills without a prescription or diagnosis is prescription drug abuse. But since most users are abusing the pills in order to study or focus at work, they don’t think about it that way. In a 2008 study on the ADHD drug habits of 1,800 college students, researchers wrote that, “Perhaps the most disturbing finding …was the general lack of guilt or dissonance…students [expressed] over taking illegal stimulants…the illegal use of ADHD medication seems to be stigma free.”

Tap into your core beliefs to overcome perfectionism

Does fear of not turning in the perfect paper or project drive you to consistent procrastination? If so, it’s time to figure out your core beliefs,which are at the heart of your perfectionism. Core beliefs reflect general perceptions and our self-values, how we view ourselves, others, and the world.

The most common core beliefs shared by people with high perfectionism are “to be lovable I need to be perfect” and that they are either “perfect or a perfect failure.”

Thousands of thoughts are driven by these few core beliefs—and what those thoughts are may shock you.

The process of discovering your core beliefs is a lot like peeling back the layers of an onion. Using a Cognitive Behavioral Therapy (CBT) exercise, you can peel back the layers of thoughts to understand what is really driving you to push yourself past your limits, feel like you’re never good enough, and live with a sense of dread or worry.

To be most effective at overcoming perfectionism, you need to change the thoughts that are driving your fear of failure.

You can apply this technique by becoming aware of your thoughts and asking yourself “what would it mean if that was true?” or “what does that mean?” For example:

Automatic thought: I’m a terrible writer

Ask “What would it mean if that is true?”

> “I’ll never be good at my job”

Ask “What would it mean if that is true?”

“I’m not going to accel at my career.”

Ask “What would it mean if that is true?”

“I’m going to be stuck in an unsatisfying and boring job.

Ask “What would it mean if that is true?”

“I’ll be a failure”

Ask “What would it mean if that is true?”

Core belief: “No one will love me”

So you can see why this person would feel so stressed and insecure about their writing—the origin of their thought is a much bigger, much scarier core belief. Many people with anxiety and perfectionism discover core beliefs that are almost unbelievable, but the exercise demonstrates the connection between automatic thoughts and the beliefs that create them.

It takes some work to become aware of our core beliefs because they’re so deeply ingrained in us. But the work pays off. As we begin to notice our core beliefs, we can begin to challenge them. In fact, CBT offers a proven process for developing healthier, more realistic, more compassionate core beliefs.