We know everything about celebrities, except what it feels like to be one. From the outside, it looks like a dream: designer wardrobes, VIP parties, and endless admiration. But behind closed doors, the picture is far more complicated. Loneliness, distrust, addiction, and emotional instability are among the most common struggles for the ultra-visible elite. And according to Dr. Sarah Boss, Clinical Director of The Balance Rehab Clinic, very few people truly understand what this population faces.
“There are no scientific studies on this group, no academic literature,” says Dr. Boss. “It’s one of the most misunderstood demographics in mental health, and one of the most isolated.” At the world-renowned clinic in Mallorca, which has treated everyone from Grammy winners to Formula 1 drivers, Dr. Boss sees the same psychological patterns emerge again and again. Here are there of the most common issues.
Paranoia, Isolation, and the Loneliness of Fame
For many celebrities, the real cost of fame isn’t public scrutiny, it’s private doubt.“One of the hardest questions they face is: Who would still be here if I wasn’t famous?” says Dr. Boss. “They start to notice that everyone around them is on the payroll. And that is a deeply isolating, destabilising feeling.”
Trust becomes nearly impossible to build. Therapists, assistants, even doctors are seen through the lens of status and money. “When you have that much access, that much wealth, people stop treating you like a human being,” Dr. Boss explains. “They either want something from you, or they assume you don’t need anything at all.”
The pandemic forced this reality into focus. “When everything shut down—no premieres, no parties—many of our clients were stunned by the silence. No one called to ask if they were okay. They realised just how few people were really there for them, not their platform.” This lack of secure attachments leads to mistrust, loneliness, and even paranoia.
Extreme Pressure
For high-profile clients, the pressure is non-stop. Their careers can be unrelenting, and on top of that, “they’re not allowed to have a bad day,” says Dr. Boss. “Someone is always watching, waiting for them to mess up, to be human. But they’re expected to be perfect. All the time.”
They live under extreme, constant scrutiny every day. “A normal person can have an off moment,” she explains. “But when you’re famous, every expression, outfit, or sentence becomes something to be judged. It’s relentless, and it’s exhausting.”
Over time, many begin to withdraw. “They stop doing normal things like grabbing a coffee or walking on the beach,” Dr. Boss says. “They only go out when there’s security, or when it’s a controlled environment. The simple things get lost. And so do the real friendships.” They are no longer able to enjoy simple things. They either live in a bubble of fame or are completely isolated.
The result? A distorted sense of reality, where there’s no room for mistakes, and no autonomy over their own life. “They have no safe space,” Dr. Boss says. “That’s what we build in treatment, a space where they can finally just be without expectation.”
Substance Abuse and a Dangerous Lack of Limits
In the world of fame, drugs, alcohol, and medication are not just accessible, they’re encouraged. “Drugs and alcohol are everywhere. It’s at their parties, their business meetings, everywhere. It’s all access, all the time.”
With success comes a dangerous kind of immunity. “Celebrities don’t face the same consequences as everyone else. Nobody says ‘no’ to them. This goes back to the no real friends issue. People want something from them; there is an agenda to relationships. They have no real friends to hold them accountable.”
The daily emotional toll that they live with often leads them to develop substance abuse. “It’s important to understand that addiction is not about the substance. It’s a coping mechanism to deal with underlying emotional struggles.”
The Bottom Line
Mental health doesn’t discriminate based on wealth or fame. In fact, those who seem to have it all are often carrying the heavy psychological burdens. As Dr. Boss puts it: “It doesn’t matter how rich or famous you are. You still need to feel seen, safe, and cared for.”