This thesis explored conceptual and pathological issues of perfectionism within the developmental period of adolescence. Quantitative and qualitative methodological approaches were utilised in the study of both general and clinical adolescent populations. Overall, the thesis aimed to provide an empirically driven account of adolescent perfectionism within a clinical context. Introductory chapters discuss adolescent development and mental health, developmental theories of perfectionism, and adolescent expressions of perfectionism. Historical and conceptual developments in perfectionism theory are critically discussed before the current conceptualisations used in adolescent research are identified and considered. The findings of a systematic review examining associations between perfectionism, mental illness, and treatment outcomes in clinical adolescent populations are reported. PRISMA guidelines and pre-specified qualitative assessment criteria were utilised. Sixteen studies were included in the review. Good quality research indicates that socially-prescribed perfectionism relates to suicide and depression. Lower quality research suggests that self-oriented perfectionism has a role in eating disorders. Studies of eating disorder, depression, and chronic fatigue syndrome treatment all indicate that perfectionism negatively impacts on outcomes for these adolescent groups but the effect is less consistent in suicidal adolescents A questionnaire-based survey of 507 Scottish adolescents (272 females, 233 males; age range: 12.24-15.50 years) was conducted to explore the relationships of perfectionism and clinical perfectionism to mental health risk in the general adolescent population. Exploratory and confirmatory factor analyses were performed on the Child-Adolescent Perfectionism Scale (CAPS) and the Clinical Perfectionism Questionnaire (CPQ). The identified factor structures of these measures were then used to examine risk for depression, anxiety, and eating disorders in adolescents. Path analyses using structural equation modelling identified unique paths between varied facets of adolescent perfectionism and mental health disorders. Perfectionistic concerns, measured by the CPQ, was found to be transdiagnostic for all three disorders in adolescents. A focus group study of clinician perspectives of adolescent perfectionism was conducted and analysed through thematic analysis. The results highlighted similarities and differences between clinician-perspectives and published conceptual models. The study also revealed some of the issues clinicians face in their clinical work with clinical adolescent perfectionists. The study provided a reference framework to inform the development of the final study. With the aim of developing a novel conceptualisation of perfectionism in adolescent clinical populations, a grounded theory study of sixteen adolescents diagnosed with an eating disorder was conducted. Semi-structured, individual interviews were conducted and methodically analysed according to grounded theory methodology to explore the young peoples’ experiences of perfectionism. A novel framework for adolescent clinical perfectionism is proposed based on the findings of this study. The framework encapsulates a developmentally relevant construction of perfectionism as it is experienced by these young people. The thesis findings are related to associated literature regarding mental health problems in adolescents and conceptualisations of perfectionism. Implications for clinical intervention are suggested. Future directions for the field of adolescent clinical perfectionism are proposed. The unique contribution of this thesis to the wider adolescent perfectionism literature is discussed.

The British government currently requires mental health services to be targeted at the most needy (Department of Health, 1999). For occupational therapy services, where service demand far exceeds service availability, skill in referral prioritisation is essential. The studies in this thesis describe how experienced occupational therapists’ referral prioritisation policies were used to successfully educate novices. 40 British occupational therapists’ referral prioritisation policies were modelled using judgement analysis. Individuals’ prioritisation decisions were regressed onto 90 referral scenarios to statistically model how referral information had been used. It was found that the reason for referral, history of violence and diagnosis were most important. The occupational therapists’ capacity for self-insight into their policies was also examined by comparing statistically modelled policies derived from their behaviour with their subjective view of their cue use. Self-insight was found to be moderate (mean r = 0.61). A Ward’s cluster analysis was used on the statistically modelled policies to identify if subgroups of therapists had differing referral prioritisation policies. Four clusters were found. They differed according to several factors including the percentage of role dedicated to specialist occupational therapy rather than generic work. The policies that led to more of an occupational therapy role were found to give particular importance to the reason for referral and the client’s diagnosis. The occupational therapy professional body supports this latter method of working as it has recommended that occupational therapists should use their specialist skills to ensure clients’ needs are met effectively. Therefore the policies that focussed on clients’ occupational functioning were used to train the novices. Thirty-seven students were asked to prioritise a set of referrals before and after being shown graphical and descriptive representations of the policies. Students gained statistically significant improvements in prioritisation. Students’ pre-training policies were found to be those of generic therapists; a method of working that has been found to be leading to reduced work satisfaction and burnout (Craik et al.1998b). The training is therefore needed to ensure undergraduate occupational therapy students develop effective referral prioritisation skills. This will help to ensure that clients’ needs are met most effectively and work stress is reduced.

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