Clinical perfectionism is characterized by rigidly pursuing unrealistically high standards on which self-worth is contingent and experiencing distress when these standards are not met. Because clinical perfectionism is associated with many psychological diagnoses, understanding how to treat it may help streamline available treatments. The aim of this dissertation was to test the effect of acceptance and commitment therapy (ACT), a cognitive-behavioral therapy, on 53 individuals with clinical perfectionism. Participants in the ACT group received 10 therapy sessions and those in the control group were on a waitlist for 14 weeks. The first study supported the effectiveness of ACT relative to the waitlist control group with respect to perfectionism severity, quality of life, and general symptom distress. The second study showed changes in psychological inflexibility and self-compassion explained improvements in quality of life and concern over mistakes, respectively. It also found a variable effect of baseline psychological inflexibility on response to treatment depending on the outcome tested. In contrast, average self-compassion was generally associated with better outcomes in ACT. Neurological results from the third study suggest receiving ACT was associated with greater cognitive efficiency while performing error-prone tasks and decreased responsivity to emotionally meaningful stimuli. In addition, changes in brain activation were not linked to changes in self-report outcomes. Collectively, this dissertation examined not only the efficacy of an intervention focused on a maladaptive behavioral pattern like clinical perfectionism but also how and for whom such a therapy works.

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Perfectionism can be constructed as a trans diagnostic concept that co exists and probably contributes to the onset development and maintenance of a number of Axis 1 disorders. There is also a significant relationship between perfectionism and low self- esteem. There is considerable theoretical debate in the literature concerning whether perfectionism is uni or multi-dimensional with most therapies being based upon uni dimensional conceptualisations and thus overlooking interpersonal factors. This is also reflected in the relative absence of qualitative studies that explore perfectionism from a lived experience perspective. Aims: This study aims to explore the experiences of perfectionism and low self-esteem in different life domains. It also aims to evaluate the client’s experiences and efficacy of a proposed treatment protocol that targets perfectionism from a multidimensional perspective. Method: The study is divided into three phases. A Multiple baseline design is used to evaluate the treatment protocol including cognitive and behavioural interventions, compassionate mind training and assertiveness training to target perfectionism and low self-esteem. Two clinical groups experiencing Axis 1 disorders and high perfectionism are divided amongst the different phases of this study, 13 and 8 participants respectively. Mixed methods are administered to analyse the data with greater emphasis on the qualitative ones. Measures administered include the Beck Depression & Anxiety Inventories; the Rosenberg Self Esteem Scale; the Dysfunctional Attitudes Scale; the Multidimensional Perfectionism Scale by Frost and the Perfectionistic Self Presentation Scale. 8 semi-structured interviews are analysed utilising Interpretative Phenomenological Approach (IPA). Results: from the analysis of data it is evident that perfectionism is a multidimensional construct with strong interpersonal features that affect several different life domains. The proposed treatment protocol appears significantly effective in reducing perfectionism and Axis 1 disorder symptomatology. Additionally, there is a significant increase in self- esteem. Interventions that appear most helpful are behavioural experiments, assertiveness training, compassionate mind training, continuum and positive logging.

Background: Psychological perfectionism, from a clinical perspective, started to be a topic of interest for cognitive behavioural clinicians at the beginning of the 1950s. Whilst many studies have identified perfectionism as a pivotal motivator in different conditions of neurosis, the exact nature of its interactions remains unclear. In the research community there is still a debate as to whether there is such a thing as good perfectionism, and there remains no consensual theory of psychopathological perfectionism. Aims: The aim of the study was to investigate why the nature of the phenomena remains a contentious issue, and to develop a robust theory of psychopathological perfectionism, within a cognitive behavioural framework, which will find general acceptance. From the literature review this appears to be the first qualitative study to develop such a theory. Method: Substantive grounded theory was developed within a framework of methodical hermeneutics which, it is argued, is capable of generating formative theory. 20 volunteers who came forward in response to advertisements became participants in semi-structured interviews using a post classic qualitative methodology, from which emerging data became the basis of categories leading to the development of the theory, and functions of the phenomena. Results and Conclusions: The study sets out reasons why there remains an impasse amongst researchers and clinicians about the condition of psychopathological perfectionism. A parsimonious theory of pathological perfectionism has been developed, the constructs of which are just necessary and sufficient to describe the condition. The developed theory makes a contribution to theories proposed prior to 1990 and to contemporary research. However as with all theories it is necessarily provisional, so that its usefulness is in need of further research and development. Psychopathological perfectionism has only two constructs, namely a demand to achieve perfectionism in at least one idiosyncratic sphere, which is in response to a core schema of conditional worth. A number of symptoms or functions of psychopathological perfectionism have also been identified, and there are suggestions as to how the condition develops and is maintained to the detriment of the sufferer. The study synthesizes over fifty years of theory and research into the phenomena. The developed theory and its symptoms or functions have important implications for clinical interventions, training, and for further psychological and psychosocial research. These implications are discussed.

This thesis is a qualitative investigation of the factors which maintain anorexia nervosa (AN) according to the transdiagnostic theory of eating disorders (Fairburn et al., 2003). AN is difficult to treat and continues to evade complete understanding. The present study aimed to promote further understanding of food restriction and physical activity in relation to the constructs of clinical perfectionism, core low self-esteem, mood intolerance, and interpersonal difficulties. Twenty females with self-reported AN were recruited from Guelph, Ontario and participated in semi-structured interviews. Thematic analysis revealed eight major themes for clinical perfectionism, five for core low self-esteem, five for mood intolerance, and six for interpersonal difficulties. The in-depth emotional accounts and details of food restriction and physical activity in relation to the four constructs examined in this study may contribute to further appreciation of AN, informing practitioners and family members, promoting empathy, and improving treatment options.