The Relationship between Perfectionism, Psychiatric disorders and Use of Mental Health Services in Adolescence: Results from a National Patient Register Linkage Study

doi:10.21203/rs.3.rs-3131669/v1

Download PDF

Research Article

The Relationship between Perfectionism, Psychiatric disorders and Use of Mental Health Services in Adolescence: Results from a National Patient Register Linkage Study

https://doi.org/10.21203/rs.3.rs-3131669/v1

This work is licensed under a CC BY 4.0 License

Version 1

posted

You are reading this latest preprint version

The aim of the present study was to examine perfectionism among adolescents in relation to psychiatric disorders and contact with child and adolescent mental health care services (CAMHS). The sample consisted of adolescents (16–19 years) who participated in the youth@hordaland survey and consented to a linkage to the patient registry data (n = 9072, 53.2% girls). Those who had received help from CAMHS (n = 933, 10.3%) were categorized as the clinical group, while the remaining adolescents (n = 8139, 89.7%) defined a reference group. Perfectionism was measured by the Eating Disorder Inventory-2 as a sum score (EDI-P) and subscales for Self-Oriented (SOP) and Socially-Oriented (SPP) perfectionism.

The clinical group scored higher on SPP than the reference group (1.99, SD = 1.75, vs. 1.88, SD = 1.56, p < .05), but not on EDI-P or SOP. There were more high scorers in the clinical group than the reference group for EDI-P (11.8% vs. 8.9%, p < .01) and SPP (11.9% vs. 6.7%, p < .001), but not for SOP. Adolescents with depression and eating disorders scored higher on all dimensions of perfectionism compared to the reference group, also when adjusting for sex.

Perfectionism was higher in the clinical group than the reference group, and this was more pronounced for SPP than SOP. Only depression and eating disorders were associated with elevated perfectionism scores in the clinical group. Perfectionism should be targeted in future longitudinal studies as well as in clinical interventions in other to strengthen the mental health among adolescents.

Perfectionism

mental health

adolescence

psychiatric disorders

clinical data

Perfectionism is suggested to develop in childhood and consolidate in adolescence as a personality disposition and part of a more general identity formation (Negru-Subtirica et al., 2021). It may create a conflict between actual performances and expectations from oneself or others (Einstein et al., 2000), as described in the self-discrepancy theory by Higgins (1987). Perfectionism seems to be more pronounced among current youth populations, as suggested by a multi-national study from 1989 to 2016 reporting a 32% increase among college students (Curran & Hill, 2019).

Perfectionism is understood as a multidimensional phenomenon, encompassing different expressions of perfectionistic traits that can be more or less adaptive (Rice & Richardson, 2014). While adaptive perfectionism is associated with conscientiousness, motivation and self-efficacy, maladaptive perfectionism is often characterized by unattainable goals, self-doubt and symptoms of distress (Enns et al., 2001). Maladaptive perfectionism can be operationalized by high levels of perfectionism or more specific unhealthy and self-critical concerns (Limburg et al., 2017). Further, maladaptive perfectionism has been reported in up to 3 of 10 adolescents in non-clinical samples (Sironic & Reeve, 2015), and is associated with reduced well-being (Leone & Wade, 2018) as well as internalizing and externalizing mental health problems in youth populations (Taylor et al., 2017).

While perfectionism has been suggested to be a transdiagnostic phenomenon, it has been most strongly associated with a risk of depression, eating disorders, and anxiety disorders in adolescence (Robinson & Wade, 2021). Perfectionism has also been described as a predisposing factor for depressive symptoms in youth (Hewitt et al., 2022), and a reciprocal relationship between maladaptive perfectionism and depressive symptoms has been reported in both clinical and non-clinical samples (Smith et al., 2021). Elevated perfectionism is also described as one of the predisposing and maintaining factors of eating disorders (Fairburn et al., 2003) and is shown to be associated with eating-related symptoms among children and adolescents in clinical samples (Johnston et al., 2018) and among students from the general population (Asl et al., 2022). According to a meta-study, this association is especially strong for self-critical perfectionistic concerns, although some studies also found this for perfectionistic strivings in early and middle adolescence (Vacca et al., 2021). Anxiety represents several symptom clusters, and perfectionism has been associated with both social anxiety (Wang et al., 2022) and test anxiety (Lowe, 2022) in student samples. It is suggested that especially maladaptive aspects of perfectionism predict symptoms of anxiety and depression, such as cognitive perseveration (Kannis-Dymand et al., 2020). In children and adolescents diagnosed with eating disorders, perfectionism has been related to both co-occurring anxiety and depression at intake and at 6 and 12 months (Johnston et al., 2018). Students with high levels of self-critical perfectionism also experienced more severe symptoms of anxiety and depressive symptoms when entering university (Levine et al., 2021).

In addition to depression, eating disorders and anxiety, perfectionism has been associated with other mental health problems such as obsessive-compulsive disorders (OCD) (Ye et al., 2008), traumatic experiences (Chen et al., 2019), anger issues (Hewitt et al., 2002), ADHD (Marshall, 2019) and autism spectrum disorders (Greenaway & Howlin, 2010). The association between perfectionistic traits and psychosis is less studied, but negative symptoms of schizophrenia in clinical samples may be related to dysfunctional cognitive beliefs about performances and anticipated failure in tasks and social interaction (Rector et al., 2005).

Furthermore, dimensions of perfectionism have been shown to relate differentially to mental health problems. A common distinction is between Self-Oriented (SOP) and Socially Oriented (SPP) perfectionism depending on whether the standards are experienced as self-imposed or based on social pressure from the surroundings (Sherry et al., 2004). This supports a multidimensional approach to perfectionism (Flett & Hewitt, 2014), as well as underscoring the intra- and interpersonal qualities of perfectionistic traits, reactive to both inner pressure and sociocultural tendencies (Curran & Hill, 2019). In general, SPP has been most strongly related to negative outcomes with regard to well-being and mental health (Flett et al., 2022), while SOP has been related to more adaptive qualities such as positive self-esteem, perceived self-control, and achievement motivation (Klibert et al., 2005). The association between SPP and mental health problems has been reported for depression in preadolescents (Huggins et al., 2008) and undergraduates (Smith et al., 2019) as well as for test anxiety (Stoeber et al., 2009) and generalized anxiety in students (Klibert et al., 2015). The results are less consistent for eating disorders, but both SPP and SOP have been associated with eating disturbances in female university students (Welch et al., 2009).

These findings highlight the need for more research on perfectionistic traits in adolescence and how these are related to mental health problems in order to plan suitable clinical interventions (Wilksch & Wade, 2010). Although earlier research has shown an association between perfectionism and mental health problems, few studies have combined dimensions of perfectionism with a broad range of psychiatric disorders among adolescents. Furthermore, perfectionism has been reported to have a negative effect on treatment outcome and delayed help-seeking (Bardone-Cone et al., 2007; Jacobs et al., 2009; Mitchell et al., 2013), but the use of specialized mental health services in relation to perfectionism in adolescence has not been studied in clinical samples to our knowledge.

Perfectionism has not shown consistent sex (Curran & Hill, 2019) or age (Stoeber & Stoeber, 2009) differences. Accordingly, it has previously been reported similar levels for EDI-P and SOP across gender in the present sample, and while girls scored slightly higher on SPP, this difference represented a small effect size (Sand et al., 2021). (Stornaes et al., 2019).

The overall aim of this study is to explore how dimensions of perfectionism among adolescents admitted to child and adolescent mental health services (CAMHS) are associated with psychiatric disorders, adjusted for sex. Data from an epidemiological study in Norway, youth@hordaland, with self-reported measures of perfectionism (total score of EDI-P, SOP, and SPP) were linked to the National Patient Register (NPR) with reports on psychiatric disorders as well as number of admissions and consultations within CAMHS. Adolescents in contact with CAMHS were categorized in the clinical group, with those not in contact defined a reference group. We formulated the following hypotheses for the present study:

Levels of perfectionism are higher in the clinical group than in the reference group.

Levels of perfectionism differ across psychiatric diagnoses within the clinical group, with especially high scores for those with depression, eating disorders and anxiety.

The associations between EDI-P, SOP, SPP and mental health problems differ across psychiatric disorders, adjusted for sex and independent of comorbid conditions.

Participants and procedure

The present data is drawn from the youth@hordaland survey a broad epidemiological study assessing mental and physical health among adolescents in three age cohorts during spring 2012. All adolescents born between 1993 and 1995 in the county of Hordaland in Norway were invited to participate via email and sms, and the questionnaires were filled out online in the school setting or at home. The sample included adolescents eligible for high school,and for those not in school, the information about the study was sent by postal mail. The questionnaire was web-based and covered mental health issues, use of health care and social services, and request for permission to linkage to health registries.

A total of 19.430 adolescents were invited to participate in the youth@hordaland survey, of which 10.257 adolescents agreed to take part in the study, yielding a participation rate of 53%. The present sample included subjects who consented to the linkage to the National Patient Registry (NPR) (n = 9294, 53.2% girls), and after removing those with missing values on the perfectionism scale (n = 222) the final sample was 9072 participants.

Self-report measures

Sex and age were based on the personal identity number of the adolescents, and age was calculated by the interval of time between date of participation and date of birth.

Indicators of SES were were measured by perceived economic well-being and parental education level. Perceived economic well-being was categorized as ‘poorer than others’, ‘equal to others’ or ‘better than others’, while parental education was rated by the adolescents from primary school to higher university levels for their mothers and fathers. Parental education level was then categorized as basic, intermediate, and higher.

Perfectionistic traits were assessed by the 6-item perfectionism subscale in the Eating Disorders Inventory 2 (EDI-2) for children and adolecents (Garner, 1991). In accordance with the multidimensional model of perfectionism defined by Hewitt and Flett (1991), EDI-P can be divided in two dimensions, namely self-oriented (SOP) and socially prescribed perfectionism (SPP) (Sherry et al., 2004). Both subscales have three items, and they have a strong face validity as SOP refers to internal pressure while SPP refers to external pressure from parents or family.

The EDI-P items were originally rated on a 6-point Likert scale and then converted to scores from 0 to 3. In the present study, the items were rated as 0 (“not true”), 1 (“sometimes true”), or 2 (“true”) to adjust the categories to the broad questionnaire of youth@hordaland, allowing a range of 0–12 for the total score on EDI-P. Both EDI in general (Engelsen & Laberg, 2001) and EDI-P specifically (Lampard et al., 2012) have been shown to have satisfactory psychometric properties in comparable populations. The EDI-P showed an acceptable internal consistency (α = 0.73) in the sample, while it was questionable for SOP (α = 0.64) and poor for SPP (α = 0.49). The dimensions of perfectionism were split at the 90th percentile for the total sample in order to compare the distribution in the clinical group and reference group, and the scores for this were8 for EDI-P, 5 for SOP, and 4 for SPP, respectively.

Clinical data from CAHMS

Clinical data from the child and adolescent mental health services (CAMHS) were obtained by NPR, and a linkage between youth@hordaland and NPR was performed by the registry owner at the Norwegian Directorate of Health using a deidentified dataset. The data from NPR on psychiatric disorders included Axis 1 diagnoses registered from January 2008 to December 2018 when the adolescents ranged from 12 to 19 years of age. The adolescents could have been in contact with CAMHS before or after participating in the youth@hordaland survey during spring 2012.

The diagnoses were coded in accordance with the ICD-10 diagnostic manual (WHO, 1992) by clinicians within CAMHS during the treatment. Psychiatric diagnoses were included from the following categories: Depression disorder, anxiety disorders, eating disorders, conduct disorder, attention deficit/hyperactivity disorder (ADHD), trauma-related disorders, autism spectrum disorders, and psychotic conditions. The sub-categories of the main disorders have been described in more detail in previous studies from the youth@hordaland survey (Heradstveit et al., 2019). Low-frequent clinical disorders were categorized as ‘less common diagnoses’, but due to a large conceptual heterogeneity these were not included in the present study.

Having a valid registration within CAHMS defined the contact variable. We included all 933 adolescents who had been in contact with CAMHS, and a total of 111 of these (11.9%) had no registered psychiatric diagnoses on Axis 1. The data with regard to contact with CAMHS were categorized in number of admissions and consultations for the clinical sample, respectively. The number of admissions represented separate entries of referrals to CAMHS, while consultations defined number of clinical interventions in the form of either direct (e.g., therapy sessions) or indirect contact (e.g., cooperation between therapists and school or other health care services).

Ethics

The youth@hordaland study was approved by Regional Committee for Medical and Health Research Ethics (REC) in Western Norway (2011/811/ and 2012/1467 REC) and SIKT (Norwegian Agency for Shared Services in Education and Research; 371 974 and 259 631). All participation was based on electronic consent from the adolescents in line with national Norwegian health authorities, stating that individuals aged 16 years or more can make decisions regarding their own health. Parents or guardians received information in advance of the study.

Statistical procedure

All statistical analyses were performed by IBM SPSS for Windows, version 29 (IBM, 2022). Categorical variables were presented as percentages, while continous variables were presented as means (M) with standard deviations (SD) or as Estimated Marginal Means (EMM) with standard error (SE). Reliability analyses of the perfectionism scale were performed by Cronbach’s alpha. Descriptive statistics were performed using chi-squared tests and independent samples t-tests when examining differences in demographic variables between the clinical and reference group.

Differences in the dimensions of perfectionism across the clinical and reference group were investigated by mean levels using independent samples t-tests. The perfectionism scores were also split at the 90th percentile for the total sample in order to compare the distribution in the clinical group and reference group for those with high and low perfectionism using chi-squared tests, with adjusted standardized residuals indicating significance levels.

Levels of perfectionism in the clinical group across the psychiatric disorders were compared to the reference group by ANOVA, with computed Estimated Marginal Means (EMM) for EDI-P, SOP and SPP, adjusting for sex. Based on the results that only adolescents diagnosed with depression and eating disorders in the clinical group scored higher on the dimensions of perfectionism than the reference group, we performed post hoc tests by logistic regression analyses for the association between perfectionism and these disorders. The dimensions of perfectionism were entered as continous variables, adjusting for sex and comorbid conditions (e.g anxiety and eating disorders for depression, and anxiety and depression for eating disorders).

When analyzing perfectionism and contact with CAMHS, we compared number of admissions and consultations among the high and low scorers on EDI-P, SOP, and SPP in the clinical group. The dimensions of perfectionism were split at the 90th percentile based on levels for the total sample, and the comparisons were done by using ANOVA, adjusting for sex. We also performed post hoc tests for contact with CAHMS among adolescents diagnosed with depression and eating disorders compared to the means levels for the clinical group, computing EMM for number of admissions and consultations adjusted for sex.

With regard to effect sizes, we used Odds Ratios (OR) for the regression analyses, Cohen’s d for t-tests (small effect size for d = .2, medium d = .5, and large d = .8), and partial eta² for ANOVA (small effect size for η² = .01, medium η² = .06, and large η² = .14) based on recommended guidelines (Cohen, 1988).

Sample characteristics

Mean age in the total sample was 17.43 (SD = 0.84). The subjects formed an ethnically homogenous sample with 94.3% of the subjects born in Norway. With regard to perceived economic well-being, 67.4% and 25.6% reported an equal to or better than others economic situation, respectively. Concerning the parents’ education level, 21.9 of the mothers and 22.7% of the fathers had higher education.

In the present sample, 10.3% (n = 933) had been in contact with CAMHS and comprised the clinical sample, while the remaining 89.8% of the adolescents (n = 8139) defined the reference group. Among those in the clinical group, the average number of admissions within CAMHS were 1.33 (SD = .71, range = 1–9) and consultations 11.35 (SD = 10.30, range = 1–65). Table 1 presents demographic variables across the clinical group and reference group. The participants in the clinical group were generally younger in age, had more girls and showed a trend towards lower SES regarding both perceived economic-wellbeing and parental education level than the reference group.

Table 1

*Demographic variables across contact with CAMHS*ⁿ
Contact with CAMHS	Contact (n = 933)	No contact (n = 8139)
Age in years, mean (SD)	17.30 (0.83)	17.42 ( 0.83)***
Girls	11.7%***	8.7%
Ethnicity other than Norwegian	6.4%	5.4%
Perceived economic well-being Worse than others Equal to others Better than others	13.5%*** 65.4% 21.2%	6.4% 67.6% 26.1%***
Maternal education level Basic Intermediate Higher Unknown	10.6%* 41.0% 18.7% 29.7%*	7.4% 47.9%* 22.3%* 22.4%
Paternal education level Basic Intermediate Higher Unknown	9.5% 39.0% 15.8% 35.7%	7.8% 45.2%* 23.6%* 23.4%***
ⁿSignificant differences with higher values at p < .05, p < 01, and **p < .001 based on independent samples t-tests for continuous variables and chi-square tests for dichotomous variables across contact with Child and Adolescent Mental Health Services (CAMHS).

Insert Table 1 here

Perfectionism across clinical and comparison group

The scores on perfectionism across the clinical and reference group are presented in Table 2. Adolescents in the clinical group scored higher than the reference group with regard to the SPP-subscale (t(9070) = 2.06, p = .040, Cohen’s d = .071), but with a small effect size This difference did not prove significant for the SOP-subscale (t(9070) = − .650, p = .52, Cohen’s d =-.022) or full scale EDI-P (t(9070 = .83, p = .41, Cohen’s d = .029).

Table 2

*Levels of perfectionism for clinical and reference group*ⁿ
	Clinical group (n = 933)		Reference group (n = 8139)		Effect size
Perfectionism	Mean	SD	Mean	SD	Cohen’s d
EDI-P SOP SPP	4.66 2.66 1.99*	2.92 1.53 1.75	4.58 2.70 1.88	2.73 1.49 1.56	.029 − .022 .071
ⁿLevels of perfectionism for scores on EDI-P, Self-Oriented Perfectionism (SOP) and Socially Prescribed Perfectionism (SPP) presented as means (M) and standard deviations (SD) based on independent samples t-tests with significance level at *p < .05.

Insert Table 2 here

When comparing adolescents with levels of perfectionism above the 90th percentile with those showing lower levels, there were significantly more high scorers in the clinical group than in the reference group for EDI-P (11.8% vs. 8.9%, Chi-square = 8.32, df = 1, p = .004) and SPP (11.9% vs. 6.7%, Chi-Square = 33.96, df = 1, p < .001), but not with regard to SOP.

Perfectionism across psychiatric diagnoses

The levels of perfectionism for the clinical group across psychiatric disorders are presented in Table 3. Adolescents in the clinical group diagnosed with depression and eating disorders scored higher on both full scale EDI-P and the two subscales SOP and SPP than the reference group, also when adjusting for sex, yet with small effect sizes (η² = .001 − .002).

Table 3

*Levels of perfectionism for clinical and reference group across psychiatric disorders*ⁿ
		EDI-P	SOP	SPP
Diagnoses	n	EMM (SE)	EMM (SE)	EMM (SE)
Reference group		4.58 (0.30)	2.69 (0.02)	1.89 (1.57)
Anxiety	175	4.65 (0.11)	2.61 (0.11)	2.04 (0.12)
Depression	235	5.22 (0.18)***	2.89 (0.10)**	2.33 (0.10)***
Eating disorders	55	5.99 (0.37)***	3.14 (0.20)*	2.86 (0.21)***
Conduct disorders	33	4.82 (0.48)	2.56 (0.26)	2.27 (0.28)
Psychotic cond.	22	4.86 (0.59)	2.81 (0.32)	2.05 (0.34)
Autistic cond.	52	4.45 (0.38)	2.46 (0.21)	1.99 (0.22)
ADHD	166	4.51 (0.21)	2.58 (0.12)	1.94 (0.12)
PTSD	84	4.65 (0.30)	2.76 (0.16)	1.89 (0.17)
ⁿLevels of perfectionism for continuous scores on EDI-P, Self-Oriented Perfectionism (SOP) and Socially Prescribed Perfectionism (SPP) presented as estimated marginal means (EMM) and standard error (SE) for clinical sample compared to the reference group across psychiatric disorders (ADHD = Attention Deficit Hyperactivity Disorders, PTSD = Post Traumatic Stress Disorder) adjusted for sex, with significance levels at p < .05, p < 01, and **p < .001.

Insert Table 3 here

Based on the results that only adolescents with depression and eating disorders in the clinical group showed higher levels on perfectionism than the reference group, we performed post hoc tests for the association between perfectionism and these disorders adjusted for sex and comorbid conditions (e.g., anxiety and eating disorders for depression, and anxiety and depression for eating disorders). The logistic regression analyses are presented in Table 4, showing increased odds of perfectionism on all dimensions of perfectionism for adolescents diagnosed with depression. For eating disorders, the associations were significant for EDI-P and SPP, but not for SOP, respectively.

Table 4

*The association between perfectionism and depression/eating disorders*ⁿ
		EDI-P		EDI-SOP		EDI-SPP
	n	OR	95% CI	OR	95% CI	OR	95% CI
Depression	235	1.08**	1.03–1.14	1.11*	1.01–1.22	1.15***	1.06–1.25
Eating disorders	55	1.15**	1.05–1.26	1.18	0.98–1.41	1.31***	1.13–1.53
^aAssociations between perfectionism defined as EDI-P, Self-Oriented Perfectionism (SOP) and Socially Prescribed Perfectionism (SPP) and depression and eating disorders based on logistic regressions analyses with significance levels at p < .05, p < 01, and **p < .001, adjusted for sex and comorbid conditions (e.g anxiety and eating disorders for depression, and anxiety and depression for eating disorders).

Insert Table 4 here

Perfectionism and contact with CAMHS

Adolescents with high scores on EDI-P and SPP had significantly more contact with CAMHS with regard to number of admissions and consultations adjusted for sex, yet with small effect sizes (η² = 0.007–0.012). This association was not significant for SOP (see Table 5 for details).

Table 5

*Contact with CAMHS across levels of perfectionism*ⁿ
	Number of admissions		Number of consultations		Effect size (η²)
Perfectionism	High	Low	High	Low	Treatments	Consultations
EDI-P	1.48 (0.06)*	1.32 (0.02)	13.73 (0.98)**	11.03 (0.36)	.009	.007
EDI-SOP	1.49 (0.12)	1.33 (0.02)	12.61 (1.74)	11.30 (0.34)	.002	.001
EDI-SPP	1.53 (0.07)**	1.31 (0.03)	14.44 (0.98)***	10.94 (0.36)	.010	.012
ⁿPerfectionism split at the 90th percentile on EDI-P, SOP, and SPP defined as “high” and “low” levels across number of admissions and consultations presented as estimated marginal means (EMM) and standard error (SE) with p < .05, p < .01 and **p < .001 and effect size defined as partial eta² (η²), adjusted for sex.

Insert Table 5 here

We performed post hoc analyses presented in Table 6 for contact with CAMHS among adolescents diagnosed with depression and eating disorders since these conditions were shown to be associated with perfectionism in the present sample. Adolescents with these disorders had significantly higher number of admissions and consultations than the mean levels for the clinical group, also when adjusting for sex. The effect sizes for these comparisons were generally small, but slightly larger for depression (η² = 0.080–0.122) than for eating disorders (η² = 0.005–0.029).

Table 6

*Contact with CAMHS for depression and eating disorders*ⁿ
		Number of admissions		Number of consultations		Effect size
	n	EMM (SE)	p	EMM (SE)	p	Admissions	Consultations
Mean levels	933	1.33 (0.02)		11.35 (0.34)		η²	η²
Depression	235	1.68 (0.05)***	< .001	17.61 (0.64)***	< .001	.080	.122
Eating disorders	55	1.54 (0.10)*	0.27	18.47 (1.39)***	< .001	.005	.029
ⁿContact with CAMHS for depression and eating disorders presented as estimated marginal means (EMM) and standard error (SE) compared to mean number of admissions and consultations for the clinical sample with p < .05, p < .01, and **p < .001 and effect size as partial eta² (η²) adjusted for sex.

Insert Table 6 here

Main findings

The present study investigated dimensions of perfectionism in adolescents defined as a total score on EDI-P as well as self-oriented (SOP) and socially oriented perfectionism (SPP), comparing a clinical group based on contact with CAMHS to a reference group. Adolescents who had been in contact with CAMHS had higher levels of socially prescribed perfectionism (SPP), but not full-scale EDI-P or self-oriented perfectionism (SOP). There were higher levels of perfectionism among adolescents with depression and eating disorders compared to the reference group, but this difference was not found for anxiety disorders. Number of admissions and consultations within the CAMHS were higher for those with elevated levels on EDI-P and SPP, although with small effect sizes.

The clinical group scored higher on the subscale SPP than the reference group, but not on full scale EDI-P or the subscale SOP. There were also significantly more high scorers in the clinical group than in the comparison group for EDI-P and SPP, but not with regard to SOP. These findings partly accord with our first hypothesis that levels of perfectionism would be higher in the clinical group than in the reference group. To our knowledge, there are no previous studies to relate the present findings to, as earlier research has mainly investigated samples from clinical or general populations without comparing these on dimensions of perfectionism. However, the present findings accord with previous studies that have found a stronger association between SPP and mental health problems than for SOP (Flett et al., 2022).

When analyzing perfectionism in relation to specific psychiatric disorders, all dimensions of perfectionism were higher for those with depression and eating disorders compared to the reference group, adjusted for sex. The regression analyses also showed increased odds of perfectionism on all dimensions of perfectionism for adolescents diagnosed with depression. For eating disorders, the associations were significant for EDI-P and SPP, but not for SOP, respectively. These results were also significant when adjusted for sex and comorbid conditions defined as anxiety and eating disorders for depression, and inversely anxiety and depression for eating disorders. According to previous studies, depressive symptoms may lead to increases in SPP among children (Asseraf & Vaillancourt, 2015), but it has also been found that perfectionistic traits measured as excessive evaluative concerns predicted symptoms of depression and hopelessness among students (Smith, Sherry, et al., 2018). Other authors have reported that perfectionism is associated with eating-related symptoms among children and adolescents in clinical samples (Johnston et al., 2018), and a reciprocal relationship is suggested where eating disorders in female adolescents mediate the relationship between perfectionism and anxiety and/or depression (Drieberg et al., 2019). Thus, the present findings are in accordance with earlier studies and partly support our second hypotheses, expecting that levels of perfectionism would differ across psychiatric diagnoses within the clinical group, with especially high scores among adolescents with depression and eating disorders.

Contrary to the second hypothesis, adolescents with anxiety disorders did not report higher levels of perfectionism than the reference group in the current study. A possible explanation is that the present study used overall diagnostic category of anxiety disorders, while earlier studies have largely identified associations between perfectionism and specific symptom clusters, such as social anxiety among students (Wang et al., 2022) as well as trait anxiety (Dobos & Piko, 2018) and generalized anxiety (Klibert et al., 2015) in young females. Some authors also argue that although perfectionism is understood as a risk factor for anxiety, the research on perfectionistic traits and anxiety in adolescence is scarce (Damian et al., 2017). Further, earlier research reporting an association between perfectionism and anxiety have often specified this to maladaptive perfectionistic traits that the present study did not measure, such as perfectionistic concerns (Smith, Vidovic, et al., 2018). Accordingly, it has been reported that maladaptive perfectionistic concerns, and not healthy perfectionistic strivings, predicted longitudinal increases in anxiety symptoms in adolescence (Damian et al., 2017).

Both number of admissions and consultations within CAMHS were higher for those in the clinical group with elevated levels of perfectionism on EDI-P and SPP, although with small effect sizes. This could be understood in accordance with the mental distress and psychopathology associated with perfectionistic traits (Egan et al., 2011), especially for SPP (Einstein et al., 2000), possibly presenting a higher symptom severity and longer treatment needed in order to attain progress. Yet, this could also be explained by the finding that some psychiatric disorders with elevated perfectionism levels are associated with more extensive contact with CAMHS than average, such as for depression and eating disorders as shown in the present sample. Accordingly, it has been shown that high levels of perfectionism may prolong the treatment of depression (Jacobs et al., 2009) as well as maintaining eating disorders (Bardone-Cone et al., 2007) and accounting for the persistence of these conditions (Fairburn et al., 2003).

The present findings indicate that among the dimensions of perfectionism, SPP was related especially strongly to both psychiatric disorders and contact with CAMHS. Theoretically, the association between perfectionism and SPP and mental distress is often explained by the self-discrepancy theory formulated by Higgins (1987), proposing that a conflict can arise between social expectations defining an ‘ideal self’ in contrast with the ‘actual self’ among adolescents (Johnston et al., 2018) and students (Asl et al., 2022). Yet, the effect size was small for the comparison between the levels on SPP in the clinical group and reference group, and this could be explained by findings of relatively high perfectionism scores in general youth populations (Curran & Hill, 2019; Sironic & Reeve, 2015).

Strengths and limitations

The present study has several strengths with regard to a large sample size, and the possibility to investigate self-reported scores on dimensions of perfectionism among adolescents in relation to a broad spectrum of psychiatric disorders and contact with CAMHS based on a registry linkage.

Yet, we did not analyze the temporal order of contact with CAMHS and self-reported perfectionism and do therefore not have the possibility to infer causal associations between perfectionism and mental health problems, that might take numerous pathways (Nazari, 2022).. It could also be noted that the reliability of the subscales of perfectionism (SOP and SPP) measured as internal consistency was questionable in the present sample. Further, the assessment of the psychiatric disorders within CAMHS were not standardized with regard to diagnostic procedures, and the broad categorization of psychiatric diagnoses could cover potential associations between perfectionism and more specific sub-categories of psychiatric conditions, such as for anxiety disorders.

Furthermore, the attrition may have influenced the representativeness of the sample. Earlier studies have compared adolescents participating in youth@hordaland who consented to the registry linkage to NPR with those who did not consent to this linkage (Heradstveit et al., 2019)., and those who did not consent to the registry linkage was generally older as well as reporting slightly higher conduct problems and alcohol usage, although with small effect sizes.

Finally, even if the study scope was broad with regard to participants and clinical data, we did not include other variables influencing the relation between perfectionism and mental health problems, such as self-esteem (Chai et al., 2020) and self-worth (Bardone-Cone et al., 2017).

Implications for research and clinical interventions

While perfectionism is understood as a multidimensional phenomenon and a transdiagnostic process (Egan et al., 2011), there is no universally accepted method of categorizing dimensions of perfectionism. Many authors therefore use a continuous approach with levels of perfectionism rather than the split between adaptive and maladaptive traits (Affrunti & Woodruff-Borden, 2014), or dimensions based on the source of perceived pressure such as SOP and SPP utilized in the present study. This shows a need for unifying measures of perfectionism, encompassing different dimensions as well as adaptive and maladaptive perfectionistic traits with positive and negative qualities for the individual (Nazari, 2022). In addition, longitudinal studies could add further knowledge on how perfectionism contribute to mental health problems over time both at sub-clinical and clinical levels.

Further studies of the relation between perfectionism and treatment of psychiatric disorders could also be of interest, and the utilization of specialized mental health care services especially among youth with high levels of SPP should be further explored in clinical studies. Routine assessment of perfectionism among vulnerable youth has been recommended (Egan et al., 2011), and the present findings suggest that this is particularly important for adolescents with symptoms of depression or eating disorders. Targeting perfectionism in treatment may also reduce comorbid conditions such as for co-occurring eating disorders, depression and anxiety disorders (Drieberg et al., 2019; Galloway et al., 2022). This supports the importance of including perfectionism in clinical interventions, especially for adolescents with eating disorders, depression and anxiety conditions, helping them to reduce self-critical (Levine et al., 2021) and automatic (Besser et al., 2020) perfectionistic thoughts and encourage more adaptive and realistic perfectionistic strivings (Nazari, 2022).

The present study investigated dimensions of self-reported perfectionism in adolescents, comparing a clinical group based on contact with CAMHS to a reference group. Adolescents who had been in contact with CAMHS had higher levels of socially prescribed perfectionism (SPP), but not full-scale EDI-P or self-oriented perfectionism (SOP). There were significantly higher levels of perfectionism among adolescents in the clinical group with depression and eating disorders compared to the reference group. Further, those in the clinical group with elevated levels of SPP showed more extensive contact with CAMHS. The study supports the association between perfectionism and emotional distress, especially regarding pressure from the social surroundings as defined by SPP. Perfectionism should be targeted in future longitudinal studies as well as in clinical interventions in other to strengthen the mental health and wellbeing among adolescents.

Ethical approval

Competing interests

No potential conflict of interest was reported by the authors.

Authors' contributions

The authors MH, KMS, and TB were involved in the data acquisition for youth@hordaland, while LS and MH were responsible for planning the design of the present study. LS conducted the statistical analyses and conferred with MH and TB regarding the results. Author LS drafted the manuscript, while KMS and JB contributed to specifying the research questions as well as interpreting the results. All authors have reviewed the manuscript critically, and they have read and approved the final manuscript.

Funding

The lead author has received a postdoctoral grant from Helse Vest with Grant No. 912154. The funding source was not involved in the planning of the study design, data collection, or interpretation of the results of this study.

Availability of data and materials

The register linkage expires at the end of the year 2023. After that, the full linked data set will no longer be available. Further data linkages will involve a new approval procedure. From the second half of 2024, the research project group can be contacted at [email protected] for updated information about how to access data from the project.

Acknowledgements

We would like to thank all the adolescents who participated in the youth@hordaland study and the Regional Centre for Child and Youth Mental Health and Child Welfare at NORCE Norwegian Research Centre for making the data available for the present study.

Affrunti, N. W., & Woodruff-Borden, J. (2014). Perfectionism in pediatric anxiety and depressive disorders. Clin Child Fam Psychol Rev, 17(3), 299-317. https://doi.org/10.1007/s10567-014-0164-4
Asl, E. M., Rostami, H., Sadegh, A. M., Abdi, L., & Behrouzian, F. (2022). Mediating Role of Self-esteem and Self-efficacy in the Relationship of Perfectionism and Negative Reactivity with Eating Disorders. Iranian Journal of Psychiatry and Behavioral Sciences, 16(1). https://doi.org/10.5812/ijpbs.111449
Asseraf, M., & Vaillancourt, T. (2015). Longitudinal Links Between Perfectionism and Depression in Children. Journal of Abnormal Child Psychology, 43(5), 895-908. https://doi.org/10.1007/s10802-014-9947-9
Bardone-Cone, A. M., Lin, S. L., & Butler, R. M. (2017). Perfectionism and Contingent Self-Worth in Relation to Disordered Eating and Anxiety. Behav Ther, 48(3), 380-390. https://doi.org/10.1016/j.beth.2016.05.006
Bardone-Cone, A. M., Wonderlich, S. A., Frost, R. O., Bulik, C. M., Mitchell, J. E., Uppala, S., & Simonich, H. (2007). Perfectionism and eating disorders: current status and future directions. Clin Psychol Rev, 27(3), 384-405. https://doi.org/10.1016/j.cpr.2006.12.005
Besser, A., Flett, G. L., Sherry, S. B., & Hewitt, P. L. (2020). Are Perfectionistic Thoughts an Antecedent or a Consequence of Depressive Symptoms? A Cross-Lagged Analysis of the Perfectionism Cognitions Inventory. Journal of Psychoeducational Assessment, 38(1), 99-111. https://doi.org/10.1177/0734282919877764
Chai, L., Yang, W., Zhang, J., Chen, S., Hennessy, D. A., & Liu, Y. (2020). Relationship Between Perfectionism and Depression Among Chinese College Students With Self-Esteem as a Mediator. Omega (Westport), 80(3), 490-503. https://doi.org/10.1177/0030222819849746
Chen, C., Hewitt, P. L., & Flett, G. L. (2019). Adverse childhood experiences and multidimensional perfectionism in young adults. Personality and Individual Differences, 146, 53-57. https://doi.org/10.1016/j.paid.2019.03.042
Cohen, J. (1988). Statistical Power Analysis for the Behavioral Sciences (2nd ed.). Erlbaum.
Curran, T., & Hill, A. P. (2019). Perfectionism is increasing over time: A meta-analysis of birth cohort differences from 1989 to 2016. Psychol Bull, 145(4), 410-429. https://doi.org/10.1037/bul0000138
Damian, L. E., Negru-Subtirica, O., Stoeber, J., & Baban, A. (2017). Perfectionistic concerns predict increases in adolescents' anxiety symptoms: a three-wave longitudinal study. Anxiety Stress Coping, 30(5), 551-561. https://doi.org/10.1080/10615806.2016.1271877
Dobos, B., & Piko, B. (2018). [The role of perfectionism, social phobia, self-efficacy and life satisfaction in the background of trait anxiety]. Psychiatr Hung, 33(4), 347-358. https://www.ncbi.nlm.nih.gov/pubmed/30540258
Drieberg, H., McEvoy, P. M., Hoiles, K. J., Shu, C. Y., & Egan, S. J. (2019). An examination of direct, indirect and reciprocal relationships between perfectionism, eating disorder symptoms, anxiety, and depression in children and adolescents with eating disorders. Eat Behav, 32, 53-59. https://doi.org/10.1016/j.eatbeh.2018.12.002
Egan, S. J., Wade, T. D., & Shafran, R. (2011). Perfectionism as a transdiagnostic process: a clinical review. Clin Psychol Rev, 31(2), 203-212. https://doi.org/10.1016/j.cpr.2010.04.009
Einstein, D. A., Lovibond, P. F., & Gaston, J. E. (2000). Relationship between perfectionism and emotional symptoms in an adolescent sample. Australian Journal of Psychology, 52(2), 89-93. https://doi.org/Doi 10.1080/00049530008255373
Engelsen, B. K., & Laberg, J. C. (2001). A comparison of three questionnaires (EAT-12, EDI, and EDE-Q) for assessment of eating problems in healthy female adolescents. Nordic Journal of Psychiatry, 55, 129-135. https://doi.org/10.1080/08039480151108589
Enns, M. W., Cox, B. J., Sareen, J., & Freeman, P. (2001). Adaptive and maladaptive perfectionism in medical students: a longitudinal investigation. Med Educ, 35(11), 1034-1042. https://doi.org/10.1046/j.1365-2923.2001.01044.x
Fairburn, C. G., Cooper, Z., & Shafran, R. (2003). Cognitive behaviour therapy for eating disorders: a "transdiagnostic" theory and treatment. Behav Res Ther, 41(5), 509-528. https://doi.org/10.1016/s0005-7967(02)00088-8
Flett, G. L., & Hewitt, P. L. (2014). The multidimensional assessment of perfectionistic automatic thoughts: a commentary on "Examining mutual suppression effects in the assessment of perfectionism cognitions: evidence supporting multidimensional assessment". Assessment, 21(6), 661-665. https://doi.org/10.1177/1073191114553015
Flett, G. L., Hewitt, P. L., Nepon, T., Sherry, S. B., & Smith, M. (2022). The destructiveness and public health significance of socially prescribed perfectionism: A review, analysis, and conceptual extension. Clin Psychol Rev, 93, 102130. https://doi.org/10.1016/j.cpr.2022.102130
Galloway, R., Watson, H., Greene, D., Shafran, R., & Egan, S. J. (2022). The efficacy of randomised controlled trials of cognitive behaviour therapy for perfectionism: a systematic review and meta-analysis. Cogn Behav Ther, 51(2), 170-184. https://doi.org/10.1080/16506073.2021.1952302
Garner, D. M. (1991). The Eating Disorder Inventory-2. FL: Psychological Assessment Resources.
Greenaway, R., & Howlin, P. (2010). Dysfunctional Attitudes and Perfectionism and Their Relationship to Anxious and Depressive Symptoms in Boys with Autism Spectrum Disorders. Journal of Autism and Developmental Disorders, 40(10), 1179-1187. https://doi.org/10.1007/s10803-010-0977-z
Heradstveit, O., Skogen, J. C., Hetland, J., Stewart, R., & Hysing, M. (2019). Psychiatric Diagnoses Differ Considerably in Their Associations With Alcohol/Drug-Related Problems Among Adolescents. A Norwegian Population-Based Survey Linked With National Patient Registry Data. Front Psychol, 10, 1003. https://doi.org/10.3389/fpsyg.2019.01003
Hewitt, P. L., Caelian, C. F., Flett, G. L., Sherry, B. S., Collins, L., & Flynn, C. (2002). Perfectionism in children: Associations with depression, anxiety and anger. Personality and Individual Differences, 32, 1049-1061.
Hewitt, P. L., & Flett, G. L. (1991). Perfectionism in the Self and Social Contexts - Conceptualization, Assessment, and Association with Psychopathology. Journal of Personality and Social Psychology, 60(3), 456-470. https://doi.org/Doi 10.1037/0022-3514.60.3.456
Hewitt, P. L., Smith, M. M., Ge, S. Y. J., Mossler, M., & Flett, G. L. (2022). Perfectionism and Its Role in Depressive Disorders. Canadian Journal of Behavioural Science-Revue Canadienne Des Sciences Du Comportement, 54(2), 121-131. https://doi.org/10.1037/cbs0000306
Higgins, E. T. (1987). Self-discrepancy: a theory relating self and affect. Psychol Rev, 94(3), 319-340. https://www.ncbi.nlm.nih.gov/pubmed/3615707
Huggins, L., Davis, M. C., Rooney, R., & Kane, R. (2008). Socially Prescribed and Self-Oriented Perfectionism as Predictors of Depressive Diagnosis in Preadolescents. Australian Journal of Guidance and Counselling, 18(2), 182-194. https://doi.org/DOI 10.1375/ajgc.18.2.182
IBM. (2022). IBM SPSS Statistics for Windows, Version 29.0. In (Version 29) IBM Corp.
Jacobs, R. H., Silva, S. G., Reinecke, M. A., Curry, J. F., Ginsburg, G. S., Kratochvil, C. J., & March, J. S. (2009). Dysfunctional attitudes scale perfectionism: a predictor and partial mediator of acute treatment outcome among clinically depressed adolescents. J Clin Child Adolesc Psychol, 38(6), 803-813. https://doi.org/10.1080/15374410903259031
Johnston, J., Shu, C. Y., Hoiles, K. J., Clarke, P. J. F., Watson, H. J., Dunlop, P. D., & Egan, S. J. (2018). Perfectionism is associated with higher eating disorder symptoms and lower remission in children and adolescents diagnosed with eating disorders. Eat Behav, 30, 55-60. https://doi.org/10.1016/j.eatbeh.2018.05.008
Kannis-Dymand, L., Hughes, E., Mulgrew, K., Carter, J. D., & Love, S. (2020). Examining the roles of metacognitive beliefs and maladaptive aspects of perfectionism in depression and anxiety. Behav Cogn Psychother, 48(4), 442-453. https://doi.org/10.1017/S1352465820000144
Klibert, J., Lamis, D. A., Naufel, K., Yancey, C. T., & Lohr, S. (2015). Associations Between Perfectionism and Generalized Anxiety: Examining Cognitive Schemas and Gender. Journal of Rational-Emotive and Cognitive-Behavior Therapy, 33(2), 160-178. https://doi.org/10.1007/s10942-015-0208-9
Klibert, J. J., Langhinrichsen-Rohling, J., & Saito, M. (2005). Adaptive and maladaptive aspects of self-oriented versus socially prescribed perfectionism. Journal of College Student Development, 46(2), 141-156. https://doi.org/DOI 10.1353/csd.2005.0017
Lampard, A. M., Byrne, S. M., McLean, N., & Fursland, A. (2012). The Eating Disorder Inventory-2 Perfectionism scale: factor structure and associations with dietary restraint and weight and shape concern in eating disorders. Eat Behav, 13(1), 49-53. https://doi.org/10.1016/j.eatbeh.2011.09.007
Leone, E. M., & Wade, T. D. (2018). Measuring perfectionism in children: a systematic review of the mental health literature. Eur Child Adolesc Psychiatry, 27(5), 553-567. https://doi.org/10.1007/s00787-017-1078-8
Levine, S. L., Tabri, N., & Milyavskaya, M. (2021). Trajectories of depression and anxiety symptoms over time in the transition to university: Their co-occurrence and the role of self-critical perfectionism. Development and Psychopathology. https://doi.org/10.1017/S0954579421000626
Limburg, K., Watson, H. J., Hagger, M. S., & Egan, S. J. (2017). The Relationship Between Perfectionism and Psychopathology: A Meta-Analysis. Journal of Clinical Psychology, 73(10), 1301-1326. https://doi.org/10.1002/jclp.22435
Lowe, P. A. (2022). Do Dimensions of Perfectionism Predict Dimensions of Test Anxiety While Controlling for Depression? Journal of Psychoeducational Assessment. https://doi.org/10.1177/07342829221095653
Marshall, K. (2019). Symptoms of Attention Deficit Hyperactivity Disorder and Perfectionism in Youth: A Multi-Informant Perspective University of Ottowa]. https://ruor.uottawa.ca/handle/10393/39562
Mitchell, J. H., Newall, C., Broeren, S., & Hudson, J. L. (2013). The role of perfectionism in cognitive behaviour therapy outcomes for clinically anxious children. Behav Res Ther, 51(9), 547-554. https://doi.org/10.1016/j.brat.2013.05.015
Nazari, N. (2022). Perfectionism and mental health problems: Limitations and directions for future research. World J Clin Cases, 10(14), 4709-4712. https://doi.org/10.12998/wjcc.v10.i14.4709
Negru-Subtirica, O., Pop, E. I., Damian, L. E., & Stoeber, J. (2021). The Very Best of Me: Longitudinal Associations of Perfectionism and Identity Processes in Adolescence. Child Dev. https://doi.org/10.1111/cdev.13622
Rector, N. A., Beck, A. T., & Stolar, N. (2005). The negative symptoms of schizophrenia: A cognitive perspective. Canadian Journal of Psychiatry-Revue Canadienne De Psychiatrie, 50(5), 247-257. https://doi.org/Doi 10.1177/070674370505000503
Rice, K. G., & Richardson, C. M. (2014). Classification challenges in perfectionism. J Couns Psychol, 61(4), 641-648. https://doi.org/10.1037/cou0000040
Robinson, K., & Wade, T. D. (2021). Perfectionism interventions targeting disordered eating: A systematic review and meta-analysis. International Journal of Eating Disorders, 54(4), 473-487. https://doi.org/10.1002/eat.23483
Sand, L., Boe, T., Shafran, R., Stormark, K. M., & Hysing, M. (2021). Perfectionism in Adolescence: Associations With Gender, Age, and Socioeconomic Status in a Norwegian Sample. Front Public Health, 9, 688811. https://doi.org/10.3389/fpubh.2021.688811
Sherry, S. B., Hewitt, P. L., Besser, A., McGee, B. J., & Flett, G. L. (2004). Self-oriented and socially prescribed perfectionism in the Eating Disorder Inventory Perfectionism Subscale. International Journal of Eating Disorders, 35(1), 69-79. https://doi.org/10.1002/eat.10237
Sironic, A., & Reeve, R. A. (2015). A Combined Analysis of the Frost Multidimensional Perfectionism Scale (FMPS), Child and Adolescent Perfectionism Scale (CAPS), and Almost Perfect Scale-Revised (APS-R): Different Perfectionist Profiles in Adolescent High School Students. Psychol Assess. https://doi.org/10.1037/pas0000137
Smith, M. M., Sherry, S. B., Glowacka, M., Speth, T. A., Stewart, S. H., Saklofske, D. H., & Etherson, M. E. (2019). Who is the most demanding of them all ? A multisource investigation of other-oriented perfectionism, socially prescribed perfectionism, and depressive symptoms. Personality and Individual Differences, 138, 328-332. https://doi.org/10.1016/j.paid.2018.09.023
Smith, M. M., Sherry, S. B., McLarnon, M. E., Flett, G. L., Hewitt, P. L., Saldofske, D. H., & Etherson, M. E. (2018). Why does socially prescribed perfectionism place people at risk for depression? A five-month, two-wave longitudinal study of the Perfectionism Social Disconnection Model. Personality and Individual Differences, 134, 49-54. https://doi.org/10.1016/j.paid.2018.05.040
Smith, M. M., Sherry, S. B., Ray, C., Hewitt, P. L., & Flett, G. L. (2021). Is perfectionism a vulnerability factor for depressive symptoms, a complication of depressive symptoms, or both? A meta-analytic test of 67 longitudinal studies. Clinical Psychology Review, 84. https://doi.org/10.1016/j.cpr.2021.101982
Smith, M. M., Vidovic, V., Sherry, S. B., Stewart, S. H., & Saklofske, D. H. (2018). Are perfectionism dimensions risk factors for anxiety symptoms? A meta-analysis of 11 longitudinal studies. Anxiety Stress Coping, 31(1), 4-20. https://doi.org/10.1080/10615806.2017.1384466
Stoeber, J., Feast, A. R., & Hayward, J. A. (2009). Self-oriented and socially prescribed perfectionism: Differential relationships with intrinsic and extrinsic motivation and test anxiety. Personality and Individual Differences, 47(5), 423-428. https://doi.org/10.1016/j.paid.2009.04.014
Stoeber, J., & Stoeber, F. S. (2009). Domains of perfectionism: Prevalence and relationships with perfectionism, gender, age, and satisfaction with life. Personality and Individual Differences, 46(4), 530-535. https://doi.org/10.1016/j.paid.2008.12.006
Stornaes, A. V., Rosenvinge, J. H., Sundgot-Borgen, J., Pettersen, G., & Friborg, O. (2019). Profiles of Perfectionism Among Adolescents Attending Specialized Elite- and Ordinary Lower Secondary Schools: A Norwegian Cross-Sectional Comparative Study. Front Psychol, 10, 2039. https://doi.org/10.3389/fpsyg.2019.02039
Taylor, E. P., Couper, R., & Butler, C. M. (2017). Adolescent perfectionism: Structural features of the Frost Multidimensional Perfectionism Scale and correlates with attachment and psychopathology. Psychol Psychother, 90(4), 686-704. https://doi.org/10.1111/papt.12133
Vacca, M., Ballesio, A., & Lombardo, C. (2021). The relationship between perfectionism and eating-related symptoms in adolescents: A systematic review. Eur Eat Disord Rev, 29(1), 32-51. https://doi.org/10.1002/erv.2793
Wang, Y. Z., Chen, J., Zhang, X. S., Lin, X. X., Sun, Y. B., Wang, N., Wang, J. Y., & Luo, F. (2022). The Relationship between Perfectionism and Social Anxiety: A Moderated Mediation Model. International Journal of Environmental Research and Public Health, 19(19). https://doi.org/10.3390/ijerph191912934
Welch, E., Miller, J. L., Ghaderi, A., & Vaillancourt, T. (2009). Does perfectionism mediate or moderate the relation between body dissatisfaction and disordered eating attitudes and behaviors? Eat Behav, 10(3), 168-175. https://doi.org/10.1016/j.eatbeh.2009.05.002
WHO. (1992). The ICD-10 classification of mental and behavioural disorders : clinical descriptions and diagnostic guidelines. W. H. Organization. https://apps.who.int/iris/handle/10665/37958
Wilksch, S. M., & Wade, T. D. (2010). Risk factors for clinically significant importance of shape and weight in adolescent girls. J Abnorm Psychol, 119(1), 206-215. https://doi.org/10.1037/a0017779
Ye, H. J., Rice, K. G., & Storch, E. A. (2008). Perfectionism and peer relations among children with obsessive-compulsive disorder. Child Psychiatry Hum Dev, 39(4), 415-426. https://doi.org/10.1007/s10578-008-0098-5

No competing interests reported.

Download PDF

Version 1

posted

You are reading this latest preprint version

The Relationship between Perfectionism, Psychiatric disorders and Use of Mental Health Services in Adolescence: Results from a National Patient Register Linkage Study

Status:

Version 1

Abstract

Introduction

Method

Participants and procedure

Self-report measures

Clinical data from CAHMS

Ethics

Statistical procedure

Results

Sample characteristics

Perfectionism across clinical and comparison group

Perfectionism across psychiatric diagnoses

Perfectionism and contact with CAMHS

Discussion

Main findings

Strengths and limitations

Implications for research and clinical interventions

Conclusion

Declarations

References

Additional Declarations

Status:

Version 1