In a recently published online book1 self-compassion in primary care is explored. It includes a section on the perfectionist patient who generally operates from a place of a lack of self-compassion. A good question (especially for teenagers) is to ask “what's the emotional tone of the conversation in your mind” and in a distressed patient, it is usually not kind.
In primary care, we see this as a lot of self-blame and strong words such as failure, rather than evaluating what went wrong. Patients tend to compare themselves negatively to others, and can be challenging to please, blaming others, and being self-critical.
Detecting issues with self-compassion. If you suspect this is an issue refer to Kristen Neff’s website Self-Compassion and do her questionnaire.
Management. Ask the patient to cultivate the voice of self-kindness in their minds. Suggest they have a personal coach rather than an angry sergeant-major in their mind.