Daily Occupations and Adaptation to Daily Life Described by Women Suffering from Borderline Personality Disorder

Capturing Between- and Within-Person Variability of Borderline Traits in Youth from a Developmentally Sensitive Situational Judgment Perspective

The significance of early maladaptive traits for understanding the roots of borderline personality disorder (BPD) is increasingly endorsed. Given the interpersonal nature of BPD and fluctuations in phenotypic symptomatology, this study aims to test the assumption that a situation-contingent contextualized assessment of borderline traits is a viable avenue to more fully capture the way underlying traits are reflected in socioaffective behavior that occurs in age-relevant situations. We aimed to explore the extent to which the variability on these responses represents a meaningful construct for understanding the clinical richness of BPD. Toward this end, a contextualized measure of DSM-5 BPD traits was developed along a situational judgment test (SJT) format, allowing us to explore both between-person and within-person variability in a more economic format than repeated measurement does. Examination of the psychometric properties of the SJT revealed distinctive correlational patterns of the situation-based traits with symptom scales of a youth BPD measure, but also indicated that for certain traits consistency in trait level across different situations is more maladaptive, whereas for other traits a greater degree of variability in trait expression is more maladaptive. Overall, this work could set the stage for further research on the potential of SJTs for understanding personality vulnerabilities both at the dispositional and the dynamic level.

The relationship between borderline personality disorder and occupational participation: An integrative review

This integrative review explores the impact of borderline personality disorder (BPD) symptomology and behaviours on occupational capacity, participation, and sustainability. The disorder has also been associated with lower education levels, higher levels of attrition in tertiary education populations, and low occupational participation and employment rates. Personality traits and symptomology have been found to substantially detract from employability. Articles were identified from CINAHL (Cumulative Index to Nursing and Allied Health Literature), PsycINFO/Ovid, ProQuest, and PubMed databases. The Joanna Briggs' Institute (JBI) critical appraisal tools were used to evaluate the quality of evidence, and inductive thematic analysis used to extract main themes. Four themes regarding 'barriers', 'enablers', 'treatment', and 'benefits' emerged amongst the 11 eligible articles. The negative symptomology was a barrier to occupational participation, and people with BPD engaged in self-stigmatizing and non-disclosure. However, the positive symptomology such as boldness and honesty were enablers. Treatment was found to be a key element, and occupational engagement was also found to have positive effectives. The evidence indicates that employment improved the symptoms, and a long-term treatment plan is a key element. Some upskilling of mental health workers may be required, including a focus on possible positive symptomology as a way of dealing with the stigmatization. Some awareness raising of the disorder, including for employers, may be needed, with education programmes that deal with the stigmatization. Future funding should focus on specialized programmes targeting unemployment for this group.

The experience of loneliness among people with a "personality disorder" diagnosis or traits: a qualitative meta-synthesis

BACKGROUND

Loneliness is prevalent among people with a "personality disorder" diagnosis or who have related personality traits, but the experience of loneliness among people with "personality disorder" diagnoses/traits has not been well described. A qualitative approach has potential to help understand the experience of loneliness among people with "personality disorder" diagnoses/traits, and to develop interventions that promote recovery. We therefore aimed to synthesise the qualitative literature relevant to this topic.

METHOD

We conducted a meta-synthesis of qualitative studies exploring the subjective experience of loneliness as reported by people with "personality disorder" diagnoses/traits. We searched four databases using pre-formulated search terms, selected eligible articles, appraised the quality of each, and analyzed data from eligible studies using thematic synthesis.

RESULT

We identified 39 articles that described the experience of loneliness in people with "personality disorder" diagnoses/traits. From extracted data, we identified seven themes: (1) disconnection and emptiness: a "haunting alienation", (2) alienation arising from childhood experiences, (3) thwarted desire for closeness and connection, (4) paradox: for both closeness and distance, (5) experiences of existential loneliness, (6) recovery, embedded in a social world, and (7) group therapy: a setback. Our results suggest that for our sample early alienating and traumatic experiences may pave the way for experiences of loneliness, which further exacerbate "personality disorder" symptoms and distress.

CONCLUSION

Despite describing a need to belong and efforts to cope with unmet social needs, people with "personality disorder" diagnoses/traits (particularly "emotionally unstable personality disorder") report experiencing an intense disconnection from other people. This seems rooted in early adversities, reinforced by later traumatic experiences. Given the apparent salience of loneliness to people with "personality disorder" diagnoses/traits, interventions focused on helping people connect with others, which may include both psychological and social components, have potential to be beneficial in reducing loneliness and promoting recovery.

Functional Disability in Psychiatric Patients With Deliberate Self-Harm as Compared to a Clinical Control Group

Background: Deliberate self-harm (DSH) is a common behavior in psychiatric populations. However, little is known regarding how DSH impacts daily life. The concept of functional disability, adopted by the World Health Organization (WHO), refers to the impact of disorders on six domains of daily functioning. The aim of the current study was to explore the functional disability of psychiatric patients with DSH as compared to a psychiatric control group. Methods: 32 psychiatric patients with DSH and 31 psychiatric patients without DSH were assessed with regards to demographic information, functional disability, psychiatric illness, DSH, general cognitive functioning, and measures of psychopathology. Group comparisons were made by means of t-tests, Mann-Whitney-tests, and Chi-square tests. Correlation analyses were done to assess the association between measures of psychopathology and functional disability. Results: The results indicated that patients with DSH had a lower ability to self-care as compared to the patients without DSH (p = 0.001, d = 0.90). Also, the patients with DSH reported a significantly higher number of days when they were totally unable to carry out usual activities in the past month (p = 0.008, d = 0.70) and that they were admitted in an inpatient setting significantly more days over the past year compared to the patients without DSH (p < 0.001, d = 0.58). The group with DSH was significantly younger (t = 3.00, p = 0.004) and reported significantly more BPD-symptoms (p = 0.013, d = 0.64) as well as higher current suicidality (p < 0.001, d = 1.32) compared to the group without DSH. The group with DSH also included a significantly higher number of patients diagnosed with borderline personality disorder (χ2 = 13.72, p < 0.001). There were no differences between the groups regarding general cognitive functioning or severity of depression. More research is needed to understand the underlying factors involved.

Experience of Occupations among People Living with a Personality Disorder

INTRODUCTION

Personality disorders are common mental health disorders, with an estimated lifetime prevalence of 4 to 15%. People living with personality disorders are extensively seeking mental health services, yet few papers focus on their unique occupational needs or effective rehabilitation interventions that may alleviate the occupational issues they face. Occupational therapists are encouraged to support engagement in socially valued occupations, while preventing engagement in damaging ones, despite a lack of evidence on the meaning and the lived experiences of people.

OBJECTIVES

This paper describes the meaning attributed by people living with personality disorders to their main occupations and the underlying needs they strive to fulfill through occupational engagement, whether or not these occupations are sanctioned.

METHODS

This exploratory study rests on a descriptive interpretative methodology. The participants were ten men and women, aged between 18 and 35 years old and living with a Cluster B personality disorder. A semistructured interview guide allowed participants to build narratives on occupations that are important to them and discuss how these occupations shape their identity. A thematic content analysis fostered the development of a coding structure that reflected a first-account perspective.

RESULTS

The narratives provided by the participants depict a variety of meaningful occupations, many of which are socially disapproved. Many of these occupations serve as a coping strategy to deal with distressing situations, to connect with others who share similar life experiences, or to reestablish a fragile sense of control. Other occupations are socially disapproved due to the overinvestment of the participants' commitment. While participants described how this overinvestment allowed them to control destructive impulses, significant others perceived it as counterproductive and unnecessary. Participants perceived self-care occupations as painful and tedious chores or meaningless occupations. Engaging in productive occupations allowed some participants to gain recognition or to identify their competencies, but also confirmed their differences, creating some form of alienation or marginalisation.

CONCLUSION

This exploratory study invites clinicians and researchers to develop a more responsive understanding of occupational engagement for this population. The results highlight the importance of situating occupations in their context, while endorsing a first-account perspective, to better understand the forces that shape occupational engagement. Ultimately, occupational therapists should critically appraise their assumptions around healthy and unsanctioned occupations, in order to respond with sensitivity to the needs and experience of their clients, without perpetuating the marginalisation and discrimination they face.

Experiences of people with a personality disorder or mood disorder regarding carrying out daily activities following discharge from hospital

Introduction

People with a diagnosed personality or mood disorder can experience challenges to participating in everyday life. Having a relapse of symptoms and an admission to hospital can further disrupt daily life. The aim of this study is to explore the experiences of people with a personality or mood disorder regarding carrying out everyday activities following discharge from hospital.

Method

Semi-structured interviews were carried out with 16 service users, by a researcher with lived experience of mental health problems and admissions to hospital.

Findings

Five themes were identified: The cumulative effect of multiple admissions on activities of daily living; the consequences of long admissions on daily living; reduced activities caused by social isolation in the first few months post-discharge; activities that people would like to do better post-discharge from hospital and longer term goals.

Conclusion

The findings of this study identified challenges people with a personality or mood disorder experience post-discharge from hospital regarding developing a daily routine, managing their home environment and participating in social activities. This indicates the importance of occupational therapy provision following discharge from hospital.

Comparison of Objective and Subjective Life Balance Between Women With and Without a Personality Disorder

Life balance is associated to health, well-being and quality of life and is a target of psychiatric rehabilitation interventions. However, little is known about this life dimension in women living with personality disorders. The purpose of this descriptive-correlational study was to compare and explore relationships between subjective life balance, objective time use, quality of life and perceived stress in women without a mental health disorder (n = 43) and women with a personality disorder (clusters B and C) (n = 30), aged between 18 and 50 years old. The variables were measured with the Life Balance Inventory (subjective life balance), the Occupational Questionnaire (objective time use), the Depression Anxiety Stress Scale (perceived stress) and the Quality of Life Index (satisfaction and importance with life domains). The analyses showed that women with a personality disorder spend significantly less time in work but more time in daily tasks and leisure. Subjective life balance, quality of life and perceived stress were significantly lower in women with a personality disorder (p < 0.05). In women with a personality disorder, subjective life balance was explained by quality of life (R² = 27.5 %). In women without a mental illness, subjective life balance was explained by quality of life and motherhood (R² = 36.1 %). To support the recovery of women with personality disorders and their quality of life, it is important to address objective and subjective time use to enable accomplishment of a variety of meaningful activities.

Recovery, as Experienced by Women with Borderline Personality Disorder

Studies examining recovery through the service users' perspectives have mainly included persons with schizophrenia or bipolar disorder. Giving voice to those with borderline personality disorder (BPD) would enrich our understanding of recovery, as their specific experiences may bring new dimensions, obstacles and facilitators. The objective of this study was to qualitatively capture the experience of recovery in women with BPD. Participants were women between 18 and 65 years old who had a diagnosis of BPD and completed at least 2 years in a program for persons with BPD. During the first meeting, they produced a picture collage, followed by an interview on their experience of recovery. The second meeting was a phone interview to discuss new thoughts. In addition, their medical records were reviewed. A thematic analysis of the interviews was conducted and organized with the Person-Environment-Occupation model. Although recovery was not the best term to name their experience, they all talked about a process towards stability and wellbeing (n = 12). Dimensions of recovery included, for example, letting go of the past (person), being involved in meaningful activities (occupation) and having healthy relationships (environment). Facilitators included social support and participation in a specialized therapy program. The main obstacle was unstable family relationships. The findings from this study showed similar dimensions to previous recovery studies, new perspectives on certain dimensions, as well as new ones. They also reinforced the importance to incorporate intervention outcomes that target the person with BPD, their social environment and meaningful occupations.

In the footsteps of Wilcock, Part two: The interdependent nature of doing, being, becoming, and belonging

The four dimensions of occupation developed by Wilcock in the Occupational Perspective on Health-doing, being, becoming, and belonging-have evolved. Although the inter-relationships between the dimensions have been explored by clinicians and researchers to some degree, the reciprocal and multidimensional nature of these relationships are rarely explicitly addressed. This article will present a critical analysis of the relationships and interaction between doing, being, becoming, and belonging, initially in dyads and then in a multidimensional way. The article proposes provisional understandings of how they combine and influence each other in occupational engagement. Six observations are made on the dimensions of occupation, along with a discussion of the impact of their interrelationships on research and practice.

In the footsteps of Wilcock, Part one: The evolution of doing, being, becoming, and belonging

This article will present a critical analysis of the four dimensions of occupation, doing, being, becoming and belonging, and propose clearer understandings of the terms. The concepts have developed and evolved since Wilcock first introduced them as main constructs of Occupational Perspective of Health (OPH), with doing and being receiving the most comprehensive development. However, the concepts of becoming and belonging remain underdeveloped. Given the complex nature of occupation, this comprehensive analysis of each dimension adds greater depth to our understanding, and provisional definitions of each term are provided to guide their ongoing development.