Yaeda, Jun

Yuzawa, Yumi

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  Center on Disability Studies, University of Hawai'i at Mānoa Pacific Rim International Conference on Disability & Diversity   Difficulties in the Workplace for People with Borderline Personality Disorder: A Literature Review Yumi Yuzawa, M.S., PSW, Tanzawa Hospital, Kanagawa, Japan, yumi.yuzawa@tanzawahp.or.jp Jun Yaeda, Rh.D., University of Tsukuba, Tokyo, Japan  Recommended Citation Yuzawa, Y., & Yaeda, J. (2020). Difficulties in the workplace for people with borderline personality disorder: A literature review. Pacific Rim International Conference on Disability and Diversity Conference Proceedings. Honolulu, Hawai'i: Center on Disability Studies, University of Hawai'i at Mānoa. Licensed under CC BY 4.0. This article is brought to you for free and open access by the Center on Disability Studies, ISSN 2641-6115.    1 Difficulties in the Workplace for People with Borderline Personality Disorder: A Literature Review Yumi Yuzawa, M.S., PSW Tanzawa Hospital, Kanagawa, Japan Jun Yaeda, Rh.D.  University of Tsukuba, Tokyo, Japan Abstract: The purpose of the study was to identify the factors behind workplace problems of people with borderline personality disorder (BPD) and to seek methods of employment support that would lead them to attain their goals. Results found that impulsivity was an important predictor of vocational functioning of BPD. Another factor is that their motivation to work passionately can be a strength. Though, the stigma still exists that they have little chance of employment. The lack of collaboration between mental health and vocational rehabilitation was discussed. Keywords: Borderline Personality Disorder; Workplace Problems; Employment Support Knowledge Focus: Research/Theory Focus Topic Area: Employment Background There are various types of interventions for people with borderline personality disorders (BPD), including Dialectical Behavioural Therapy (DBT), Mentalization-Based Therapy, Schema-Focused Therapy (SFT), Transference-Focused Psychotherapy (TFP), Cognitive Analytic Therapy, and Systems Training for Emotional Predictability and Problem-Solving (STEPPS) (Storebø et al., 2018). However, these interventions might not necessarily lead to achieving the client’s own goals, although such interventions seem to be increasing (Ng, Bourke, & Grenyer, 2016). Psychotherapy for BPD often focuses on specific aspects, such as self-harm and relationships; therefore, certain patients with BPD feel that some of their goals are neglected in psychotherapy (Katsakou et al., 2012). Also, the vocational functions of BPD patients are more deteriorated than their psychosocial functions (Zanarini, Frankenburg, Reich, & Fitzmaurice, 2010). Moreover, according to a 20-year follow-up study, appropriate vocational functioning in adulthood is one of the predictors of recovery in people with BPD (Zanarini, Frankenburg, Reich, & Fitzmaurice, 2018). Consequently, it is necessary to develop effective techniques for supporting people with BPD to achieve the goal of maintaining employment.    2 Aim and Research Questions The purpose of this review was to identify factors in the difficulty of being employed by people with BPD and develop employment-support methods that would lead them to attain their goal of maintaining employment: RQ (1) What are the difficulties faced by individuals with BPD in the workplace? RQ (2) What should employment specialists do on behalf of people with BPD that want to work? Methods A literature review was conducted by searching PubMed and CINII (Japanese literature) on October 12, 2019. Studies conducted in the previous ten years were retrieved by using the following keywords: “borderline personality disorder” and “workplace,” or “working area,” or “place of work,” or “on the job,” or “vocational” or “employment,” or “return to work,” or “difficulty at work.” Results A total of 86 studies were identified through the literature search of the databases. Subsequently, they were screened by their titles and abstracts, and as a result, 69 studies were excluded. The remaining 17 full-text documents were assessed for eligibility for the review, and 13 studies were excluded based on the inclusion criteria that studies should describe barriers to work, experienced by people with BPD. Finally, the remaining four studies were included in the review (Figure 1). Figure 1. Flow Chart of Searching Process Figure 1 Image Description: The flow chart figure includes six labeled boxes linked by arrows that point forward to one or two boxes. The chart is multi-directional, in which the next possible steps are listed right or beneath each box label. Text includes: Box 1 “Studies identified through literature search (n=86).” “Searched by PubMed and CINII (Japanese literature) on October12, 2019.” Forwarded to Box 2 “Studies screened based on abstract (n=86).” Forwarded Box 3 “Studies excluded based on abstract (n=69)”; or forward Box 4 “Full text documents assessed by eligibility (n=17).” Forwarded to Box 5 “Studies excluded based on inclusion criteria (n=13)”; or forwarded Box 6 to “Studies included in review (n=4).”    3 Difficulties in the Workplace for People with BPD Borderline personality symptoms were associated with poor working conditions, such as low decision latitude, less job insecurity, and low co-worker support (Juurlink et al., 2018). Mood swings and impulsive behaviors caused problems in complying with previously made appointments (Juurlink et al., 2019). Impulsivity due to the inability to regulate emotions were likely to disrupt behaviors. Therefore, impulsivity was an essential predictor of vocational functioning in BPD (Juurlink et al., 2019; Sio et al., 2011). Strengths of People with BPD The significant strengths of people with BPD included working hard passionately, and having different interests, as well as entrepreneurship. The strength of people with BPD was an essential facilitator because most patients with BPD wanted to be employed and expressed the hope of achieving this goal (Juurlink et al., 2019). Issues Related to Supporters of People with BPD Stigmas still exist regarding BPD, including the idea that BPD patients would not recover from their disorder, and have little chance of employment, which lead people with BPD to quit work (Juurlink et al., 2019; Sansone & Wiederman, 2013). Moreover, most treatment programs for people with BPD pay little attention to employment. Furthermore, there is little collaboration between mental health and vocational rehabilitation services (Juurlink et al., 2019). Discussion We should disregard any stigma regarding people with BPD, and increase their opportunities to receive more vocational rehabilitation services leading to the achievement of their goal. People with BPD need to learn about their own emotional and impulsive coordination and interpersonal skills in the working environment. Employment specialists should also take advantage of their strengths, such as working hard passionately. Also, the collaboration between mental health and vocational rehabilitation services regarding people with BPD should be promoted. Finally, since there are only a few studies on the difficulties faced by people with BPD in the workplace, further studies are needed to identify factors related to their difficulties, as well as specific intervention techniques that would enhance their hope of maintaining employment. In addition, supporting co-workers facing problems because of borderline personality symptoms needs to be considered.      4 Authors Yumi Yuzawa, M.S., PSW, Tanzawa Hospital, Kanagawa, Japan is a Certified Psychiatric Social Worker and a Certified Career Consultant. She currently works at a psychiatric hospital in Japan and supports people with mental issues to obtain employment. Image Description: Photo of Yumi Yuzawa  Jun Yaeda, Rh.D. University of Tsukuba is an associate professor at Rehabilitation Course, University of Tsukuba, Tokyo, Japan. His research interests include: rehabilitation philosophy, vocational rehabilitation counseling, and international rehabilitation education. Image Description: Photo of Jun Yaeda  Acknowledgements The authors would like to thank TEXT. Co., Ltd. (www.text-edit.com) for English language editing. References Juurlink, T.T., Ten, H. M., Lamers, F., van Marle, H. J. F., Anema, J. R., de Graaf, R., & Beekman, A.T. F. (2018). Borderline personality symptoms and work performance: a population-based survey. BMC Psychiatry, 18, 202. doi.org/10.1186/s12888-018-1777-9 Juurlink, T. T., Vukadin, M., Stringer, B., Westerman, M. J., Lamers, F., Anema, J. R., Beekman, A. T. F., & van Marle, H. J. F. (2019). Barriers and facilitators to employment in borderline personality disorder: A qualitative study among patients, mental health practitioners and insurance physicians. PLoS One, 14(7), e0220233. doi.org/10.1371/journal.pone.0220233. Katsakou, C., Marougka, S., Barnicot, K., Savill, M., White, H., Lockwood, K., & Priebe, S. (2012). Recovery in Borderline Personality Disorder (BPD): A qualitative study of service users' perspectives. PLoS One, 7(5), e36517. doi:10.1371/journal.pone.0036517. Ng, F. Y. Y, Bourke, M. E., & Grenyer, B. F. S. (2016). Recovery from borderline personality disorder: A systematic review of the perspectives of consumers, clinicians, family and carers. PLoS One, 11(8), e0160515. doi:10.1371/journal. pone.0160515. Sansone, R. A., & Wiederman, M. W. (2013). Losing a job on purpose: Relationships with borderline personality symptomatology. Early Intervention in Psychiatry, 7(2), 210–212. Sio, I. T., Chanen, A. M., Killackey, E. J., & Gleeson, J. (2011). The relationship between impulsivity and vocational outcome in outpatient youth with borderline personality features. Early Intervention in Psychiatry, 5(3), 249–253. Storebø, O. J., Stoffers-Winterling, J. M., Völlm, B. A., Kongerslev, M. T., Mattivi, J. T., Kielsholm, M. L., Nielsen, S. S., Jørgensen, M. P., Faltinsen, E. G., Lieb, K., &    5 Simonsen, E. (2018). Psychological therapies for people with borderline personality disorder. Cochrane Database of Systematic Reviews, 2(CD0129550). Zanarini, M. C., Frankenburg, F. R., Reich, D. B., & Fitzmaurice, G. (2010). The 10-year course of psychosocial functioning among patients with borderline personality disorder and axis II comparison subjects. Acta Psychiatrica Scandinavica, 122(2), 103–9. Zanarini, M. C., Temes, C. M., Frankenburg, F. R., Reich, D. B., & Fitzmaurice, G. M. (2018). Description and prediction of time-to-attainment of excellent recovery for borderline patients followed prospectively for 20 year. Psychiatry Research, 262, 40–45. 

Difficulties in the Workplace for People with Borderline Personality Disorder: A Literature Review

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Difficulties in the Workplace for People with Borderline Personality Disorder: A Literature Review

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