Justin S. Leung

Self-reported bullying in childhood: Relationships with employment in adulthood

Abstract Objective. To our knowledge, relationships between being bullied in childhood and employment functioning in adulthood have not been previously studied—hence the focus of the present study. Method. Using a cross-sectional approach and a self-report survey methodology in a consecutive sample of 328 internal medicine outpatients, we examined relationships between being bullied (i.e., have you ever been bullied, how many years, how many bullies) and history of employment (i.e., since age 18, number of full-time jobs, percentage of time employed, ever paid “under the table,” and ever fired). Results. Participants reporting a history of having been bullied reported a relatively greater number of different jobs as well as a greater likelihood of having been “paid under the table” and having been fired. While the number of years bullied evidenced no statistically significant correlations with employment variables, the number of different bullies was statistically significantly correlated with the number of different jobs held and ever having been fired. Conclusions. Findings indicate a relationship between being bullied in childhood and experiencing reduced employment viability in adulthood.

Driving citations and aggressive behavior

Background: Anger and driving have been examined in a number of studies of aggressive drivers and in drivers with road rage using various psychological and environmental study variables. However, we are not aware of any study that has examined the number of driving citations (an indication of problematic driving) and various forms of anger not related to driving. Method: Using a cross-sectional approach in a consecutive sample of 331 respondents (68% female), we surveyed participants about the number of past driving citations, not necessarily convictions, and 21 aggressive behaviors using the Aggressive Behavior Questionnaire. Results: The number of driving citations demonstrated a statistically significant correlation with the number of aggressive behaviors in the 21-item Aggressive Behavior Questionnaire. There were no differences between men and women. As for specific aggressive behaviors, the number of driving citations was statistically significantly related to punching a wall when angry, causing and getting into a bar fight, getting into fistfights (not in a bar), causing someone to have an accident, and intentionally running someone off the road. Conclusions: The number of driving citations, an indication of problematic driving, appears to be related to generally aggressive behavior. Findings indicate that if aggression plays a role in problematic driving, it is likely not limited to the road.

Litigious history and borderline personality symptomatology.

To the Editor: Patients with borderline personality disorder are frequently overrepresented in civil, criminal, and child custody cases in a defensive posture because of their self-regulation and interpersonal difficulties.1 However, victimization in adulthood has been described as a “basic theme” in borderline personality disorder,2(p46) and we wondered about the inclination of such patients to initiate legal proceedings (ie, to be litigious). Method. Participants were men and women, aged 18 years or older, being seen at an internal medicine outpatient clinic by resident providers for non-emergent medical care. The recruiter excluded individuals with compromising symptoms of a severity that would preclude the candidate’s ability to successfully complete a survey (n = 62). Of the 480 individuals approached, 369 agreed to participate (participation rate of 76.9%). Of these, 336 completed the relevant study measures; 228 (67.9%) were women, 106 (31.5%) were men, and 2 (0.6%) did not indicate sex. Participants ranged in age from 18 to 90 years (mean = 50.09, SD = 15.71). Most were white/Caucasian (86.2%), followed by African American (9.3%). All but 7.6% had at least graduated from high school, whereas 29.9% had earned a 4-year college degree or higher. During clinic hours, one of the authors (J.S.L.) positioned in the clinic lobby, approached consecutive incoming patients, and informally assessed exclusion criteria. With candidates, the recruiter reviewed the project and then invited each to complete a 6-page survey that consisted of (1) a demographic query, (2) an author-developed litigation history (litigious queries as well as the need for legal defense), and (3) 2 self-report measures for borderline personality disorder symptomatology—the borderline personality scale of the Personality Diagnostic Questionnaire-43 and the Self-Harm Inventory.4 This project was reviewed and exempted by the institutional review boards of the community hospital and university. Survey completion was assumed to function as implied consent (explicitly clarified on the cover page of the booklet). Data were collected in October 2011. Results. Ninety-one respondents (27.1%) exceeded the clinical cutoff score on at least 1 of the 2 measures of borderline personality disorder symptomatology (42 of whom exceeded the cutoff score on both measures). Both subgroups were compared to those respondents who did not exceed the clinical cutoff score on either measure of borderline personality disorder (see Table 1). Table 1. Comparisons as a Function of Whether Respondents Exceeded the Clinical Cutoff Score on at Least 1 Measure of Borderline Personality Disorder Symptomatology Contrary to our hypothesis, patients with borderline personality disorder symptomatology were no more likely to initiate a lawsuit than those without borderline personality disorder symptomatology. However, the former subsample was more likely to contact a lawyer to defend themselves—a finding supported by the current literature. This study has a number of potential limitations (eg, self-report nature of the litigation data; use of self-report measures for borderline personality disorder, which may be overinclusive; risk of data bias due to the low socioeconomic status of participants, who may not be able to afford a lawyer except to defend themselves). However, to our knowledge, this is the first study to examine litigiousness in borderline personality disorder. In this study, we found no differences in litigiousness between patients with versus without borderline personality disorder symptomatology.

Externalized aggressive behaviors in patients with borderline personality symptomatology.

Objective Borderline personality disorder (BPD) is commonly characterized by self-directed aggressive behavior, although the literature indicates that externalized aggressive behavior may be present. The simultaneous examination of multiple types of externalized aggressive behavior in individuals with BPD and the exploration of such relationships in a primary care population have not, to our knowledge, been undertaken; this is the focus of the present study. Methods Using a cross-sectional approach in a consecutive sample of 335 internal medicine outpatients, we explored through a self-report survey the relation between 21 externalized aggressive behaviors and BPD symptomatology, using two self-report measures for assessment: the borderline personality disorder scale of the Personality Diagnostic Questionnaire-4 (PDQ-4) and the Self-Harm Inventory (SHI). Results Scores on the measure for externalized aggressive behavior correlated strongly with scores on the PDQ-4 (r = 0.60; P < 0.001) and the SHI (r = 0.67; P < 0.001) and were statistically significantly greater among respondents who exceeded the cutoff scores for BPD symptomatology on both the PDQ-4 and the SHI as compared with respondents who did not exceed these scores. Conclusions In addition to self-directed aggressive behavior, individuals with BPD symptomatology also exhibit various externalized aggressive behaviors.

Having been bullied in childhood: Relationship to aggressive behaviour in adulthood

Aims: Victimization through being bullied in childhood is traditionally associated with subsequent internalizing symptoms, but some literature suggests otherwise. In this study, we examined a history of being bullied in relationship to 21 externalized aggressive behaviours in adulthood. Methods: Using a cross-sectional approach and a self-report survey methodology, we examined a history of being bullied in childhood in relation to 21 aggression variables in a consecutive sample of 342 internal medicine outpatients. Results: In comparison with the not bullied, participants who reported having been bullied in childhood had a statistically significantly greater overall number of self-reported aggressive behaviours. Longer duration of being bullied was statistically significantly correlated with a greater number of reported aggressive behaviours. With regard to individual behaviours, four were statistically significantly associated with being bullied: hitting walls; intentionally breaking things; getting into fist fights; and pushing/shoving a partner. Conclusions: While relationships between bullying in childhood and subsequent internalizing symptoms have been well established, the present study indicates that bullying in childhood is also associated with externalizing/aggressive behaviours in adulthood.

Five forms of childhood trauma: relationships with aggressive behavior in adulthood.

OBJECTIVE To examine relationships between 5 types of childhood trauma (witnessing violence, physical neglect, emotional abuse, physical abuse, and sexual abuse) and an aggression score based on 21 self-reported aggressive behaviors in adulthood. METHOD Using a cross-sectional design and a self-report survey methodology, we examined relationships between 5 types of childhood trauma and the number of aggressive behaviors engaged in during adulthood in a consecutive sample of 342 internal medicine outpatients at Sycamore Primary Care Center, Kettering, Ohio, during October 2011. The primary outcome measure was the score on the Aggressive Behavior Questionnaire. RESULTS In univariate analyses, each childhood trauma variable demonstrated a statistically significant relationship with the number of aggressive behaviors endorsed (P < .001). In addition, there was a linear relationship between the number of different forms of childhood trauma and the number of aggressive behaviors endorsed. In multivariate analyses, only 2 childhood trauma variables remained independently predictive: witnessing violence (P < .001) and emotional abuse (P < .05). CONCLUSIONS There appear to be indistinct relationships between trauma in childhood and aggression/violence in adulthood. In this sample of primary care patients, witnessing violence and experiencing emotional abuse were particularly relevant variables associated with the number of aggressive behaviors in adulthood.

The abuse of prescription medications and employment history.

Objective: The relationship between prescription medication abuse and employment history is rarely studied and is the focus of the present study. Method: Using a cross-sectional consecutive sample of 325 internal medicine outpatients and a self-report survey methodology, we examined prescription medication abuse (“Have you ever intentionally, or on purpose, abused prescription medications?”) and four employment variables. Results: We found statistically significant relationships between the abuse of prescription medications and all four employment variables—i.e., number of different jobs held since age 18 (5.05 in nonabusers versus 7.81 in past abusers), estimated percentage of time employed since age 18 (79.0% in nonabusers versus 63.3% in past abusers), being paid “under the table” (24.9% in nonabusers versus 77.4% in past abusers), and being fired (37.2% in nonabusers versus 64.5% in past abusers)—all indicating less employment viability in participants with past histories of prescription medication abuse. Conclusions: The abuse of prescription medications is associated with impaired functionality in the work arena.