Kate L. Lewis

Borderline Personality or Complex Posttraumatic Stress Disorder? An Update on the Controversy

There remains controversy surrounding the nature of the relationship between borderline personality disorder and posttraumatic stress disorder, with strong arguments that it would be more accurate and less stigmatizing for the former to be considered a trauma spectrum disorder. This article reviews the major criticisms of the DSM-IV diagnosis of borderline personality disorder that have fueled this controversy, including the absence of an etiology for the disorder, which is widely believed to be associated with early traumatic experiences. Also reviewed are recent attempts to redefine the disorder as a trauma spectrum variant based on the apparent overlap in symptomatology, rates of diagnostic comorbidity, and the prevalence of early trauma in individuals with a borderline diagnosis. The conceptual and theoretical problems for these reformulations are discussed, with particular reference to discrepancies in theoretical orientation, confusion of risk with causation, and the different foci of interventions for borderline personality disorder and posttraumatic stress disorder.

The cumulative impact and associated costs of multiple health conditions on employee productivity

Objective: This study investigates and provides comparative data on the relative contributions of multiple physical and psychological health conditions on work productivity. Methods: A total of 667 employees from the headquarters office of a multinational consumer goods manufacturing firm in Germany completed a purpose-designed self-report questionnaire addressing the presence of 13 common health conditions, and associated absenteeism and presenteeism. Adjustments for comorbidity and self-report bias were made using an innovative approach. Results: A total of 34.8% of participants experienced absenteeism and 78.4% experienced presenteeism for at least one health condition. The overall annualized productivity loss due to the 13 health conditions was more than 27 days, equating to 12.3% of employee capacity and about &OV0556;8.78 million for the 1298 persons employed at the site. Conclusions: The combined effects of multiple health conditions on productivity account for a significant proportion of total employee costs.

Improving services for people with personality disorders: views of experienced clinicians

People with personality disorders are frequent users of both inpatient and outpatient psychiatric services, representing a significantly large proportion of all mental health clients. Despite this, most services find it a challenge to offer the most appropriate and effective treatment models for people with personality disorders. This paper is a report of a study of clinician opinions about how organizations can improve the delivery of services to people with personality disorders. Data was collected from experienced clinicians attending a personality disorders clinical and scientific meeting who were asked to work together in groups and present solutions for how organizations can improve the services provided to people with personality disorders. Qualitative data was collected and thematically and semantically analyzed using Nvivo and Leximancer. The Nvivo analysis revealed five main areas in which clinicians believe organizations can improve services for people with personality disorders. These focused on: (i) more training and education for health professionals and carers; (ii) better support through supervision and leadership; (iii) adoption of a more consistent evidence-based approach to client management and treatment; (iv) clearer guidelines and protocols; and (v) changed attitudes about personality disorder to decrease stigma. The Leximancer analysis of responses indicated the identified themes were not distinct; rather they were interconnected and related to one another, semantically. In summary, clinicians across a large and diverse geographical area developed a consensus that mainstream management of personality disorder is largely poor and inadequate. The findings lend support to an integrative and collaborative whole-service approach that enhances evidence-based practice in the community.

Development and pilot testing of a decision aid for drivers with dementia

BackgroundAn increasing number of older adults drive automobiles. Given that the prevalence of dementia is rising, it is necessary to address the issue of driving retirement. The purpose of this study is to evaluate how a self-administered decision aid contributed to decision making about driving retirement by individuals living with dementia. The primary outcome measure in this study was decisional conflict. Knowledge, decision, satisfaction with decision, booklet use and booklet acceptability were the secondary outcome measures.MethodsA mixed methods approach was adopted. Drivers with dementia were recruited from an Aged Care clinic and a Primary Care center in NSW, Australia. Telephone surveys were conducted before and after participants read the decision aid.ResultsTwelve participants were recruited (mean age 75, SD 6.7). The primary outcome measure, decisional conflict, improved following use of the decision aid. Most participants felt that the decision aid: (i) was balanced; (ii) presented information well; and (iii) helped them decide about driving. In addition, mean knowledge scores improved after booklet use.ConclusionsThis decision aid shows promise as an acceptable, useful and low-cost tool for drivers with dementia. A self-administered decision aid can be used to assist individuals with dementia decide about driving retirement. A randomized controlled trial is underway to evaluate the effectiveness of the tool.

The developmental and social history of repetitively aggressive mental health patients

Objective: A small subgroup of patients is primarily responsible for the large number of aggressive and violent incidents in psychiatric inpatient units. This study aims to identify the developmental, social and interpersonal histories of repeatedly aggressive patients in order to better understand their treatment needs. Methods: A total of 1269 consecutive inpatients were studied over 18 months, identifying 64 who were repeatedly aggressive; 128 non-aggressive patients were randomly matched to the aggressive patients by age, sex and diagnosis. Developmental, social, interpersonal and familial histories were obtained from a chart review. Results: Repeatedly aggressive patients were significantly more likely to have had a history of aggression, physical and sexual abuse, and experienced interpersonal problems and parental divorce. Conclusions: Aggressive patients do not just need short-term skills training, but interventions that target interpersonal and personality disorder deficits associated with their developmental histories.

Treatment history and its relationship to outcome in psychotherapy for depression

Abstract Patients with major depression can expect an average of four depressive episodes in their lifetime. Thus most clients presenting to therapy have had multiple prior episodes of treatment. These ‘psychotherapy careers’ have as yet received only minimal study and there is little data regarding the relationship of these prior treatments and responsiveness to psychotherapy. Aim: To explore prior treatment history and its relationship to psychotherapy outcome in people with major depression. Method: For 48 individuals with major depression presenting to an Australian community-based psychotherapy facility, structured diagnostic and treatment history interviews were taken and outcomes monitored. Results: In all, 90% had received some form of prior psychotherapy or counselling with on average 3.5 previous episodes of care (range 1–7). This Australian sample was less likely to have received group, family, or couples therapy than international samples. Those receiving psychotherapy at the time of intake sh...

A new intervention for people with borderline personality disorder who are also parents: A pilot study of clinician acceptability

BackgroundEngaging parents who have a personality disorder in interventions designed to protect children from the extremes of the disorder supports both parenting skills and healthy child development. In line with evidence-based guidelines, a ‘Parenting with Personality Disorder’ brief intervention was developed, focusing on child safety, effective communication and parenting strategies.MethodRatings of acceptability for the brief intervention model were given by 168 mental health clinicians who attended training. Changes in clinician attitudes, knowledge and skills were also assessed following training.ResultsProviding clinicians treating personality disorder clients with additional skills to address parenting was well received and filled a gap in service provision. Clinicians reported improvements in clinical skills, knowledge, willingness and confidence to intervene in parenting issues with clients. Qualitative responses endorsed three major modes of learning: case study analysis, reflective learning activities, and skills-based intervention practices.ConclusionsCurrent treatment guidelines emphasise addressing parenting, but no evidence-based therapy includes specific parenting skills. This brief intervention model improved skills, efficacy and willingness to intervene. This approach can be readily added to current evidence-based therapy protocols and promises to improve client functioning and protect children from the extremes of the disorder. Clinical trials are now required to validate the approach in the field.

Developing a decision aid for drivers living with dementia: supporting consumers and carers in the process of making decisions about driving retirement

Abstract of paper that presented at the Occupational Therapy Australia, 25th National Conference and Exhibition, 24-26 July 2013, Adelaide Convention Centre.Abstract of paper that presented at the Occupational Therapy Australia, 25th National Conference and Exhibition, 24-26 July 2013, Adelaide Convention Centre.Abstract of paper that presented at the Occupational Therapy Australia, 25th National Conference and Exhibition, 24-26 July 2013, Adelaide Convention Centre.