Of the identified papers, ten were expert opinion papers and did not follow a scientific methodology. Of the remaining papers, nine employed a quantitative methodology, typically a cross-sectional survey design 5 papers ; also including cost-benefit analysis 2 papers ; or simple statistical description of clinical records 2 papers. A further eight studies utilised a qualitative methodology. The overall quality of the evidence identified by the search was very low according to the hierarchy proposed by Greenhalgh [ 17 ] and operationalised by the CEBM checklist [ 16 ].
No previous systematic reviews or meta-analyses were identified, and no studies featured RCTs or quasi-experimental methods. This was not unexpected given that the review was not of an intervention, but related to exposure. Only one identified study [ 18 ]met the criteria for Level 3 Evidence according to the CEBM checklist as an adequately statistically powered, non-randomised follow-up study.
Four further studies [ 19 , 20 ] employed a form of non-randomised longitudinal design: however, one was qualitative [ 19 ]; two more were case-control only [ 21 , 22 ]; and the fourth [ 20 ] was inadequately powered to detect a common harm due to working with PD offenders, and was therefore downgraded from Level 3 to Level 4 Evidence.
Qualitative studies tended to focus on a single discipline—usually 'frontline' staff such as nurses or prison officers—and did not take multidisciplinary working into account. Quantitative studies identified suffered from a number of general weaknesses, including: low sample sizes; heterogeneity of outcomes; lack of a clear assessment of PD; no control for confounding variables. Overall, work with PDOs inspired negative attitudes amongst staff. Staff felt that PDOs inspired a greater sense of blameworthiness and susceptibility to censure [ 27 ] and lower levels of sympathy [ 28 ].
Attitudes to working with PDOs was found to show a trend toward becoming more negative with increased duration of exposure [ 19 ]. Nurses considered PDOs difficult to treat and to engage in treatment. They lacked confidence in the efficacy of clinical interventions [ 13 , 24 , 25 , 29 ] and believed that PDOs were least likely to make progress and most likely to drop out of treatment, relative to other patients [ 21 ]. A guide document produced by the UK Ministry of Justice [ 30 ] suggested that PDOs evoked reactions in staff including: puzzlement and irritation; frustration; helplessness; defensiveness; fear and feelings of being manipulated, causing staff to lose the capacity for empathy and become more punitive towards PDOs.
Staff with a sense of enjoyment of their job and strong job performance showed a more positive attitude to their work with PDOs [ 18 ].
- What Is Borderline Personality Disorder? | Child Mind Institute?
- Services on Demand.
- Join Kobo & start eReading today.
- Theory and Event: A Journal of Political Philosophy - Vol.15, Iss.3, 2012 Supplement - Part 1 of 2 - Zine edition (re)produced by the Philosophy Students Association of McGill University!
- The future of the sciences and humanities: four analytical essays and a critical debate on the future of scholastic endeavour.
- Schizophrenia | Mental Health America?
The quality of evidence in this area of impact was relatively good with only one identified paper being expert opinion. In her narrative review, Kurtz highlighted that holding negative attitudes to PDOs was associated with job stress, burnout and possible vicarious traumatisation [ 13 ]. Work with female PDOs in high security was reported to be emotionally exhausting and intense for nurses in particular [ 32 ]. An increased emotional burden associated with working with female, when compared with male, PDOs at follow-up was also described by Nathan et al.
Bowers et al. Challenging and inappropriate behaviour by PDOs was also thought to be draining, stressful and to inspire a degree of fear [ 33 ]. Such behaviour could also lead to splits within the staff team itself [ 34 ] or difficulties with communication [ 35 ] that could deepen over time. The lack of openness of PDOs was also noted as particularly frustrating.
They noted that senior practitioners felt particularly drained, overburdened and burned out. The quality of evidence in this area of impact was low given that it was based entirely on expert opinion papers. A number of papers written from a psychodynamic perspective suggested that work with PDOs was associated with negative counter-transferential experiences and hate in the countertransference [ 38 ] amongst staff.
Morris [ 43 ] observed that the high level of competence of PDOs to attack and circumvent treatment efforts subjected staff to unexpected negative dynamics. The quality of evidence in this area of impact was relatively high given that it was based on data-based research and not expert opinion papers. Two studies [ 36 , 37 ] identified a minimal sense of risk and anxiety associated with work in forensic settings per se , and also noted that greater experience in working with PDOs was associated with a perception of decreased risk to staff. J ob enjoyment was associated with lower rates of staff interaction with PDOs [ 18 ].
Our review confirmed that the evidence base is sparse, heterogeneous and used methodologies generally considered to be of a low level according to standard classifications [ 17 ]. The lack of use of standardised assessment of factors related to impact areas limited the robustness and generalizability of findings. However, the evidence identified suggests that working with PDOs is associated with negative attitudes, burnout, stress, and negative counter-transferential experiences, whilst perceived risk of violence related to PDOs is experienced according to the amount of experience working with PDOs, such that those with more experience perceive less of a risk.
Despite the predominance of negative impact areas, positive experiences of excitement from being involved in innovative services for PDOs were identified. Although many studies identified the need for interventions to improve the health and wellbeing of staff working with PDOs, no studies were identified that evaluated a specific intervention, even with a quasi-experimental methodology.
This lack of evaluation of interventions limits the generalisability and applicability of the evidence identified to forensic services; however, the findings of several studies relating to the specific negative effects of working with PDOs namely: hardening of attitudes; staff burnout; diminished job satisfaction; negative countertransference; exposure to violence; and job stress may provide a basis for the future identification of interventions directed at improving the staff experience.
- Americas National Park System;
- Join Kobo & start eReading today.
- Upcoming Events!
- Is Borderline Personality Disorder a Serious Mental Illness?.
- The Shooters (Presidential Agent, Book 4);
- Vegan Brunch: Homestyle Recipes Worth Waking Up For—From Asparagus Omelets to Strawberry Pancakes!
The studies identified by this review showed little control for bias. Even after excluding the clinical papers, which did not follow any form of scientific or experimental design, there were a number of biases in the studies employing a clear methodology. Selection bias: studies employing survey methodologies did not allow for possible systematic differences between self-selected responders and non-responders in terms of the variables under investigation.
Our stories shine a light on challenges and victories
Population bias: most studies tended to focus on a single professional discipline, typically or prison officers. The few studies that included a range of professions were often qualitative in nature. One quantitative study did include multiple professional groups outside of nursing but considered these as a homogeneous group when compared with nurses. Measurement bias: there seemed to be little agreement about appropriate measurements of impact on staff, and studies utilised a range of outcome measures, ranging from change in attitudes to burnout and violent incidents.
Only one study adopted a longitudinal methodology. Such categories will have included some patients with disorders other than PD. One study was conducted with a homogeneous group of PDOs and mentally ill offenders, although these were separated to an extent in the analysis. Although not the focus of this review, this study identified a lack evidence for interventions intended to moderate the impact of working with PDOs. Whilst Turley et al.
Borderline personality disorder - Wikipedia
Services for the assessment and management of PDOs have expanded considerably over recent years. However, the evidence for their effectiveness, and cost- effectiveness, has thus far been equivocal [ 44 ]. Randomised controlled trials or robust quasi-experimental studies of interventions aimed at moderating the negative impact of working with PDOs on staff are now important in order not only to better meet the needs of this challenging clinical population but also encourage the development of a sustainable workforce and to optimise the clinical and risk outcomes of services. Browse Subject Areas?
Click through the PLOS taxonomy to find articles in your field. Abstract Background Personality disordered offenders PDOs are generally considered difficult to manage and to have a negative impact on staff working with them. Aims This study aimed to provide an overview of studies examining the impact on staff of working with PDOs, identify impact areas associated with working with PDOs, identify gaps in existing research,and direct future research efforts.
Methods The authors conducted a systematic review of the English-language literature from — across 20 databases in the medical and social sciences. Results 27 papers were included in the review. Conclusions The review identified a significant amount of descriptive literature, but only one cohort study and no trials or previous systematic reviews of literatures. Introduction People with personality disorder PD are generally considered particularly difficult to manage, treat, and interact with; they are often disliked by mental health professionals [ 1 ]; and are widely believed to have a negative impact on staff working with them [ 2 ].
Objectives This study had four key objectives: To provide an overview of existing studies examining the impact on staff of working in treatment services for PDOs. To identify the core impact areas positive or negative associated with working with PDOs. To identify gaps in existing research on this topic. To direct future research efforts.
Methods Study inclusion criteria A systematic review was carried out of studies that address the research question directly, i. This implies that the review itself would: Be relatively complex, extensive, and time-consuming, because of the need to review very heterogeneous types of evidence.
Consider a wide range of questions, the inclusion criteria for the studies would be complex, and would have to take the findings of a number of different—both qualitative and quantitative—study designs into account. Involve a complex search for studies including a review of the grey literature. Require a range of approaches to quality assessment, and would not focus just on outcomes, but processes. Search methods for identification of studies Electronic Searches. Download: PPT. Hand Searches. Data collection and analysis Selection of articles.
To select articles on the basis of relevance, we employed a PEO algorithm, which was applied as follows and operationalised for electronic searches in Table 1 : Population: Any individual or group of individuals working professionally with offenders or mental health patients. Exposure: The population must have been exposed to individuals diagnosed with either a personality disorder or a psychopathic disorder during the course of their daily work.
The setting must be one where individuals are detained for reasons of offending or socially unacceptable behaviour: forensic inpatient wards or prisons. Outcome: Any outcome relating to staff wellbeing, physical or mental health. Data extraction and management.
Personality Disorder Treatment
Single studies employing quantitative data These studies were assessed for i construct validity of outcome measures or concepts used; ii validity of statistical conclusion based on sample size, effect size and power calculations if available ; iii internal validity coherence of argument ; iv external validity applicability outside the given setting and congruence with other literature ; and v descriptive validity comprehensiveness of reporting; description of outcomes.
Sign in. People with personality disorders are to be found in all branches of psychiatric services, from the outpatient and community care through to acute inpatient care. Their behaviour is difficult, manipulative, threatening and they are hard to manage in institutional settings. Dangerous and Severe Personality Disorder is based on unique research study conducted in the three English high security hospitals - Ashworth, Rampton and Broadmoor. Through in-depth analysis of an extensive questionnaire survey followed by personal interviews, Len Bowers shows how positive or negative attitudes to PD patients arise and are maintained over time, as well as discusses what impact they have upon nurses and the care they provide to patients, and draws some practical conclusions.
The difficulties facing staff who care for and treat PD patients are enormous, and constitute a significant personal challenge for the psychiatric professional of any discipline. For the first time this book provides details of the most effective ways of creating a positive context for working with personality disorder and contains a blueprint for training and organisational structures across the professional spectrum. Daniel Nettle. Ruth Elder. The Question of Competence. Brian D. The Heroic Client. Barry L. Not In Your Genes. Oliver James.
Stephen Loftus. Love, Fear, and Health.
- Geographies of Mars: Seeing and Knowing the Red Planet.
- Dangerous and severe personality disorder: Response and role of the psychiatric team.
- Dangerous and Severe Personality Disorder.
- Better Doctors, Better Patients, Better Decisions: Envisioning Health Care 2020 (Strüngmann Forum Reports).
- What Causes BPD??
- Dangerous and Severe Personality Disorder : Len Bowers : .
Robert Maunder. Young Children's Behaviour. Louise Porter. Jean Morrissey. Applying Social Psychology. Abraham P Buunk. Larry Davidson. Morley D. Patient and Person. Jane Stein-Parbury. James Davies. The Nine Degrees of Autism. Philip Wylie. Reflective Practice in Nursing. Chris Bulman. Leading Billion Neurons: A journey into the brain and how this impacts business and leadership. Andy Habermacher. The Physician as Patient.
Michael F. A Prescription for Psychiatry. Becoming a High Expectation Teacher. Christine Rubie-Davies. Andrew Wilkinson. Use Your Head. Jason Freeman. Psychology for the IB Diploma Second edition. Eleanor Willard. Quincy Fisher. Bullying in Adulthood. Peter Randall. Handbook of Adult Resilience.
Services on Demand
John W. Terry Krupa. Maddie Burton. Rehabilitation and recovery. Jean Pierre Wilken. Introducing Mental Health Nursing. Brenda Happell. Communication - eBook. Psychotherapy is the most important aspect of treatment and may include dialectical behavioral therapy DBT , cognitive behavioral therapy and any other type of therapy that teaches ways to cope with emotional dysregulation. Medication is sometimes used to control symptoms such as anxiety or mood swings. When a person with BPD is experiencing extreme self-harming behavior, including suicidal tendencies, short-term inpatient treatment may be recommended.
Many people who are diagnosed and treated for BPD eventually have their symptoms brought under control and can go on to lead stable and happy lives.
Contact us today for a Confidential Consultation. Call us at or fill out the form below. Free Consultation First Name. Add Me to Your Newsletter.
Related Dangerous and Severe Personality Disorder: Reactions and Role of the Psychiatric Team
Copyright 2019 - All Right Reserved