Difficult Interpersonal Relationships Research Articles

Reconciliation and Diversity for Educators: The Medicine Wheel, Bloom's Taxonomy, and CanMEDS Competencies.

Reconciliation and Diversity for Educators: The Medicine Wheel, Bloom's Taxonomy, and CanMEDS Competencies.

Borderline Personality Disorder And Childhood Trauma: Witch Relationship?

IntroductionBorderline Personality Disorder (BPD) is a pervasive pattern of impulsiveness, emotional dysregulation, and difficult interpersonal relationships. Several studies showed that its onset depends on the combination of biological and psychosocial factors, particularly between biological vulnerabilities and traumatic experiences during childhood.ObjectivesWe aimed to explore the mediators of the effects of childhood trauma in BPD vulnerability.MethodsWe conducted a literature review using “PubMed” database and keywords “borderline personality disorder”, “childhood trauma”, “hypothalamic-pituitary-adrenal axis”, “stress”, adverse childhood experiences”.ResultsSeveral studies showed that a diagnosis of BPD is associated with child abuse and neglect more than any other personality disorders, with a range between 30 and 90% in BPD patients. All types of abuse and neglect happen to be significantly associated with BPD features. Besides, the exposure to multiple types of maltreatment through multiple development periods increased the severity of BPD. Several studies highlighted the role of alterations in Hypothalamic-Pituitary-Adrenal axis, in neurotransmission, in the endogenous opioid system and in neuroplasticity in the childhood trauma-associated vulnerability to develop BPD. Besides, morphological changes in several BPD brain areas and in particular in those involved in stress response have also been incriminated.ConclusionsOur findings regarding the role of childhood trauma in the development of BPD would help identify and develop early intervention services for a vulnerable population. The critical role of psychotherapy in treating individuals with early life stress may partially explain why the prevailing empirically validated treatments for BPD are psychotherapeutic.DisclosureNo significant relationships.

Ethics and Total Worker Health®: Constructs for Ethical Decision-Making and Competencies for Professional Practice.

Work has become increasingly technologically driven and fast paced, with long work hours, new/emerging hazards, and rising health care costs. Threats to worker safety, health, and well-being including non-traditional work arrangements and practices, precarious work, uncertain hazardous exposures, and work organization issues, such as heavy workloads, design of work, uneven work hours, and difficult interpersonal relationships among workers and managers are apparent. Furthermore, the relationship between personal health risk factors and workplace risks and exposures has drawn increased attention and concern. As employer economic pressures continue to build, it is anticipated that ethical dilemmas for practitioners will become increasingly complex. A review of relevant Total Worker Health® (TWH) literature, related ethical constructs and competencies, an examination of codes of ethics for occupational safety and health and health promotion/education disciplines was conducted. A case study for TWH utilizing an ethical decision-making model for the analysis of key ethical issues and solutions was completed. TWH approaches to protecting safety, promoting health, and advancing well-being are increasingly being adopted. These approaches can reveal ethical dilemmas, and ethical constructs are needed to guide decision-making. A core set of proposed ethical competencies for TWH professionals are identified as a transdisciplinary framework to support workplace ethical culture.

The lived experience of anxiety and the many facets of pain: A qualitative, arts-based approach

ABSTRACT Background: Findings reported in this article emerged from the study titled “Youth’s Voices: Their Lives and Experiences of Living with an Anxiety Disorder.” Though the initial focus of this study was not on the pain experiences of youth living with an anxiety disorder, it became apparent from the very first interviews that pain and suffering was key in the youth lived experience, permeating their everyday lives and impeding their participation and functioning in the world. Aims: The aim of this article is to highlight the ways in which pain is a central experience for young people living with an anxiety disorder. Methods: The study was approached from the qualitative research design of hermeneutic phenomenology. Fifty-eight young people who were living with anxiety disorders and their parents participated in the study. Youth took part in multiple qualitative open-ended interviews and the participatory arts-based method of photovoice. Themes were developed using van Manen’s method of data analysis. Results: The overall theme emerged as “anxiety is very much about pain.” The four subthemes are (1) embodied experience of anxiety: physical pain; (2) a prominent symptom of anxiety: mental–emotional pain; (3) difficult interpersonal relationships: social pain; and (4) articulating their pain. Conclusions: Use of qualitative, arts-based methodologies provided the opportunity and space for youth with anxiety to articulate their multifaceted experience with pain in their own words. This work reinforces the need for use of qualitative approaches to understanding pain experiences in young people.

Teaching Efficiency and Satisfaction of Clinical Practicum for College Students in Audiology Major

Purpose: This study investigated teaching efficiency and satisfaction with clinical practicum for college students in the audiology major. Through this research, the author seeks to improve quality and teaching methods in clinical practicum.Methods: Although a total of 140 participants who completed at least one course in audiology clinical practicum were recruited, the author analyzed only 131 surveys. The questionnaire consisted of general characteristics, audiology clinical practicum satisfaction, and teaching efficiency in audiology practicum education. All questions other than those related to general characteristics were prepared on the Likert 5-point scale.Results: Audiology clinical practicum satisfaction and teaching efficiency averaged 3.91 and 4.04, respectively. Audiology clinical practicum satisfaction and teaching efficiency based on participants’ characteristics showed statistically significant differences related to clinical practicum period, health status, interpersonal relationships, difficult interpersonal relationships in clinical practicum, satisfaction with college life, satisfaction with major, and satisfaction with audiology clinical practicum. There were significant positive correlations between the sub-factors of teaching efficiency and audiology clinical practicum satisfaction.Conclusion: In the audiology major, teaching efficiency and clinical practicum satisfaction were very similar to or higher than those in health departments, and teaching efficiency was found to have a significant effect on clinical practicum satisfaction. Therefore, the College of Audiology and the Korean Faculty Council for Audiology will develop and investigate specific clinical practicum instructional plans and clinical practicum guidelines that can improve audiology clinical practicum satisfaction, and the introduction of a systematic system to reflect these results should be actively considered.

Developmental cascades from child maltreatment to negative friend and romantic interactions in emerging adulthood.

Maltreatment during childhood is associated with difficult interpersonal relationships throughout the life course. The aim of the current study was to investigate differential pathways from child maltreatment to emerging adult relationship dysfunction. Specifically, we prospectively tested whether child maltreatment initiates a developmental cascade resulting in coercive negative romantic and friend interactions in emerging adulthood via childhood antisocial tendencies and via childhood relational aggression. Utilizing a longitudinal sample of emerging adult participants (N = 392; mean age = 20 years old) who took part in a summer research camp program as children (mean age = 11 years old), results supported pathways via both childhood antisocial behavior and childhood relational aggression. We found specificity within these pathways such that childhood antisocial behavior was a mediator of child maltreatment effects on emerging adult negative romantic interactions, whereas childhood relational aggression was a mediator of child maltreatment effects on emerging adult negative friend interactions. Taken together, results indicate that children exposed to maltreatment face significant interpersonal challenges in emerging adulthood, within both the friend and the romantic domains, and point to distinct childhood pathways to these negative interactions. Our findings are consistent with Dishion's (2016) theoretical framework for understanding the development of coercion in relationships and highlight the criticality of early intervention with maltreating families.

Depressive disorders as cause of absenteeism among public sector health care workers in Sergipe, Brazil, from 2009 to 2017.

Health care workers are available to provide care to patients, but lack of concern with their lives, work organization and difficult interpersonal relationships make them susceptible to physical or mental diseases. To establish the profile of health care workers in the public sector in Sergipe, Brazil, granted sick leave due to depression, frequency of relapse and characteristics of absenteeism. Cross-sectional and descriptive study in which we analyzed secondary data for the period from 2009 2017 available in the State Secretariat of Planning, Budget and Management electronic records. Sixty-three workers required sick leave, representing a total of 290 medical legal examinations. Workers who required sick leave were mostly female (90.5%), married (54.0%), had a master's degree (33.3%) and were nursing technicians (34.9%). The most frequent diagnosis as per the International Classification of Diseases (ICD-10) was single major depressive disorder (F32), 26.5%. The average number of recurrent spells was 3.6 per worker. The prevalence of depression among the analyzed health care workers was high and thus represents a cause of concern requiring intervention.

A Patient-Centered Approach to a Rural General Practice in Distress and the Search for a Solution.

A general practice in rural UK (Cumbria) was overwhelmed by staff burnout. To present a case study for how the staff of a practice came together, used data, agreed on a plan for improvement, implemented the plan, improved subjective distress, and objectively evaluated the intervention. We conducted an audit using the electronic health record for patients coming to the practice 5 or more times annually from 2008 to 2012 (frequent attenders). We planned an intervention to reduce utilization (frequency of visits) while still serving patients. The intervention used a genogram, psychoeducation, and up to six 30-minute sessions of solutions-focused psychotherapy, in which difficult interpersonal relationships were identified and efforts were made to resolve 1 major problem related to those relationships. Quantitative data (number of visits per year) and qualitative data about the changes that resulted in the practice from the audit and the intervention. The frequency of visits for patients with mental health conditions (41.0% of all frequent attenders in the practice) dropped significantly from 2007 to 2012 (p = 0.019; initial visits per year, 10.0, standard deviation = 2.51; final visits per year = 5.6, standard deviation = 3.8). The frequency of visits for patients without mental health diagnoses did not change. Intervening with frequent attenders of primary care who have mental health conditions improved their symptoms and reduced their health care utilization, with beneficial impact on practitioners and improvement in the morale of the staff.

Child Sexual Abuse, Sexual Anxiety, and Sexual Satisfaction: The Role of Self-Capacities

Research indicates that child sexual abuse produces lasting alterations in interpersonal relatedness, identity, and affect regulation, often referred to as self-capacity disturbance. Child sexual abuse also has been shown to negatively impact sexual functioning. This study examined the role of altered self-capacities in mediating the relationship between child sexual abuse and sexual responses. Path analysis revealed that child sexual abuse was related to sexual anxiety and decreased sexual satisfaction through its association with reduced self-awareness and a propensity to be involved in difficult interpersonal relationships.

Mindfulness of the kindness of others: The contemplative practice of Naikan in cultural context.

Mindfulness in the Buddhist tradition involves a variety of practices, and contemporary secular forms of mindfulness practices, therapies, and interventions can similarly be broadened to include more of these forms. The Japanese practice of Naikan takes one mindfulness practice from the Buddhist tradition--that of recollecting the kindness of others--and asks clients to engage in this practice for 1 solid week, 15 hours per day. Difficult interpersonal relationships and a perceived lack of social support are chief sources of stress, and Japanese selfhood in particular has been described as interdependent and highly social in nature. It is unsurprising therefore that Japanese would be drawn to relational forms of practice like Naikan, and that they would find particular benefit from such practices. Recent ethnographic and survey work I have conducted at 2 Naikan centers suggests that Naikan significantly improves positive mental health, perceived connection with others, and perceived meaning in life, even up to 6 months later, thereby potentially undercutting factors contributing to depression and suicide. Naikan practice is not entirely limited to Japan, however, and its use in Europe and North America prompts us to ask about the culturally specific and universal aspects of mindfulness practices, and how we may construct mindfulness interventions that are best suited for addressing the mental health problems that face our communities.

Exploration of the patient-therapist relationship in psychotherapy.

Research from several domains indicates that genetic factors, childhood environment, and later interpersonal experiences are important sources of how patients relate to their therapists (transference). Transference work, a core specific technique in psychodynamic psychotherapy, focuses on exploring the patient-therapist relationship, with the idea that this may lead to improvement of the patients' relationships outside therapy. Many psychotherapy researchers hold the position that specific techniques do not contribute much to the outcome of psychotherapy. However, more than 30 studies have reported significant associations between transference work and outcome. These findings indicate that transference work interventions are indeed active ingredients (for better or worse). Naturalistic studies suggest that a high frequency of transference interventions may have negative effects. Randomized clinical trials indicate that transference-based treatments and alternative treatments work equally well with regard to symptom improvement. However, transference-based treatments appear to be much more effective with regard to interpersonal relations and other measures of personality functioning. The average between-groups effect size for the experimental studies listed in this article was large. Contrary to common clinical wisdom, transference interventions seem to be most important for (mainly female) patients with difficult interpersonal relationships and more severe personality pathology. Gain of insight may be a specific mechanism of change in dynamic psychotherapy, but only one treatment component study has linked transference work directly to gains in insight and subsequent improvement in interpersonal functioning. Research that examines how transference phenomena may be responded to in nondynamic therapies is scarce.

An analysis of laypeople’s beliefs regarding the origins of their worst nightmare

While many studies have examined the aetiological underpinnings and psychological correlates of nightmares, very few have focused on laypeople’s conceptions of the underlying causes of their own nightmares. The present study investigated laypeople’s causal beliefs about their worst nightmare experience and examined whether these beliefs varied as a function of participants’ gender, age of nightmare occurrence, and recurrence of the nightmare itself. Five hundred and eighty-three adult participants completed a series of questionnaires and their beliefs categorized according to a coding protocol. The results showed that: 1) The three most frequently reported explanations for people’s worst nightmare were difficult interpersonal relationships, attributions of unknown or nonexistent causality, and mediums of entertainment; 2) Women were more likely than men to attribute their worst nightmare to factors related to interpersonal relationships; 3) Some attributions varied depending on whether the worst nightmare had occurred during childhood, adolescence, or adulthood; and 4) Worst nightmares that were recurrent in nature were more likely to be attributed to phobias and negative emotions than non-recurrent worst nightmares. Interestingly, many of the lay beliefs endorsed in the present study were in line with empirical and theoretical studies on the aetiology of nightmares.

Issues in the Diagnosis and Management of Disorders of Sexual Development

Disorders of sexual development (DSD) are a complex group of disorders to manage, not only because the diagnosis is difficult, but also because it involves many factors related to the psychosexual well being, the social stigma associated with the disorder, confusion and reluctance on the part of medical professionals in dealing with this issue, catastrophic experience of parents of these children and difficult interpersonal relationships between parents and children born with this disorder. This brief review attempts to throw light on the recent advances in understanding and management of these disorders to help improve immediate and long term care of these patients and their families.

Death Ideation in Cancer Patients: Contributing Factors

Advances in cancer research and therapy have improved prognosis and the quality of life of many patients. However, previous epidemiological studies in oncologic patients have shown an increased risk of suicide. Suicidal thoughts, relatively well known in those terminally ill, may be just as important for cancer patients who are survivors or are living with the disease. Nonetheless, there is a relative paucity of data about suicidality in this setting. The authors conducted a prospective observational study to identify death thoughts and to explore the factors associated with suicidal ideation in cancer patients. A sample of 130 patients referred for psychiatric consultation was obtained following informed consent and authorization from the local ethics committee. A semistructured interview assessed sociodemographic data, psychosocial support, and information regarding the cancer process and its treatment. Psychometric instruments were used to evaluate psychopathology, namely the Hospital Anxiety and Depression Scale, the Beck Hopelessness Scale, and the Beck Scale for Suicide Ideation. Psychiatric diagnoses were obtained through the application of the Mini International Neuropsychiatric Interview. Death ideation was identified in 34.6% of patients, yet only 10% had active suicidal thoughts. Risk of suicide was associated with female gender, a psychiatric diagnosis (major depressive disorder, panic disorder, or dysthymia), difficult interpersonal relationships, associated pain, high hopelessness, and depressive and anxiety symptoms. Although suicidal thoughts are frequent in cancer patients at different stages of disease, most are transitory. Risk factors for suicidal ideation have been identified, such as depression, hopelessness, uncontrolled pain, and difficult interpersonal relationships. Further assessment is necessary to identify those at higher risk of attempting suicide, and underlying psychiatric disorders should be vigorously treated.

The experience of drug‐dependent adolescents in a therapeutic community

Drug treatment programs for adolescents are now more widespread with some evidence of success. However, there has been little in-depth exploration of factors that may encourage or hinder program completion. This ethnographic study of an adolescent therapeutic community aimed to provide insights into the experience of the adolescent residents. Four months of participant observation at a program for drug-dependent adolescents in a metropolitan city in Australia. Twenty-one residents (15 boys and six girls) aged between 14 and 18 years participated, comprising all residents admitted during the study period. Vocational Education and Art Therapy are activities that universally engaged residents whereas frustration was evident in Journaling-a core program activity. Group sessions were often used to set up or dismantle social cliques, although they were also useful to expose difficult inter-personal relationships. The risk of residents 'taking off' was heightened during breaks from program activities when strong emotions surfaced. There needs to be a more central role for creative and vocational activities in adolescent programs and a variety of ways for them to document their journey. Group encounters need to be skillfully facilitated by staff to handle fluid inter-personal dynamics and residents need support outside of formal program time to minimise drop-out. The concept of a navigation-engagement continuum is discussed and the need to see treatment as a series of encounters that may be 'successful' despite 'non-completion'. This study gives adolescents a voice in program evaluation which may help improve retention.

Evaluating Patients With Suspected Nonepileptic Psychogenic Seizures

Evaluating Patients With Suspected Nonepileptic Psychogenic Seizures

Mixed Amphetamine Salts Extended-Release in the Treatment of Adult ADHD:A Randomized, Controlled Trial

Attention-deficit/hyperactivity disorder (ADHD) is a serious neurobehavioral disorder of childhood onset that often persists into adolescence and adulthood. Functional impairments, underachievement, and difficult interpersonal relationships illustrate the need for effective treatment of ADHD through adulthood. This prospective, multisite, randomized, double-blind, placebo-controlled, parallel-group, dose-escalation study was conducted to assess the efficacy, safety, and duration of action of mixed amphetamine salts extended-release (MAS XR) in adults with ADHD, combined type. Adults > or =18 years of age were given placebo or MAS XR 20, 40, or 60 mg/day for 4 weeks. The main outcome measures were the ADHD Rating Scale and Conners' Adult ADHD Rating Scale Short Version Self-Report (CAARS-S-S). Two hundred fifty-five subjects were randomly assigned to treatment with MAS XR or placebo. MAS XR treatment was associated with statistically and clinically significant ADHD symptom reduction at endpoint; mean ADHD Rating Scale scores were 18.5 for the 20-mg group (P=.001), 18.4 for the 40-mg group (P<.001), and 18.5 for the 60-mg group (P<.001). Adults with severe symptoms (ADHD Rating Scale score >32 at baseline) had significantly greater symptom reduction with the highest MAS XR dose (60 mg/day), however, this dose-response relationship was determined by post-hoc analysis. The mean MAS XR effect size was 0.8. Statistically significant (P<.05) improvements in CAARS-S-S ADHD index scores occurred at 4- and 12-hours postdose for all MAS XR groups, indicating a 12-hour duration of effect. Symptoms improved within the first treatment week. Most adverse events reported were mild or moderate in intensity, and the most commonly reported adverse events were consistent with the known profile of stimulant medications. Vital signs and electrocardiograms showed no clinically significant cardiovascular changes. These results suggest that MAS XR is safe and effective in adults with ADHD and controlled ADHD symptoms for up to 12 hours.

Symptom patterns and the acceptance of the ‘sick role’ in attempted suicide

Summarystudy has been made of 300 patients who have attempted suicide. Most were young people, predominantly women, in the age group 21 to 45 years old. Data were collected within 1 week of the attempt and a follow-up made on the status of 299 of the patients at least I year or more after. The attitudes of ‘significant other’ people, e.g. parent, boy friend, spouse, were also assessed. Almost all the patients had difficult interpersonal relationships. The majority presented a clinical picture of depressive reaction.The author discusses the symptom patterns of the patients in relation to the key variables of anxiety, guilt, tension, diagnosis, age, sex, patient status, and the nature of the suicidal act. The importance in prognosis of interpersonal conflict, symptom distress and the social setting of the attempt is stressed.