Pain catastrophizing and employment histories.

BACKGROUND: Studies examining pain catastrophizing and employment have had mixed findings. No study of pain catastrophizing has examined its relationship to lifetime employment status in a general clinical population. AIMS: To examine pain catastrophizing in relationship to lifetime employment functioning in a sample of US primary care patients (rather than injured workers). METHODS: A cross-sectional anonymous self-report survey of consecutive adults in a US internal medicine outpatient clinic. We assessed pain catastrophizing using the Pain Catastrophizing Scale and employment histories using a four-item author-developed measure. RESULTS: There were 239 participants and an initial participation rate of 70%. While pain catastrophizing was not related to the number of different full-time jobs held or the percentage of time employed in adulthood, pain catastrophizing was statistically significantly associated with ever having been paid 'under the table' [F(1,236) = 27.89, P < 0.001] and ever having been fired from a job [F(1,237) = 50.78, P < 0.001], as well as with not getting along with fellow employees [F(1,60) = 7.48, P < 0.01]. CONCLUSIONS: In this clinical sample, pain catastrophizing demonstrated varying relationships with different aspects of lifetime employment, rather than exerting an overall global effect on employment.

The relationship between borderline personality symptoms and body mass index in a consecutive sample of cardiac stress test patients.

Borderline personality disorder (BPD) is characterized by inherent difficulties with self-regulation. While a number of studies have examined the relationship between BPD and body mass index (BMI)/overweight/obesity, findings have been mixed. In this cross-sectional study of a consecutive sample of 238 participants presenting for cardiac stress testing, we investigated the relationship between borderline personality symptoms, according to two self-report measures, and BMI. Compared to participants who were negative on both measures of borderline personality symptoms, participants who were positive on either measure of borderline personality symptoms demonstrated no differences in current BMI or highest BMI in adulthood. These results in a unique study population mirror the findings of other studies in medical and community populations.

Eating disorder symptoms and borderline personality symptomatology.

According to the empirical literature, there are high rates of borderline personality disorder (BPD) among individuals with formal diagnoses of eating disorders, and high rates of eating disorders among individuals with BPD. In this study, we examined relationships between three eating disorder symptoms (i.e., binge eating, starving oneself, abusing laxatives) and borderline personality symptomatology according to two self-report measures (the borderline personality scale of the Personality Diagnostic Questionnaire-4 and the Self- Harm Inventory) in a sample of psychiatric inpatients (N=126) and in a sample of internal medicine outpatients (N=419). Each individual eating disorder item, as well as a composite score of all three items, demonstrated statistically significant correlations with both measures of borderline personality symptomatology in both samples. In addition, endorsement of all three symptoms was invariably associated with borderline personality symptomatology on both measures. Specific eating disorder symptoms, alone, may predict for borderline personality symptomatology.

Weight loss pressure on a 5 year old wrestler.

The case is reported of a 5 year old boy who was pressured to lose weight in order to wrestle at a lower weight class. Although a minority of athletes engage in unhealthy weight management practices, this is an unusual case because of the age of the athlete and the influential role of a parent.

Prevalence of borderline personality symptoms in two groups of obese subjects.

OBJECTIVE: The purpose of this study was to compare the prevalence of borderline personality symptoms and self-harm behavior in two distinct groups of obese subjects. METHOD: Obese women, 17 from an eating disorders program and 60 from a primary care setting, were administered the borderline personality scale of the Personality Diagnostic Questionnaire--Revised, the Diagnostic Interview for Borderline Patients, and the Self-Harm Inventory. RESULTS: There was a significant between-group difference on all study measures, with subjects in the eating disorders program displaying more psychopathology. CONCLUSIONS: Study group membership appears to have a significant effect on the prevalence of psychopathology in obese women.

Increased health care utilization as a function of participation in trauma research.

OBJECTIVE: This study was designed to compare, in a primary care setting, the health care utilization of women who participated in a trauma research study with the health care utilization of women who did not. METHOD: Health care utilization in the 12 months before and the 12 months after participation in trauma research was determined for both participants (N = 116) and a group of control subjects (N = 100) matched for day of service. RESULTS: Pairwise t test results indicated that for the women who participated in the research, all measures of health care utilization significantly increased in the 12 months after the trauma study; for the control subjects, only the number of ongoing prescriptions significantly increased. Sign tests confirmed that a significantly greater number of research participants demonstrated a positive difference (increase in utilization) for all health care variables, whereas only ongoing prescriptions demonstrated a significant systematic increase among control subjects. CONCLUSIONS: The findings suggest that participation in trauma research may increase subsequent health care utilization.

Affective disorder in the families of women with normal weight bulimia.

The authors determined the lifetime prevalence of affective disorder in the first- and second-degree relatives, excluding children, of 27 bulimic women who had never had anorexia nervosa and 27 women with no history of an eating disorder. Family diagnoses were made blind to the proband's diagnosis. The prevalence of affective disorder was 9% in the relatives of the bulimic probands and 10% in the relatives of the control probands, a nonsignificant difference. These findings are in contrast to reports of an increased prevalence of affective disorder in the relatives of patients with anorexia nervosa.

Borderline personality symptomatology, experience of multiple types of trauma, and health care utilization among women in a primary care setting.

BACKGROUND: This project was designed to explore the relationship between recollected trauma history, borderline personality symptomatology, and health care utilization among women in a primary care setting. METHOD: Women (N = 116) consecutively recruited during routine gynecological appointments were given a set of questionnaires that explored 5 types of trauma (i.e., sexual, physical, and emotional abuse; physical neglect; witnessing violence) as well as borderline personality symptomatology. The preceding 12 months of participants' medical records were blindly reviewed to determine several measures of health care utilization (i.e., number of telephone contacts to the facility, physician visits, ongoing and acute prescriptions, specialist referral). RESULTS: Multiple forms of trauma were related to increased telephone contacts, physician visits, acute prescriptions, and ongoing prescriptions. Borderline personality symptomatology was related to physician visits and ongoing prescriptions. Neither was related to the number of specialist referrals. Total number of types of trauma and borderline personality symptomatology scores were moderately related to each other (r = .36, p < .01). CONCLUSION: With the exception of specialist referrals, the experience of multiple types of trauma and borderline personality symptomatology contribute to higher health care utilization among women in a primary care setting, but not to a substantial degree. The experience of trauma and borderline personality symptomatology appear partially related to each other. This relationship has several implications.

The prevalence of borderline personality among primary care patients with chronic pain.

This study was designed to explore the prevalence of borderline personality disorder among primary care patients (N=17) with various pain syndromes. All participants completed two self-report measures [Personality Diagnostic Questionnaire-Revised (PDQ-R); Self-Harm Inventory (SHI)] and a semi-structured interview [Diagnostic Interview for Borderlines (DIB)] for the assessment of borderline personality disorder. According to study measures, 8 (47.1%), 5 (29.4%), and 8 (47.1%) participants scored positively on the PDQ-R, SHI, and DIB, respectively. Nearly 25% of the sample scored positively on two measures, and 18% scored positively on all three measures. In this sample, the prevalence of BPD was substantial. Chronic pain may be a manifestation of a self-regulatory disturbance among some patients with BPD.

Patterns of self-harm behavior among women with borderline personality symptomatology: psychiatric versus primary care samples.

The current study investigated differences in self-harm behavior among individuals with borderline personality symptomatology from two different clinical settings. Participants were women, between the ages of 18 and 45, from an outpatient mental health setting or a primary care setting. Each participant completed the Self-Harm Inventory (SHI) and the borderline personality scale of the Personality Diagnostic Questionnaire-Revised (PDQ-R). Using a predetermined cut-off for substantial borderline personality symptomatology on the SHI, group comparisons with chi(2) analyses indicated that "overdosed" and "hit self" were significantly more common in the mental health subsample whereas "abused laxatives" was significantly more common in the primary care subsample. Using a predetermined cut-off for borderline personality on the PDQ-R, chi-square analyses indicated that "overdosed" and "hit self" remained significantly more common in the mental health subsample. Despite these differences, there was remarkable similarity of symptoms between groups. The implications of these findings are discussed.

Perceptions of parents' health status and relationship to somatic preoccupation.

OBJECTIVES: This study was designed to examine the potential relationship of family factors to somatic preoccupation. METHOD: A total of 116 internal medicine patients completed research booklets exploring perceptions of parents' health, childhood trauma, borderline personality symptomatology [Personality Diagnostic Questionnaire-Revised (PDQ-R)], and somatic preoccupation (Bradford Somatic Inventory). RESULTS: Simple correlations revealed that most of the relationships between somatic preoccupation and remaining study variables were statistically significant (e.g., poor parental health status correlated to somatic preoccupation). Using path analysis, poor perception of mother's health demonstrated an indirect effect on somatic preoccupation via borderline personality symptomatology, whereas, poor perception of father's health demonstrated an indirect effect on somatic preoccupation via childhood trauma. Neither parents' health status demonstrated direct effects on somatic preoccupation. CONCLUSIONS: There appear to be parent gender differences in the mediation of the relationship between poor parental health status and somatic preoccupation in the offspring. The implications of these findings are discussed.

The comorbidity, relationship and treatment implications of borderline personality and obesity.

Studies indicate that a significant minority of obese individuals in clinical studies meet criteria for borderline personality. Although the relationship between obesity and borderline personality remains unexplained, the following article discusses the implications of treating obesity among individuals with this personality disorder. Longitudinal intervention, normalizing or regulating eating patterns, and reframing weight plateaus are emphasized.

An investigation of primary care patients receiving extended treatment with selective serotonin reuptake inhibitors.

OBJECTIVE: To determine the psychiatric characteristics of a sample of primary care patients receiving extended treatment with selective serotonin reuptake inhibitors (SSRIs) as well as to assess the appropriateness of extended treatment. STUDY DESIGN: A prospective case series of patients (convenience sample) assessed with survey, psychological testing, interview, and medical record review. METHODS: Participants (n = 39) were patients in a health maintenance organization primary care setting receiving treatment with SSRI-type antidepressants for 12 months or longer, with no psychiatric evaluation or treatment immediately before commencement of antidepressant therapy. Each participant completed measures of self-destructive behavior and personality disturbance, underwent a clinical psychiatric interview, and had their medical record reviewed to determine psychiatric diagnoses by the primary care physician at the initiation of antidepressant treatment. RESULTS: On psychiatric interview, 64.1% of participants were diagnosed with major depression, the majority recurrent (46.2% of the entire sample); 46.2% with dysthymia; and 38.5% with panic disorder. Psychiatric morbidity in this sample was reflected by recurrent depressive episodes, long-standing depression, comorbid psychiatric diagnoses on interview (average of 1.8 diagnoses per participant), self-harm behaviors, and personality pathology. Seventy-seven percent of primary care diagnoses gleaned from medical records reflected depressive diagnoses. The approximate "match" rate for a depression-spectrum diagnosis between psychiatric interviewer and primary care physicians was 90%; however, on psychiatric interview, 16.7% of participants had bipolar disorder and 38.5% had panic disorder, which were not noted in the primary care medical record. CONCLUSIONS: Patients in primary care settings receiving extended treatment with SSRIs may have complex psychopathology for which long-term antidepressant treatment appears appropriate.

Healthcare utilization among women with eating disordered behavior.

This study was designed to explore relationship between self-reported eating disordered behavior (without formally established eating disorder diagnoses) and healthcare utilization among women in a primary care setting. Through a self-report questionnaire, 150 participants between the ages of 17 and 49 were asked if they had ever vomited, starved themselves, or abused laxatives in a manner that was intentional and self-harming (i.e., eating disordered behavior identified as pathologic by the participant). Participants who reported a history of disordered eating (n = 17) exhibited higher scores on two of five measures of healthcare utilization (mean number of telephone contacts and mean number of specialist referrals) compared with participants without eating disorders (n = 133). These data suggest that eating disordered behavior may be a predictor of increased healthcare utilization among women in primary care settings.

Reporting of weight history: sexually abused versus nonabused males.

In this study we explored among males a possible relationship between recollection of adult body weights and a history of sexual abuse prior to the age of 15. Using a survey format, 34 men hospitalized in an acute care psychiatric facility completed measures. Of the men who acknowledged sexual abuse (n=9), all reported their lowest, highest, and perceived ideal body weight, compared with non-sexually abused men of whom only 80%, 48%, and 52%, respectively, reported the requested weight information. It may be that sexual abuse among men during childhood results in heightened body awareness in adulthood.

The prevalence of borderline personality disorder among individuals with obesity: a critical review of the literature.

Through a MEDLINE and PsycLIT database search, all US studies relating to the prevalence of borderline personality disorder (BPD) among obese individuals were reviewed. The highest rates of BPD among these individuals were found in samples recruited from psychologically oriented settings (i.e., eating disorders program, mental health setting). Lowest rates were found among those seeking weight loss in non-psychological programs or those in primary care settings. Among those studies examining individuals with binge-eating disorder (BED), all indicated a higher-than-community prevalence of BPD. These data suggest that the prevalence of BPD appears increased among those obese individuals seeking psychological care or who have BED.