علائم شخصیت مرزی و عملکرد کار: یک بررسی مبتنی بر جمعیت Borderline personality symptoms and work performance: a population-based survey

Background Borderline personality disorder (BPD) is a severe mental disorder characterized by impulsivity, emotional instability, interpersonal dysfunction, perturbed self-image and severe functional impairment [1, 2]. BPD is associated with unemployment, extensive use of social benefits, and therefore high societal costs [2–4]. Ten Have and colleagues [5] found that even minimal borderline personality symptoms are associated with functional impairment and unemployment. Furthermore, Zimmerman and colleagues [6] found that individuals with one borderline personality symptom had significantly more common mental disorders (CMD), psychiatric hospitalizations and missed time from work compared to individuals with no borderline personality symptoms. Extensive, research emphasizes that BPD should be studied as a dimensional construct, because BPD is heterogeneous and trait severity differs [7, 9]. However, little is known about the prevalence of borderline personality symptoms and functioning among those still at work. Studying risk factors for impaired work performance is important, because the costs due to work loss constitute the bulk of total societal costs associated with mental disorders [6]. Furthermore, most people want to work, emphasizing the importance for interventions aimed at improving work performance. Impaired work performance is often defined as absenteeism (days a worker is absent) and presenteeism (days of reduced functioning while at work) [7]. Potential risk factors of impaired work performance are mental health, such as common mental disorders and personality disorders [2, 7, 8], and adverse working conditions [9]. The job demands-control model of Karasek is often used for measuring psychosocial working conditions such as decision latitude, psychological job demands, job security and co-worker support [10]. Plaisier and colleagues [11] showed that low co-worker support and low decision latitude were associated with higher absenteeism among workers with and without depressive and anxiety disorders. Vlasveld and colleagues [12] showed that personality characteristics are associated with absenteeism in both healthy workers and workers with depressive and anxiety disorders. We expect that this is also true for workers with borderline personality symptoms and therefore hypothesize that borderline personality symptoms influence work performance and that adverse working conditions will mediate the relationship between borderline personality symptoms and impaired work performance (Fig. 1). With respect to the working conditions, we expect (i) that borderline personality symptomatology diminishes the experienced decision latitude because individuals with BPD have been shown to experience difficulties in planning, decision-making and controlling their impulses [13, 14]. Difficulties with planning and decision-making might increase feelings of stress. Thus, we hypothesize (ii) that workers with borderline personality symptoms experience high psychological job demands. Individuals with BPD were previously found at increased risk for dismissal and demotion [2] and therefore we anticipate (iii) that workers with borderline personality symptoms experience high job insecurity.