Individual risk factors for physician boundary violations: the role of attachment style, childhood XXXX and maladaptive beliefs.

@entity1 @entity148 @entity12437 @entity130
OBJECTIVE: The assessment and remediation of boundary-challenged healthcare professionals is enhanced through examination of individual risk factors. We assessed three such factors--attachment style, childhood @entity130 and @entity12437 (mostly physicians) of a CME professional boundaries course. We propose a theoretical model which draws a causal arc from childhood maltreatment through insecure attachment and maladaptive beliefs to elevated risk for boundary violations. METHODS: We administered the Experiences in Close Relationship Questionnaire (ECR-R), Childhood @entity130 Questionnaire (CTQ), and Young Schema Questionnaire (YSQ) to 100 healthcare professionals (mostly physicians) attending a CME course on professional boundaries. Experts rated @entity1 autobiographies to determine attachment style and early adversities. Correlations and relationships among self- and expert ratings and between different risk factors were examined. RESULTS: Five percent of @entity1 reported CTQ total scores in the moderate to severe range; eleven percent reported moderate to severe emotional neglect or emotional abuse. Average @entity148 and attachment avoidance were low, and more than half of @entity1 were rated    secure    by experts. Childhood maltreatment was correlated with @entity148 and avoidance and predicted expert-rated insecure attachment and maladaptive beliefs. CONCLUSION: Our findings support a potential link between childhood adversity and boundary difficulties, partly mediated by insecure attachment and early maladaptive beliefs. Furthermore, these results suggest that boundary education programs and professional wellness programs may be enhanced with a focus on sequelae of childhood maltreatment, attachment and common maladaptive thinking patterns.
