title: Individual risk factors for physician boundary violations: the role of attachment style, childhood trauma and maladaptive beliefs.
abstract: 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 trauma and maladaptive beliefs--in 100 attendees (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 Trauma Questionnaire (CTQ), and Young Schema Questionnaire (YSQ) to 100 healthcare professionals (mostly physicians) attending a CME course on professional boundaries. Experts rated participant 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 participants reported CTQ total scores in the moderate to severe range; eleven percent reported moderate to severe emotional neglect or emotional abuse. Average attachment anxiety and attachment avoidance were low, and more than half of participants were rated “secure” by experts. Childhood maltreatment was correlated with attachment anxiety and avoidance and predicted expert-rated insecure attachment and maladaptive beliefs.
  
  
  CONCLUSIONS
  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.
authors.forename: Kai
authors.initials: K
authors.lastname: MacDonald
authors.forename: Andrés F
authors.initials: AF
authors.lastname: Sciolla
authors.forename: David
authors.initials: D
authors.lastname: Folsom
authors.forename: David
authors.initials: D
authors.lastname: Bazzo
authors.forename: Chris
authors.initials: C
authors.lastname: Searles
authors.forename: Christine
authors.initials: C
authors.lastname: Moutier
authors.forename: Michael L
authors.initials: ML
authors.lastname: Thomas
authors.forename: Katherine
authors.initials: K
authors.lastname: Borton
authors.forename: Bill
authors.initials: B
authors.lastname: Norcross
mesh_terms: D000328:Adult; D002648:Child; D002649:Child Abuse; D005260:Female; D006282:Health Personnel / Q000523:psychology; D006801:Humans; D008297:Male; D001523:Mental Disorders; D008875:Middle Aged; D008962:Models, Theoretical; D009769:Object Attachment; D010817:Physician-Patient Relations; D010820:Physicians / Q000523:psychology*; D012307:Risk Factors; D011795:Surveys and Questionnaires