Center on Disability Studies, University of Hawai'i at Manoa
Pacific Rim International Conference on Disability & Diversity
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Difficulties in the Workplace for People with Borderline 
Personality Disorder: A Literature Review
Yumi Yuzawa, M.S., PSW, Tanzawa Hospital, Kanagawa, Japan, 
yumi.yuzawa@tanzawahp.or.jp
Jun Yaeda, Rh.D., University of Tsukuba, Tokyo, Japan
 
Recommended Citation
Yuzawa, Y., & Yaeda, J. (2020). Difficulties in the workplace for people with borderline personality 
disorder: A literature review. Pacific Rim International Conference on Disability and Diversity Conference Proceedings. 
Honolulu, Hawai'i: Center on Disability Studies, University of Hawai'i at Manoa.
Licensed under CC BY 4.0. This article is brought to you for free and open access by the Center on 
Disability Studies, ISSN 2641-6115.
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Difficulties in the Workplace for People with Borderline 
Personality Disorder: A Literature Review
Yumi Yuzawa, M.S., PSW
Tanzawa Hospital, Kanagawa, Japan
Jun Yaeda, Rh.D. 
University of Tsukuba, Tokyo, Japan

Abstract: The purpose of the study was to identify the factors behind workplace problems of 
people with borderline personality disorder (BPD) and to seek methods of employment support 
that would lead them to attain their goals. Results found that impulsivity was an important 
predictor of vocational functioning of BPD. Another factor is that their motivation to 
work passionately can be a strength. Though, the stigma still exists that they have little chance of 
employment. The lack of collaboration between mental health and vocational rehabilitation was 
discussed.

Keywords: Borderline Personality Disorder; Workplace Problems; Employment Support
Knowledge Focus: Research/Theory Focus
Topic Area: Employment

Background
      There are various types of interventions for people with borderline personality disorders 
(BPD), including Dialectical Behavioural Therapy (DBT), Mentalization-Based Therapy, 
Schema-Focused Therapy (SFT), Transference-Focused Psychotherapy (TFP), Cognitive 
Analytic Therapy, and Systems Training for Emotional Predictability and Problem-Solving 
(STEPPS) (Storebø et al., 2018). However, these interventions might not necessarily lead to 
achieving the client's own goals, although such interventions seem to be increasing (Ng, Bourke, 
& Grenyer, 2016). Psychotherapy for BPD often focuses on specific aspects, such as self-harm 
and relationships; therefore, certain patients with BPD feel that some of their goals are neglected 
in psychotherapy (Katsakou et al., 2012). Also, the vocational functions of BPD patients are 
more deteriorated than their psychosocial functions (Zanarini, Frankenburg, Reich, & 
Fitzmaurice, 2010). Moreover, according to a 20-year follow-up study, appropriate vocational 
functioning in adulthood is one of the predictors of recovery in people with BPD (Zanarini, 
Frankenburg, Reich, & Fitzmaurice, 2018). Consequently, it is necessary to develop effective 
techniques for supporting people with BPD to achieve the goal of maintaining employment.

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Aim and Research Questions
      The purpose of this review was to identify factors in the difficulty of being employed by 
people with BPD and develop employment-support methods that would lead them to attain their 
goal of maintaining employment:
RQ (1) What are the difficulties faced by individuals with BPD in the workplace?
RQ (2) What should employment specialists do on behalf of people with BPD that 
want to work?
Methods
      A literature review was conducted by searching PubMed and CINII (Japanese literature) 
on October 12, 2019. Studies conducted in the previous ten years were retrieved by using the 
following keywords: "borderline personality disorder" and "workplace," or "working area," or 
"place of work," or "on the job," or "vocational" or "employment," or "return to work," or 
"difficulty at work."
Results
      A total of 86 studies were identified through the literature search of the databases. 
Subsequently, they were screened by their titles and abstracts, and as a result, 69 studies were 
excluded. The remaining 17 full-text documents were assessed for eligibility for the review, and 
13 studies were excluded based on the inclusion criteria that studies should describe barriers to 
work, experienced by people with BPD. Finally, the remaining four studies were included in the 
review (Figure 1).

Figure 1. Flow Chart of Searching Process
Figure 1 Image Description: The flow chart figure includes six labeled boxes linked by arrows that point forward to 
one or two boxes. The chart is multi-directional, in which the next possible steps are listed right or beneath each 
box label. Text includes: Box 1 "Studies identified through literature search (n=86)." "Searched by PubMed and 
CINII (Japanese literature) on October12, 2019." Forwarded to Box 2 "Studies screened based on abstract 
(n=86)." Forwarded Box 3 "Studies excluded based on abstract (n=69)"; or forward Box 4 "Full text documents 
assessed by eligibility (n=17)." Forwarded to Box 5 "Studies excluded based on inclusion criteria (n=13)"; or 
forwarded Box 6 to "Studies included in review (n=4)."

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Difficulties in the Workplace for People with BPD
      Borderline personality symptoms were associated with poor working conditions, such as 
low decision latitude, less job insecurity, and low co-worker support (Juurlink et al., 2018). 
Mood swings and impulsive behaviors caused problems in complying with previously made 
appointments (Juurlink et al., 2019). Impulsivity due to the inability to regulate emotions were 
likely to disrupt behaviors. Therefore, impulsivity was an essential predictor of vocational 
functioning in BPD (Juurlink et al., 2019; Sio et al., 2011).

Strengths of People with BPD
      The significant strengths of people with BPD included working hard passionately, and 
having different interests, as well as entrepreneurship. The strength of people with BPD was an 
essential facilitator because most patients with BPD wanted to be employed and expressed the 
hope of achieving this goal (Juurlink et al., 2019).

Issues Related to Supporters of People with BPD
      Stigmas still exist regarding BPD, including the idea that BPD patients would not 
recover from their disorder, and have little chance of employment, which lead people with BPD 
to quit work (Juurlink et al., 2019; Sansone & Wiederman, 2013). Moreover, most treatment 
programs for people with BPD pay little attention to employment. Furthermore, there is little 
collaboration between mental health and vocational rehabilitation services (Juurlink et al., 2019).

Discussion
      We should disregard any stigma regarding people with BPD, and increase their 
opportunities to receive more vocational rehabilitation services leading to the achievement of 
their goal. People with BPD need to learn about their own emotional and impulsive coordination 
and interpersonal skills in the working environment. Employment specialists should also take 
advantage of their strengths, such as working hard passionately. Also, the collaboration between 
mental health and vocational rehabilitation services regarding people with BPD should be 
promoted. Finally, since there are only a few studies on the difficulties faced by people with 
BPD in the workplace, further studies are needed to identify factors related to their difficulties, 
as well as specific intervention techniques that would enhance their hope of maintaining 
employment. In addition, supporting co-workers facing problems because of borderline 
personality symptoms needs to be considered.

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Authors
Yumi Yuzawa, M.S., PSW, Tanzawa Hospital, Kanagawa, Japan is a Certified Psychiatric 
Social Worker and a Certified Career Consultant. She currently works at a psychiatric hospital in 
Japan and supports people with mental issues to obtain employment.
Image Description: Photo of Yumi Yuzawa.

Jun Yaeda, Rh.D. University of Tsukuba is an associate professor at Rehabilitation Course, 
University of Tsukuba, Tokyo, Japan. His research interests include: rehabilitation philosophy, 
vocational rehabilitation counseling, and international rehabilitation education.
Image Description: Photo of Jun Yaeda.

Acknowledgements
      The authors would like to thank TEXT. Co., Ltd. (www.text-edit.com) for English 
language editing.

References
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Zanarini, M. C., Frankenburg, F. R., Reich, D. B., & Fitzmaurice, G. (2010). The 10-year course 
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