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An experimental Investigation of the Impact of Personality Disorder Diagnosis on Clinicians: Can We See Past the Borderline?

Published online by Cambridge University Press:  25 August 2015

Danny C.K. Lam ,
Elena V. Poplavskaya ,
Paul M. Salkovskis ,
Lorna I. Hogg  and
Holly Panting
Danny C.K. Lam
Affiliation:
Kingston University, and St. George's Hospital Medical School, London, UK
Elena V. Poplavskaya
Affiliation:
South West London and St Georges NHS Trust, London, UK
Paul M. Salkovskis
Affiliation:
University of Bath, UK
Lorna I. Hogg*
Affiliation:
University of Bath, UK
Holly Panting
Affiliation:
University of Bath, UK
*
Reprint requests to Lorna Hogg, Department of Psychology, University of Bath, Claverton Down, Bath BA2 7AY, UK. E-mail: l.i.hogg@bath.ac.uk
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Abstract

Background: There is concern that diagnostic labels for psychiatric disorders may invoke damaging stigma, stereotypes and misunderstanding. Aims: This study investigated clinicians’ reactions to diagnostic labelling by examining their positive and negative reactions to the label borderline personality disorder (BPD). Method: Mental health professionals (n = 265) viewed a videotape of a patient suffering from panic disorder and agoraphobia undergoing assessment. Prior to viewing the videotape, participants were randomly allocated to one of three conditions and were given the following information about the patient: (a) general background information; (b) additional descriptive information about behaviour corresponding to BPD; and (c) additional descriptive information about behaviour corresponding to BPD, but explicitly adding BPD as a possible comorbid diagnostic label. All participants were then asked to note things they had seen in the videotape that made them feel optimistic or pessimistic about treatment outcome. Results: Participants in the group that were explicitly informed that the patient had a BPD diagnostic label reported significantly fewer reasons to be optimistic than the other two groups. Conclusions: Diagnostic labels may negatively impact on clinicians’ judgments and perceptions of individuals and therefore clinicians should think carefully about whether, and how, they use diagnoses and efforts should be made to destigmatize diagnostic terms.

Keywords

Borderline personality disorderpanic disorderdiagnosis
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 44 , Issue 3 , May 2016 , pp. 361 - 373
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2015 

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References

American Psychiatric Association (1994). Diagnostic and Statistical Manual of Mental Disorders (4th ed.). Washington, DC: American Psychiatric Press.Google Scholar
American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders (5th ed.). Washington, DC: American Psychiatric Press.Google Scholar
Angermeyer, M.C., Holzinger, A. and Matschinger, H. (2009). Mental health literacy and attitude towards people with mental illness: a trend analysis based on population surveys in the eastern part of Germany. European Psychiatry, 24, 225–232.CrossRefGoogle ScholarPubMed
Arntz, A. (1999). Do personality disorders exist? On the validity of the concept and its cognitive-behavioral formulation and treatment. Behaviour Research and Therapy, 37, S97–S134.CrossRefGoogle ScholarPubMed
Arntz, A., Bernstein, D., Gielen, D., van Nieuwenhuyzen, M., Penders, K., Haslam, N., et al. (2009). Taxometric evidence for the dimensional structure of cluster-C, paranoid, and borderline personality disorders. Journal of Personality Disorders, 23, 606–628.Google Scholar
Byrne, P. (1997). Psychiatric stigma: past, passing and to come. Journal of the Royal Society of Medicine, 90, 618–620 Google Scholar
Byrne, P. (2000). Stigma of mental illness and ways of diminishing it. Advances in Psychiatric Treatment, 6, 65–72.CrossRefGoogle Scholar
Corrigan, P.W. (2007). How clinical diagnosis might exacerbate the stigma of mental illness. Social Work, 52, 31–39.CrossRefGoogle ScholarPubMed
Corrigan, P.W. and Watson, A.C. (2002). Understanding the impact of stigma on people with mental illness. World Psychiatry, 1, 16–20.Google Scholar
Dreessen, L., Arntz, A., Luttels, C. and Sallaerts, S. (1994). Personality disorders do not influence the results of cognitive behavior therapies for anxiety disorders. Comprehensive Psychiatry, 35, 265–274.Google Scholar
Dreessen, L. and Arntz, A. (1998). The impact of personality disorders on treatment outcome of anxiety disorders: best-evidence synthesis. Behaviour Research and Therapy, 36, 483–504.Google Scholar
Dreessen, L. and Arntz, A. (1999). Personality disorders have no excessively negative impact on therapist-rated therapy process in the cognitive and behavioural treatment of axis 1 anxiety disorders. Clinical Psychology and Psychotherapy, 6, 384–394.Google Scholar
Frances, A., First, M., Pincus, H.A., Widiger, T. and Davis, W. (1990). An introduction to DSM-IV. Hospital and Community Psychiatry, 41, 493–494.Google ScholarPubMed
Garand, L., Lingler, J.H., Conner, K.O. and Dew, M.A. (2009). Diagnostic labels, stigma, and participation in research related to dementia and mild cognitive impairment. Research in Gerontological Nursing, 2, 112–121.CrossRefGoogle ScholarPubMed
Glen, M. (2005). Dangerous and severe personality disorder: an ethical concept? Nursing Philosophy. 6, 98–105.CrossRefGoogle ScholarPubMed
Goffman, E. (1963). Stigma: notes on the management of spoiled identity. Englewood Cliffs, NJ: Prentice Hall.Google Scholar
Hayward, P. and Bright, J. A. (1997). Stigma and mental illness: a review and critique. Journal of Mental Health, 6, 345–354.Google Scholar
Lam, D., Salkovskis, P. M. and Hogg, L. I. (in press). Judging a book by its cover: an experimental study of the impact of a diagnosis of borderline personality disorder on clinicians’ judgements of uncomplicated panic disorder. British Journal of Clinical Psychology.Google Scholar
Link, B.G. and Phelan, J.C. (2001). Conceptualizing stigma. Annual Review of Sociology, 27, 363–385.Google Scholar
Markham, D. (2003). Attitudes towards patients with a diagnosis of “borderline personality disorder”: social rejection and dangerousness. Journal of Mental Health, 12, 595–612.Google Scholar
Markham, D. and Trower, P. (2003). The effects of the psychiatric label “borderline personality disorder” on nursing staff's perceptions and causal attributions for challenging behaviours. British Journal of Clinical Psychology, 42, 243–256.Google Scholar
Martin, J.K., Pescosolido, B.A. and Tuch, S.A. (2000). Fear and loathing: the role of “disturbing behaviour”, labels, and causal attributions in shaping public attitudes toward people with mental illness. Journal of Health and Social Behaviour, 41, 208–223.Google Scholar
Massion, A.O., Dyck, I.R., Shea, M.T., Phillips, K.A., Warshaw, M.G. and Keller, M.B. (2002). Personality disorders and time to remission in generalized anxiety disorder, social phobia, and panic disorder. Archives of General Psychiatry, 59, 434–440.Google Scholar
Mukolo, A., Heflinger, C.A. and Wallston, K.A. (2010). The stigma of childhood mental disorders: a conceptual framework. Journal of the American Academy of Child and Adolescent Psychiatry, 49, 92–103.Google ScholarPubMed
Nurnberg, H., Raskin, M., Levine, P. E., Pollack, S., Prince, R. and Siegel, O. (1989). Borderline personality disorder as a negative prognostic factor in anxiety disorders. Journal of Personality Disorders, 3, 205–216.Google Scholar
Pescosolido, B.A., Martin, J.K., Lang, A. and Olafsdottir, S. (2008). Rethinking theoretical approaches to stigma: a framework integrating normative influences on stigma (FINIS). Social Science & Medicine, 67, 431–440.CrossRefGoogle ScholarPubMed
Philo, G. (1996). Media and Mental Distress. New York: Addison Wesley Longman.Google Scholar
Rose, D. and Thornicroft, G. (2010). Service user perspectives on the impact of a mental illness diagnosis. Epidemiologia e Psichiatria Sociale, 19, 140–147.CrossRefGoogle ScholarPubMed
Ruscio, J. (2004). Diagnoses and the behaviours they denote: a critical evaluation of the labelling of mental illness. Scientific Review of Mental Health Practice, 3, 5–22.Google Scholar
Sanderson, W. C., Beck, A. T. and McGinn, L. K. (2002). Cognitive therapy for generalized anxiety disorder: significance of comorbid personality disorders. Reprinted in Leahy, R.H. and Dowd, E.T. (Eds.), Clinical Advances in Cognitive Psychotherapy (pp.287–294).Google Scholar
Sansone, R.A. and Sansone, L.A. (2013). Responses of mental health clinicians to patients with borderline personality disorder. Innovations in Clinical Neuroscience, 10, 39–43.Google Scholar
Schomerus, G., Schwahn, C., Holzinger, A., Corrigan, P.W., Grabe, H.J., Carta, M.G. and Angermeyer, M.C. (2012). Evolution of public attitudes about mental illness: a systematic review and meta-analysis. Acta Psychiatrica Scandinavia, 125, 440–452.CrossRefGoogle ScholarPubMed
Silton, N.R., Flannelly, K.J., Milstein, G. and Vaaler, M. (2011). Stigma in America: has anything changed? Impact of perceptions of mental illness and dangerousness on the desire for social distance: 1996 and 2006. The Journal of Nervous and Mental Disease, 199, 361–366.CrossRefGoogle ScholarPubMed
Szeto, A.C.H., Dobson, K.S. and Luong, D. (2013). Does labelling matter? An examination of attitudes and perceptions of labels for mental disorders. Social Psychiatry and Psychiatric Epidemiology, 48, 659–671.Google Scholar
Townsend, J. (1979). Stereotypes of mental illness: a comparison with ethnic stereotypes. Culture, Medicine and Psychiatry, 24, 205–229.Google Scholar
World Health Organization (2010). International Classification of Diseases (ICD-10). Geneva: World Health Organization.Google Scholar
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