Lecture 3

Question 1

article Sheehan et al. (2016) “The stigma of personality disorders

Sheehan et al., (2016)

Answer 1

• Difining stigma
• Stigma - mental illness
• Stigma - pd
• Provider stigma
• Self-stigma
• Structural stigma
• Anti-stigma interventions for PD

Question 2

What are PDs with highest prevalence?

Sheehan et al., (2016)

Answer 2

• Antisocial pd (3.8%)
• Borderline pd (2.7%)
• OCPD (1.2%)

Cluster B is most common cluster (5.5%)

Question 3

Ervin Goffma’s definition of stigma

Sheehan et al., (2016)

Answer 3

“Social rejection resulting from negatively perceived characteristics”

–> This rejection leads to “spoiled identity” (societal outcast) of stigmatized individuals

Question 4

Link and Phelan identified 4 qualities of stigma

Sheehan et al., (2016)

Answer 4

1. Individual differences are recognized
2. Differences are perceived by society as negative
3. Stigmatized group is seen as outgroup
4. End result is loss of opportunity, power, or status

Question 5

From a social-cognitive perspective: what are cognitive, affective and behavioral componants of stigma?

Sheehan et al., (2016)

Answer 5

1. Stereotypes
2. Prejudice
3. Discrimination

Question 6

What is self-stigma?

Sheehan et al., (2016)

Answer 6

If person believes that negative societal attitudes imposed upon them are true.

This may lead to: low self-esteem, depression or lack of motivation

Question 7

What is structural stigma?

Sheehan et al., (2016)

Answer 7

Occurs when stigmatizing beliefs and attitudes leads to unfair social institutions and policies for stigmatized groups.

Question 8

What are most common stigma’s towards those with mental illness?

Sheehan et al., (2016)

Answer 8

• Incompetence
• Dangerousness
• Responsibility

Schizophrenia is stereotypes as incompetent –> employers doubt ability to perform (predudice) and avoid hiring (discrimination)

Question 9

The fear associated with mental illness fuels behaviors like:

Sheehan et al., (2016)

Answer 9

• Segregation
• Avoidance/withdrawal

Question 10

Have attitudes towards mental illness improved over time?

Sheehan et al., (2016)

Answer 10

No

Research highlights continued prejudice and discrimination

Question 11

Public stigma of PDs

Sheehan et al., (2016)

Answer 11

There is evidence that especially PDs are stigmatized.

There are beliefs that people with PDs can control their behavior –> leads to that society sees them as difficult and misbehaving instead of sick.

Also, general public has less knowledge of PDs than other mental illnesses

Question 12

Mental health literacy

Sheehan et al., (2016)

Answer 12

Public knowledge about PDs

• Connected with treatment-seeking behavior and public stigma
• Individuals with PDs are maybe ostracized (verstoten) rather than referred to treatment and less likely to recognize their own behaviors as symptoms of illness

Question 13

Which PD is most stigmatized (and most stigma research)?

Sheehan et al., (2016)

Answer 13

BPD

• Characterized by mood instability, extreme sensitivity to abandonment, impulsivity, self-mutilating behavior and difficulty controlling anger

Question 14

How are people with BPD seen?

Sheehan et al., (2016)

Answer 14

As annoying and undeserving –> resulting in inadequate treatment and help (may have frequent contact with law enforcement due to anger and suicidality)

Question 15

Symptoms of ASPD

Sheehan et al., (2016)

Answer 15

• Lack of remorse and empathy
• Aggressiveness
• Recklessness

Beginning in childhood

Question 16

How are children is ASPD symptoms labeled?

Sheehan et al., (2016)

Answer 16

Often as delinquents –> leads to self-fulfilling prophecy

Question 17

Results stigma ASPD

Sheehan et al., (2016)

Answer 17

• Can lead to individuals being denied prospects of treatment and recovery
• Most court officials don’t consider ASPD to be a mental illenss

New research connecting ASPD to brain changes –> revising its importance in legal settings.

Question 18

Stigma OCPD

Sheehan et al., (2016)

Answer 18

Because of similarity OCD, OCPD is understood by public.

• Public sees it as quite amenable to treatment

Question 19

NPD stigma

Sheehan et al., (2016)

Answer 19

• Not familiar to general public
• Not a lot of research: suggesting that people with NPD are viewed as being fragile, lacking self-esteem and excperiencing problematic relationships.

Question 20

Stigma in healthcare providers

Sheehan et al., (2016)

Answer 20

• Studies indicate negative attitudes of healthcare professionals towards people with PDs (especially BPD)
• Perceived discrimination is common occurrence for patients with PDs when seeking hospital admission

Question 21

Consequences stigmas health care

Sheehan et al., (2016)

Answer 21

Negative provider attitudes can lead to differential treatment of people with PDs

Stigma may reduce amount of services available, reduce quality of those services and discourage people from seeking treatment

Question 22

For which PD is self-stigma established problem?

Sheehan et al., (2016)

Answer 22

BPD

• May feel shame about diagnosis and stay away from treatment to avoid self-labeling as sick/weak
• People with BPD have more existential shame

Question 23

What are effects of structural stigma?

Sheehan et al., (2016)

Answer 23

Can impact:

• Availability of services
• Quality of services
• Insurance coverage
• Research on PDs
• Diagnosis and assessment (diagnostic or screening tools are absent or not precise enough)
• Misdiagnosis –> wrong treatment
• Psychiatrists may avoid diagnosis of PDs to protect people from stigma, or avoid telling person their diagnosis

Question 24

What are anti-stigma interventions for PDs?

Sheehan et al., (2016)

Answer 24

• Education
• Members of stigmatized groups engaging in personal contact with others
• Interventions targetting providers (anti-stigma training, self-management, skills training)
• Provide neurobiological differences (critics say this increases separation and decreases idea of change and recovery)
• Combining neurobiological info with recovery info was more effective

Question 25

Article Sheenan et al. (2022) "Debate: stigma implications for diagnosing PDs in adolescents | Sheehan et al., (2022)

Answer 25

Zelfde soort article als eerder maar nu dan focus op adolescenten ipv volwassenen

Question 26

Public stigma | Sheehan et al., (2022)

Answer 26

Is comprised of stereotypes, prejudice and discrimination that are directed ar people who are living with PDs.

Question 27

Commong stereotypes about people with PDs | Sheehan et al., (2022)

Answer 27

- Attention seeking - Manipulative - Violent - Deviant - Selfish

Question 28

Why do member of public endorse these stereotypes? | Sheehan et al., (2022)

Answer 28

They might experience fear and/or frustration while interacting with individuals with PDs

Question 29

gevolgen self-stigma adolescents | Sheehan et al., (2022)

Answer 29

- Lowered self-esteem - Depression - Suicide ideation - Social isolation - Secracy and avoidance of help - "Why try" effect

Question 30

Associative stigma | Sheehan et al., (2022)

Answer 30

Families feel blamed or tainted by the young person's illness and may be judged or ostracized by their communities. *"It's your fault that your son is getting into trouble at school because of his mental illness"*

Question 31

Vicarious stigma | Sheehan et al., (2022)

Answer 31

Family members suffer pain from seeing the impact of public stigma on their affected family member. --> In efforts to avoid associative and vicarious stigma, families might prefer that their child not receive a diagnosic label

Question 32

# Moderators of stigma What's the problem? | Sheehan et al., (2022)

Answer 32

Viewing mental health disorders as the fault of the person, or as being within their control to change, tends to increase stigma.

Question 33

What helps? | Sheehan et al., (2022)

Answer 33

Viewing mental health disorders as occuring on a continuum ("we all have mental health challanges sometimes") tends to result in reduced stigma

Question 34

Possible solutions | Sheehan et al., (2022)

Answer 34

Biogenetic explenations have been posed as an attempt to reduce stigma. However: these threaten to undermine beliefs about recovery if individuals or families become resigned to the diagnosis as a physical illness that can only be "fixed" via medical interventions.

Question 35

BPD = | Sheehan et al., (2022)

Answer 35

High levels of stigma

Question 36

ASPD = | Sheehan et al., (2022)

Answer 36

Justice-system involvement

Question 37

Development stigma | Sheehan et al., (2022)

Answer 37

1. Adolescence may have limited knowledge and experiences with mental illness --> increased knowledge about long-term prognosis PD or continued exposure to public stigma will likely increase harm over time 2. Adolescents experience different social contexts than adults including high levels of influence from parents, peers, school systems, and social media 3. Youth avoid care: mental healthcare in school systems (stigma), stigmatizing/bullying on social media, adolescents can't yet make autonomous dicisions

Question 38

Advantages of diagnosis | Sheehan et al., (2022)

Answer 38

- Might enhance general understanding about these disorders - Youth with PD could be viewed as recovering from a treatable illness instead of being judged as inherently "bad" or "different". - Severe symptoms --> higher stigma, even before diagnosis --> careful approach to early intervention might outweigh the risk of the diagnostic label

Question 39

Recommendations | Sheehan et al., (2022)

Answer 39

- Adolescents entering treatment for first time: how to talk to friends/teachers about symptoms - To reduce stigma: focus on coping and relationships rather than medical or clinical aspects such as diagnosis.

Question 40

Article: van Schie et al. (2024) "Borderline pd and stigma: Lived experience perspectives on helpful and hurtful language" | Van Schie et al. (2024)

Answer 40

Study investigated helpful and unhelpful language as used in different settings inside the health service system, outside of health settings, and in the immediate environment of family and friends

Question 41

# Results What phrases are currently used and being viewed as unhelpful and helpful? | Van Schie et al. (2024)

Answer 41

Unhelpful: *attention seeking, manipulative, crazy* Helpful: *validating someones feelings, understand, doing their best*

Question 42

# Results: consumer and carer perspectives on language use 6 unhelpful responses of others | Van Schie et al. (2024)

Answer 42

1. Being blamed 2. Being given up on 3. Having needs ignored 4. Having needs misunderstood 5. Not being accepted as a person 6. Having experiences trivialised

Question 43

# Results: consumer and carer perspectives on language use Responses of self (how responses from others affected carers) | Van Schie et al. (2024)

Answer 43

1. Despair 2. Frustration 3. Guilt and shame 4. Inadequacy as a person

Question 44

Found that people with BPD felt inadequate and frustrated when: | Van Schie et al. (2024)

Answer 44

When they experienced others as trivialising their needs and not seeing them as a unique individual

Question 45

When were carers mostly frustrated? | Van Schie et al. (2024)

Answer 45

When experienced others as blaming them and not acknowledging their needs.

Question 46

Both personal and professional relationships could become marked by: | Van Schie et al. (2024)

Answer 46

- Misunderstanding - Disconnection - Loss of hope

Question 47

What struggles can clinicians experience | Van Schie et al. (2024)

Answer 47

Clinicians feelings of inadequacy and hopelessness may be expressed by lack of empathy and intolerance

Question 48

Suggestions for reframing language that provides: | Van Schie et al. (2024)

Answer 48

1. Acceptance 2. Connection 3. Empowerment 4. Gratitude 5. Hope 6. Validation