1
Q
Sheehan et al. (2016) - Summary
A
Aim:
- review of literature on the stigma of personality disorders
- including an overview of general mental illness stigma and an examination of the personality-specific stigma
- Overall, public knowledge of personality disorders is low, and people with personality disorders may be perceived as purposefully misbehaving rather than experiencing an illness
- Health provider stigma seems particularly pernicious for those with a borderline personality disorder
- Most stigma research on personality disorders has been completed outside the USA, and few stigma-change interventions specific to personality disorders have been scientifically tested
- Limited evidence suggests that health provider training can improve stigmatizing attitudes and that interventions combining positive messages of recovery potential with biological etiology will be most impactful to reducing stigma
- Anti-stigma interventions designed specifically for health providers, family members, criminal justice personnel, and law enforcement seem particularly beneficial, given these sources of stigma
2
Q
Personality Disorders - Highest Prevalences
A
- Antisocial personality (3.8%)
- Borderline personality (2.7%)
- Obsessive-compulsive personality (1.9%)
- Paranoid personality (1.9%)
- Avoidant personality (1.2%)
3
Q
Personality Disorders - Clusters
A
Cluster A: distinguished by features of eccentricity, including paranoid, schizoid, and schizotypal personality disorders
Cluster B: characterized by emotionality or unpredictability, including antisocial, borderline, and histrionic personality disorders
Cluster C: characterized by features of anxiety, including avoidant, dependent, and obsessive-compulsive personality disorders
- Cluster B personality disorders are most common – 5.5% of the U.S. population meet criteria)
- Cluster A and C less common – 2.1% and 2.3% prevalence
- 67% of individuals with PD also met diagnostic criteria for at least one other psychiatric diagnosis
4
Q
Stigma – Def.
A
social rejection resulting from negatively perceived characteristics
- rejection leads to “spoiled identity” of stigmatized individuals
5
Q
Stigma – 4 qualities
A
- Individual differences are recognized
- These differences are perceived by society as negative
- The stigmatized group is seen as the outgroup
- The end result is loss of opportunity, power, or status
6
Q
Social stigma – Def.
A
Stigma includes cognitive, affective, and behavioral components called stereotypes, prejudice, and discrimination
7
Q
Public stigma – Def.
A
manifests in a variety of forms, ranging from lack of eye contact to complete ostracization of an individual based on their membership in a stigmatized group
- Becomes internalized into self-stigma, if the person believes that negative societal attitudes imposed upon them are true
- low self-esteem, depression, or lack of motivation
8
Q
Structural stigma – Def.
A
occurs when stigmatizing beliefs and attitudes lead to unfair social institutions and policies for the stigmatized group
9
Q
Sigma of Mental Illness
A
- Specific stereotypes and prejudice towards those with mental illness incite discriminatory treatment against these individuals
- e.g., schizophrenia is perceived s incompetent, where employers doubt their abilities (prejudice) and avoid hiring them (discrimination)
10
Q
Sigma of Mental Illness - Common stereotypes
A
- incompetence, violence, responsibility people with mental illness made choices that lead to illness
- Serotypes of incompetence can lead to coercive behavior such as forced hospitalization, guardianship, or restriction of independent living
- Stereotypes of “dangerous” individuals can lead to public fear of the mentally ill, which fuels behavior including segregation, avoidance, or withdrawal
- Stereotypes of responsibility, where people are blamed for their illness, lead to prejudice of public, such as that individuals have made choices that led to their symptoms
11
Q
“Why Try” effect
A
recovery efforts stall when the person has fully incorporated the stigmatized mentality of incompetence
12
Q
Public stigma of Personality Disorder - Borderline Personality Disorder
A
- Among the most stigmatized of all personality disorders and is most researched in terms of stigma
- Characterized by mood instability, extreme sensitivity to abandonment, impulsivity, self-mutilating behavior, and difficulty controlling anger
- Often seen as annoying and undeserving – inadequate treatment and help
- Often in contact with police, due to anger and suicidality – can create stigma because of frustration in police
13
Q
Public stigma of Personality Disorder - Antisocial Personality Disorder
A
- Children with antisocial PD are often labeled as delinquents – a self-fulfilling prophecy that he/ she is a bad person and engages in a future life of crime
- Stigma of danger – denied prospects of treatment and recovery, especially within the justice system
14
Q
Public stigma of Personality Disorder - Obsessive-Compulsive Personality Disorder
A
- Because it is very similar to OCD, it is well-understood by the general public
- The public sees people with OCPD as quite amenable to treatment
- Attitudes are probably more favorable than for other PDs
15
Q
Public stigma of Personality Disorder - Narcissistic Personality Disorder
A
- Not as familiar in general public
- Recent survey: people with NPD are seen as being fragile, lacking self-esteem, and experiencing problematic social relationships, but also as a potential advantage in business contexts
16
Q
Provider Stigma
A
- Recent studies highlight the negative attitudes and behaviors of health care professionals towards people with PD, particularly those with BPD
- Psychiatric nurses, social workers, psychologists, and psychiatrists are all sources of harmful attitudes towards people with PD
- Negative provider attitudes can lead to differential treatment of people with personality disorders:
- may reduce the number of services available
- reduce the quality of those services
- discourage people from seeking and continuing treatment
17
Q
Self-stigma
A
- People self-stigmatizing, accepting the public stereotypes not only about mental illness in general but also those more specific to BPD
- problems with self-esteem, depression, and identity
- Self-stigma is established in BPD
- Feel shame about their diagnosis and stay away from treatment to avoid self-labeling as sick, weak, or incapable of handling problems independently
18
Q
Structural Stigma
A
- Structural stigma can impact the availability of services, quality of services, insurance coverage, and research on personality disorders
- There is less funding, research, and services available for PDs
19
Q
Stigma changing interventions
A
- Education
- By correcting misperceptions about mental illness and providing information - Interpersonal contact
- Members of the stigmatized group engage in personal contact with others
- through an interactive presentation about their story of recovery from mental illness
- Showed that both education and providing meaningful interpersonal contact are most effective in changing stigma
- but interpersonal contact has a distinct advantage over education
- In professionals:
- anti-stigma training including self-management or skills training
- leads to more positive attitudes, improved relationships with clients, and lower desire for social distance from their clients
20
Q
Catthoor et al. (2015) - Summary
A
Aim:
- assess the severity of psychiatric stigma in a sample of personality disordered adolescents in order to evaluate whether differences in stigma can be found in adolescents with different types and severity of personality disorders (PDs).
- stigma in children and adolescents has hardly been investigated
- Personality disordered adolescents with fragile identities and self-esteem might be especially prone to feeling stigmatized, an experience that might further shape their identity throughout this critical developmental phase
Materials and methods:
- 131 adolescent patients
- standard assessment with Axis I and Axis II diagnostic interviews and
- two stigma instruments, Stigma Consciousness Questionnaire (SCQ) and Perceived Devaluation–Discrimination Questionnaire (PDDQ)
Results and conclusions:
- Adolescents with severe mental health problems experience a burden of stigma
- Personality disordered patients experience more stigma than adolescents with other severe psychiatric Axis I disorders
- Borderline PD is the strongest predictor of experiences of stigma
- More severely personality-disordered adolescents tend to experience the highest level of stigma
21
Q
Three major types of psychiatric stigma
A
- Public or societal stigma – the extent to which being labeled with a psychiatric diagnosis leads to discriminatory attitudes, devaluation, or rejection
- Condition-specific
- Adolescents receive the most-stigmatizing reactions of all age groups - Associative stigma – a form of social disapproval because of its direct connection with a stigmatized individual
- In children and adolescents bidirectional: parents are directly blamed for the mental disturbance of their children, and children can be seen as part of a mentally disturbed family - Self-stigma occurs when a labeled person assumes himself or herself to be part of an undesirable group and applies negative stereotypes to himself or herself
- shame, self-directed prejudice, depression, lowered self-esteem, social isolation, and reluctance to seek help
- Self-labeling in adolescents may be demoralizing, stigmatizing, and disempowering
- adolescents seem to assess their problems as mental disorders only when they experience them for longer durations of time and after multiple episodes of treatment
