Beliefs about causes, behavioural manifestations and treatment of borderline personality disorder in a community sample

Barriers to care for adolescents with borderline personality disorder

Intervention for borderline personality disorder (BPD) in adolescence is crucial as early onset of the disorder predicts more severe course, and intervention 'late' in the course of the disorder is associated with more negative outcomes. In spite of this, access to services is poor. This is because several unique barriers to accessing care exist for adolescents with BPD. In this article we highlight key barriers to care for adolescents with BPD utilizing a conceptual model for understanding health care access that emphasizes the interaction between patient and health care system characteristics. We conclude with proposed recommendations to address these identified barriers.

Stigma: A linguistic analysis of personality disorder in the UK popular press, 2008-2017

WHAT IS KNOWN ON THE SUBJECT?: People with a diagnosis of personality disorder often experience stigma both outside of, and within, mental health services. The media contribute to people's understanding of mental health issues, and negative portrayals appear to lead to increased negative attitudes in readers. Relatively little is known about how the press represent personality disorder, and the types of messages that people with this disorder may be receiving, which may impact on their understanding of themselves and emotional well-being. WHAT THE PAPER ADDS TO EXISTING KNOWLEDGE?: The key findings indicate that in a 10-year period, the representation of personality disorder in the popular tabloid press in the UK was characterized by the frequent use of language of violence. The research approach enabled the study to identify significant patterns in the language used, rather than only using a checklist of words that the press are directed to avoid. This adds to our understanding about the images repeatedly presented that may affect how readers treat people with a diagnosis of personality disorder and affect the self-esteem of those with the diagnosis. WHAT ARE THE IMPLICATIONS FOR PRACTICE?: Mental health nurses are well placed to address issues of stigma both in terms of the general public's beliefs and the impact it has on those who use mental health services. A greater understanding of the messages in the press can help nurses to support service users who are vulnerable to believing that their lives will start to reflect the negative messages they have read. ABSTRACT: Introduction Many people with a diagnosis of personality disorder experience stigma, and the press' representations may contribute to those processes. To date, little is known about how the press write about people with personality disorder and analysis of language used is often limited to checklists of words to avoid. Aim The aim of the study was to explore the linguistic characteristics of press articles about personality disorder in popular tabloids in the UK and consider the implications for stigmatization. Method Corpus linguistics was used to examine a 50% sample of all articles published by the popular press in the UK, from 2008 to 2017, that referred to personality disorder (n = 260). Results The findings identified a range of words that constructed narratives of violence. Discussion The method enabled the findings to expand the current level of knowledge in the field, identifying patterns in the use of the language of violence, which may contribute to the processes of self-stigma. Implications for practice Greater understanding of the messages in the press can sensitize nurses to common misconceptions about the disorder, how these may have become internalised and the need for psycho-social interventions to address the impact of self-stigma on self-esteem.

Mental health literacy, sub-clinical personality disorders and job fit

BACKGROUND

This study looked at lay theories of how people with sub-clinical personality disorders experience the world of work.

AIMS

The aim was to investigate the paradox that subclinical and clinical personality disorders are seen as beneficial for success, rather than a handicap in certain jobs.

METHODS

In all, 230 participants read 14 vignettes derived from Oldham and Morris's book describing DSMIII personality disorders for a popular audience. Participants were invited to suggest what type of work each disordered person may be successful at, as well as six ratings of their social adjustment.

RESULTS

There was a tendency for people to believe those with OCD to be suited to Accountancy, Narcissism and Paranoia to General Management, Histrionic PD to being an Actor and Schizotypal an Artist. Surprisingly Paranoid and Sadistic people were judged to be good managers and Histrionic, Passive Aggressive and Schizotypal the worst. People in Cluster C were judged as best managers, but those in Cluster B as better adjusted.

CONCLUSIONS

Results show that lay people believe that certain "dark-side" traits associated with personality disorders, particularly dependency and OCD, are thought to be beneficial for success, rather than failure, in many jobs.

Empathy and Mental Health Literacy

Background:

There is growing literature on mental health literacy (MHL), but few studies have conducted research on anything more than demographic predictors of MHL. We believe that those who are more empathic would be more interested in and more knowledgeable about mental illnesses.

Objective:

This study was concerned to establish whether people who were more empathic would have higher MHL.

Methods:

The 129 volunteer, university panel, participants completed the Interpersonal Reactivity Index and were presented with 15 vignettes describing people with various mental disorders. Questions assessed participants' identification of the disorders and their perception of the life adjustment of each person.

Key Results:

The results showed that 3 of the 4 empathy subscales correlated with the MHL score. Results from correlation and regression analyses suggest that people who are more empathic, have studied psychology, and have had personal experience of mental illness demonstrate better MHL.

Conclusions:

As predicted, people with greater MHL had greater empathy, but this cross-sectional correlational study could not ascertain causal patterns. [Health Literacy Research and Practice. 2017;1(2):e31–e40.]

Plain Language Summary:

This study addressed whether people who are more empathic tend to be better informed about mental health issues because of their care for, interest in, and sympathy toward those with a range of mental illnesses. This was a questionnaire study and we did indeed find the relationship we thought may occur. However, we cannot be certain which caused which—do those who know more about mental illnesses and how common they are become more empathic or do those with greater empathy learn more about all aspects of mental illness?

Qualitative Analysis of Resources and Barriers Related to Treatment of Borderline Personality Disorder in the United States

OBJECTIVE

Resources and treatment for individuals with borderline personality disorder (BPD) are limited and often difficult to obtain. This article aimed to identify key resources for and barriers to obtaining supportive and treatment services for BPD from the perspective of individuals seeking information or services related to BPD ("BPD care seekers").

METHODS

Data came from transcripts of resource requests to the Borderline Personality Disorder Resource Center from January 2008 to December 2015 (N=6,253). Basic statistics, including the type of service requested, demographic information for the BPD care seeker, and national distribution of requests, were generated for all eligible transcripts. Qualitative analysis of a random subset of 500 transcripts was used to identify themes, challenges, and common experiences reported by BPD care seekers.

RESULTS

The greatest number of requests for primary services or resources among the random subset of transcripts was for outpatient services (51%), informational materials (13%), and day programs (9%). Family services, crisis intervention, and mental health literacy were identified as areas where available resources did not meet current demand and that could be improved or expanded. Factors identified as potential barriers to finding and obtaining appropriate treatment for BPD included stigmatization and marginalization within mental health care systems, financial concerns, and comorbidity with psychiatric or medical disorders.

CONCLUSIONS

BPD care seekers face numerous barriers to obtaining appropriate care. Expanded services and resources to connect individuals with treatment are needed to meet the current demands and preferences of those seeking care.

The recognition of the personality disorders among young people

BACKGROUND

Previous research suggests that mental health literacy regarding the personality disorders is low, with few disorders being recognised.

AIMS

The current study aimed to examine the effect of a background in psychology as a predictor of knowledge of the personality disorders.

METHODS

An opportunistic sample of 165 participants (mean age = 30.12 years, standard deviation (SD) = 15.27 years) took part in the study. Participants were instructed to read 10 personality disorder vignettes and other 'filler' items and rate each person in terms of how happy, successful at work and good at personal relationships they are, as well as whether they have a psychological problem.

RESULTS

Results showed, as predicted, that those with a background in psychology were more accurate at labelling disorders. In addition, laypeople's mental health literacy was good for identifying the presence of personality disorders, but was considerably poorer when naming them.

CONCLUSION

Recognising that people may have a disorder and having a 'correct' or recognised label are not the same thing.

Mental health literacy and obsessive--compulsive personality disorder

An opportunistic sample of 342 participants completed a vignette identification task that required them to name the possible psychological problem of an individual described in vignettes describing people with depression, schizophrenia, OCD and OCPD. Participants rated the degree to which they believed the individual experienced distress, they felt sympathetic towards the described individual, and the degree to which they believed the individual was well-adjusted in the community. There were very low recognition rates of OCPD, with participants more likely to identify depression, schizophrenia and OCD. Analysis of distress, sympathy and adjustment ratings also revealed significant differences between the disorders. The findings highlight the necessity of greater mental health awareness and the importance of psycho-education in order to increase successful treatment seeking of OCPD patients.