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Paper代写:The Effect of Stigma on Borderline Personality Disorder Patients

2019-04-22 17:20:08 | 日記
本篇paper代写- The Effect of Stigma on Borderline Personality Disorder Patients讨论了病耻感对边缘性人格障碍患者的影响。有研究证明,边缘性人格障碍患者的治疗存在诸多困难,其中患者的病耻感是一个重要的难点。临床医生往往对以前诊断为边缘性人格障碍的患者有负面印象,对患者治愈的可能性持悲观态度。本篇paper代写由51due代写平台整理,供大家参考阅读。

The concept of borderline personality disorder (BPD) was firstly appeared in the 1930s, and the psychologists and psychiatrists found that some patients could not be diagnosed as neurosis or schizophrenia. In 1938, Adolf Stern firstly used the term “borderline” to described a group of patients who suffered from nervous disorder when receive classic psychoanalytic treatment (Stefana, 2015). However, people still could not clearly distinguish the symptoms of BPD from other symptoms in the 1970s. In 1980, American Psychiatric Association published Diagnostic and Statistical Manual of Mental Disorders III (DSM III), and BPD was included (Reich, 1990). DSN IV further extended its concept (Chabrol et al., 2001). Currently, BPD was no longer used to describe incorrigible and typically female patients, but used to refer to a valid evidence-based mental disorder which is different from other diagnosis-specific treatments and psychiatric disorders (Sisti et al., 2016). Nonetheless, debate continues on the stigma of BPD, which plays an important role in the treatment of BPD patients. The prevalence of BPD is relatively high among all of the personality disorders. However, this disorder is also labeled “therapist killer” and “hard to be cured” as its natures. The stigma from therapist also increases possibility of patients’ self-stigma. The effect of stigma has become an important barrier of curing the epidemic mental disorder. At the same time, film and television also influence public’s views on BPD patients. For example, the films Play Misty for Me and Single White Female show that, BPD patients are aggressive to others, which is not characteristic of the disease (Robinson, 2003). In this way, the paper seeks to research the effect of stigma on BPD patients. On the basis of literature review, the paper will discuss how stigma influences the effect of therapy for BPD patients.

BPD is one of ten personality disorders called in The Diagnostic and Statistical Manual Disorders, 5th Edition (DSM-5) (Riggenbach, 2016). In DSM-5, a person who has a persuasive and enduring pattern of inner cognition, behavior, and experience which deviates markedly from the individual’s culture is treated as suffering from personality disorder (Riggenbach, 2016). Furthermore, these patterns tend to begin at an early stage of development, are inflexible and enduring, and play an important role in clinical impairment and distress (Riggenbach, 2016). When it comes to BPD, it is demonstrated as a pattern of self-undermining just prior to goal completion by the DSM-5 (Riggenbach, 2016). At the same time, BPD patients are supposed to feel unlovable or “bad” for themselves, and they need others for self-definition, fear of abandonment, have stormy emotions and relationships, tend to be impulsive and angry outbursts to minor interpersonal sights (Slide, p.21). On the other hand, it is important to note that different BPD patients have not exact symptoms. For example, some BPD patients have walls to refuse to let anyone in, but they can also have good social skills on the surface level (Riggenbach, 2016). Some BPD patients especially fear of abandonment, and they can be freaking out at incidents which are very meaningless or small to their family members or close friends (Riggenbach, 2016). For example, a delayed reply may totally infuriate them. In this way, there are various difficulties in treating BPD patients, the stigma of BPD patients is one important difficulty.

Various researches focus on the stigma on BPD patients. In “Judging A Book by Its Cover”, Danny C.K. Lam, Paul M. Salkovskis and Lorna I. Hogg try to evaluate experimentally whether a clinician’s judgment with regard to a patient with panic disorder will be impacted by an inappropriately suggested diagnosis of BPD (Lam et al., 2016). They pay specific attention to the effect of stigma on BPD patients. In order to achieve the goal, they used an experimental manipulation. 265 clinicians from Community Mental Health Teams in London and South West areas took participate in the experiment. They were divided into three groups at random. First group of clinicians were required to read written information about general background and personal details about a woman (Lam et al., 2016). The second group of clinicians were required to read information about a behavioral description which accord with BPD in addition to the general background and personal details about the woman (Lam et al., 2016). The third group of clinicians were required to read the information about the past BPD diagnosis of the woman in addition to the behavior description and general background about the woman (Lam et al., 2016). After the three groups read all the information, they were asked to watch a video-recorded assessment of the woman describing her experience of panic disorder (Lam et al., 2016). After that, these clinicians were required to rate the problems and likely prognosis of the woman (Lam et al., 2016). Eventually, the third group of clinicians hold a more pessimistic opinion on the treatment of panic disorder of the patients, furthermore, they also had more negative impressions on the patient (Lam et al., 2016). For example, when it comes to question “how curable is her condition”, there is no difference between the first group of clinicians and the second group of clinicians, but the third group of clinicians thought the woman less likely to be curable than the first and second group (Lam et al., 2016). In this way, Lam and his associates (2016) argue that, it is necessary for clinicians to attach importance to the evidence base and make related clinical decisions rather than be blinded by an incorrect cover.

In “Diagnosing, Disclosing, and Documenting Borderline Personality Disorder”, Dominic Sisti et al. seek to figure out whether or how often psychiatrists willfully fail to document and or disclose the BPD diagnosis of their patients. For the sake of solve the research question, Sisti et al. used Qualtrics survey software on tablet computers to invite psychiatrists at the 2014 Annual Meeting of the American Psychiatric Association to answer 14 questions with fixed response (Sisti et al., 2016). Firstly, after the participates answered the questions about their general background such as gender, theoretical orientation, number of years in practice and number of patients treated with BPD, the participants were required to answer whether or not they had not disclosed or documented the diagnosis (Sisti et al., 2016). The participants whose answer was yes had to express their opinions on the reason why they willingly failed to disclose or document the diagnosis. Specifically, they had to respond via a five-point Likert scale in the stigma of BPD and uncertainty of diagnosis (Sisti et al., 2016). Finally, all the participated were required to answer the question that whether or not they refused to take on a new patient since they knew that the patient had a BPD diagnosis before (Sisti et al., 2016). Generally, 143 psychiatrists participated in the survey, and 134 participants treated BPD patients (Sisti et al., 2016). Among the 134 participants, 57 percent expressed that they had not disclosed the diagnosis of BPD more than once; 43 percent agreed or strongly agreed that their decision of not disclosing was due to stigma; 63 percent presented that stigma was a reason for not document (Sisti et al., 2016). There were 5.2 percent of participates strongly agreed and 17.9 percent agreed that they refused to take on a new patient if he or she had a previous BPD diagnosis (Sisti et al., 2016). Sisti et al. stressed that, a large number of psychiatrists prefer not to document their patient’s diagnosis because of stigma, and some psychiatrists refuse to treat a patient if he or she has a previous BPD diagnosis.

In “What’s in A Name”, Kirsten Barnicot and Paul Ramchandani mainly demonstrated the research of Professor Peter Fonagy and his colleagues in the difficulties of diagnosing adolescent BPD patients. According to Barnicot and Ramchandani (2015), Fonagy and colleagues argue that, stigma is an important reason which lead to the reluctance to diagnose amongst clinicians. Compared with adolescents suffering from other severe mental diseases, adolescent BPD patients encountered high levels of stigma, and the latter group have strongly negative and fragile self-concepts. At the same time, these patients have difficult in trusting clinicians and therapies. The severe interpersonal trauma is an important impact of the stigma. Consequently, Barnicot and Ramchandani (2015) suggest that, it is necessary for each individual to fight with the stigma through challenging negative stereotypes and better understand the BPD patients.

In “Impact of Diagnosis Disclosure on Adolescents with Borderline Personality Disorder”, Darren B. Courtney and Judy Makinen seek to examine the experience of adolescent patient who is diagnosed with BPD. For the sake of achieving the purpose, Courtney and Makinen asked 25 adolescent BPD patients who had received a diagnosis of BPD to answer 8 questions (Courtney & Makinen, 2016). What is more, most patients expressed their understanding on the construct, and they felt that the diagnosis was an accurate reflection of their problems which could help them understand their symptoms (Courtney & Makinen, 2016). Generally, Courtney and Makinen’s research does not prove the existence of stigma.

In general, Lam and colleagues directly present the impact of stigma on BPD patients in “Judging A Book by Its Cover”. They suggest that, clinicians tend to have negative impressions on the patients who have a previous diagnosis of BPD, and they also held pessimistic view on the possibility that BPD patients could be cured. At the same time, Sisti et al. focus on the reason why clinicians prefer not to disclose or document their patients’ diagnosis, and they argue that, stigma is an important reason. In this way, the research proves the negative impact of stigma from a side. Besides, some clinicians even refuse to take on a new patient if he or she has a previous diagnosis about BPD also prove the seriousness of stigma. In addition, both “What’s in A Name” and “Impact of Diagnosis Disclosure on Adolescents with Borderline Personality Disorder” pay attention to the adolescent BPD patients, but they have different conclusions. The former research mainly reviews the research of Fonagy and colleagues, and it finds that adolescent BPD patients tend to have problems in communicating with clinicians, and they do not trust clinicians and therapies. However, the research of Courtney and Makinen does not show the impact of stigma.

Reference Demographics Measure Results

Lam et al., 2016 N=265 participants (69 psychologists, 30 psychiatrists, 65 community psychiatric nurses, 55 social workers and 46 mental health students on their final year of a Diploma/BSc programme)were at 20 to 60 years Participants were randomly assigned to one of three groups which were in label, no label and control conditions. They were asked to complete the ‘Clinical Assessment Questionnaire’ after reading related instructions and information about a patient. The investigation consisted of twenty-three 0-100 visual analogue scales tapping clinical judgements. Clinicians who know previous diagnosis of BPD hold a more pessimistic opinion on the treatment of panic disorder of the patients, furthermore, they also had more negative impressions on the patient

Sisti et al., 2016 N=134 psychiatrists A brief 14-question fixed-response survey instrument was designed to ascertain whether participants disclose the diagnosis of BPD;

SPSS Version 21.0 was used to perform descriptive analyses. 57 percent argued that they failed to disclose BPD during their career; 37 percent indicated that they had not documented the diagnosis. For participants who failed to disclose the diagnosis of BPD, 43 percent agreed or strongly agreed that stigma contributed to their decision.

Barnicot and Ramchandani, 2015 / Literature review Adolescent BPD patients tend to have difficult in trusting clinicians and therapies. The severe interpersonal trauma is an important impact of the stigma.

Courtney and Makinen, N=23 adolescent patients who were diagnosed with BPD The Impact of Diagnosis Scale was administered to participants to explore their experience of being diagnosed with BPD 21 participants answered the question. The internal consistency of the measure demonstrated Cronbach’s alpha of 0.66. most patients expressed their understanding on the construct, and they felt that the diagnosis was an accurate reflection of their problems which could help them understand their symptoms.

In conclusion, the four articles directly or indirectly present the effect of stigma on BPD patients, but there still exists debate on the effect. For example, the former three articles show that stigma of BPD negatively influence the clinicians and patients, while the fourth article maintains that most adolescent patients felt that the diagnosis was an accurate reflection of their problems, and they believed that the diagnosis could help them understand their symptoms. However, it is also important to note the limitations of these articles. For example, the third article only takes one research paper for reference, and it did not conduct any survey or research. The fourth article only asked 25 adolescents to answer the questionnaires, the sample cannot stand for the majority of BPD patients. The second article mainly pay attention to the issue that why certain clinicians prefer not to disclose or document their patients’ diagnosis, which does not directly demonstrate the impact of stigma on BPD patients. In this way, more researches are necessary to figure out the effect of stigma. It is also essential to distinguish the effect of stigma on adolescent BPD patients and adult BPD patients, as well as male and female BPD patients.

References:

Barnicot, K., & Ramchandani, P. (2015). What’s in a name? Borderline personality disorder in adolescence. European Child Adolescent Psychiatry, 24, 1303–1305

Chabrol, H., Chouicha, K., Montovant, A., & Callahan, S. (2001). Symptoms of DSM IV borderline personality disorder in a nonclinical population of adolescents: Study of a series of 35 patients. Encephale, 27(2), 120-7

Courtney, D.B., & Makinen, J. (2016). Impact of diagnosis disclosure on adolescents with borderline personality disorder. Journal of Canadian Academy Child Adolescent Psychiatry, 25(3), 177-184

Lam, D.C.K., Salkovskis, P.M, & Hogg, L.I. (2016). ‘Judging a book by its cover’: An experimental study of the negative impact of a diagnosis of borderline personality disorder on clinicians’ judgements of uncomplicated panic disorder. British Journal of Clinical Psychology, 55, 253–268

Reich, J. (1990). Criteria for diagnosing DSM-III borderline personality disorder. Annals of Clinical Psychiatry, 2(3), 189-197

Riggenback, J. (2016). Borderline personality disorder toolbox: A practical evidence-based guide to regulating intense emotions. PESI Publishing & Media.

Robinson, D.J. (2003). Reel psychiatry: Movie portrayals of psychiatric conditions. Port Huron, Michigan: Rapid Psychler Press.

Sisti, D., Segal, A.G., Siegel, A.M., Johnson, R., & Gunderson, J. (2016). Diagnosing, disclosing, and documenting borderline personality disorder: A survey of psychiatrists’ practices. Journal of Personality Disorders, 30(6), 848–856

Stefana, A. (2015). Adolph Stern, father of term “borderline personality”. Minerva Psichiatrica, 56(2), 95.

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