Aaron Beck (American psychiatrist and professor emeritus, University of Pennsylvania) describes two therapists talking:
‘I’m having trouble with my patient with personality disorder.’
‘How do you know they have personality disorder?’
”Because I’m having trouble with them.’
The above tautological, verbal exchange, whilst it may (or may not) be apocryphal, succinctly reflects how many individuals who have suffered severe, protracted, interpersonal childhood trauma are being labelled as having borderline personality disorder and then, as a result, are unjustly dismissed (not infrequently by those who have taken the Hippocratic Oath) as trouble-makers.
Below, I describe a particular study that has a clear relationship to this devastatingly harmful and invalidating attitude.
A study conducted at Bath University in the United Kingdom has found that labelling an individual as suffering from BPD can lower the standard of treatment they receive.
The study involved 3 groups of mental health clinicians and required them to watch a video of a man manifesting symptoms of anxiety disorder.
However, each of these 3 groups was given different sets of information about the man featured in the video. These differences were as follows:
GROUP 1: Those in GROUP 1 were provided with only simple and basic information about the man in the video
GROUP 2: Those in GROUP 2 were given the same information as those in GROUP 1 AND ADDITIONALLY given information about the man’s behaviour that implied he might be suffering from BPD.
GROUP 3: Those in GROUP 3 were ADDITIONALLY informed that the man in the video had previously been FORMALLY DIAGNOSED as suffering from BPD by a psychiatrist.
RESULTS OF THE STUDY:
Despite the fact that mental health clinicians in each of the 3 groups watched exactly the same video and were given identical instructions to make an evaluation and assessment of the man in the video, the researchers involved in the study found that many of them had been negatively influenced in their interpretations of what they saw because they believed the label of borderline personality disorder had been attached to the patient.
WHAT CAN BE INFERRED FROM THE RESULTS OF THE STUDY?
The results of the study suggest that mental health clinicians may be negatively influenced in their analysis of a patient’s behaviours by their prior expectations, even if those prior expectations are predicated upon false information – in this case, that the man in the video was likely to have or was formally diagnosed as having borderline personality disorder as those in GROUP 2 and GROUP 3 respectively believed due to the bogus information with which they were supplied by those running the experiment.
Researchers at Bath University (where the study was conducted) suggested that such negatively biased attitudes towards patients based upon the psychiatric labels (in this case, borderline personality disorder) that have been foisted upon them may adversely affect the treatment they receive.
According to Huda, author of the book Medical Model in Mental Health (Oxford University Press), BPD is a misnomer as it implies that there is something intrinsically wrong with the essence of the person rather than emphasizing that the individual has become mentally ill through no fault of his/her won This idea is strongly supported by the fact that the vast majority of BPD sufferers have experienced significant childhood trauma (even those who don’t report having suffered childhood trauma may still have done so but have no memory of it as it occurred prior to the age of three years, are in denial or can’t bring themselves to talk about it due to societal taboos). He, therefore, suggests that BPD should be renamed complex PTSD (others have suggested Emotional Instability Disorder) or, where a clear link with childhood trauma can not be established, ‘mood instability’ would more judiciously and sensitively reflect the individual’s condition.
To further his argument about the inappropriateness of the term borderline personality disorder, Huda also highlights the fact that research has been largely unsuccessful when it comes to trying to explain the condition with reference to models of personality (such as the 5-Factor model).
Huda has also expressed the view that the stigmatizing effect of being labelled as having BPD makes the sufferer vulnerable to discrimination within the medical profession, including being discriminated against by doctors and other healthcare workers.
Due to the highly controversial and evocative nature of a BPD diagnosis, such diagnoses have not uncommonly been hidden from the individual (i.e. the patient is diagnosed with BPD and this is recorded in his/her notes but s/he is not told about this). Huda’s view of this dubious and ethically questionable practice is that it defeats the two main aims of providing an individual with a diagnosis relating to his/her mental state, namely, first, to help the individual understand his/her condition and why s/he is feeling, thinking and behaving as s/he does and, second, as a way of facilitating treatments, therapies, and care plans.
Huda, S., author of the book Medical Model in Mental Health (Oxford University Press)
Lam, D.C.K., Salkovskis, P.M. and 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. Br J Clin Psychol, 55: 253-268. https://doi.org/10.1111/bjc.12093
David Hosier BSc Hons; MSc; PGDE(FAHE).
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