Lecture 3 Flashcards
Stigma
article Sheehan et al. (2016) “The stigma of personality disorders
Sheehan et al., (2016)
- Difining stigma
- Stigma - mental illness
- Stigma - pd
- Provider stigma
- Self-stigma
- Structural stigma
- Anti-stigma interventions for PD
What are PDs with highest prevalence?
Sheehan et al., (2016)
- Antisocial pd (3.8%)
- Borderline pd (2.7%)
- OCPD (1.2%)
Cluster B is most common cluster (5.5%)
Ervin Goffma’s definition of stigma
Sheehan et al., (2016)
“Social rejection resulting from negatively perceived characteristics”
–> This rejection leads to “spoiled identity” (societal outcast) of stigmatized individuals
Link and Phelan identified 4 qualities of stigma
Sheehan et al., (2016)
- Individual differences are recognized
- Differences are perceived by society as negative
- Stigmatized group is seen as outgroup
- End result is loss of opportunity, power, or status
From a social-cognitive perspective: what are cognitive, affective and behavioral componants of stigma?
Sheehan et al., (2016)
- Stereotypes
- Prejudice
- Discrimination
What is self-stigma?
Sheehan et al., (2016)
If person believes that negative societal attitudes imposed upon them are true.
This may lead to: low self-esteem, depression or lack of motivation
What is structural stigma?
Sheehan et al., (2016)
Occurs when stigmatizing beliefs and attitudes leads to unfair social institutions and policies for stigmatized groups.
What are most common stigma’s towards those with mental illness?
Sheehan et al., (2016)
- Incompetence
- Dangerousness
- Responsibility
Schizophrenia is stereotypes as incompetent –> employers doubt ability to perform (predudice) and avoid hiring (discrimination)
The fear associated with mental illness fuels behaviors like:
Sheehan et al., (2016)
- Segregation
- Avoidance/withdrawal
Have attitudes towards mental illness improved over time?
Sheehan et al., (2016)
No
Research highlights continued prejudice and discrimination
Public stigma of PDs
Sheehan et al., (2016)
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
Mental health literacy
Sheehan et al., (2016)
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
Which PD is most stigmatized (and most stigma research)?
Sheehan et al., (2016)
BPD
- Characterized by mood instability, extreme sensitivity to abandonment, impulsivity, self-mutilating behavior and difficulty controlling anger
How are people with BPD seen?
Sheehan et al., (2016)
As annoying and undeserving –> resulting in inadequate treatment and help (may have frequent contact with law enforcement due to anger and suicidality)
Symptoms of ASPD
Sheehan et al., (2016)
- Lack of remorse and empathy
- Aggressiveness
- Recklessness
Beginning in childhood
How are children is ASPD symptoms labeled?
Sheehan et al., (2016)
Often as delinquents –> leads to self-fulfilling prophecy
Results stigma ASPD
Sheehan et al., (2016)
- 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.
Stigma OCPD
Sheehan et al., (2016)
Because of similarity OCD, OCPD is understood by public.
- Public sees it as quite amenable to treatment
NPD stigma
Sheehan et al., (2016)
- 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.
Stigma in healthcare providers
Sheehan et al., (2016)
- 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
Consequences stigmas health care
Sheehan et al., (2016)
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
For which PD is self-stigma established problem?
Sheehan et al., (2016)
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
What are effects of structural stigma?
Sheehan et al., (2016)
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
What are anti-stigma interventions for PDs?
Sheehan et al., (2016)
- 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
Article Sheenan et al. (2022) “Debate: stigma implications for diagnosing PDs in adolescents
Sheehan et al., (2022)
Zelfde soort article als eerder maar nu dan focus op adolescenten ipv volwassenen
Public stigma
Sheehan et al., (2022)
Is comprised of stereotypes, prejudice and discrimination that are directed ar people who are living with PDs.
Commong stereotypes about people with PDs
Sheehan et al., (2022)
- Attention seeking
- Manipulative
- Violent
- Deviant
- Selfish
Why do member of public endorse these stereotypes?
Sheehan et al., (2022)
They might experience fear and/or frustration while interacting with individuals with PDs
gevolgen self-stigma adolescents
Sheehan et al., (2022)
- Lowered self-esteem
- Depression
- Suicide ideation
- Social isolation
- Secracy and avoidance of help
- “Why try” effect
Associative stigma
Sheehan et al., (2022)
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”
Vicarious stigma
Sheehan et al., (2022)
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
Moderators of stigma
What’s the problem?
Sheehan et al., (2022)
Viewing mental health disorders as the fault of the person, or as being within their control to change, tends to increase stigma.
What helps?
Sheehan et al., (2022)
Viewing mental health disorders as occuring on a continuum (“we all have mental health challanges sometimes”) tends to result in reduced stigma
Possible solutions
Sheehan et al., (2022)
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.
BPD =
Sheehan et al., (2022)
High levels of stigma
ASPD =
Sheehan et al., (2022)
Justice-system involvement
Development stigma
Sheehan et al., (2022)
- 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
- Adolescents experience different social contexts than adults including high levels of influence from parents, peers, school systems, and social media
- Youth avoid care: mental healthcare in school systems (stigma), stigmatizing/bullying on social media, adolescents can’t yet make autonomous dicisions
Advantages of diagnosis
Sheehan et al., (2022)
- 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
Recommendations
Sheehan et al., (2022)
- 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.
Article: van Schie et al. (2024) “Borderline pd and stigma: Lived experience perspectives on helpful and hurtful language”
Van Schie et al. (2024)
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
Results
What phrases are currently used and being viewed as unhelpful and helpful?
Van Schie et al. (2024)
Unhelpful: attention seeking, manipulative, crazy
Helpful: validating someones feelings, understand, doing their best
Results: consumer and carer perspectives on language use
6 unhelpful responses of others
Van Schie et al. (2024)
- Being blamed
- Being given up on
- Having needs ignored
- Having needs misunderstood
- Not being accepted as a person
- Having experiences trivialised
Results: consumer and carer perspectives on language use
Responses of self (how responses from others affected carers)
Van Schie et al. (2024)
- Despair
- Frustration
- Guilt and shame
- Inadequacy as a person
Found that people with BPD felt inadequate and frustrated when:
Van Schie et al. (2024)
When they experienced others as trivialising their needs and not seeing them as a unique individual
When were carers mostly frustrated?
Van Schie et al. (2024)
When experienced others as blaming them and not acknowledging their needs.
Both personal and professional relationships could become marked by:
Van Schie et al. (2024)
- Misunderstanding
- Disconnection
- Loss of hope
What struggles can clinicians experience
Van Schie et al. (2024)
Clinicians feelings of inadequacy and hopelessness may be expressed by lack of empathy and intolerance
Suggestions for reframing language that provides:
Van Schie et al. (2024)
- Acceptance
- Connection
- Empowerment
- Gratitude
- Hope
- Validation
