Week 3

Question 1

Sheehan et al. (2016) - Summary

Answer 1

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

Question 2

Personality Disorders - Highest Prevalences

Answer 2

• Antisocial personality (3.8%)
• Borderline personality (2.7%)
• Obsessive-compulsive personality (1.9%)
• Paranoid personality (1.9%)
• Avoidant personality (1.2%)

Question 3

Personality Disorders - Clusters

Answer 3

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

Question 4

Stigma – Def.

Answer 4

social rejection resulting from negatively perceived characteristics

• rejection leads to “spoiled identity” of stigmatized individuals

Question 5

Stigma – 4 qualities

Answer 5

• 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

Question 6

Social stigma – Def.

Answer 6

Stigma includes cognitive, affective, and behavioral components called stereotypes, prejudice, and discrimination

Question 7

Public stigma – Def.

Answer 7

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

Question 8

Structural stigma – Def.

Answer 8

occurs when stigmatizing beliefs and attitudes lead to unfair social institutions and policies for the stigmatized group

Question 9

Sigma of Mental Illness

Answer 9

• 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)

Question 10

Sigma of Mental Illness - Common stereotypes

Answer 10

• 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

Question 11

“Why Try” effect

Answer 11

recovery efforts stall when the person has fully incorporated the stigmatized mentality of incompetence

Question 12

Public stigma of Personality Disorder - Borderline Personality Disorder

Answer 12

• 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

Question 13

Public stigma of Personality Disorder - Antisocial Personality Disorder

Answer 13

• 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

Question 14

Public stigma of Personality Disorder - Obsessive-Compulsive Personality Disorder

Answer 14

• 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

Question 15

Public stigma of Personality Disorder - Narcissistic Personality Disorder

Answer 15

• 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

Question 16

Provider Stigma

Answer 16

• 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

Question 17

Self-stigma

Answer 17

• 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

Question 18

Structural Stigma

Answer 18

• 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

Question 19

Stigma changing interventions

Answer 19

1. Education
   - By correcting misperceptions about mental illness and providing information
2. 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

Question 20

Catthoor et al. (2015) - Summary

Answer 20

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

Question 21

Three major types of psychiatric stigma

Answer 21

1. 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
2. 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
3. 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