Abstract
Objective: The aim of the present study was to assess the attitudes of mental health and emergency medicine clinicians towards patients diagnosed with borderline personality disorder. The clinician gender, primary occupation and service setting, level of university training and years of experience, frequency of clinical contact, and completion of specific training in borderline personality disorder were expected to influence the attitudes of health professionals towards working with borderline patients that engage in self-harm.
Method: A purpose-designed questionnaire and an assessment tool to quantify attitudinal levels were used to collect demographic information and assess the attitudes of 140 mental health and emergency medicine practitioners across two Australian health services and a New Zealand health service.
Results: Statistically and clinically significant differences were found between emergency medical staff and mental health clinicians in their attitudes towards working with borderline personality disorder. The strongest predictor of attitudes was whether the clinician worked in emergency medicine or mental health. This was followed by years of experience and specific training in personality disorders as significant predictors of attitudes to self-harm.
Conclusions: The implications of these findings for the professional training of clinicians in the management and treatment of borderline personality disorder patients are discussed.
Commons Treloar AJ, Lewis AJ (2008) Professional Attitudes Towards Deliberate Self-Harm in Patients With Borderline Personality Disorder, Aust N Z J Psychiatry 42(7) https://doi.org/10.1080/00048670802119796
Key Points
"The self-harming actions tend to be managed with behavioural techniques, such as seclusion and restraint, or diversion and distraction. This can be ineffective when the patient’s reasoning behind their self-harming behaviour is not investigated; due to their diagnostic label and frequent presentations, their compulsions to continue to self-harm are frequently misunderstood."
"The significantly lower attitude scores of the clinicians from emergency medicine may be a function of the form of contact that this group typically has with BPD patients. Emergency medicine clinicians are required to provide urgent medical attention to the patient with BPD following episodes of self-harm and this may result in such professionals having a greater difficulty in maintaining an empathetic attitude to such patients. This may also be influenced by the high level of distress in which the patient with BPD presents in the emergency department immediately following self-mutilation or a suicide attempt."
"These differences in professional groups may suggest that basic professional trainings in psychosocial factors in mental illness may predispose allied health clinical to more positive attitudes to patients with severe personality disorders than traditional biomedical trainings. Such differences found between the attitude ratings among allied health professionals and their nursing and medical counterparts may be related to the limited efficacy in the use of the medical model in the psychotherapeutic treatment of BPD."
Note from PDV!: For anybody with lived experience of the symptom cluster that gets labelled BPD, the conclusion that a psychosocial understanding over the biomedical might produce less negative attitudes is not surprising. Personality disorders, while conceptualised as essential individual issues of personality traits by psychology, when considered through the examination of social and cultural influence and the experiences of marginalisation and abuse within the highly hierarchical society we have reveal themselves to be very much a pathologising of what is a reasonable and normal reaction to such an environment. For BPD, the gaslighting and minimising of the pain endured by girls who are overwhelmingly victimised as children is bound to lead to increasing distress and deterioration in a person's identity.
Something common to all these studies of attitudes towards people diagnosed with BPD is the implication that more positive attitudes, often concluded to improve with specific training, would lead necessarily to better treatment. However, the only study I have encountered actually examining attitudes towards BPD vs attitudes toward containment methods challenges this. The correlation is weak, though examination of the data suggests statistically significant, but indicates that positive attitudes towards BPD is associated with more positive attitudes towards the use of observation and restraint. Having nurses enthusiastic to surveil and physically assault people is not what I'd consider a positive outcome. Even if it is sometimes a necessity within the current system, testimony from people who have stayed as an inpatient in psychiatric wards can attest to the fact that restraint is used far more frequently than is necessary and the threat of it is constant and overwhelming, and the lack of privacy, the threat of constant unannounced invasions into your space and surveillance, so far as to wake people every fifteen minutes, can take an incredible toll on a person.
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