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Borderline Personalities; The Impact Of Clinician Bias & Education Shortfalls

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  • 1. A Literature Review Stefanie C. Marshall Argosy University-San Francisco June 20 th , 2010
  • 2.
    • Purpose: Assess and critique common trends of stigma and causation of bias toward Borderline Personality Disorder (BPD) found in clinical settings:
      • Discusses clinician stigma and myths that prevent adequate treatment and resources.
      • Discusses need for further research.
      • Discusses need for continued education programs for clinicians.
      • Recommendations made for education program development plan.
    • Two Reoccurring Themes:
      • Biases toward borderline pathology and its implications prevent clinicians from providing accurate and timely treatment.
      • Lack of education and training for clinicians that focuses on managing and deterring these biases.
  • 3.
    • Borderline Personality Disorder (BPD) has been “a controversial diagnosis among clinicians since its inception, and it is poorly understood among the general public.” (Hersh, 2008, p. 13)
      • “ a characteristic pervasive pattern of instability in affect regulation, impulse control, interpersonal relationships, and self-image.” (Lieb et al., 2004, p. 453)
        • experiences a wide range of intense emotional disturbances.
        • exhibits impulsive behaviors (physically self-destructive & generalized impulsivity).
        • intense unstable relationships characterized by a fear of abandonment.
    • BPD presents in a wide variety of ways, sometimes even in the same patient. (Hersh, 2008)
    • BPD has been described as ever changing, ‘the great imitator’. (Hersh, 2008)
  • 4.
    • A sense of fear toward BPD within clinical settings has created indifference amongst clinical staff.
      • Prevents providing adequate treatment options and resources for their patients.
    • There is lack of training and education for clinicians who are in direct contact with BPD patients.
      • Deficiency in training and education programs perpetuates misunderstanding and indifference toward the disorder.
    • To increase clinicians’ willingness to provide adequate information and resources to BPD patients:
      • Development of comprehensive training programs.
        • Focus on the alleviation of fear of borderline pathology.
      • Education on current treatment options.
  • 5.
    • Search was made of EBSCO host and PsycINFO databases
      • Time period 1995–2010
    • Search words used:
      • borderline personality disorder, treatment, resources, education, and stigma.
    • Ten papers assessed & included:
      • Information related to stigma and clinician bias toward borderline pathology.
      • Studies documenting lack of knowledge, treatment, and resources provided to clinicians and BPD patients.
    • Review included qualitative and quantitative data.
  • 6.
    • The Assessment Intention:
      • Theorize the origin of clinician fears & ways to alleviate them.
      • Seek out research that illustrated potential topics to be included in comprehensive education and training programs for clinicians.
    • Strategies Used:
      • Content analysis:
        • Concepts of clinician aversion toward providing adequate treatment.
        • Topics and interest areas to be included in potential training programs.
    • Common Themes:
      • Correlation between clinician fear and inadequate treatment.
      • Correlation between clinician desire for fear alleviation and willingness to participate in comprehensive training.
  • 7.
    • Clinician Fear:
      • misunderstanding of the mindset of the BPD patient.
      • submission to debunked myths and stereotypes.
    • Result of Clinician Fear:
      • Lack of empathy put forth by clinicians.
      • Difficult for BPD patients to express their needs.
      • Difficulty in receiving adequate care and treatment. (Holm & Severinsson, 2008)
      • Lack of empathy can become trigger for reinforcing BPD pathology.
  • 8.
    • Clinicians’ have a continued belief that there are limited resources available that provide adequate treatments for BPD patients:
      • Research shows numerous treatments that are available and can help BPD patients.
      • Clinicians do not incorporate these treatments into their everyday practice. (Buteau, Dawkins, & Hoffman, 2008)
  • 9.
    • Mysterious Mindset of the BPD patient:
      • Resistance by clinician in seeing disorder as legitimate.
      • Perceiving BPD patients have sociopathic tendencies:
        • Crossing personal and professional boundaries.
        • Manipulate the clinician’s emotions.
        • High risk for liability and lawsuits. (Hersh, 2008)
    • Fear prevents clinicians from being able to completely empathize with and adequately treat and care for BPD patients.
  • 10.
    • Qualitative Reasons for BPD Behavior:
      • Escape or get relief from situations causing extreme distress, i.e. loss of relationship. (Holm & Severinsson, 2008)
      • Obtain attention and care from other people. (Holm & Severinsson, 2008)
      • Splitting of Intent
        • Obtain emotional relief and receive care and attention
  • 11.
    • Clinicians should receive regular access to education and training in the treatment and resources.
    • Research revealed significant results in clinicians’ desires and need for assistance:
      • “ 80% of clinicians indicated that they wanted more information on where to refer clients; 76% wanted skills training workshops; 74% wanted regular education in-services to help deal with BPD, and 70% wanted a specialist service for these clients.” (Cleary, Siegfried, & Walter, 2002, p. 188-189)
  • 12.
    • Education and training can improve professional attitudes toward working with BPD patients. (Commons Treloar & Lewis, 2008)
    • Studies fell short in use of research to develop program recommendations.
      • Indecisive nature towards the legitimacy of BPD.
        • Results in misinterpreting symptoms and missed diagnoses. (Hersh, 2008)
    • Borderline personality disorder must taken seriously and fully acknowledged.
      • Designing and implementing educational and training programs will be a difficult and challenging task to achieve.
  • 13.
    • Recommended Research:
      • Exploration into the patterns and variances of BPD symptoms.
      • Pharmaceutical research
        • None approved by the FDA (Hersh, 2008)
      • Humanistic approaches for therapeutic treatment:
        • Enhance self-confidence
        • Healthy autonomy
        • Reconstruction of core beliefs
  • 14.
    • Development Plan for Education and Training Program:
      • Assessment of the various biases toward the BPD symptoms.
      • Deconstruction of emotional triggers in both real-world and clinical settings.
      • Training on current treatment methods.
      • Supplying resource literature to be utilized in any therapeutic setting.
    • Conclusion: Borderline Personality Disorder
      • Fully acknowledge as legitimate mental disorder.
      • Develop comprehensive educational programs.
      • Alleviate clinician bias and myths toward BPD pathology.
      • Encourage clinicians to provide adequate care, treatment, and resources.
  • 15.
    • Hersh, R. (2008). Confronting myths and stereotypes about borderline personality disorder. Social Work in Mental Health , 6 (1-2), 13-32. doi:10.1300/J200v06n01_03.
    • Lieb, K., Zanarini, M., Schmahl, C., Linehan, M., & Bohus, M. (2004). Borderline personality disorder. The Lancet , 364 (9432), doi:10.1016/S0140-6736(04)16770-6.
    • Holm, A., & Severinsson, E. (2008). The emotional pain and distress of borderline personality disorder: A review of the literature. International Journal of Mental Health Nursing , 17 (1), 27-35. Retrieved from PsycINFO database.
    • Buteau, E., Dawkins, K., & Hoffman, P. (2008). In their own words: Improving services and hopefulness for families dealing with BPD. Social Work in Mental Health , 6 (1-2), 203 214. doi:10.1300/J200v06n01_16.
    • Cleary, M., Siegfried, N., & Walter, G. (2002). Experience, knowledge and attitudes of mental health staff regarding clients with a borderline personality disorder. International Journal of Mental Health Nursing , 11 (3), 186-191. doi:10.1046/j.1440-0979.2002.00246.x.
    • Commons Treloar, A., & Lewis, A. (2008). Professional attitudes towards deliberate self-harm in patients with borderline personality disorder. Australian and New Zealand Journal of Psychiatry , 42 (7), 578-584. doi:10.1080/00048670802119796.