Borderline Personalities; The Impact Of Clinician Bias & Education Shortfalls


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Borderline Personalities; The Impact Of Clinician Bias & Education Shortfalls

  1. 1. A Literature Review Stefanie C. Marshall Argosy University-San Francisco June 20 th , 2010
  2. 2. <ul><li>Purpose: Assess and critique common trends of stigma and causation of bias toward Borderline Personality Disorder (BPD) found in clinical settings: </li></ul><ul><ul><li>Discusses clinician stigma and myths that prevent adequate treatment and resources. </li></ul></ul><ul><ul><li>Discusses need for further research. </li></ul></ul><ul><ul><li>Discusses need for continued education programs for clinicians. </li></ul></ul><ul><ul><li>Recommendations made for education program development plan. </li></ul></ul><ul><li>Two Reoccurring Themes: </li></ul><ul><ul><li>Biases toward borderline pathology and its implications prevent clinicians from providing accurate and timely treatment. </li></ul></ul><ul><ul><li>Lack of education and training for clinicians that focuses on managing and deterring these biases. </li></ul></ul>
  3. 3. <ul><li>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) </li></ul><ul><ul><li>“ a characteristic pervasive pattern of instability in affect regulation, impulse control, interpersonal relationships, and self-image.” (Lieb et al., 2004, p. 453) </li></ul></ul><ul><ul><ul><li>experiences a wide range of intense emotional disturbances. </li></ul></ul></ul><ul><ul><ul><li>exhibits impulsive behaviors (physically self-destructive & generalized impulsivity). </li></ul></ul></ul><ul><ul><ul><li>intense unstable relationships characterized by a fear of abandonment. </li></ul></ul></ul><ul><li>BPD presents in a wide variety of ways, sometimes even in the same patient. (Hersh, 2008) </li></ul><ul><li>BPD has been described as ever changing, ‘the great imitator’. (Hersh, 2008) </li></ul>
  4. 4. <ul><li>A sense of fear toward BPD within clinical settings has created indifference amongst clinical staff. </li></ul><ul><ul><li>Prevents providing adequate treatment options and resources for their patients. </li></ul></ul><ul><li>There is lack of training and education for clinicians who are in direct contact with BPD patients. </li></ul><ul><ul><li>Deficiency in training and education programs perpetuates misunderstanding and indifference toward the disorder. </li></ul></ul><ul><li>To increase clinicians’ willingness to provide adequate information and resources to BPD patients: </li></ul><ul><ul><li>Development of comprehensive training programs. </li></ul></ul><ul><ul><ul><li>Focus on the alleviation of fear of borderline pathology. </li></ul></ul></ul><ul><ul><li>Education on current treatment options. </li></ul></ul>
  5. 5. <ul><li>Search was made of EBSCO host and PsycINFO databases </li></ul><ul><ul><li>Time period 1995–2010 </li></ul></ul><ul><li>Search words used: </li></ul><ul><ul><li>borderline personality disorder, treatment, resources, education, and stigma. </li></ul></ul><ul><li>Ten papers assessed & included: </li></ul><ul><ul><li>Information related to stigma and clinician bias toward borderline pathology. </li></ul></ul><ul><ul><li>Studies documenting lack of knowledge, treatment, and resources provided to clinicians and BPD patients. </li></ul></ul><ul><li>Review included qualitative and quantitative data. </li></ul>
  6. 6. <ul><li>The Assessment Intention: </li></ul><ul><ul><li>Theorize the origin of clinician fears & ways to alleviate them. </li></ul></ul><ul><ul><li>Seek out research that illustrated potential topics to be included in comprehensive education and training programs for clinicians. </li></ul></ul><ul><li>Strategies Used: </li></ul><ul><ul><li>Content analysis: </li></ul></ul><ul><ul><ul><li>Concepts of clinician aversion toward providing adequate treatment. </li></ul></ul></ul><ul><ul><ul><li>Topics and interest areas to be included in potential training programs. </li></ul></ul></ul><ul><li>Common Themes: </li></ul><ul><ul><li>Correlation between clinician fear and inadequate treatment. </li></ul></ul><ul><ul><li>Correlation between clinician desire for fear alleviation and willingness to participate in comprehensive training. </li></ul></ul>
  7. 7. <ul><li>Clinician Fear: </li></ul><ul><ul><li>misunderstanding of the mindset of the BPD patient. </li></ul></ul><ul><ul><li>submission to debunked myths and stereotypes. </li></ul></ul><ul><li>Result of Clinician Fear: </li></ul><ul><ul><li>Lack of empathy put forth by clinicians. </li></ul></ul><ul><ul><li>Difficult for BPD patients to express their needs. </li></ul></ul><ul><ul><li>Difficulty in receiving adequate care and treatment. (Holm & Severinsson, 2008) </li></ul></ul><ul><ul><li>Lack of empathy can become trigger for reinforcing BPD pathology. </li></ul></ul>
  8. 8. <ul><li>Clinicians’ have a continued belief that there are limited resources available that provide adequate treatments for BPD patients: </li></ul><ul><ul><li>Research shows numerous treatments that are available and can help BPD patients. </li></ul></ul><ul><ul><li>Clinicians do not incorporate these treatments into their everyday practice. (Buteau, Dawkins, & Hoffman, 2008) </li></ul></ul>
  9. 9. <ul><li>Mysterious Mindset of the BPD patient: </li></ul><ul><ul><li>Resistance by clinician in seeing disorder as legitimate. </li></ul></ul><ul><ul><li>Perceiving BPD patients have sociopathic tendencies: </li></ul></ul><ul><ul><ul><li>Crossing personal and professional boundaries. </li></ul></ul></ul><ul><ul><ul><li>Manipulate the clinician’s emotions. </li></ul></ul></ul><ul><ul><ul><li>High risk for liability and lawsuits. (Hersh, 2008) </li></ul></ul></ul><ul><li>Fear prevents clinicians from being able to completely empathize with and adequately treat and care for BPD patients. </li></ul>
  10. 10. <ul><li>Qualitative Reasons for BPD Behavior: </li></ul><ul><ul><li>Escape or get relief from situations causing extreme distress, i.e. loss of relationship. (Holm & Severinsson, 2008) </li></ul></ul><ul><ul><li>Obtain attention and care from other people. (Holm & Severinsson, 2008) </li></ul></ul><ul><ul><li>Splitting of Intent </li></ul></ul><ul><ul><ul><li>Obtain emotional relief and receive care and attention </li></ul></ul></ul>
  11. 11. <ul><li>Clinicians should receive regular access to education and training in the treatment and resources. </li></ul><ul><li>Research revealed significant results in clinicians’ desires and need for assistance: </li></ul><ul><ul><li>“ 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) </li></ul></ul>
  12. 12. <ul><li>Education and training can improve professional attitudes toward working with BPD patients. (Commons Treloar & Lewis, 2008) </li></ul><ul><li>Studies fell short in use of research to develop program recommendations. </li></ul><ul><ul><li>Indecisive nature towards the legitimacy of BPD. </li></ul></ul><ul><ul><ul><li>Results in misinterpreting symptoms and missed diagnoses. (Hersh, 2008) </li></ul></ul></ul><ul><li>Borderline personality disorder must taken seriously and fully acknowledged. </li></ul><ul><ul><li>Designing and implementing educational and training programs will be a difficult and challenging task to achieve. </li></ul></ul>
  13. 13. <ul><li>Recommended Research: </li></ul><ul><ul><li>Exploration into the patterns and variances of BPD symptoms. </li></ul></ul><ul><ul><li>Pharmaceutical research </li></ul></ul><ul><ul><ul><li>None approved by the FDA (Hersh, 2008) </li></ul></ul></ul><ul><ul><li>Humanistic approaches for therapeutic treatment: </li></ul></ul><ul><ul><ul><li>Enhance self-confidence </li></ul></ul></ul><ul><ul><ul><li>Healthy autonomy </li></ul></ul></ul><ul><ul><ul><li>Reconstruction of core beliefs </li></ul></ul></ul>
  14. 14. <ul><li>Development Plan for Education and Training Program: </li></ul><ul><ul><li>Assessment of the various biases toward the BPD symptoms. </li></ul></ul><ul><ul><li>Deconstruction of emotional triggers in both real-world and clinical settings. </li></ul></ul><ul><ul><li>Training on current treatment methods. </li></ul></ul><ul><ul><li>Supplying resource literature to be utilized in any therapeutic setting. </li></ul></ul><ul><li>Conclusion: Borderline Personality Disorder </li></ul><ul><ul><li>Fully acknowledge as legitimate mental disorder. </li></ul></ul><ul><ul><li>Develop comprehensive educational programs. </li></ul></ul><ul><ul><li>Alleviate clinician bias and myths toward BPD pathology. </li></ul></ul><ul><ul><li>Encourage clinicians to provide adequate care, treatment, and resources. </li></ul></ul>
  15. 15. <ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul><ul><li>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. </li></ul>