Abstract
The psychological effects of six Diagnostic and Statistical Manual of Mental Disorders (5th ed.; DSM-5) psychiatric labels on respondents were evaluated, three of them being variants of “personality disorder” (PD). Self-selecting students from a university in London, United Kingdom, were invited to take part in a repeated-measures questionnaire study delivered online. One hundred and seventy-three participants completed the questionnaire, responding to 16 items for each of the six mental health labels. Results showed that respondents reported the greatest dysphoric reactions to the “paranoid personality disorder” label, followed by the “borderline” and “antisocial” personality disorder labels, with “major depression,” “anxiety disorder,” and “posttraumatic stress disorder” thereafter. Borderline personality disorder was designated as being least understandable of the six labels. It is evident that the PD psychiatric labels have greater iatrogenic effects than the others included here. From this, we conclude that PD labels produce greater dysphoric consequences because they can be construed as implying a fault in an individual’s core and immutable sense of self, which in turn may cause significant stigma and distress in those to whom they have been applied. We conclude that given these adverse effects of PD labels and conceptual problems associated with the notion of personality disorder, that such labels at the very least should be replaced by more compassionate and self-explanatory terms, which reflect the chronic difficulties forming and maintaining attachments that underpin this group of presenting complaints.
Highlights
Labeling theory, originating in the work of Tannebaum (1938), and later in that of Goffman (1963), argued that having an attribute that is discrediting is stigmatiz-ing, with stigmatized individuals being diminished in the minds of those perceiving the negative attribute and being blamed as the source of the discrediting characteristic, resulting in observers distancing themselves
paranoid personality disorder (PPD) is not included in the hybrid model in DSM-5, and its removal was flagged as a possibility, it remains in DSM-5 as one of the 10 personality disorder” (PD) specified therein
Mental health nurses completed questionnaires to indicate their attitudes and perceptions of patients with borderline personality disorder (BPD), schizophrenia, and depression. Markham found that these respondents were less optimistic about individuals with BPD compared with those designated as having schizophrenia or depression
Summary
Labeling theory, originating in the work of Tannebaum (1938), and later in that of Goffman (1963), argued that having an attribute that is discrediting is stigmatiz-ing, with stigmatized individuals being diminished in the minds of those perceiving the negative attribute and being blamed as the source of the discrediting characteristic, resulting in observers distancing themselves. In the transition from Diagnostic and Statistical Manual for Mental Disorders (4th ed., text rev.; DSM-IV-TR) to DSM-5, there was much debate about the methods by which personality disorders were diagnosed, with a hybrid dimensional-categorical model included in DSM-5 as an alternative for further study (which retains both borderline and antisocial personality disorder [PD] as subtypes). Psychiatric nurses in a study by Fraser and Gallop (1993) reported that they were more empathic to patients diagnosed as having affective disorder than they were with patients diagnosed with BPD This response is unfortunate for clients with BPD, given this group is especially sensitive to rejection and may perceive it as abandonment, thereafter resorting to self-harm or withdrawal from treatment (Brown, 2002). Heller argues that research on BPD indicates that the cause of the disorder is not a “flawed personality,” but rather it is a biologically based brain disorder, with a dysfunction in the limbic system; he proposes thereby that BPD be relabeled “dyslimbia,” with others suggesting it be called “emotional dysregulation disorder” (Porr, 2001)
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