Stigma towards borderline personality disorder: effectiveness and generalizability of an anti-stigma program for healthcare providers using a pre-post randomized design.

Stephanie Knaak,Andrew Ch Szeto,Scott Patten,Kathryn Fitch,Geeta Modgill

doi:10.1186/s40479-015-0030-0

Abstract

BackgroundStigmatization among healthcare providers towards mental illnesses can present obstacles to effective caregiving. This may be especially the case for borderline personality disorder (BPD). Our study measured the impact of a three hour workshop on BPD and dialectical behavior therapy (DBT) on attitudes and behavioral intentions of healthcare providers towards persons with BPD as well as mental illness more generally. The intervention involved educational and social contact elements, all focused on BPD.MethodsThe study employed a pre-post design. We adopted the approach of measuring stigmatization towards persons with BPD in one half of the attendees and stigmatization towards persons with a mental illness in the other half. The stigma-assessment tool was the Opening Minds Scale for Healthcare Providers (OMS-HC). Two versions of the scale were employed – the original version and a ‘BPD-specific’ version. A 2x2 mixed model factorial analysis of variance (ANOVA) was conducted on the dependent variable, stigma score. The between-subject factor was survey type. The within-subject factor was time.ResultsThe mixed-model ANOVA produced a significant between-subject main effect for survey type, with stigma towards persons with BPD being greater than that towards persons with a mental illness more generally. A significant within-subject main effect for time was also observed, with participants showing significant improvement in stigma scores at Time 2. The main effects were subsumed by a significant interaction between time and survey type. Bonferroni post hoc tests indicated significant improvement in attitudes towards BPD and mental illness more generally, although there was a greater improvement in attitudes towards BPD.ConclusionsAlthough effectiveness cannot be conclusively demonstrated with the current research design, results are encouraging that the intervention was successful at improving healthcare provider attitudes and behavioral intentions towards persons with BPD. The results further suggest that anti stigma interventions effective at combating stigma against a specific disorder may also have positive generalizable effects towards a broader set of mental illnesses, albeit to a lessened degree.

Highlights

Stigmatization among healthcare providers towards mental illnesses can present obstacles to effective caregiving
Our study sought to contribute to this literature by examining the extent to which a three hour workshop on borderline personality disorder (BPD) and dialectical behavior therapy (DBT) was effective at improving attitudes and behavioral intentions of healthcare providers towards patients with BPD
Of the 230 participants registered for the session, 191 pre and post surveys were completed (94 paired Opening Minds Scale for Healthcare Providers (OMS-HC) surveys; 97 paired ‘BPD-specific’ surveys), representing a response rate of 83%

Summary

Introduction

Stigmatization among healthcare providers towards mental illnesses can present obstacles to effective caregiving. Stigmatization among healthcare providers towards persons with a mental illness is believed to present obstacles to effective caregiving [1,2,3,4] This may be especially the case for persons with borderline personality disorder (BPD), where it has been suggested that negative reactions can lead to counter-therapeutic conditions including premature termination of treatment, rationalization of treatment failures, a lower likelihood of forming an effective treatment alliance with patients, emotional and social distancing, difficulty empathizing, a lack of belief in recovery, and perceptions of patients as powerful, unrelenting, dangerous, manipulative and more in control of their behaviors than other patients [1,5,6,7,8,9]. Our study sought to contribute to this literature by examining the extent to which a three hour workshop on BPD and dialectical behavior therapy (DBT) was effective at improving attitudes and behavioral intentions of healthcare providers towards patients with BPD. Our study design offered the opportunity to examine spillover effects of the intervention; namely, the impact of this disorderspecific intervention on attitudes towards persons with a mental illness more generally

Methods

Results

Discussion

Conclusion