WEEK 3 LITERATURE
LECTURE 5
o To identify and distinguish the different types of stigma, incl.:
o Characteristics
o Prevalence rate
o Origin/how these stigmas come about
o Differences between PDs
o Unique position of adolescents
o To identify good vs. poor anti-stigma interventions
o To identify potential (neg) effects of stigma
o To apply knowledge of stigma in PD to clinical examples
Sheehan 2016 – the stigma of personality disorders
defining stigma
- stigma: social rejection resulting from negatively perceived characteristics
o this rejection leads to spoiled identity of the stigmatized person
- 4 qualities of stigma:
o individual differences are recognized
o these differences are perceived by society as negative
o the stigmatized group is seen as the outgroup
o end result is loss of opportunity, power or status
- social-cognitive perspective:
o stigma includes stereotypes (cognitive), prejudice (affective), and
discrimination (behavioral)
- public stigma manifests in many forms, from lack of eye contact to complete
ostracization
- public stigma becomes internalized into self-stigma if the person believes the
negative societal attitudes are true
- self-stigma might lead to low self-esteem, depression, lack of motivation
- structural stigma occurs when stigmatizing beliefs and attitudes lead to unfair social
institutions and policies for stigmatized group
,stigma of mental illness
- stereotypes and prejudices cause discriminatory treatment
- incompetence, dangerousness and irresponsibility are the most commonly endorsed
stereotypes
o media reports exaggerate violence, fueling people with mental illness to live
in poor neighborhoods, avoidance and withdrawal
o people with mental illnesses are blamed for their illnesses
- attitude toward mental illness has not improved over time
- “why try” effect: recovery efforts stall when the person believes stigmatized
mentality of incompetence
- those who fail to seek treatment are seen as “crazy”
public stigma of PDs
- PDs might be more stigmatized than other diagnoses
- fear and frustration among common public with PDs
- symptoms are viewed as manipulations or rejections of help
o can cause people to be seen as difficult and misbehaving rather than sick
- general public has less knowledge about PDs than other illnesses
- only 2.3% recognize BPD symptoms, whereas 72.5% recognized depression and
65.6% recognizes schizophrenia
- mental health literacy is connected to treatment seeking behavior and stigma
- people with PDs are ostracized rather than being referred and less likely to recognize
their own symptoms
BPD
- most stigmatized of all PDs
- people with BPD are seen as annoying and undeserving
- frequent contact with law due to anger and suicidality, leading police to feel
frustrated, angry
- officers might get more frustrated if they think people with PDs are intentionally
troublesome
- when people with BPD are seen as deliberately wasting police time, they could
experience harsher treatments and services
Antisocial PD
- self-fulfilling prophecy where child believes s/he is a bad person and engages in a
future of crime life
- stigma of dangerousness can lead to denied treatment and recovery especially within
the justice system
- often referred as psychopaths or sociopaths and stigmatized as evil
- seen as more violent but sane and responsible for their actions
- most court officials don’t consider ASPD as a mental illness
- being labeled with ASPD might affect sentencing and possibility for death penalty
- bc of these attitudes people with ASPD are not able to complete rehabilitation while
in prison system
- recent evidence: ASPD is associated with brain abnormalities which may lead the
justice system to re-evaluate
,OCPD
- due to similarity to OCD, OCPD is a well-understood PD by general public
- the public sees people with OCPD quite open to treatment
- public understanding: OCPD is taught to be caused by childhood experience,
parenting styles, stress/anxiety, and can be treated with CBT
- more favorable, less stigma
Narcissistic PD
- not familiar to the general public
- no research examines stigma for this but a recent survey found that people with NPD
are seen as fragile, lacking self-esteem and experiencing problematic social
relationships
- NPD is also seen as a potential advantage in business contexts
- lack of understanding suggests potential stigma, more research needed
provider stigma
- negative attitudes and behaviors of health care professionals toward people with
PDs, especially BPD
- one study: psychiatric nurses have the most stigmatizing attitudes
- diff study: psychiatrists have the lowest empathy toward people with BPD in
comparison to other professionals
- negative provider attitudes
o can lead to differential treatment
o can reduce the amount of services available
o reduce quality of services
o discourage people from seeking and continuing treatment
o for BPD, may even cause exclusion from treatment
o lead to poor decisions to hospitalize and assign negative traits
- perceived discrimination is common when they seek hospital admission in times of
crisis
- suicide attempts are seen as attention-seeking rather than sign of illness
- BPD patients are discharged quicker from the ER than others
self-stigma
- can lead to problems with self-esteem, depression and identity
- self-stigma in BPD bc of shame they may avoid diagnosis and treatment to avoid
self-labeling as sick, weak and incapable
- BPD patients have more existential shame than others
structural stigma
- impact availability of services, quality of services, insurance coverage, research of PD
- although PDs are more prevalent, there is less funding, research and services
- diagnostic and screening tools are absent or not sufficient
- bc of overlap between BPD and bipolar or PTSD; people get misdiagnosed
- psychiatrists may avoid diagnosis of PD to protect people from the systemic stigma
, anti-stigma interventions for PDs
- education: correcting misperceptions
- interactive presentation of stories of recovery
- meta-analysis: interventions with education and meaningful interpersonal contact
are most effective
- contact with health provides is trickier: health professionals who have more
experience with BPD more negative or positive views mixed results
- designs that combat diagnostic-specific stigma: e.g. 2-days of BPD anti-stigma
training
o positive results, positive attitudes, improved relationships, lower desire for
social distance and 6-month maintenance
- recent brain imaging shows differences in PD brains and challenge the belief that PDs
are character flaws or intentional
o but criticism: this might increase the notions of differentness and downplays
the possibility for change or recovery
o this prevention shows change in knowledge and attitude but not empathy
o instead: combining neurobiological info about causes with recovery-oriented
info more effective
gaps in the literature
- explore stigma differences for diff PDs or between clusters
- explore how stigma manifests within the context of diff services
- PD stigma interacting with co-occurring stigma conditions explore impact of
multiple stigmas
CATHOOR 2015 – ADOLESCENTS WITH PDS SUFFER FROM SEVERE PSYCHIATRIC STIGMA
general mental disorders and stigma
- lack of stigma research on adolescents and kids
- stigma research focused on minors show that public stigma is condition-specific
- labeling antisocial behavior in youth as delinquent leads to poorer diagnoses
- minors with ADHD or depression are thought to be more dangerous than others
- adolescents receive the most-stigmatizing reaction of all age groups
- associative stigma: form of social disapproval bc of its direct connection with the
stigmatized person, associative stigma is bidirectional
o parents are directly blamed for the mental disturbance of their children, and
children are seen as a part of mentally disturbed family
- adolescents hesitate to apply diagnostic labels to themselves
o desire not to distinguish themselves from normality
o self-labeling in ado. is demoralizing, stigmatizing, disempowering
o ado. assess their problems only when they experience then for longer times
- ado. with depression rate their own depression stigma lower than other’s depression
stigma
o ado. who were briefly hospitalized for psy reasons show low levels of stigma
apprehension
- evidence that receiving a label of a mental illness is stigmatizing, but can also be
beneficial for treatment
LECTURE 5
o To identify and distinguish the different types of stigma, incl.:
o Characteristics
o Prevalence rate
o Origin/how these stigmas come about
o Differences between PDs
o Unique position of adolescents
o To identify good vs. poor anti-stigma interventions
o To identify potential (neg) effects of stigma
o To apply knowledge of stigma in PD to clinical examples
Sheehan 2016 – the stigma of personality disorders
defining stigma
- stigma: social rejection resulting from negatively perceived characteristics
o this rejection leads to spoiled identity of the stigmatized person
- 4 qualities of stigma:
o individual differences are recognized
o these differences are perceived by society as negative
o the stigmatized group is seen as the outgroup
o end result is loss of opportunity, power or status
- social-cognitive perspective:
o stigma includes stereotypes (cognitive), prejudice (affective), and
discrimination (behavioral)
- public stigma manifests in many forms, from lack of eye contact to complete
ostracization
- public stigma becomes internalized into self-stigma if the person believes the
negative societal attitudes are true
- self-stigma might lead to low self-esteem, depression, lack of motivation
- structural stigma occurs when stigmatizing beliefs and attitudes lead to unfair social
institutions and policies for stigmatized group
,stigma of mental illness
- stereotypes and prejudices cause discriminatory treatment
- incompetence, dangerousness and irresponsibility are the most commonly endorsed
stereotypes
o media reports exaggerate violence, fueling people with mental illness to live
in poor neighborhoods, avoidance and withdrawal
o people with mental illnesses are blamed for their illnesses
- attitude toward mental illness has not improved over time
- “why try” effect: recovery efforts stall when the person believes stigmatized
mentality of incompetence
- those who fail to seek treatment are seen as “crazy”
public stigma of PDs
- PDs might be more stigmatized than other diagnoses
- fear and frustration among common public with PDs
- symptoms are viewed as manipulations or rejections of help
o can cause people to be seen as difficult and misbehaving rather than sick
- general public has less knowledge about PDs than other illnesses
- only 2.3% recognize BPD symptoms, whereas 72.5% recognized depression and
65.6% recognizes schizophrenia
- mental health literacy is connected to treatment seeking behavior and stigma
- people with PDs are ostracized rather than being referred and less likely to recognize
their own symptoms
BPD
- most stigmatized of all PDs
- people with BPD are seen as annoying and undeserving
- frequent contact with law due to anger and suicidality, leading police to feel
frustrated, angry
- officers might get more frustrated if they think people with PDs are intentionally
troublesome
- when people with BPD are seen as deliberately wasting police time, they could
experience harsher treatments and services
Antisocial PD
- self-fulfilling prophecy where child believes s/he is a bad person and engages in a
future of crime life
- stigma of dangerousness can lead to denied treatment and recovery especially within
the justice system
- often referred as psychopaths or sociopaths and stigmatized as evil
- seen as more violent but sane and responsible for their actions
- most court officials don’t consider ASPD as a mental illness
- being labeled with ASPD might affect sentencing and possibility for death penalty
- bc of these attitudes people with ASPD are not able to complete rehabilitation while
in prison system
- recent evidence: ASPD is associated with brain abnormalities which may lead the
justice system to re-evaluate
,OCPD
- due to similarity to OCD, OCPD is a well-understood PD by general public
- the public sees people with OCPD quite open to treatment
- public understanding: OCPD is taught to be caused by childhood experience,
parenting styles, stress/anxiety, and can be treated with CBT
- more favorable, less stigma
Narcissistic PD
- not familiar to the general public
- no research examines stigma for this but a recent survey found that people with NPD
are seen as fragile, lacking self-esteem and experiencing problematic social
relationships
- NPD is also seen as a potential advantage in business contexts
- lack of understanding suggests potential stigma, more research needed
provider stigma
- negative attitudes and behaviors of health care professionals toward people with
PDs, especially BPD
- one study: psychiatric nurses have the most stigmatizing attitudes
- diff study: psychiatrists have the lowest empathy toward people with BPD in
comparison to other professionals
- negative provider attitudes
o can lead to differential treatment
o can reduce the amount of services available
o reduce quality of services
o discourage people from seeking and continuing treatment
o for BPD, may even cause exclusion from treatment
o lead to poor decisions to hospitalize and assign negative traits
- perceived discrimination is common when they seek hospital admission in times of
crisis
- suicide attempts are seen as attention-seeking rather than sign of illness
- BPD patients are discharged quicker from the ER than others
self-stigma
- can lead to problems with self-esteem, depression and identity
- self-stigma in BPD bc of shame they may avoid diagnosis and treatment to avoid
self-labeling as sick, weak and incapable
- BPD patients have more existential shame than others
structural stigma
- impact availability of services, quality of services, insurance coverage, research of PD
- although PDs are more prevalent, there is less funding, research and services
- diagnostic and screening tools are absent or not sufficient
- bc of overlap between BPD and bipolar or PTSD; people get misdiagnosed
- psychiatrists may avoid diagnosis of PD to protect people from the systemic stigma
, anti-stigma interventions for PDs
- education: correcting misperceptions
- interactive presentation of stories of recovery
- meta-analysis: interventions with education and meaningful interpersonal contact
are most effective
- contact with health provides is trickier: health professionals who have more
experience with BPD more negative or positive views mixed results
- designs that combat diagnostic-specific stigma: e.g. 2-days of BPD anti-stigma
training
o positive results, positive attitudes, improved relationships, lower desire for
social distance and 6-month maintenance
- recent brain imaging shows differences in PD brains and challenge the belief that PDs
are character flaws or intentional
o but criticism: this might increase the notions of differentness and downplays
the possibility for change or recovery
o this prevention shows change in knowledge and attitude but not empathy
o instead: combining neurobiological info about causes with recovery-oriented
info more effective
gaps in the literature
- explore stigma differences for diff PDs or between clusters
- explore how stigma manifests within the context of diff services
- PD stigma interacting with co-occurring stigma conditions explore impact of
multiple stigmas
CATHOOR 2015 – ADOLESCENTS WITH PDS SUFFER FROM SEVERE PSYCHIATRIC STIGMA
general mental disorders and stigma
- lack of stigma research on adolescents and kids
- stigma research focused on minors show that public stigma is condition-specific
- labeling antisocial behavior in youth as delinquent leads to poorer diagnoses
- minors with ADHD or depression are thought to be more dangerous than others
- adolescents receive the most-stigmatizing reaction of all age groups
- associative stigma: form of social disapproval bc of its direct connection with the
stigmatized person, associative stigma is bidirectional
o parents are directly blamed for the mental disturbance of their children, and
children are seen as a part of mentally disturbed family
- adolescents hesitate to apply diagnostic labels to themselves
o desire not to distinguish themselves from normality
o self-labeling in ado. is demoralizing, stigmatizing, disempowering
o ado. assess their problems only when they experience then for longer times
- ado. with depression rate their own depression stigma lower than other’s depression
stigma
o ado. who were briefly hospitalized for psy reasons show low levels of stigma
apprehension
- evidence that receiving a label of a mental illness is stigmatizing, but can also be
beneficial for treatment
