Finding the balance : the attitudes of mental health profes[s]ionals toward borderline personality disorder

Abstract

Mental health professionals may have less positive attitudes toward clients with a diagnosis of borderline personality disorder (BPD) in comparison to clients with other psychiatric diagnoses. Organisational variables such as collegial support may also impact upon attitudes toward work with clients with BPD. The current research investigated attitudes of New Zealand clinicians toward BPD. Two mini focus groups investigated experiences of clinicians with clients with BPD, with an emphasis on attitudes toward the disorder. The focus groups were analysed using grounded theory. Three major themes emerged: professionalism, cost and value, and deservingness. Focus group results were used in the design of a questionnaire to measure attitudes toward BPD in comparison to schizophrenia. Participants were 235 clinicians who read a vignette about a hypothetical client and responded to attitudinal questions that followed the vignette. Attitudes about the client's presentation, symptom exaggeration, clinician motivation and effectiveness of therapy were assessed. The diagnosis in the vignette was varied between BPD and schizophrenia. A colleague's reaction to the clinician's work was depicted as either positive or negative. Results suggested clinicians held significantly less positive attitudes toward a client with BPD in comparison to a client with schizophrenia (p<0.001). No significant effect for colleague reaction was identified, nor was a significant interaction between diagnosis and colleague reaction found. Contrary to the Contact Hypothesis, amount of contact with clients with BPD or schizophrenia was not related to more positive attitudes toward a hypothetical client with one of these diagnoses. Participants with choice over the type of clients on their caseload showed an association between contact with clients with BPD and positive attitudes toward the hypothetical client with BPD. This was not the case for schizophrenia. The findings of this study may suggest ways to enhance non-pejorative case conceptualisation for clients with different psychiatric diagnoses.