“Judging a book by its cover”

An experimental study of the negative impact of a diagnosis of borderline personality disorder on clinicians’ judgments of uncomplicated panic disorder

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Abstract

Objectives. Diagnosis is ubiquitous in Psychiatry, and whilst it can bring benefits; adverse effects of “labelling” may also be possible. The present study aimed to evaluate experimentally whether clinicians’ judgements about a patient with panic disorder were influenced by an inappropriately suggested diagnosis of co-morbid borderline personality disorder (BPD).
Design. An experimental design was used to evaluate clinician’s judgments when the nature of the information they were given was varied to imply BPD comorbidity.
Methods. Two hundred and sixty five clinicians watched a video recorded assessment of a woman describing her experience of uncomplicated “Panic Disorder”, and then rated her present problems and likely prognosis. Prior to watching the video recording, participants were randomly allocated to one of three conditions with written information including; (a) her personal details and general background; (b) the addition of a behavioural description consistent with BPD; (c) the further addition of a “label” (past BPD diagnosis).
Results. The BPD label was associated with more negative ratings of the woman’s problems and her prognosis than both information alone and a behavioural description of BPD “symptoms”.
Conclusions. Regardless of potential actuarial value of such diagnoses, it is concluded that clinicians can be overly influenced by diagnostic labels in the context of a supposed comorbid problem, although such biases appear to be less likely if a description of the relevant behaviours is used instead. Thus the label, rather than the behaviour it denotes, may be stigmatising in mental health professionals.
Original languageEnglish
Pages (from-to)253-268
JournalBritish Journal of Clinical Psychology
Volume55
Issue number3
Early online date25 Jul 2015
DOIs
Publication statusPublished - Sep 2016

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Borderline Personality Disorder
Panic Disorder
Video Recording
Psychiatry
Comorbidity
Mental Health
Research Design

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@article{bc19f9e9b7d74908a6ad01b4b82377f3,
title = "“Judging a book by its cover”: An experimental study of the negative impact of a diagnosis of borderline personality disorder on clinicians’ judgments of uncomplicated panic disorder",
abstract = "Objectives. Diagnosis is ubiquitous in Psychiatry, and whilst it can bring benefits; adverse effects of “labelling” may also be possible. The present study aimed to evaluate experimentally whether clinicians’ judgements about a patient with panic disorder were influenced by an inappropriately suggested diagnosis of co-morbid borderline personality disorder (BPD).Design. An experimental design was used to evaluate clinician’s judgments when the nature of the information they were given was varied to imply BPD comorbidity. Methods. Two hundred and sixty five clinicians watched a video recorded assessment of a woman describing her experience of uncomplicated “Panic Disorder”, and then rated her present problems and likely prognosis. Prior to watching the video recording, participants were randomly allocated to one of three conditions with written information including; (a) her personal details and general background; (b) the addition of a behavioural description consistent with BPD; (c) the further addition of a “label” (past BPD diagnosis).Results. The BPD label was associated with more negative ratings of the woman’s problems and her prognosis than both information alone and a behavioural description of BPD “symptoms”.Conclusions. Regardless of potential actuarial value of such diagnoses, it is concluded that clinicians can be overly influenced by diagnostic labels in the context of a supposed comorbid problem, although such biases appear to be less likely if a description of the relevant behaviours is used instead. Thus the label, rather than the behaviour it denotes, may be stigmatising in mental health professionals.",
author = "Lam, {Danny C. K.} and Salkovskis, {Paul M.} and Hogg, {Lorna I.}",
year = "2016",
month = "9",
doi = "10.1111/bjc.12093",
language = "English",
volume = "55",
pages = "253--268",
journal = "British Journal of Clinical Psychology",
issn = "0144-6657",
publisher = "Wiley-Blackwell",
number = "3",

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AU - Hogg, Lorna I.

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N2 - Objectives. Diagnosis is ubiquitous in Psychiatry, and whilst it can bring benefits; adverse effects of “labelling” may also be possible. The present study aimed to evaluate experimentally whether clinicians’ judgements about a patient with panic disorder were influenced by an inappropriately suggested diagnosis of co-morbid borderline personality disorder (BPD).Design. An experimental design was used to evaluate clinician’s judgments when the nature of the information they were given was varied to imply BPD comorbidity. Methods. Two hundred and sixty five clinicians watched a video recorded assessment of a woman describing her experience of uncomplicated “Panic Disorder”, and then rated her present problems and likely prognosis. Prior to watching the video recording, participants were randomly allocated to one of three conditions with written information including; (a) her personal details and general background; (b) the addition of a behavioural description consistent with BPD; (c) the further addition of a “label” (past BPD diagnosis).Results. The BPD label was associated with more negative ratings of the woman’s problems and her prognosis than both information alone and a behavioural description of BPD “symptoms”.Conclusions. Regardless of potential actuarial value of such diagnoses, it is concluded that clinicians can be overly influenced by diagnostic labels in the context of a supposed comorbid problem, although such biases appear to be less likely if a description of the relevant behaviours is used instead. Thus the label, rather than the behaviour it denotes, may be stigmatising in mental health professionals.

AB - Objectives. Diagnosis is ubiquitous in Psychiatry, and whilst it can bring benefits; adverse effects of “labelling” may also be possible. The present study aimed to evaluate experimentally whether clinicians’ judgements about a patient with panic disorder were influenced by an inappropriately suggested diagnosis of co-morbid borderline personality disorder (BPD).Design. An experimental design was used to evaluate clinician’s judgments when the nature of the information they were given was varied to imply BPD comorbidity. Methods. Two hundred and sixty five clinicians watched a video recorded assessment of a woman describing her experience of uncomplicated “Panic Disorder”, and then rated her present problems and likely prognosis. Prior to watching the video recording, participants were randomly allocated to one of three conditions with written information including; (a) her personal details and general background; (b) the addition of a behavioural description consistent with BPD; (c) the further addition of a “label” (past BPD diagnosis).Results. The BPD label was associated with more negative ratings of the woman’s problems and her prognosis than both information alone and a behavioural description of BPD “symptoms”.Conclusions. Regardless of potential actuarial value of such diagnoses, it is concluded that clinicians can be overly influenced by diagnostic labels in the context of a supposed comorbid problem, although such biases appear to be less likely if a description of the relevant behaviours is used instead. Thus the label, rather than the behaviour it denotes, may be stigmatising in mental health professionals.

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