Clinician Attitudes toward Borderline Personality Disorder - Essay Example

?Clinician Attitudes toward Borderline Personality Disorder This study is aiming to provide information on attitudes of various mental health workerstowards patients with Borderline Personality Disorder (BPD). BPD is a controversial mental illness, particularly because a diagnosis stigmatizes patients, without giving a clear treatment or prognosis pathway. These issues have caused many to believe that the word borderline should be removed to encourage BPD to be seen more seriously. This study aims to prove that often, even the mental health clinicians dealing with BPD have less than sympathetic views on the disorder. The study is correlational, because there are no experimental techniques used. Correlational studies look to show the relationship between variables and results. This study looks to see correlation between sub-types of clinician, years worked in mental health care and number of patients with BPD cared for in the past year and the attitudes toward patients with BPD. It is also a cross-sectional study, in that it provides information on attitudes at a certain point in time. The questionnaire was distributed to all relevant clinicians at all nine centers simultaneously, and thus all responses were formed at a similar point in time. The study provides no information on how the variables may affect the participants over time (and is thus not a longitudinal study). The subjects were 706 mental health clinicians (clinicians in this case being an umbrella term for nurses, physicians, social workers, psychologists, etc.) from 9 different academic centers. Every clinician within these centers was provided with a questionnaire, and the 706 respondents were those that replied – they were a self-selecting sample. The issue with this is that there may be a subtype of person who is more likely to respond to this type of survey – they may have more time available than others and thus may be more understanding of patients with BPD, or the other way around. Either way, this lowers the generalizability of the study - the only truly generalizable test would incorporate the views of all clinicians at a full range of mental health provision centers. With regards to external validity, the fact that the questionnaire was anonymous raises the chances of the responses given being true and thus generalized from the study settings to reality. However, the aforementioned subtype of clinician likely to respond and the very nature of questionnaires mean that any responses lack true ecological validity. The primary variables, as defined by the study, were the specific subgroup of clinician (psychiatrist, psychiatry resident, social worker, staff nurse, nurse practitioner/physician assistant, psychologist, and “other”), the number of years having worked with mental health patients, and the number of patients with BPD that the individual has worked with over the past year. The secondary variables or covariates were the gender of the individual and the center at which they worked. In my opinion, the primary variables were reasonable for this study. The specific subgroup opinion was part of the hypothesis (the coordinators of the study made predictions such as ‘social workers will have more caring attitudes’) and thus was a key variable. The number of patients with BPD that the individual has worked with is also key. The number-based variables were assessed in groups, such as 0-5, 6-10 etc., and again this is a reasonable measurement, although there are some issues where a clinician has worked in the area for 5 years – the individual may have attitudes more similar to the 6-10 group. The subgroup variable was also useful as it had a diverse range of roles available, although the “other” group may be too ambiguous and provide results that need further probing. The main problem with the study is the fact that the subtype of clinician was highly variable in the number of respondents – 227 psychiatrists responded, compared to only 17 nurse practitioners. This means that any conclusion formed from the responses of the categories with low number of respondents (nurse practitioners, psychologists) is less valid than conclusions formed from the responses from psychiatrists. For example, the study concludes that staff nurses and social workers had less empathy overall for patients with BPD, but this is not necessarily representative when considering the small sample size. However, the fact that most of the analysis was statistical and did not come to many significant conclusions means that manipulation is less likely (or at least less obvious). Cause is definitely not being inferred without good reason (the authors of the study seem very reluctant to draw any conclusion, particularly based on the variables) although the problems mentioned throughout this review (the type of person likely to respond to a questionnaire, the small sample sizes) and others (the possibility of leading questions, the fact that all respondents were from academic centers) mean that any conclusion does not have full external validity and may be false. The main conclusion of the study was that overall, mental health clinicians did not have particularly sympathetic views towards those with BPD, and do not give particularly good prognoses for these patients. As a group, there was a reluctance to deal with BPD patients. This conclusion dismisses all variables discussed earlier and thus perhaps is too much of a generalization where one should not be made. This conclusion also takes away from the fact that the study was designed to investigate the effect of the aforementioned variables. The study itself recommends that a longitudinal study should be carried out to observe if dealing with more patients with BPD changes the clinicians’ view of the disorder. This could help remove a significant problem identified by those who analyzed the study. There is a positive correlation between the number of BPD patients that a clinician has seen in the past year and a caring and sympathetic view of BPD. However, it is unclear from a cross-sectional study if someone who has an initial sympathy for BPD patients is more likely to choose to work with BPD individuals, or if repeated exposure provokes this attitude. A longitudinal study that tracked the evolution of responses throughout the career of these clinicians could help provide information on this. Other research that could be undertaken to support this study could be to ask more qualitative questions. The questionnaire relied solely on scaled questions, which are not always appropriate when talking about something as anthropocentric and personal as a mental health disorder. Conducting interviews with clinicians could also help remove this issue. Additionally, the very nature of the questionnaire allows people to falsify the results. Some respondents may be skeptical of the anonymity of the survey and attempt to appear more caring than they initially are. Even without the impulse to falsify, it is often hard to measure your own capability and attitudes in the workplace. Watching the clinicians in their dealings with BPD patients would provide more realistic information on the attitudes to caring that these clinicians have. As previously mentioned, the number of respondents to this questionnaire is fairly large, but the number within each sub-group of clinician is far smaller. This means that the value of the results based on the sub-group variable is lower than the value of results based on clinicians as a whole. Distributing the questionnaire would help to remove this problem. The study also suggests that the response rate was less than 50%, meaning that there is a large proportion of the target demographic that have not been considered when drawing conclusions. Making the questionnaire mandatory would significantly improve the generalizability of this test. However, making the survey mandatory could cause respondents to answer the questions in a careless manner, again leading to false results. Any anger towards being forced to take part in a task could manifest itself in the result and again reduce ecological validity. Finally, the psychometric values of the questionnaire have not been officially tested. The questionnaire was developed in accordance with each of the centers, and has face-value, but the lack of true testing for the questionnaire leads the results to be considered exploratory. Original Article: Kreger, Randi. "New Study Shows Clinician Attitudes about BPD (and Borderline Patients) Differ by Experience and Type of Clinician | Psychology Today." Psychology Today: Health, Help, Happiness Find a Therapist. 02 Apr. 2011. Web. 03 Apr. 2011. . Read More