Effects of diagnostic disclosure and varying diagnostic terminology on social attitudes to personality disorder: An experimental vignette study.

Abstract

Personality disorder (PD) diagnosis is currently in flux, with the latest edition of the International Classification of Diseases proposing to overhaul PD classification. The stigma purportedly attached to PD labels is a common concern in debates about PD diagnosis. However, there is a paucity of data on the general public's attitudes to PD diagnoses. The current study used an experimental vignette method to explore (a) whether attitudes to a person displaying undesirable behavior are affected by disclosing a PD diagnosis, and (b) whether the different variants of PD diagnoses present in Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition and International Classification of Diseases elicit different social responses. Participants (n ϭ 328) were recruited via an online platform and randomly assigned to read one of six vignettes. Vignettes described a person displaying socially undesirable behaviors, whose diagnosis was either withheld or defined as Borderline, Antisocial, Mild, Moderate, or Severe PD. Participants then completed a battery of measures assessing their attitudes to the vignette character. Relative to groups who were told of a PD diagnosis, diagnostically unaware participants were less likely to see the person's problems as biologically caused, expected the problems would be shorter in duration, and attributed the character more a greater degree of personal control over their conduct. Withholding a diagnosis also resulted in greater anger and social distance and less positive affect and pity. Between the conditions in which different diagnostic classifications were stated, the specific terminology used had minimal effect. Results suggest that disclosing a PD diagnosis may ameliorate negative responses to undesirable behavior, irrespective of the particular diagnostic terminology used.

Borderline personality disorder stigma: Examining the effects of diagnostic disclosure, behavior, and gender as sources of stigma in the general population.

“…Specifically, although stigma associated with BPD symptoms appeared to decrease when a BPD diagnosis was provided, no significant differences were observed for the fear, coercion, segregation, avoidance, and dangerousness subscales. This finding is contrary to what was hypothesized and what has been shown in similar experimental studies with online community samples demonstrating that attaching a diagnosis to disordered behavior reduced levels of anger and desire to social distance (Masland & Null, 2022), as well as increased anger, pity, and desire to social distance when there was no diagnosis provided (O’Connor & Murphy, 2021). Instead, the current findings suggest that disclosing a diagnosis of BPD to the general population when displaying disordered behavior does not seem to attenuate stigma, and it may not actually matter for stigma levels whether a person discloses a diagnosis of BPD.…”

“…The balanced sample feature on Prolific was used to allow for an equal distribution of self-identified men and women participants. The study was advertised in accordance with similar stigma studies, indicating that this research examines how people form impressions based on different personality traits (O'Connor & Murphy, 2021). A summary of participant characteristics is shown in Table 1.…”

“…More recent work demonstrates that characters labeled as a man with BPD are perceived as more dangerous and evoke higher levels of fear, whereas women characters with the disorder are viewed with greater levels of pity (Masland & Null, 2022). Moreover, in another study, a hypothetical vignette character with a gender-neutral name was more likely to be labeled as a man (O’Connor & Murphy, 2021). Generally, these findings suggest a contrast to existing beliefs of stigma surrounding women with BPD.…”

“…Moreover, this study explores whether attaching a diagnosis of BPD to symptomatic behavior or nonclinical behavior, namely behavior that has certain elements of BPD symptoms but is not indicative of BPD symptoms, influences stigma. Based on extant literature (Masland & Null, 2022; O’Connor & Murphy, 2021), it is hypothesized that attaching a diagnosis of BPD to symptomatic behavior will be associated with lower levels of stigma while attaching a diagnosis to nonclinical behavior will lead to greater levels of stigma. The current study also aims to determine whether the gender of the target individual influences the stigmatization of BPD.…”

Quantifying the psychological and behavioural consequences of a diagnostic label for non-cancer conditions: systematic review

“…To date, research on the impacts of diagnostic labelling has predominantly focused on intervention effectiveness, including symptom management or eradication, associated stigma and/or have been conducted using hypothetical, vignette or scenariobased studies. 4,[18][19][20][21] Although important, this research overlooks the specific impact of a diagnostic label in real-world contexts.…”