Motion: 'the stigma attached to personality disorder is inevitable'

For...

You need to establish rapport before you can talk about the substance use and its treatment. If there is no rapport then there is no point to any kind of intervention; service users will not take in anything that is said to them, they will probably dislike their practitioner, and are likely to drop out.

Against...

Establishing rapport is important and needs to be part of dealing with the problem the service user wants help with. It is no good wasting time just trying to strike up some rapport. Service users want to know that they are going to get the help they need and that their practitioner has that as their focus.

For... There is a low level of understanding personality disorder in the general population and this results in mislabelling and negatively labelling its manifestations. There is also a perception that there is little that can be done about personality disorder. To exacerbate the problem, personality disorder is often manifest in behaviours that are socially disruptive. Against... There is a low level of understanding of both mental and physical health disorders in the general population: most illnesses and disorders are stigmatised but nonetheless the stigma can and should be addressed. One of the ways to address the stigma is to familiarise the population with the fact that help can be given for both the patient and their friends and family to manage the problem. This summary of a research article should help you clarify your thoughts on the issues raised by the debate… Psychiatric Literacy The place of personality disorder and its treatment have been debated in the psychiatric literature and in the politics of provision. Low levels of knowledge of the variety of conditions and their management mean help is not often sought, and not often forthcoming. This article reports research that gets at the root of these problems and suggests some ways forward. The researchers report on a study of the levels of knowledge about personality disorder in a “convenience sample” of 223 lay people. The nature of the sample means it was quite biased towards students (60%) and a more literate sub-sample of the general population. A questionnaire entitled ‘eccentric people’ contained vignettes of 10 personality disorders which were to be rated as well as labelled. The researchers found that lay people recognise people with personality disorders as being unhappy, unsuccessful at work and as having poor personal relationships, but do not associate these problems with psychological causes. The level of knowledge in the general population is low Different personality disorder types were differentially recognised and understood. With the exception of 3 personality disorders, the correct identification (applying the correct label) rate for the personality disorders was very low, below 7%. Paranoid and obsessive compulsive disorders were more often correctly labelled than the others. The labels of depression, autism spectrum disorder and low self-esteem were most likely to be erroneously used. A history of psychological education and illness were found to be positively correlated with correct recognition of 70% and 60% of the personality disorders, respectively. Implications for personality disorder recognition and treatment Mental health literacy is related to help-seeking behaviour and diagnosis as well as stigma and the potential social neglect of people living with particular disorders. Personality disorder is often perceived as offensive behaviour to be avoided and/or punished rather than treated and managed by professionals, family and friends. Improved recognition, as with so many other disorders, will result in improved access to the right treatment and help for individuals with problems and their families and friends. Cultural influences on the way mental illnesses and disorders are manifest needs to be taken account of and this study was largely conducted in a mono-cultural setting. Some problems like depression are more well known and more similarly manifest across cultures than others like schizophrenia. Find the full text of the articles here… Burnham A and Winceslaus J (2012) Psychiatric Literacy and the Personality Disorders. Psychopathology 45: 29–41  DOI: 10.1159/000325885 Decide which side of the debate you support and then Make Your Own Case