• Diagnosing borderline personality disorder:the effect of therapist's negative emotional reactions on diagnostic judgements.

      Mayo, Keith (2012-05-09)
      Previous studies suggest that clinicians are prone to bias in diagnosing Borderline Personality Disorder(BPD)and that BPD symptoms elicit negative emotional reactions(NER)from clinicians.However,no studies have specifically examined the effect of NER on the diagnosis of BPD.This study examined the decision-making processes used when assigning a diagnosis of BPD,specifically,whether clinicians NER towards patients exhibiting BPD symptoms bias decision-making and result in misuse of the BPD diagnosis.A randomly-selected national sample of 98 licensed psychologists completed an Internet survey in which they read two case vignettes that were designed to elicit NER but were below threshold for a diagnosis of BPD.Participants rated the representatives of a series of Axis I and II diagnosis and rated their level of confidence;rated severity,prognosis,and the likelihood of the individual in the case benefiting from treatment;and rated the applicability of a series of symptoms for the case(including each of the DSM-IV criteria for BPD).They then rated the degree of NER felt toward the patient using two subscales of the Impact Message Inventory(IMI).Results provided moderate support for the prediction that participants who report higher levels of NER wold be more likely to diagnose BPD,would assign higher BPD representativeness ratings, and would rate the prognosis and likelihood of response to treatment lower.Predictions concerning the moderating effects of clinician variables(years of clinical experience,percentage of time spent in direct patient contact) were not supported,but clinician gender had significant effects on the diagnosis of BPD.The hypothesis that clinicians who were asked to assign diagnosis before rating symptoms(i.e a stimulated prototype approach)would be more prone to over-diagnosis of BPD was also not supported,but order of the cases had unexpected effects on the results.Implications for clinical training and directions for future research are discussed.