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Tag: Psychology and Psychiatry

  • Borderline personality disorder-related stigma undermines patient care and efforts to reduce suicide

    Borderline personality disorder-related stigma undermines patient care and efforts to reduce suicide

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    Newswise — People with a diagnosis of borderline personality disorder and their carers report experiencing discrimination and stigma when presenting to health services following self-harm or a suicide attempt, leading to inadequate treatment and care for suicide prevention, say authors of a new large-scale review.

    Researchers at Flinders University are calling for better use of existing resources to improve health and community-based services and staff training, which would not only boost the health and wellbeing of all Australians but significantly contribute to a reduction in emergency department presentations and hospital admissions.

    Led by Pauline Klein, a Casual Academic and PhD Candidate in Flinders University’s College of Medicine and Public Health, the research team undertook a review of the international literature to investigate people with a diagnosis of borderline personality disorder, their carers, and health practitioners’ experiences of health services.

    “Our aim was to identify any challenges, gaps, and barriers in health services and supports, as well as recommendations for addressing these issues,” says Ms Klein.

    Borderline personality disorder affects one to two percent of the global population but has high rates of self-harm and suicide, leading to frequent presentations to emergency departments and mental health services, the review found.

    “Unlike schizophrenia, borderline personality disorder is much less likely to respond to medications, with previous research finding longer-term solutions, such as face to face therapy and ongoing support, better suited to manage the underlying trauma that is thought to have led to the disorder for many of the people who experience it,” says co-author Dr Kate Fairweather, a Mental Health Epidemiologist and Public Health/Health Equity Lecturer at Flinders University.

    The review identified significant structural problems in the health system for people with a diagnosis of borderline personality disorder and their carers, including the limited public health services and community group programs available to meet the urgent demand for support.

    “We found that the available public health services and programs have long wait lists, and specialist services are not an affordable option for many people with a diagnosis of borderline personality disorder and their families,” says Ms Klein.

    “Similarly, health practitioners reported experiencing challenges navigating health services and referral pathways, due to the limited services and supports available.”

    The research further suggests that there is a dominant stigmatising culture, particularly in emergency and acute mental health services, that perpetuates misconceptions regarding the legitimacy of the diagnosis of borderline personality disorder as well as its treatability and recovery prospects, leading to reluctance among some health practitioners to diagnose or treat people with this mental health condition.

    “Alarmingly, there are consistent reports in the literature indicating that when experiencing a suicidal crisis, people with a borderline personality disorder diagnosis and their carers are treated disrespectfully and denied treatment when presenting to some health services, leading to a lack of support being offered to these patients at a pivotal time when crisis intervention is needed,” says Ms Klein.

    “The Clinical Practice Guidelines for the Management of Borderline Personality Disorder, developed in 2012, state that treatment for this disorder is a legitimate use of healthcare resources and that having a diagnosis of borderline personality disorder is never a reason for withholding healthcare to a person.

    “These stigmatising experiences lead to patients and their carers facing discrimination and high levels of anxiety when seeking treatment because the presenting condition is not taken seriously, undermining patient care and potentially retraumatising and exacerbating patients’ self-harming behaviour.”

    The authors say the results of the review echo existing structural problems impacting other areas of the health system and provide further evidence of a critical need for health reform.

    “This should serve as a call to action for governments to prioritise and address these important public health concerns,” says Ms Klein.

    “We need a system-wide approach including providing health practitioners who work with people with borderline personality disorder ongoing access to education, training, and supervision to better support them in their role.”

    The paper ‘Structural stigma and its impact on healthcare for borderline personality disorder: a scoping review’ by Pauline Klein, Kate Fairweather, and Sharon Lawn is published in the International Journal of Mental Health Systems. DOI: 10.1186/s13033-022-00558-3.

    The research was funded by the Suicide Prevention Research Fund, established by the Federal Government to support research into suicide prevention. The aim of the fund is to support world-class Australian research and facilitate the rapid translation of knowledge into more effective services for individuals, families, and communities. Suicide Prevention Australia manages the fund on behalf of the Federal Government. We also acknowledge our partner organisation, Lived Experience Australia.

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    Flinders University

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  • Empathizing With the Opposition May Make You More Politically Persuasive 

    Empathizing With the Opposition May Make You More Politically Persuasive 

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    Newswise — Trying to understand people we disagree with can feel like an effort hardly worth making, particularly in contentious political environments in which offering even the smallest olive branch to the opposition can be perceived as betraying our own side. Research in Psychological Science, however, suggests that cross-partisan empathy may actually make our political arguments more persuasive, rather than softening our convictions. This holds true for even the most politically partisan among us. 

    “Empathizing across differences can not only help us better understand people’s perspectives but also make us more convincing advocates of our own beliefs,” said Luiza A. Santos, who conducted this research with Jan G. Voelkel, Robb Willer, and Jamil Zaki (Stanford University). People who are encouraged to value empathy across party lines are also more likely to support bipartisan cooperation and less likely to report hating people on the other side of a political issue, Santos added. 

    To explore how belief in the utility of empathy can decrease partisan animosity and increase political persuasiveness, Santos and colleagues conducted a series of four studies involving 3,650 Democrat and Republican participants in the United States. 

    In the first study of 411 participants, the researchers found that people who placed more value on cross-partisan empathy were also more likely to desire bipartisan cooperation and to hold less animosity toward the other political party. A follow-up study of 688 college freshmen revealed that students with more cross-partisan empathy were likelier than less empathetic students to report having more friends with different political beliefs. 

    Cross-partisan empathy isn’t a static trait, however—and Santos and colleagues’ work suggests that even the most politically partisan individuals may be open to walking in the opposition’s shoes.  

    A third study involved 1,551 participants using Amazon Mechanical Turk. When they read text arguing for or against the value of cross-partisan empathy, participants reacted as you might expect: Those in the high-utility condition, which emphasized increased understanding of the opposition, reported a greater desire for bipartisan cooperation and less out-party animosity, moral superiority, and desire to socially distance from political out-group members. Those in the low-utility condition, which emphasized the threat to their own beliefs, had the opposite response. 

    The strength of this response wasn’t the same for everyone, though. Whereas the effects were relatively small for participants with mild political beliefs, staunch Democrats and Republicans in the high-utility condition reported significantly larger decreases in animosity and moral superiority toward out-group members. 

    “These findings indicate that strong partisans can be moved by beliefs about cross-partisan empathy. If anything, our manipulations had, in some cases, stronger effects on more partisan individuals,” Santos and colleagues wrote. 

    Finally, the researchers put these findings to the test by having 1,000 participants read a high- or low-utility argument on the value of empathy before writing a message to a member of the opposing party intended to change their beliefs about gun control laws. Each of these messages was then shared with a participant who identified with that party, so that Democrats read messages written by Republicans and vice versa. 

    Through analyzing the text of each message, the researchers found that participants in the high-utility condition were nearly twice as likely to use conciliatory language to express cross-partisan empathy. This included trying to find common ground, represented by terms like “we all want” and “I agree,” as well as using perspective-taking language like “I understand that” to acknowledge the reader’s existing beliefs. They were also more likely to focus on common goals such as safety and on institutions like the U.S. Constitution rather than directly discussing more contentious concepts like crime and violence. Despite the more empathetic tone of the high-utility participants’ messages, condition-blind coders rated these messages as arguing for similarly strong political positions as those in the low-utility condition.  

    Readers from the opposing party rated the high-utility writers as being more likable and persuasive than low-utility writers and reported less animosity toward high-utility writers’ political parties after reading those messages. They were also more likely to soften their views on gun laws after reading a high-utility message, Santos added. 

    “In other words, people’s belief in the utility of empathizing not only improved intergroup feelings but also helped create greater common ground,” she said. 

    It remains to be seen how long the effects of cross-partisan empathy may last after an interaction, she noted. There may also be differences in how empathy influences asynchronous communication, such as letter writing, versus face-to-face conversations. 

    “Believing in cross-partisan empathy’s usefulness helps people attain shared goals of decreasing partisan animosity and building consensus around critical issues. In this light, cross-partisan empathy can be a valuable resource—an instrumental tool for not only connecting minds but also changing them,” Santos and colleagues concluded. 

    Reference 

    Santos, L. A., Voelkel, J. G., Willer, R., & Zaki, J. (2022). Belief in the utility of cross-partisan empathy reduces partisan animosity and facilitates political persuasion. Psychological Science, 33(9), 1557–1573. https://doi.org/10.1177/09567976221098594  

    Request a copy of this article by emailing [email protected] 

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    Association for Psychological Science

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  • Don’t throw away your antidepressants just yet

    Don’t throw away your antidepressants just yet

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    A study published in Nature Molecular Psychiatry is being used to question the use of SSRIs for people with depression. The study involved a new umbrella review of past studies of depression’s relationship with serotonin levels. One major conclusion is that there is no convincing evidence that low serotonin levels are the primary cause of depression. While the review has made headlines for “debunking” the serotonin imbalance theory, it is important not to jump to conclusions on the efficacy of antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs). 

    This new study has led to various articles that have focused on how “scientists have called into question the widespread use of antidepressants.”  However, this does not mean that doctors will stop utilizing antidepressants as a treatment option. Instead, it calls for more research about why antidepressants work the way they do.

    A blog entry posted by  Michigan Medicine – University of Michigan on Newswise discusses this recent coverage on antidepressants.

    Srijan Sen, M.D., Ph.D., is concerned about the impact of a new study about the role of serotonin in depression that’s getting a lot of attention.

    Sen notes that mental health experts certainly don’t believe that a simple ‘chemical imbalance’ is the root cause of depression.

    Serotonin is one of the primary brain chemicals, called neurotransmitters, that helps brain cells “talk” to one another by connecting to receptors on cells’ outer surfaces.

    The new study that’s getting lots of attention looks at a lot of older studies about serotonin, and tries to draw conclusions by combining the information from them.

    The study did not conduct new experiments or even combine previous studies in a meta-analysis. But instead, the researchers conducted an “umbrella review” of some, but not all, meta-analyses related to serotonin.

    By coincidence, another such “study of studies” on serotonin and depression was published just a week before the one that’s in the news. It concluded that serotonin transporter gene variations do play a key role in depression risk, in combination with stressful experiences across a person’s life. But that study hasn’t gotten nearly as much attention.

    In other words, Sen says, the science of serotonin’s exact role is far from settled.

    An article by Ruairi J Mackenzie in Technology Networks explains how this study doesn’t quite debunk years of science, since most scientists don’t adhere to the “chemical imbalance” theory on depression in the first place.

    The review article, published by an international research team including first author Prof. Joanna Moncrieff, aimed to assess the available evidence for and against the serotonin theory of depression systematically. The team explain this theory near the start of their paper: “[The theory is] the idea that depression is the result of abnormalities in brain chemicals, particularly serotonin (5-hydroxytryptamine or 5-HT).” The theory has been around for decades, but their overarching conclusion is that it is not correct, given that there appears to be no link between measurable serotonin concentration and depression.

    The reaction of many academics to this finding can be summed up, briefly, as “Obviously!” In comments to the UK-based Science Media Centre, Dr. Michael Bloomfield, consultant psychiatrist and head of the translational psychiatry research group at University College London (UCL), said, “The findings from this umbrella review are really unsurprising. Depression has lots of different symptoms and I don’t think I’ve met any serious scientists or psychiatrists who think that all causes of depression are caused by a simple chemical imbalance in serotonin.”

    Criticism of the review call into question how these indirect measures of serotonin function or are merely proxies for serotonin activity. They also question how depression is defined since there are multiple factors that contribute to the cause.*

    Dr. Michael Bloomfield adds…

    What remains possible is that for some people with certain types of depression, that changes in the serotonin system may be contributing to their symptoms. The problem with this review is that it isn’t able to answer that question because it has lumped together depression as if it is a single disorder, which from a biological perspective does not make any sense.

    “Many of us know that taking paracetamol can be helpful for headaches and I don’t think anyone believes that headaches are caused by not enough paracetamol in the brain. The same logic applies to depression and medicines used to treat depression. There is consistent evidence that antidepressant medicines can be helpful in the treatment of depression and can be life-saving. Antidepressant medicines are one type of treatment alongside other types of treatment like psychotherapy (talking therapy). Patients must have access to evidence-based treatments for depression and anyone taking any treatment for depression who is contemplating stopping treatment should discuss this with their doctor first.”

     

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    Newswise

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