Social identification, identity integration and wellbeing in people who hear voices.

OBJECTIVES: Hearing voices is associated with public stigma and this can influence readiness to identify as a voice hearer (VH) and psychological wellbeing. In this study, we investigated the relationships between a VH social identity, the integration of that identity with other important social identities and wellbeing. DESIGN: Cross-sectional study, with a subset of longitudinal data across three time points. METHODS: People who self-identified as voice hearers completed questionnaires (VH social identity, identity integration, wellbeing and perceptions of in-group and out-group empathy) at three time points, spaced at 3-monthly intervals. The final sample comprised 182 participants at T1, 91 at T2 and 75 at T3. Hierarchical linear multiple regression analyses were used to test all hypotheses. RESULTS: The integration of a VH social identity was strongly associated with better psychological wellbeing at T1. Identity integration was also associated with static wellbeing scores at 6 months. Effects on wellbeing were not accounted for by either severity of voice-hearing or paranoia. Whilst perceptions of in-group empathy were associated with VH social identification, perceptions of outgroup empathy were important for identity integration. CONCLUSIONS: Integrating a VH social identity with other important identities into a coherent sense of self is important for wellbeing in voice hearers; perceived in-group and outgroup empathy are important in this process.

An experimental Investigation of the Impact of Personality Disorder Diagnosis on Clinicians: Can We See Past the Borderline?

BACKGROUND: There is concern that diagnostic labels for psychiatric disorders may invoke damaging stigma, stereotypes and misunderstanding. AIMS: This study investigated clinicians' reactions to diagnostic labelling by examining their positive and negative reactions to the label borderline personality disorder (BPD). METHOD: Mental health professionals (n = 265) viewed a videotape of a patient suffering from panic disorder and agoraphobia undergoing assessment. Prior to viewing the videotape, participants were randomly allocated to one of three conditions and were given the following information about the patient: (a) general background information; (b) additional descriptive information about behaviour corresponding to BPD; and (c) additional descriptive information about behaviour corresponding to BPD, but explicitly adding BPD as a possible comorbid diagnostic label. All participants were then asked to note things they had seen in the videotape that made them feel optimistic or pessimistic about treatment outcome. RESULTS: Participants in the group that were explicitly informed that the patient had a BPD diagnostic label reported significantly fewer reasons to be optimistic than the other two groups. CONCLUSIONS: Diagnostic labels may negatively impact on clinicians' judgments and perceptions of individuals and therefore clinicians should think carefully about whether, and how, they use diagnoses and efforts should be made to destigmatize diagnostic terms.

'Judging a book by its cover': An experimental study of the negative impact of a diagnosis of borderline personality disorder on clinicians' judgements of uncomplicated panic disorder.

OBJECTIVES: Diagnosis is ubiquitous in Psychiatry, and whilst it does bring benefits; adverse effects of 'labelling' may also be possible. This study aimed to evaluate experimentally whether clinicians' judgements about a patient with panic disorder were influenced by an inappropriately suggested diagnosis of comorbid borderline personality disorder (BPD). DESIGN: An experimental design was used to evaluate clinician's judgements when the nature of the information they were given was varied to imply BPD comorbidity. METHODS: Two hundred and sixty-five clinicians watched a video-recorded assessment of a woman describing her experience of uncomplicated 'panic disorder' and then rated her present problems and likely prognosis. Prior to watching the video recording, participants were randomly allocated to one of three conditions with written information including the following: (1) her personal details and general background; (2) the addition of a behavioural description consistent with BPD; and (3) the further addition of a 'label' (past BPD diagnosis). RESULTS: The BPD label was associated with more negative ratings of the woman's problems and her prognosis than both information alone and a behavioural description of BPD 'symptoms'. CONCLUSIONS: Regardless of potential actuarial value of such diagnoses, it is concluded that clinicians can be overly influenced by past diagnostic labels in the context of an apparent current comorbid problem, although such biases appear to be less likely if a description of the relevant behaviours is used instead. Thus, the label, rather than the behaviour it denotes, may be stigmatizing in mental health professionals. PRACTITIONER POINTS: Diagnostic labels can have an inappropriately negative effect on clinicians' judgements not only of treatment variables such as engagement and response but also risk issues and interpersonal effectiveness. Diagnostic labels can have a greater effect on clinicians' judgements than a behavioural description or clinical presentation. Clinicians should therefore be cautious both in the use of diagnostic labels to describe patients and ensure that these are still valid, and also be mindful of the influence that such labels can have on their own clinical judgements and constantly seek to challenge these. Behavioural descriptions of difficulties are less likely to result in such negative judgements and predictions.