She brushed off the suicide attempt with a casual air, terming it as part of a larger pattern of impulsive behaviour that came under the ambit of borderline personality disorder. As if such an impulsive attempt did not count as a suicide attempt. As if such impulsivity was to be taken with a grain of salt. While it is true that such behaviours may be understood in a broader pattern of personality disorder, the attitude with which clinicians approach often becomes dismissive.
I could not blame the resident for such an attitude towards patients with personality disorders. I, too, carried such a stigmatising attitude for a considerable duration that began during and after my residency. I acquired it from my seniors, the way she must have acquired it from her seniors. Personality disorders continue to be viewed negatively among a substantial number of psychiatrists that I have come in contact with over the past few years. The chronic course, difficulty to treat and a challenging profile of clinical features partly explain such attitude.
It reminds me of a well-known study on the topic by Appleby and Lewis 1988 that concluded the personality disorder cases were seen as difficult and less deserving of care compared to control subjects. That study had its own shortcomings, as rightly pointed out in a number of publications that followed. Overinterpretation of small differences, jumping to conclusions on little basis might were a few. A follow-up study by Chartonas et al reported similar trends in 2017. Several factors have been proposed for such a negative attitude, including perceived difficulty in treating, lack of training, and challenging patient presentations, to name a few. All these factors and challenges, however, do not justify the negative and dismissive attitudes.
Despite the training curriculum that includes theories of personality development and how early experiences shape it, the clinical attitudes still remain negative. This perhaps reflects a gap between theoretical understanding and clinician attitudes. Perhaps we must re-examine our training curriculum and tweak it in a way that can help young impressionable residents to form more balanced attitudes towards such individuals.
Warm Regards
Dr. Priyash Jain
Editor, Minds Newsletter
