Report: Mental Health Staff Attitudes Impact on BPD Patients

This report investigates the impact of mental health staff attitudes on patients diagnosed with Borderline Personality Disorder (BPD). It begins with a comprehensive literature review, defining BPD, exploring its history, characteristics, and prevalence, including a focus on the UK and international contexts. The review examines stigmatization within diagnoses, implications for treatment, and the feelings of mental health professionals towards BPD patients, including gender bias. The methodology section details a systematic review of secondary data, justifying the approach and outlining the planning, execution, and data reporting processes, including search criteria and outcome tables. Data analysis utilizes thematic and content methods. The findings section presents key themes derived from the literature, addressing the research question. The discussion section links findings to relevant theories, particularly Labelling Theory, and explores implications for policy and practice. The report aims to provide a thorough understanding of the complex relationship between staff attitudes and patient outcomes in BPD, offering valuable insights for mental health professionals and researchers.

Impacts of Mental Health Staff Attitudes Towards Patients with BPD 1
IMPACTS OF MENTAL HEALTH STAFF ATTITUDES TOWARDS PATIENTS WITH
BPD
By (Student’s Name)
Professor’s Name
College
Course
Date

Impacts of Mental Health Staff Attitudes Towards Patients with BPD 2
Research question- What impact mental health staff attitudes towards patients with BPD has
on the patients?
Chapter 2: Literature Review
2.1 BDP
2.1.1 Definition
BDP is a mental disorder which impacts the manner in which a person thinks and
feels regarding himself and other people, triggering problems functioning in daily life. BDP
encompasses impulsiveness, distorted self-image, wobbly intense relationship, and extreme
emotions (Day et al. 2018). With BDP, an individual has a strong instability or abandonment
fear, and he might have challenges tolerating loneliness. However, inappropriate anger, often
mood swings and impulsiveness might push other people away, though the person wants to
have lasting and loving relationships. BDP often starts by early adulthood and appears to get
worse in young adulthood as well as might slowly become better as one ages.
2.1.2 History
The phrase “borderline” was initially introduced in the US in the year 1938. It was a
phrase utilized by ancient psychiatrists when describing individuals thought to be on the
“border” between diagnoses, mainly psychosis and neurosis. Then, individuals with neurosis
stood believed to remain treatable, while individuals with psychoses were believed
untreatable. In the 1970s, in-depth comprehension of BDD started to arise. Individuals with
BPD stood described as being extremely emotional, difficult, needy, at high suicidal risk, and
to have a general unstable functioning level. Soon, the symptoms patterns started to surface
describing the people with BPD. The symptoms encompassed rapid swifts from period of
confidence to full despair, unstable self-image, quickly alternating mood swings, fear of
abandonment, firm tendency for both suicidal- and self-harm thought (Dean et al. 2018).

Impacts of Mental Health Staff Attitudes Towards Patients with BPD 3
In 1980s, BPD emerged as official personality disorder in DSM-III. Today, much is
known regarding the condition. The phrase “neurosis” is not utilized in diagnostic system,
while BPD is not thought to be psychotic condition. Presently, BPD is acknowledged as a
disorder featuring intense emotional experiences alongside instability in relationships with
the behavior which starts in early adulthood and displays itself in various settings. Experts
have further recognized a firm genetic constituent to BPD- implying it can run in families
(Dickens, Hallett and Lamont 2016).
2.1.3 Characteristics of BDP
There are nine commonly known characteristics of BDP. The first characteristics is
frantic efforts of the person to evade imagined or real abandonment. Another characteristic is
a trend of unstable as well as intense interpersonal relationship featuring alternating extremes
of devaluation and idealization (Dickens, Lamont and Gray 2016). BDG is also characterized
by identity disturbance with remarkably as well as persistently unstable sense of self or self-
image. It is also featuring impulsivity in at minimum 2 areas which stay possibly self-
damaging, for instance binge eating, irresponsible driving, and sex, expenditure and drug
abuse. Recurrent suicidal gestures, behavior, threats as well as self-mutilating behavior
(SMB) is also common (Dickens et al. 2019). Another feature is affective instability because
of a marked mood reactivity like intense episodic irritability, anxiety, or dysphonia often
taking some hours and seldom beyond 5 days. BPD is also characterized by chronic
emptiness feeling and inappropriate, difficulty controlling anger or penetrating anger plus
recurrent manifestation of temper, recurring physical fights or constant anger. Another
feature of BPD is momentary, stress-linked distrustful ideation or even serious dissociative
symptoms.
2.2 Patients with BDP in the UK

Impacts of Mental Health Staff Attitudes Towards Patients with BPD 4
BPD affects a great number of people in the UK. It is common amongst the adulthood
especially the young adults.
2.3 Patients with BDP in the rest of the word – Example of USA/Italia/New Zealand
BPD is common in both general population alongside clinical contexts. The ratio of
females to make with BPD stays greater in clinical population than it is in general population
in the US. Nonetheless, lifetime BPD prevalence does not significantly differ in the US
between males and females. In the United States, latest study has indicated that 1.60 percent
of population suffer from BPD. Women stay far more probable to be diagnosed with BPD as
opposed to me with nearly 75 percent of individuals diagnosed being women (3:1) (Ebrahim
et al. 2016).
2.4 Stigmatization attitudes in Mental Health (MH) staff towards patients with BDP
2.4.1 Stigma within the diagnoses
There is a stigma within diagnoses in regards to BPD. It is common that BPD stigma
is gender-bias within diagnosis. Literature shows that BPD remains significantly in women
with ratio of 7:1 woman to man ratio in people with BPD. The DSM-IV-TR (2000) states that
75% percent of persons diagnosed with BPD remain females (Haynos et al. 2016).
2.4.2 Implication of the BDP diagnostics in treatment
Besides the stigma linked to BPD diagnosis, implications linked to such a diagnostic
label for treatment alongside engagement within systems exist. It is discovered that females
diagnosed with BPD remain usually regarded within communal systems as unstable
emotionally and extra probable than the people undiagnosed with it to become
institutionalized hence forcing treatment, losing potential rights as well as never considered
credible witness in instances engaging sexual abuse. BPD biased diagnosis has implications
on treatment type resulting to the clinical context and attitudes have towards patients based
on every diagnosis (Jones and Wright 2017).

Impacts of Mental Health Staff Attitudes Towards Patients with BPD 5
2.4.3 Mental health professional feelings towards patients
Researchers have examined attitudes held by professionals towards BPD patients and
discovered that 89 percent of nurses surveyed perceived BPD patients as manipulative, 38 %
viewing them as nuisance and 32 percent make them angry. Other studies have shown that
nurses view BPD patients as responsible for their individual suicidal actions (Keuroghlian et
al. 2016.).
2.4.4 Gender Bias in the diagnosis of BPD
Studies show a biased diagnosis of BPD with females being diagnosed more than
males. However, some studies have shown no significant differences in gender diagnosis
(Knaak, Mantler and Szeto 2017).
2.5 Conclusion
The review of literature has demonstrated existence of negative attitude towards the
people with BPD which not only affects the diagnosis, but also treatment of people with BPD
(Walthall 2013).
Chapter 3: Methodology
3.1 Justification
The systematic review of secondary data is the research method used in this study.
The rationale is that secondary data is gathered without the need for fieldwork. It allows for
collection of both quantitative and qualitative information already gathered in previous
studies on this topic (Johnston 2017). This systematic review has the greatest advantage of
cost-effective and time-saving. The information published in the initial studies can be quickly
and freely be retrieved from the internet and credible databases. The data is clean, reliable,
valid and accessible in several formats including electronic thus the retriever and reviewer
can easily gather useful information (Johnson 2017).

Impacts of Mental Health Staff Attitudes Towards Patients with BPD 6
Systematic review of secondary data is also advantageous since it has follows high
level of professional and expertise. The sources are peer-reviewed journals and this makes
them credible, valid and reliable sources of information (Walthall 2013). The data is retrieved
only from credible databases including public database which allows the researcher to access
an array of statistical records from essential organizations. Academic researchers or scholars
have spent enough time, energy and funds working on these resources thereby making
credible information (Johnston 2017).
The data is also viable, reliable, and valid since they have undergone re-examination
by external reviewers before being published. However, the researcher will only include up-
to-date sources, especially those published between 2015 and 2019 to avoid the risk of using
obsolete information. The data will only be included when it is peer-reviewed and the
credibility of the authors are ascertained. Moreover, the data will only be drawn from credible
databases. All these inclusion and exclusion criteria will help filter the data to guarantee
credibility, validity, reliability, and trustworthiness.

Impacts of Mental Health Staff Attitudes Towards Patients with BPD 7
3.2 Methodology Secondary Research
3.2.1 Planning the review
The researcher first undertook the search using internet and specifically credible
databases on the topic. The search only focused on peer-reviewed journals published in
English between 2015 and 2019. Keywords about the topic aided the search and retrieval of
the information including “UK mental health”, “Borderline Personality Disorder”, “BDP”,
“mental health”, “patients mental health”, “nurse behaviour”, “staff attitude towards patient”,
“Staff attitudes toward patients with borderline personality disorder.”. The outcome of the
search and retrieval is derived from e-databases; ScienceDirect alongside Discover.
3.2.2 Conduction the review
Keywords Results
UK mental health The results was about various mental health
disorders and even the population of UK
that suffers from the mental health problems
Borderline Personality Disorder The results included definition of BPD and
even the prevalence of the disorder
staff attitude towards patient The result included stigmatization of BPD
patients, the negative attitudes of staff
towards patients
BDP The result was full meaning of BPD
mental health The mental health definition and the types
of illness of mental health
patients mental health Mental health illness and definition of

Impacts of Mental Health Staff Attitudes Towards Patients with BPD 8
mental health
nurse behaviour Definition of nurse behavior
staff attitude towards patient Staff attitudes patients; negative and
positive attitudes of staff
Staff attitudes toward patients with
borderline personality disorder
Stigmatization, effects of staff attitudes,
negative and positive attitudes
Table 1: Search criteria outcome in staff attitudes toward patients with BPD
3.2.3 Data Reporting
The gathered data from sources were reported in a table designed to probe and explain
the outcomes of every source as indicated in table 2. The column of table 2 shows the year
and author, study aim, BPD antecedent, research findings, method and dependant variable.
Note: x is used to denote correspondent variable absence in sources reviewed.

Impacts of Mental Health Staff Attitudes Towards Patients with BPD 9
# Author (year) Aim of the study Antecedents of Staff attitudes
towards patients with BDP
Dependant
variable
Research
approach and
Design
Research finding
BDP Positive Negative
Lam et al.
(2016)
To find out the
impact of
personality disorder
on clinicians
Negative Clinicians Experimental Personality disorder
negatively affect the
clinicians attitudes
Lam (2016). ‘ To establish impact
of a diagnosis of
BPD on clinicians’
judgements of
uncomplicated
panic disorder
Negative Clinicians Experimental BPD negatively affects
clinicians’ judgment
Dickens, G.L.,
Lamont, E.,
To evaluate an
educational
Negative Mental health
nurse’s attitude to
Mixed methods Educational intervention
positively change mental

Impacts of Mental Health Staff Attitudes Towards Patients with BPD 10
Mullen, J.,
MacArthur, N.
and Stirling
(2019)
intervention to
change mental
health nurses’
attitudes to people
diagnosed with
BPD
individuals
diagnosed with
BPD
health attitude
Knaak, Mantle
and Szeto
( 2017)
To find out the
barriers to access
and care and
evidence-based
solutions
Negative Stigma Systematic review Lack of attitudinal
change leads to barriers
of access and care
Keuroghlian et
al. (2016)
To find out the
effect of attending
good psychiatric
management
(GPM) workshops
Negative Attitudes toward
patients with
BPD
Systematic review Attending good
psychiatric management
(GPM) workshops
positively change
attitudes towards

Impacts of Mental Health Staff Attitudes Towards Patients with BPD 11
on attitudes toward
patients with BPD
patients with BPD
Dickens et al.
(2016).
To determine the
interventions to
improve mental
health nurses’
skills, attitudes, and
knowledge related
to people with a
diagnosis of BPD
Negative Mental health
nurses’ skills,
attitudes, and
knowledge
Systematic review Interventions can
improve mental health
nurses’ skills, attitudes,
and knowledge towards
BPD patients
Warrender, D.,
2015.
To probe the staff
nurse perceptions
of the impact of
mentalization‐
based therapy skills
training when
Negative Staff nurse
perceptions
Qualitative study Mentalization‐based
therapy skills training
positively impacts nurse
perception when
working with BPD in
acute mental health

Impacts of Mental Health Staff Attitudes Towards Patients with BPD 12
working with BPD
in acute mental
health
Lanfredi et al.
(2019)
To explore the
attitudes of mental
health staff toward
Patients With BPD
Negative Attitudes of
mental staff
Cross-sectional
study
Mental health staff have
negative attitude towards
BPD patients

Impacts of Mental Health Staff Attitudes Towards Patients with BPD 13
3.3 Data Analysis
The analysis of data was based on both thematic and content methods. Research
outcomes can either be put on the continuum that indicates the degree of transformation of
data during secondary analysis procedures from account through interpretation. The use of
qualitative descriptive tactics like content and thematic analyses remain suitable for
researchers wishing to employ a comparatively low interpretation levels relative to grounded
theories and hermeutic phenomenology whereby higher interpretive complexity is needed. It
is worth noting that various views in regards to meaning of description alongside
interpretation in qualitative study, based on methodological approach exist (Vaismoradi,
Jones, Turunen and Snelgrove 2016). Thus, both interpretive and descriptive approaches
encompass interpretation even where interpretive constituent stays downplayed in
deliberating wider narrative alongside explorations. Qualitative thematic and content
analysis were employed in this qualitative descriptive study to comprehend staff attitudes’
effects BPD patients.
3.4. Ethics
Ethical issues in this study was anchored on skills of the researcher. It acknowledged
the 3 key elements that included researcher competency, worthwhile expected results and
careful design. It acknowledged that a researcher has to own desired skills and knowledge for
to investigate this topic and also being aware of researcher’s personal competence limits in
research. Therefore, the researcher was often ready to state any skills and knowledge gap in
critical review as well as worked under close supervision when necessary. Further, the
researcher chose the systematic review and data collection method carefully premised on
study objectives. This ensured validity and reliability that are key study requirements (Lam et
al. 2016).

Impacts of Mental Health Staff Attitudes Towards Patients with BPD 14
3.0 Findings
The labelling theory was used in this study. It holds that on some circumstances,
everyone shows behavior which is known as deviant. For many reasons, solely some
individuals get labelled as deviant due to this behavior. Labelling posit that identity allocated
to a person remains in certain respect, changed to his or her discredit. Some qualities
associated with a given behavior are attached to a person (Lam, Salkovskis and Hogg 2016).
The behavior that becomes object of labelling is known as the primary deviation. In a
nutshell, two influences arise from labelling. One is that the social scenario gets altered, and
the second one is that his or her self-image is also changed. Thus he starts to conceive of
himself as a deviant. These two variables when clamped together lead to deviant careers
whereby a person gradually enters a deviant means of life. Ultimately, he has developed a
deviant identity and become what individuals have said he was from the beginning by
demonstrating a secondary behavior (Lanfredi et al. 2019).
Nurses have generally used this theory to label the people with BPD as a deviant thus
making nurse to have negative attitude towards them. The stigma that nurses have towards
these patients have resulted from the use of labelling theory since nurses continuously treated
people with BPD as having some qualities that are attached to stigma communicated via
labelling. This is the reason the identity of these patients get transformed and become deviant.
The continued labelling of these patient negatively by nurses have led to increased deviant
behavior (Masland et al. 2018).
Attitude:

Impacts of Mental Health Staff Attitudes Towards Patients with BPD 15
The literature discovered that BPD has stayed controversial for decades but negative
attitudes is one area which has been consistent over the decades. This negative attitude is
evoked from the people these patients come into contact with. During the early nineteenth
century, the individuals manifesting behavior currently liked to cluster B personality
disorders specifically stood described as moral imbeciles, social misfits and morally defective
(Ring and Lawn 2019). These kinds of attitudes continued in the twentieth century with
various subtypes of personality disorders that encompassed born criminals, weak or irresolute
willed, as well as pathological liars alongside swindlers.
Stigma within the diagnoses
There is a stigma within diagnoses in regards to BPD. It is common to experience
BPD stigma is gender-bias within diagnosis. Literature shows that BPD remains significantly
diagnosed in women with ratio of 7:1 woman to man ratio in people with BPD (Walthall
2013). The DSM-IV-TR (2000) states that 75% BPD-diagnosed persons remain women
(Walthall 2013). The attitude towards patients with BPD make these patient undergo through
substantial stigmatization with BPD alongside social location (Rose, Carr and Beresford
2018). As compared to other personality disorders (PDs), BPD tops the list of the most
stigmatized PD within diagnoses (Walthall 2013). This can be explained by the labelling
theory whereby BPD patients are tagged or labelled as underserving and untreatable having
been labelled deviant. The difference is occasioned by the gender bias diagnosis, diagnostic
criterion’s tendency to get more socially features of women, and gender-linked variables. It is
also caused by greater probability that women would witness child sexual assault. The
gender-influenced risk factors include childhood temperament, genes, neurotransmitter
responsivity, and autonomic nervous system arousal among others (Walthall 2013).
The PDP’s diagnosis’ gender marginalization and bias effect is explained using
labelling theory. This theory hold that a deviant conduct is never inborn to a given act,

Impacts of Mental Health Staff Attitudes Towards Patients with BPD 16
however, such an act is well-defined as deviant due social construction. Moreover, this theory
urges that emphasis should be placed both on people being tagged “deviant” and people who
tag them in such a manner, how such a tag is arrived at, and the scenario within which such a
judgment is constructed (Walthall 2013). Stigmatization has been sub-divided into three
different types including deformity (nonconformity in personal features supposed as arising
from mental illness), physical as well as “tribal stigma” which include nationality, religion or
race. The idea of deviation of personal features describes the PD by both DSM-IV-TR and
language definition (Walthall 2013).
Studies have shown that BPD is holding a substantially increased stigma as opposed
to any other mental diagnosis. Such a stigma remains within capacities of mental health
treatment and greatly exposed to affect treatment of persons with BPD (Walthall 2013). The
nurses are likely to optimistic regarding the recovery of these patients and stay negative
regarding their experience working with persons with BPD. The staff nurses are probable to
rate people with BPD as more dangerous as well as demanding extra social distance
(Sheehan, Nieweglowski and Corrigan 2016).
A scale that assess mental health practitioners’ attitude has been to know the impacts
of such attitudes BPD patients (Shefer et al. 2015). The APDQ emerged from a sequence of
round table deliberations on the “affective statement” regarding persons with BPD. Such an
assessment has discovered the variables with significant impact on the attitude of nurses
towards people with BP. These include organization variables like supervision and support to
staff, training whereby less clinical alongside diagnostic training is found to associate with
additional negative attitudes besides appropriate training being linked to more positive
attitude. The clinicians working with BPD patients have more undesirable attitude as
contrasted to the remaining mental diseases. It has been found that education lowers the
negative attitudes amongst the nurses (Shefer et al. 2015).

Impacts of Mental Health Staff Attitudes Towards Patients with BPD 17
Implication of the BDP diagnostics in treatment
Besides the stigma linked to BPD diagnosis, implications linked to such a diagnostic
label for treatment alongside engagement within systems exist (Walthall 2013). It is
discovered that females diagnosed with BPD remain usually regarded within systems of
public as unstable psychologically and additionally probable than the people undiagnosed to
become institutionalized hence forcing treatment, losing potential rights as well as never
considered credible witness in instances engaging sexual abuse (Walthall 2013). BPD biased
diagnosis has implications on treatment type resulting to the clinical context and attitudes
have towards patients based on every diagnosis (Warrender 2015).
Mental health professional feelings towards patients
Researchers have examined attitudes held by professionals towards BPD patients and
discovered that 89 percent of nurses surveyed perceived BPD patients as manipulative, 38 %
viewing them as nuisance and 32 percent make them angry (Williams 2016). Other studies
have shown that nurses view BPD patients as responsible for their individual suicidal actions.
Patient with BPD have been labelled as demandingness or entitlement, treatment regressions
as well as ability of evoking inappropriate responses (Walthall 2013).
The nurses have a feeling that these patients generate uncomfortable personal
reactions or responses in clinicians, and that the features of BPD contribute to adversarial
clinicians as well as health service responses, inadequacies presence in health system to
address these patients’ alongside techniques or strategies required to enhance provision of
service with these patients (Wlodarczyk et al. 2018). Nurses have reported that the find BPD
patients extremely hard to deal with and nurses have even said that it is a waste of time. Other
nurses have labelled BPD and following the labelling, these patients never get objective
assessment (Walthall 2013).
Gender Bias in BPD Diagnosis

Impacts of Mental Health Staff Attitudes Towards Patients with BPD 18
Studies show a biased BPD diagnoses with females being diagnosed more than males.
However, some studies have shown no significant differences in gender diagnosis (Walthall
2013).
4.0. Discussion
The discussion focuses on linking the findings to the theory and demonstrating the
implication of the study findings to policy and practice. The results show that there is a link
between negative behavior and adversarial staff responses, culminating in ongoing adverse
staff attitudes towards the BPD patients. The literature has suggested that exposure to these
negative behaviors lead to a plunge in the confidence of staff regarding working with these
patients thereby polarizing staffing as well as negative stereotypical viewpoints being
fostered by the nursing staff (Williams 2016).
Attitudes towards the persons with a BPD diagnosis always incline to be increasingly
negative as compared towards other mental disorders like depression, schizophrenia as well
as schizophrenia disorder that stays consistent with previous literature. Such pessimistic
attitude serve as hindrance to operative and efficient BPD patient care services (Choi-Kain et
al. 2017). Nonetheless, not every staff manifests adverse attitudes; certain positive attitudes
alongside readiness to assist have been noted. The positive attitudes among the staff drawn
from various sources include education on BPD, getting to known the patients psychological
history, staff support structures, and willingness of staff to assist.
The reviewed literature have unearthed a positive linkage between attitudinal change
and the education amongst the staff. Useful proof has been identified in the literature showing
the willingness of staff to attend additional training and education on BPD to assist in the
facilitation of effective treatment alongside management (Crawford et al. 2018). The
literature has endorsed the utilization of training and education programs to give greater
comprehension of BPD utilizing enhanced acquaintance in setting of fecund patient to staff

Impacts of Mental Health Staff Attitudes Towards Patients with BPD 19
relations alongside broad-mindedness. Giving staff better BPD complexities shall enable
them to react both therapeutically as well as with decreased negativity during the crisis and
this will help reduce the rampant undesirable insolences to this patients group.
Studies have compared attitudes of nurses in mental health alongside nurses in
emergency settings towards the patient with BDP alongside self-harm and have showcased
that seventy-five percent of staff indicated that BPD behaviors including self-harming, stay
hard to manage while 65.0% of staff discovered it was challenging to construct any
meaningful relationships therapeutically. The emergency medical nurse remain highly
frustrated at being incapable of curing patient diagnosed with BPD and sensation of care
remaining unimpressive in respect of recurrent presentations with identical injuries. Such
negative attitudes towards BPD demonstrate a lack of representation of not qualified
workfoce thus disregarding a huge share of workforce as well as affects the generalizability
to their whole workforce (Day et al. 2018).
Nurses are shown to perceive the patients with BPD as ‘a destructive whirlwind”
while other view them as powerful, unrelenting and powerful force that leaves a mark
following their destructions. Patients with BPD are also found to be increasingly destructive,
draining as well as demanding for both staff and resources. Such feelings of being
disheartened as well as frustrated are quoted as amongst the primary reasons staff viewed
BPD clients negatively and culminate in perception of patients as being “underserving of care
as well as untreatable.” However, some studies have shown that nurse are positive and
indicate that BPD patients deserve care and manifest optimism sense surrounding BPD
treatment. Such backs up the idea that staff are able to demonstrate positive attitudes towards
BPD patients and negative attitudes (Dean et al. 2018). The positive attitudes are
predominantly available amongst newly-qualified staff that might culminate in hypothesis
that BPD undergraduate training stays effective tool to build positive attitudes. Nonetheless,

Impacts of Mental Health Staff Attitudes Towards Patients with BPD 20
additional target training by particular services would assist in enhancing desired clinical
skills and hence improve the confidence of the nurse in working with BPD patients (Dickens,
Hallett and Lamont 2016).
The finding shows that BPD remains among the PD that are most stigmatized of all
the PDs and also most studied based on stigma. It is characterized mainly by impulsivity,
mood instability, extreme sensitivity to abandonment, SMB as well as challenges controlling
anger (Dickens, Lamont and Gray 2016). This condition results in severe restrictions in social
relationships as well as functioning. Individuals with BPD are usually viewed as annoying as
well as undeserving thereby leading to insufficient treatment alongside assistance. Individuals
with BPD might have often contact with police officers because of anger as well as
suicidality culminating in police feeling angry, frustrated, as well as powerless to interact
with people with BPD (Dickens et al. 2019). Whereas negative emotions from the staff can
be fathomable responses to disruptive behavior, they can as well manifest stigma. This
implies that staff’s frustration could get intensified when she endorses stereotype that
individuals with PDs stay troublesome deliberately. When persons with BPD are viewed as
intentionally wasting valuable nurse time, they might witness harsher services and treatment
which are never specifically well-designed to serve the distinct needs of this group (Ebrahim
et al. 2016).
Whereas lack of awareness by the public acts as the first obstacle to care-seeking,
once persons with BPD start treatment, they get confronted by the label that might be
increasingly stigmatizing within the context of treatment than outside. The latest research
outline the negative attitudes as well as behaviors of health providers towards persons with
BPD. Many psychiatric nurses, psychologists, social workers alongside psychiatrists remain
injurious attitudes sources towards individuals with BPD (Sheehan Nieweglowski and
Corrigan 2016). In the UK, psychiatric nurses are shown to have increased adverse attitudes

Impacts of Mental Health Staff Attitudes Towards Patients with BPD 21
towards this group than towards any other mental disorders. The psychiatric nurses have been
revealed to be the most stigmatizing providers in the UK hospitals when it comes to BPD
patients. The psychiatrists have also been shown to have the least compassion to BPD
patients in contrast to the rest of specialists including psychologists, nurses and social
workers (Haynos et al. 2016).
Eventually, negative professional attitudes might culminate in differential treatment of
these individuals with BPD. Stigma might decrease the service levels available, lower quality
of such scarce services, and even dissuade persons with BPD from seeing as well as
continuing treatment. The diagnosis in terms of BPD can even trigger exclusion from the
treatment where mental health providers are referring out following diagnosis (Jones and
Wright 2017).
More than 57 percent of BPD patients in an Australian research reported that
practitioners shunned them, as opposed to solely 29 percent of individuals with other mental
diagnosis (Sheehan Nieweglowski and Corrigan 2016). Further, more ineffective decisions to
hospitalize as well as assign negative characteristics have been made for the people with BPD
as opposed to other PDs who had anxiety and depression. Such a perceived bias remains a
common trend for patients with BPD when they seek admission in hospitals during crises.
Attempts of suicide among the persons with BPD remain perceived as attention-seeking
instead of an indication of disorder. Individuals with BPD even get discharged faster from
the emergency rooms as opposed to other PDs patients. People who BPD are further
discriminated against in terms of waiting in the emergency rooms after a self-harm.
The discussion has clearly shown that stigma witnessed by persons with BPD
increasingly threaten to compound the symptoms psychiatrically and even compromise
treatment, specifically when such a stigma remains perpetrated by health providers or even
social institutions. Even though longitudinal studies demonstrate that individuals with BPD

Impacts of Mental Health Staff Attitudes Towards Patients with BPD 22
gain from treatment and subsequent recovery, the PDs misconception as untreatable might
severely restrict efforts of service practitioners alongside comprehensive programs
development. Provided the extreme suicide alongside self-harm rates of persons with BPD,
initiatives to lower stigma for this group are specifically essential. Contact-oriented anti-
stigma interventions emphasizing on possibilities of recovery as well as educate regarding
biological PDs underpinnings appear significantly promising. Structural alterations in health
system like surged funding for services and research, will assist lower disparate treatment for
BPD patients (Sheehan Nieweglowski and Corrigan 2016).
5. Conclusions
The propensity of BPD patients to refuse therapeutic care as well as involve in
challenging behaviors to manage leaves providers frustrated, unhappy as well as increasingly
negative towards them. Every staff who works with such patients remain susceptible to such
adverse emotions that subsequently result in derogatory phrases alongside negative attitudes
being attributed to the client (Keuroghlian et al. 2016).
A clear association between the staff morale, attitude as well as emotional self-
management has been identified in the literature though review of studies that have
deliberated upon the negative impact of attitude being the absence of knowledge in working
with BPD individuals triggering a challenge in management of staff’s own responses to their
BPD-diagnosed patients. A significant influences in altering derogatory and negative
attitudes into positivity is being the target education introduction on the personality disorder
associated concerns, generating a “more purposes as well as optimistic outlook” amongst the
staff (Choi-Kain et al. 2017).
Health professionals usually evade having contact with BPD patients and
subsequently fail to enter in any significant conversation surroundings the rationale for
negative behaviors. Several staff indicate they would solely deliver least care levels, towards

Impacts of Mental Health Staff Attitudes Towards Patients with BPD 23
shift end, except if it is strictly necessary. Thus, showcasing a greater social rejection level
towards BPD-diagnosed people than other mental disorders (Crawford et al. 2018).
Nonetheless, the literature shows that enhanced education on BPD will assist the staff in
responding to adverse patient behaviors without fear and rejection in a consistent way. Thus,
the provision of additional positive therapeutic input.
The study has shown that continuous labelling of persons with BPD as deviant by
nurses has led to increased negative attitude towards these patients by nurses. The main
hindrance to the diagnosis and treatment arising from the nurse working with people with
BPD is the use of labelling theory to mark these patients as deviant. Once the nurses have
marked these patient as deviant and in a repeated manner, they indeed become deviant which
impedes the existence of any therapeutic relationship between the clinicians and their
patients. With the lack of such a therapeutic relationships, everything goes including biased
diagnosis and treatment and also the recovery. This explains why women have been
diagnosed as the ones at high risk of the diseases at 3:1, female to males (Knaak, Mantler and
Szeto 2017).
This makes BPD to be a challenging diagnosis not only for staff but also patients.
This is due to the existence of behavioral challenges faced within the BPD which has only led
to damaged therapeutic relations hence directly impacting everything from diagnosis all
through the recovery (Lam et al. 2016). The undesirable attitudes alongside behaviors among
the healthcare practitioners issue remains unpalatable thought whereby negativity manifested
is working against the beneficence, equality, nommaleficense which are the principles that
nursing practitioners in entirety consider highly.
The implication or recommendation is that target education around the aetiology,
comprehension as well as awareness of diagnosis, treatment alongside management
alternatives has been demonstrated to address the current negative alongside stigmatizing

Impacts of Mental Health Staff Attitudes Towards Patients with BPD 24
attitudes nurses have towards BPD (Lam, Salkovskis and Hogg 2016). Nonetheless, the
results study show that, despite education being demonstrated to enhance staff attitudes
towards these clients with BPD, there is never a precise style of education which gives the
best results.
The implication for this is that it is hypothesized that a multi-layered strategy to
clinical education alongside continuing training need to be embraced to uphold positive
attitudes as well as deliver finest general outcomes. Diverse staff population also need diverse
training forms; and thus, targeting educational requirements to a give staff groups shall avail
better result measures in regards to attitudinal change (Lanfredi et al. 2019).
Even though there is a precise acknowledgement of BPD patients’ care needs, the
BPD diagnosis and its subsequent treatability remains a passionately disputed field.
Nonetheless, this is gradually altering with guidance alongside policies neighbouring care for
BPD patients having exponentially surged over decades, resulting in production of guidelines
on both treatment and care by NICE in the year 2009. Following the guidelines, a rise of
better detailed and incorporated services which are anchored on comprehensive multi-
disciplinary as well as multi-agency team working being established (Masland et al. 2018).

Impacts of Mental Health Staff Attitudes Towards Patients with BPD 25
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