‘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

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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).


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.


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).


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’.


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.

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