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We sought to determine attitudes toward patients with borderline personality disorder (BPD) among mental health clinicians at nine academic centers in the United States.
A self-report questionnaire was distributed to 706 mental health clinicians, including psychiatrists, psychiatry residents, social workers, nurses, and psychologists.
The study showed that most clinicians consider BPD a valid diagnosis, although nearly half reported that they preferred to avoid these patients. The clinician's occupational subgroup was significantly related to attitude. Staff nurses had the lowest self-ratings on overall caring attitudes, while social workers had the highest. Social workers and psychiatrists had the highest ratings on treatment optimism. Social workers and psychologists were most optimistic about psychotherapy effectiveness, while psychiatrists were most optimistic about medication effectiveness. Staff nurses had the lowest self-ratings on empathy toward patients with BPD and treatment optimism.
Negative attitudes persist among clinicians toward BPD, but differ among occupational subgroups. Overall, caring attitudes, empathy, and treatment optimism were all higher among care providers who had cared for a greater number of BPD patients in the past 12 months.
These findings hold important implications for clinician education and coordination of care for patients with BPD.
Difficulties in family functioning are often evident when an adolescent has anorexia nervosa, and the possible causative or contributory role of such difficulties in the illness is unclear.
To elucidate the relationship between severity of anorexia nervosa and difficulties in family functioning and whether clinical improvement results in diminution of self-rated family difficulties.
Thirty-five adolescents with anorexia nervosa and their mothers completed the Family Assessment Device (FAD) while clinicians administered the McMaster's Structured Interview of Family Functioning (McSIFF). Severity of anorexia nervosa was rated at baseline and at one year follow-up using the Morgan–Russell Schedule.
Clinicians and patients were more critical of the families' functioning than parents. There was an inverse association between the extent of family difficulties and severity of anorexia nervosa. Over time subjects improved clinically but this was not matched by improvement in family functioning.
Difficulties in family functioning do not appear to be directly associated with severity of anorexia nervosa nor do these difficulties reduce with clinical improvement, in the short term.
This study investigates the outcome of anorexia nervosa in adolescents in relation to precipitating life events and changes in family functioning over time.
Thirty-five adolescents with anorexia nervosa and their mothers were administered measures of life events and family functioning at initial assessment and 1 and 2 year follow-up, when outcome was also assessed.
Fifty-five per cent of patients had a good outcome. Patients from initially well-functioning families or those with precipitating life events improved more in the first year, than those with dysfunctional families or without events. Subjects perceived a deterioration in family functioning at 1 year follow-up but an improvement at 2 years. Mothers reported no changes.
Approximately half of a series of early onset cases of anorexia nervosa can be expected to recover by 2 years. Healthy family functioning and presence of a precipitating life event predict good short-term outcome. The relationships between subjects' perceptions of family functioning and their recovery from anorexia nervosa is discussed.
Difficulties in family functioning have been noted since early descriptions of anorexia nervosa and may be of importance aetiologically. Previous studies have a number of methodological problems.
Thirty-five anorexic adolescents were age/sex matched with psychiatric and community controls. A diagnostic interview and a questionnaire, the Family Assessment Device (FAD) were administered to control subjects and their mothers. Anorexic families only received the McMaster Structured Interview of Family Functioning.
Multivariate analyses of FAD scores showed pathological ratings for psychiatric control but not anorexic families, compared with community controls. By contrast objective ratings revealed marked dysfunction in anorexic families (greater in the purging subgroup).
Family functioning in anorexic families is normal by self-report but not by an objective measure. Anorexic families in the purging subgroup appear most dysfunctional.
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