Experience of Stigma for Individuals Living with Personality Disorders: A Systematic Review and Meta- Aggregation
A. L. Colonello, C. A. Marshall, S. Sibbald, K. Anderson, H. StuartIntroduction
The stigma literature shows that negative attitudes and discriminatory interactions lead to poorer health experiences and reduced life expectancy.Stigma is ubiquitous and healthcare providers are not immune from the outward internal and systematic manifestations of stigma in their practices. The way health care providers view patients can determine the quality of care that is provided and impact the overall treatment outcomes. There is a dearth of research which synthesizes the experiences of stigma of persons living with personality disorders (PD). No known systematic reviews have focused on the experiences of stigma for persons living with a PD.
Objectives
To synthesize existing qualitative research exploring experiences of stigma for people with PDs and to identify gaps and areas of saturation in the existing current literature.
Methods
We deployed a systematic search of seven academic databases: Medline, PsychINFO, EMBASE, SCOPUS, Nursing and Allied Health Abstracts, Social Work Abstracts, and Sociological Abstracts. We followed the methodology described by the Joanna Briggs Institute (JBI) to complete a systematic review of experience and meta-aggregation. Consistent with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, we conducted a title/ abstract screening of every article identified in the search, a full text review, and data extraction followed by a meta-aggregation of the findings of the included studies.
Results
After de-duplication, 6,079 records remained. In total, 48 studies were included in the final review (Figure 1). Half of the included studies (n=24; 50%) represented participants in Europe. Across 47 of these studies, 1,157 participants living with a PD were included. Samples focused primarily on Cluster B PDs, mainly borderline personality disorder (BPD) and antisocial personality disorder (n=1,069), with the remaining participants (n=89) described as general PDs. No studies capturing the distinct experiences of people with other PD diagnoses (e.g., schizoid) were identified. The meta-aggregation yielded 98 extracted themes which were organized into four synthesized findings: 1) the cost of labelling personality: clarity and confusion; 2) (‘ill’) legitimacy, burden, and powerlessness; 3) stigma in health-care settings and its influence on treatment; and 4) resistance to stigma and pathways to recognition: reframing and connecting.
Image 1: Long description.