Lam Danny C K, Salkovskis Paul M, Hogg Lorna I
Kingston University & St George's Hospital Medical School, London, UK.
University of Bath, UK.
Br J Clin Psychol. 2016 Sep;55(3):253-68. doi: 10.1111/bjc.12093. Epub 2015 Jul 25.
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.
Diagnostic labels can have an inappropriately negative effect on clinicians' judgements not only of treatment variables such as engagement and response but also risk issues and interpersonal effectiveness. Diagnostic labels can have a greater effect on clinicians' judgements than a behavioural description or clinical presentation. Clinicians should therefore be cautious both in the use of diagnostic labels to describe patients and ensure that these are still valid, and also be mindful of the influence that such labels can have on their own clinical judgements and constantly seek to challenge these. Behavioural descriptions of difficulties are less likely to result in such negative judgements and predictions.
诊断在精神病学中无处不在，虽然它确实带来了益处，但“贴标签”的负面影响也可能存在。本研究旨在通过实验评估临床医生对惊恐障碍患者的判断是否会受到不恰当暗示的共病边缘型人格障碍（BPD）诊断的影响。
采用实验设计来评估临床医生在其所获信息的性质有所变化以暗示BPD共病时的判断。
265名临床医生观看了一段视频记录的对一名女性的评估，该女性描述了她单纯的“惊恐障碍”经历，然后对她目前的问题和可能的预后进行评分。在观看视频记录之前，参与者被随机分配到三种情况之一，并提供书面信息，包括：（1）她的个人详细信息和一般背景；（2）添加与BPD一致的行为描述；（3）进一步添加“标签”（既往BPD诊断）。
与仅提供信息和BPD“症状”的行为描述相比，BPD标签与对该女性问题及其预后的更负面评分相关。
尽管此类诊断可能具有潜在的精算价值，但得出的结论是，在明显存在当前共病问题的情况下，临床医生可能会受到既往诊断标签的过度影响，不过如果使用相关行为的描述，这种偏见似乎不太可能出现。因此，在心理健康专业人员中，标签本身而非其所代表的行为可能具有污名化作用。
诊断标签不仅会对临床医生关于治疗变量（如参与度和反应）的判断产生不恰当的负面影响，还会对风险问题和人际效能产生影响。诊断标签对临床医生判断的影响可能大于行为描述或临床表现。因此，临床医生在使用诊断标签描述患者时应谨慎，并确保这些标签仍然有效，同时要意识到此类标签对自身临床判断的影响，并不断寻求对这些影响提出质疑。对困难的行为描述不太可能导致此类负面判断和预测。
