Personality disorders cause emotional reactions in staff

A study published today in the open access journal BMC Psychiatry suggests that the way in which professional care workers respond emotionally to substance abuse patients with personality disorders depends on the type of disorder.

Birgitte Thylstrup and Morten Hesse of Aarhus University, Centre for Alcohol and Drug Research, in Copenhagen, Denmark, explain that while previous research has shown that antisocial and aggressive behavior in patients can affect how professionals manage them, no previous studies have investigated the distinction between the full range of different personality disorders and their effects on professional health care workers.

The idea that the emotional reactions of a professional to his or her patient may play an important part in psychotherapeutic treatment dates back to the work of Sigmund Freud. He coined the term ‘countertransferance’ to describe the observation that a patient’s influence on the analyst’s unconscious feelings may interfere with the patient’s treatment.

In order to test whether this hypothesis holds for the interaction between health professionals and substance abuse patients, the researchers asked staff members to complete an inventory of emotional reactions to their patients. Concomitantly, the patients, most commonly men in their thirties, were asked to complete a personality disorder questionnaire.

The researchers then sought to determine if there were any correlations between the emotional reactions reported by staff and the type of personality disorder in the patient.

Not unexpectedly, they found that patients with features of antisocial personality disorder induced feelings of distance in their carers. Interestingly, feelings of helpfulness were induced by those with features of avoidant personality disorder.

“The patient with antisocial personality disorder tends to be manipulative and aggressive. It is natural for staff members to react to such behavior with some negative reactions, and this is not a sign of unprofessional conduct”, says Morten Hesse. “On the other hand, the patient with avoidant personality disorder is often cautious and appears vulnerable and needy. In that context, many clinicians feel that they can be useful to the patient, and feel secure in their role as treatment providers.”

The researchers point out that by using self-reporting, rather than disorders assessed by the staff, they have, for the first time, avoided the problem of a confounding diagnosis. "Staff reactions should be considered in supervision of staff, and in treatment models for substance abuse patients with personality disorders," the researchers conclude.

Notes to Editors:

1. Substance abusers' personality disorders and staff members' emotional reactions
   Birgitte Thylstrup and Morten Hesse
   BMC Psychiatry (in press)

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