Short communicationPsychiatrists׳ fear of death is associated with negative emotions toward borderline personality disorder patients
Introduction
Psychodynamic formulations contend that fear of death is a major motivation of physicians in choosing their profession, and that doctors deny this fear by experiencing professional success (Krakowski, 1971). Physicians׳ fear of death has been positively correlated with difficulties in communicating with terminally-ill patients, due to feelings of helpless when facing their unavoidable death, even after 20 years of practice (Cochrane et al., 1990, Dickinson et al., 1999).
Among the medical professions, psychiatrists are often required to cope with patients whose death is a voluntary choice, rather than the end-result of an incurable disease. Among the psychiatric diagnoses, suicide mortality in borderline personality disorder (BPD) is similar to that of mood disorders (Chesney et al., 2014). However, while clinicians perceive mood disorders as curable and sympathy-evoking illnesses, BPD patients are considered more problematic, and are held accountable for their suicidal behaviors (Bodner et al., 2015). Such patients often tend to undermine the therapeutic process, may turn members of staff against each other, have high drop-out rates from therapy, and exhibit acting out episodes that may cause psychiatrists a sense of professional impotence (Bodner et al., 2011, Bodner et al., 2015).
The current study tries to add to literature which focused solely on the link between physicians׳ fear of death and attitudes toward terminally-ill patients (Dickinson et al., 1999), or on fear of personal death among physicians (Hamama-Raz et al., 2000). This study elaborates on the above mentioned psychodynamic assumption and contends that high fear of death may lead to negative emotions toward patients that evoke a sense of professional impotence, as they tend not to comply with the treatment, and sometimes commit completed suicides. In line with this theorization, we hypothesized that psychiatrists׳ fear of death would be positively linked to negative attitudes toward BPD patients, after controlling for their professional experience with these patients, as well as for their attitudes toward suicide in general and toward their own death.
Section snippets
Method
We sent e-mails describing the study with a link to a 5-min internet questionnaire to 200 e-mail addresses of psychiatrists (Tel-Aviv Medical School Address Book). Participants provided their informed consent by using the link (response rate 60%; N=120), as approved by the Bar-Ilan University Institutional Review Board. The sample1
Results
Main statistical analyses included Pearson correlations and hierarchical linear regressions.3 Descriptive data on the questionnaires are presented.4
Discussion
In line with the hypothesis that fear of death would contribute to negative emotions toward BPD patients, psychiatrists׳ fear of death greatly contributed to negative emotions toward BPD, as it explained half of the variance of the entire model, even after controlling for professional experience with BPD and for attitudes toward suicide and death. Subjective nearness-to-death2 and suicide stigmatization2 (but not prevention or empathy) contributed to higher negative emotions toward BPD2.
Contributors
Ehud Bodner wrote the paper, Amit Shrira assisted with the analysis of the data and made critical revisions to the manuscript, the other authors, and Iulian Iancu in particular, assisted with data collection, and all authors commented on the manuscript.
Conflict of interest
None (declared by all authors).
Acknowledgment
This study was financed by Israel National Institute for Health Policy Research.
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