eell
Lond
don
t me
t of
rs
tic
the
r di
d ad
h pr
germe
ned wi
was fir
s abou
or pre
ding t
and b
d pro
elp-see
al healt
In Jorm et al.'s (1997) early study, participants were asked “What
participants to in
Psychiatry Research xxx (2011) xxx–xxx
PSY-06804; No of Pages 5
Contents lists available at ScienceDirect
Psychiatry
l seacceptance (Mubbashar and Farooq, 2001; James et al., 2002; Goldney,
et al., 2005). The exploration of many aspects of mental health literacy
has mostly been through the use of vignette methodology (Farrer et al.,
2008) which is also employed in this study.
In Jorm's (2000) review, he noted that many lay people cannot
correctly identify mental disorders and they have difficulties
understanding psychiatric terms. For example, Jorm et al. (1997)
found that 39% of participants correctly identified Depression but only
conducted more recently and the results reflecting more current
knowledge. However, they also pointed out their use of an
unrepresentative sample, consisting of more female and higher
educated participants than the Australian study. The unavailability
of demographic and socio-economic details from the Australian study
renders any comparison impossible.
In a recent paper concerned with whether lay people could label a
person as being a psychopath (i.e. having Anti-Social Personality27% correctly identified Schizophrenia. Mo
reported considerably higher recognition
Depression (Link et al., 1999; Lauber et al
increase may not entirely reflect greater awa
⁎ Corresponding author.
E-mail address: a.furnham@ucl.ac.uk (A. Furnham).
0165-1781/$ – see front matter © 2011 Elsevier Ireland
doi:10.1016/j.psychres.2011.02.024
Please cite this article as: Furnham, A.,
psychres.2011.02.024h information. Jorm et al.
(Chen et al., 2000; Jorm,
acy seems to be gaining
were able to recognise depressive symptoms and use the correct label.
The authors claimed that the higher recognition rate in their second
study compared to the Australian survey may be due to it beinghave done a great deal of research in the area
2000) and the concept of mental health literbut none have been specifically concer
The term ‘mental health literacy’
(1997) meaning ‘knowledge and belief
aid their recognition, management
comprises several components, inclu
specific mental disorders; knowledge
and causes self-help interventions an
attitudeswhich promote appropriate h
and knowledge of ways to obtain mentth personality disorders.
st coined by Jorm et al.
t mental disorders which
vention’ (p. 182). This
he ability to recognise
eliefs about risk factors;
fessional help available;
king; and the recognition
were suffering from an ‘illness’ or a ‘crisis’. Link et al. (1999) asked the
participants to rate the likelihood of X experiencing a ‘mental illness’. It
can benoted that both Link et al. (1999) and Lauber et al. (2003) implied
that therewas somethingwrongwith theperson. This implied ‘problem’
may contribute to the discrepancy between Jorm et al.'s (1997) findings
and more recent studies.
Wang et al. (2007) found that in Canada, 75.6% of their participantsre recent studies have
of Schizophrenia and
., 2003). However, this
reness; but may possibly
Disorder), Furnh
97% of participa
although only 39
Personality Diso
The current st
personality disor
some sense iden
having a problem
Ltd. All rights reserved.
et al., Psychiatric literacy and personalitydicate whether the person described in the vignettesunderstanding of psychiatry’. Many s
this area (Angermeyer et al., 2004; Anhave been conducted in
yer and Dietrich, 2006),
would you say, if anything, is wrong with John/Mary?” In contrast,
Lauber et al. (2003) presented a close-ended question. They requiredThis paper is concerned with psychiatric literacy or the ‘public
tudiesPsychiatric literacy and personality disord
Adrian Furnham a,⁎, Natasha Abajian a, Alastair McCl
a Research Department of Clinical, Educational and Health Psychology, University College
b Research Department of Cognitive, Perceptual and Brain Sciences, University College Lon
a b s t r a c ta r t i c l e i n f o
Article history:
Received 17 June 2010
Received in revised form 31 January 2011
Accepted 25 February 2011
Available online xxxx
Keywords:
Mental health literacy
Personality disorders
Lay recognition
Past literature suggests tha
aimed to examine the effec
mental illness as predicto
descriptions. An opportunis
line questionnaire in which
The results revealed majo
identification and perceive
experienced a mental healt
1. Introduction
j ourna l homepage: www.ers
and b
on, United Kingdom
, 26 Bedford Way, London WC1 0AP, United Kingdom
ntal health literacy among the general public is lamentably poor. The study
demographics, knowledge of psychology and psychiatry, and experience of
for understanding and recognising personality disorders from vignette
sample of 187 participants with a mean age of 28 years completed an on-
y were asked to describe and evaluate vignettes of 10 personality disorders.
fferences between the personality disorders in terms of recognition, and
justment. The results showed that those who were female, older and had
oblem were more accurate and mental health literate.
© 2011 Elsevier Ireland Ltd. All rights reserved.
be the result of methodological disparities in the way mental health
literacy is measured.
Research
v ie r.com/ locate /psychresam et al. (2009) used three vignettes and found that
nts could recognise Depression; 61% Schizophrenia
% could correctly identify a Psychopath (Anti-Social
rder).
udy is concerned specificallywith layunderstandingof
ders: that is, their ability to recognise a disorder, (in
tify it or correctly label it) and the person with it as
. There are a number ofwebsites such as that provided
disorders, Psychiatry Res. (2011), doi:10.1016/j.

issues like prevalence (Oldham and Skodol, 1991; Coid et al., 2006;
2 A. Furnham et al. / Psychiatry Research xxx (2011) xxx–xxxHuang et al., 2009), the reliability of diagnosis (Tyrer et al., 2007), as
well as the efficacy of treatment (Bateman and Fonagy, 2008).
There is also a literature on successful people with personality
disorders; particularly in the workplace (Board and Fritzon, 2005;
Furnham, 2010). However, with greater relevance to this study is the
existence of a number of books aimed at the lay person that attempt to
describe the various personality disorders in detail (e.g., Dotlich and
Cairo, 2003; Miller, 2008). Another example is the work of Oldham
andMorris (1995) whose book attempts to explain all the disorders in
lay language including how to live and work with them.
This exploratory study is concerned with the ability of lay
participants to recognise the presence of a psychological problem,
label a personality disorder correctly, and to rate the person with the
disorder; with respect to happiness, success at work and quality of
personal relationships. The first hypothesis is that some disorders will
be muchmore easily recognised than others by lay people, and that in
particular, Obsessive-Compulsive Personality Disorder will be readily
identified. This is because some of these concepts have “seeped” into
the media, where they are often discussed, while other types of
disorder such as Schizotypal or Borderline are infrequentlymentioned.
The second (related) hypothesis is that lay people will be reasonably
proficient at identifying the presence of a personality disorder but will
be poor at providing the correct diagnostic label for that disorder. The
third hypothesis is that there will be a negative relationship between
the probability of a disorder being identified and the ratings of
adjustment (i.e. happy, successful at work and enjoying good personal
relationships). The fourth hypothesis is that females will demonstrate
better psychiatric literacy than males — a phenomenon evident in
previous research (Cotton et al., 2006; Wang et al., 2007). We also
aimed to investigate the influence of experience of psychological
problems (either personally or knowing someonewith a psychological
problem) and age on the ability to identify personality disorders.
2. Method
2.1. Participants
A total of 187 participants took part in the study, recruited through opportunity
sampling and student mailing lists. All participants took part on a voluntary basis and
were not remunerated for their participation. Of the recorded demographics (49
participants chose not to disclose personal details) there was an age range of 18 to
66 years (M=28.01 years, S.D.=13.37 years). There were 87 recorded females and 51
males; the majority of participants reported being of British ethnicity (56.7%, N=106),
although other ethnic backgrounds, like European Caucasian (11.8%, N=22), Asian
(3.2%, N=6) and Mixed British (2.1%, N=4) were represented. Many of the
respondents were students (40.6%, N=76), but there were also some in full-time
work (19.3%, N=36), part-time work (6.4%, N=12), retired (2.7%, N=5), unemployed
(2.1%, N=4) and some with another occupational status (2.7%, N=5). As regards
highest educational qualifications, 32.1% (N=60) had A-levels (12th grade) and 31%
(N=58) had a degree. Finally, 9.1% (N=17) reported having been personally treated
for a psychological illness, and 57.2% (N=107) reported having known someone who
had been treated for a psychological illness.
2.2. Questionnaire — personality disorders questionnaire
The questionnaire consisted of 10 vignettes describing three cluster A (Schizotypal,
Paranoid and Schizoid) four cluster B (Antisocial, Borderline, Histrionic and
Narcissistic) and three cluster C (Avoidant, Dependent and Obsessive-Compulsive)
disorders as defined in DSM-IV-R (American Psychiatric Association, 2000). The
vignettes were adapted andmodified from those found in three textbooks: Spitzer et al.
(1994); Nevid et al. (1997); Seligman et al. (2001) and. The vignettes were around 150byTheRoyal College of Psychiatristswhichdescribes the disorders, their
treatment, prevalence, change over time and access to self help (The
Royal College of Psychiatrists, 2010). It points out that 10–30% of people
who visit a General Practitioner will have a personality disorder.
It does seem that some disorders are studied much more
frequently than others (i.e., Borderline, Narcissistic and Antisocial
vs. Schizoid and Dependent). Academic papers are concerned withto 200 words long and written to be easily understandable. An example is given below:
Please cite this article as: Furnham, A., et al., Psychiatric literacy
psychres.2011.02.024Laura is a married 45 year old lawyer. She was the youngest full partner in the firm's
history and is known as the hardest driving member of the firm. She is too proud to turn
down a new case and too much of a perfectionist to be satisfied with the work done by her
assistants. Displeased by their writing style and sentence structure she finds herself
constantly correcting their briefs and therefore is unable to keep up with her schedule.
When assignments gets backed up, she cannot decide which to address first, starts making
schedules for herself and her staff, but then is unable to meet them and starts working 15
hours a day. Laura never seemed to be able to relax. Even on vacations, she develops
elaborate activities schedules for every family member and gets angry and impatient if they
refuse to follow her plans. Her husband is fed up with their marriage and can no longer
tolerate her emotional coldness, rigid demands and long working hours.
How would you describe this person? …………………………………………………
How happy overall do you think they are? Very 8 7 6 5 4 3 2 1 Not at all.
How successful at work do you think they are? Very 8 7 6 5 4 3 2 1 Not at all
How good are their personal relationships? Very 8 7 6 5 4 3 2 1 Not at all
Do you think that, in any sense they have a psychological problem Yes…. No…..
If so what is it?.................................................................................................................................
We kept the sex of the Personality Disorder person the same as in the textbook
vignettes. All were male except those for Borderline, Histrionic and Obsessive-
Compulsive disorder cases. This could have had an effect on recognition and ratings as it
is known that there are sex differences in the personality disorders (Lynam and
Widiger, 2007). It is known that males are more likely to be diagnosed Narcissistic,
Anti-Social and Paranoid as compared to females. We felt it was appropriate to leave
the sex differences as they were, though it is possible that had all vignettes concerned
people of the same sex, (all male and all female) the ratings may have been different.
There were three rounds of piloting. On the advice of a test publisher who
developed a measure of the personality disorders (Hogan and Hogan, 1997) the
vignettes were changed slightly to make them less “clinical” and more “normal”. These
changes were relatively minor and also attempted to make the descriptions of similar
length. We recognise the importance of the vignettes (subtlety, veridicality and
representativeness) for all studies in this area. Readers are welcome to contact the first
author to obtain copies of the questionnaire.
Second, the 10 vignettes without labels and randomised with respect to the three
clusters were sent to six clinical psychologists in three countries. They were told that
the vignettes represented 10 personality disorders. They were given a list of the
disorders and asked tomatch them up. Five of the six got them fully “correct”, while one
confused two disorders. Three more clinicians were asked to label the disorders
without the list. Two “correctly” identified all ten, while a third got one “wrong”. Third,
the draught questionnaire was given to 10 people who were asked to be critical with
respect to the clarity of the instructions as well as vignettes — and changes were made
accordingly.
2.3. Procedure
A web-based approach was adopted for the data collection. The participants were
told that there was no time limit, but on average the questionnaire should take
approximately 20 min to complete. Participants were also informed that all
information collected would be kept strictly confidential, only accessible to members
of the research team and held in accordance with the UK Data Protection Act (Office of
Public Sector Information, 1998). They were informed that they were free to withdraw
from the study at any time. Participants were also told that all input was completely
anonymous and results could not be personally identifiable from any report or
publication.
3. Results
In order to assess how successful participants were at recognising a
psychological disorder as being present for each of the personality
disorder vignettes, a Cochran's Q test was conducted. This revealed that
there was a highly significant difference in the proportions of successful
identifications of a psychological problem as a function of the
personality disorder, Q (9)=191.815, pb0.001. Table 1 shows the
personality disorders in descending order of how successfully partici-
pants identified a problem for each vignette. Inspection of this table
reveals that participants were most successful at identifying Borderline
Personality Disorder as a psychological problem, followed by the
Schizoid, Schizotypal and Antisocial Disorders. Less than half of the
participants identified Paranoid, Histrionic, Avoidant, and Obsessive-
Compulsive disorders as being psychological problems. Dependent and
Narcissistic personality disorders were least likely to be seen as
psychological problems.
The Cochran's Q test was then used to assess how successful
participants were at actually naming the psychological problem
being described. Again, there was a highly significant difference in
and personality disorders, Psychiatry Res. (2011), doi:10.1016/j.