Background Antisocial Personality Disorder (ASPD) is one of the most stigmatized psychiatric diagnoses in the public sphere, contrasting with Major Depressive Disorder (MDD) and Generalized Anxiety Disorder (GAD), which are among the least stigmatized. ASPD stigma extends to healthcare, where many providers hold negative attitudes towards patients with ASPD, affecting their willingness to work with this population. Understanding whether medicine perpetuates this stigma is crucial for early intervention in medical training. Given the role of language in perpetuating stigma, as evident in studies on Opioid Use Disorder, this study explored how language contributes to negative attitudes about ASPD in healthcare, an area largely overlooked in stigma research, Psychiatry, and medical education. It aimed to assess medical education resources for stigmatizing language and compare how they reflect public stigma patterns, where ASPD is more stigmatized than MDD and GAD.

Methods Seven widely used medical education resources were analyzed for their depiction of ASPD, MDD, and GAD. Since many medical students favor third-party resources for studying and board exams, the analysis included Boards and Beyond, AMBOSS, First Aid, First Aid for Psychiatry Clerkship, and APA, as well as in-house materials from Warren Alpert Medical School and the DSM-5. The analysis focused on two stigma components identified by Phelan and Link: labeling and status loss, particularly through clinical pessimism. Fisher's Exact Test compared ASPD to MDD and GAD across labeling, treatment difficulty, and treatment omission.

Results The analysis revealed significant stigma toward ASPD, with 85.7% (n=6) of the materials using labels like "bad," "manipulative," and "deceitful." Notably, "bad" was used as a mnemonic. In contrast, none of the materials for MDD or GAD employed such labels (p = 0.046). Regarding status loss, 42.9% (n=3) of ASPD materials emphasized treatment difficulty, compared to none for MDD or GAD (p = 0.031). Additionally, 71.4% (n=5) of ASPD resources omitted information on available treatments, while 42.9% (n=3) did so for MDD and GAD. Although the difference in treatment omission was not statistically significant (p = 1.0), the trend still reflects a bias.

Conclusion The findings suggest that medical education promotes ASPD stigma, mirroring the disproportionate stigma seen in the general public. The use of stigmatizing language indicates that medical education may perpetuate negative attitudes among healthcare providers. Addressing this stigma is crucial to improving care and outcomes for individuals with ASPD. Further research is needed to explore causality and develop strategies to reduce stigma in medical training.