The “Attention-Seeking” Label and the Stigma It Represents

The idea of labelling people as attention-seeking is not unique to mental illness, but it’s certainly something that seems to come up an awful lot. The labellers might be friends and family, but unfortunately, they may also be health care providers. One of the labels that comes up regularly is “attention-seeking.”

Physical manifestations of mental distress

I work as a nurse at a mental health and addictions facility. One of the recent clients had borderline personality disorder and a history of significant trauma, and I heard staff frequently describe him as attention-seeking. He had a tendency to somatize mental distress, and this would often take the form of gastrointestinal discomfort, which many staff tended to dismiss out of hand.  When staff dismissed his concerns, he tended to respond with very regressive behaviours, like crawling rather than walking.

I only work nights so I mostly just saw him at the beginning of my shifts. My experience, though, was that he almost always responded very well to heaps of validation. He didn’t necessarily need to be given what he’s asking for, and often what he was asking for wasn’t an effective way to meet his needs anyway, but validation of his distress settled him right down.

The problem with labelling

The attention-seeking label is thrown around a fair bit in mental health care.\ Where I work, a lot of the staff aren’t trained mental health professionals, and most of the regular nursing staff are pretty fresh out of school. I think both of these factors contribute to a tendency to quickly leap to the conclusion of attention-seeking. I’ve also noticed that the people who are most likely to apply the attention-seeking label have the least insight into the negative effects it has for the patient.

The way I see it, we all have needs that we try to get met. Sometimes we’re unable to meet our needs, and we reach out to others to help us. For the most part, that should be considered help-seeking behaviour, which is a good thing.

There are certainly times when people engage in problematic attention-seeking behaviour. Narcissistic and antisocial personality disorders are examples of this. For the most part, though, mental health professionals really shouldn’t have that much difficulty distinguishing this from legitimate help-seeking.

Factors that contribute to labelling

Someone reaching out for help may end up being labelled as attention-seeking for a few reasons:

• the genuine underlying need is not recognized
• the underlying need is seen but deemed to be not valid
• the person is viewed as not having made an effort or “enough” of an effort to meet their needs on their own
• the assistance that the “attention-seeking” individual is looking for would not be reasonably expected to actually fulfill the underlying need
• the “attention-seeking” individual expresses that the labeller’s recommended solution to the problem at hand seems inadequate or inappropriate
• on previous occasions, the labeller has not been able to provide any sort of meaningful help when the same reaching-out behaviour has occurred
• the labeller believes the person should just “suck it up” and deal with whatever the reported problem is

Consequences

This is similar to labelling people as “drug-seeking” or “medication-seeking” when otherwise compliance is what’s expected. There’s really no way for the patient to win when providers have a double standard.

It’s disappointing that for all that people are encouraged to reach out for help when they are having thoughts of suicide, people who actually do so are far too likely to be labelled as attention-seeking. It’s simple behavioural psychology that if you shoot people down for reaching out for help, they’re going to stop reaching. When it comes to suicidality, that can have deadly consequences.

I’m not sure what the solution is for this issue. I do know that it’s not okay.

Have you ever been labelled as attention-seeking by treatment providers?