Posted: December 2nd, 2022

Controversy Associated with Personality and Paraphilic Disorders

Week 7: Personality and Paraphilic Disorders

Personality disorders represent perhaps the most challenging disorders that psychiatric-mental health nurse practitioners will have to address in their professional careers. Personality disorders can co-occur in every mental health disorder and, in some cases, can mask other disorders. Although difficult to treat, the PMHNP must be able to identify personality disorders and endeavor to work with the patient to not only recognize the disorder but also treat a disorder that patients often do not believe exist.

Although there is tremendous variety in what is considered normal sexual interests, paraphilic disorders occur when a persistent behavior or fantasy causes distress, harm, or risk of harm to oneself or others. Some paraphilic disorders include pedophilia, exhibitionism, fetishism, and voyeurism.

This week, you will explore controversies related to personality and paraphilic disorders, as well as clinical, ethical, and legal issues that should be considered when working with patients with such diagnoses.
Learning Objectives

Students will:

Analyze controversies related to the diagnosis and treatment of personality and paraphilic disorders
Analyze professional beliefs about personality and paraphilic disorders
Apply strategies for maintaining a therapeutic relationship with patients with personality and paraphilic disorders
Analyze legal and ethical considerations related to personality and paraphilic disorders

Learning Resources

Required Readings (click to expand/reduce)

National Institute for Health and Care Excellence: NICE Guidelines. (2010). Antisocial personality disorder: Prevention and management.

https://www.nice.org.uk/guidance/cg77

Sadock, B. J., Sadock, V. A., & Ruiz, P. (2015). Kaplan & Sadock’s synopsis of psychiatry (11th ed.). Wolters Kluwer. (For review as needed)

Chapter 22, “Personality Disorders”

Thapar, A., Pine, D. S., Leckman, J. F., Scott, S., Snowling, M. J., & Taylor, E. A. (Eds.). (2015). Rutter’s child and adolescent psychiatry (6th ed.). Wiley Blackwell.

Chapter 67, “Disorders of Personality”
Chapter 68, “Developmental Risk for Psychopathy”
Chapter 69, “Gender Dysphoria and Paraphilic Sexual Disorders” (pp. 988–993 only)

Zakhari, R. (2021). The psychiatric-mental health nurse practitioner certification review manual. Springer Publishing Company.

Chapter 14, “Personality Disorders”

Required Media (click to expand/reduce)

Buchanan, N. T. (2020, April 13). Lecture 14 part 3: Paraphilic disorders [Video]. YouTube. https://www.youtube.com/watch?v=ykkMo9t0bxs

MDedge. (2020, January 22). Personality disorders with Dr. Frank Yeomans [Video]. YouTube. https://www.youtube.com/watch?v=ESQIDslCX_s

Assignment: Controversy Associated with Personality and Paraphilic Disorders

Between 10% and 20% of the population experience personality disorders. They are difficult to treat as individuals with personality disorders are less likely to seek help than individuals with other mental health disorders. Treatment can be challenging as they do not see their symptoms as painful to themselves or others.

Photo Credit: Joe Houghton – www.joehoughtonphotography.ie / Moment / Getty Images

Paraphilic disorders are far more common in men than in women, and generally quite chronic, lasting at least two years. Treatment of these disorders usually involves both psychotherapeutic and pharmacologic treatments.

In this Assignment, you will explore personality and paraphilic disorders in greater detail. You will research potentially controversial elements of the diagnosis and/or treatment and explain ethical and legal considerations when working with these disorders.
To Prepare

Review this week’s Learning Resources and consider the insights they provide on assessing, diagnosing, and treating personality and paraphilic disorders.
Select a specific personality or paraphilic disorder from the DSM-5 to use for this Assignment.
Use the Walden Library to investigate your chosen disorder further, including controversial aspects of the disorder, maintaining the therapeutic relationship, and ethical and legal considerations. 

The Assignment

In 2–3 pages:

Explain the controversy that surrounds your selected disorder.
Explain your professional beliefs about this disorder, supporting your rationale with at least three scholarly references from the literature.
Explain strategies for maintaining the therapeutic relationship with a patient that may present with this disorder.
Finally, explain ethical and legal considerations related to this disorder that you need to bring to your practice and why they are important.

By Day 7 of Week 7

Submit your Assignment.
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Controversy Associated with Personality and Paraphilic Disorders
Controversy of Borderline Personality Disorder
The controversy of borderline personality disorder is related to the diagnosis, classification, assessment, and treatment. One of the critical issues is the stigma related to the diagnosis of the condition (Trull et al., 2018). It is not clear if the diagnostic method is an evidence-based practice or it should be changed. The stigma affects how practitioners tolerate the emotions and thoughts of individuals with the condition. The diagnostic process may lead to a negative view of patients with borderline personality disorder (Trull et al., 2018). For instance, practitioners may overlook strengths or minimize the symptoms. In some cases, the patients can be thought to be lazy and unable to participate in daily activities. Practitioners indicate that therapeutic nihilism is a major concern in addressing borderline personality disorder (Trull et al., 2018). The diagnosis is controversial since some practitioners believe it should not be diagnosed. Another controversy related to borderline personality disorder is how to differentiate the disease from other mental illnesses.
Professional Beliefs about the Disorder
My professional belief is that borderline personality disorder is another mental health condition that can affect any person. Borderline personality disorder can affect individuals and their ability to participate in daily activities and ability to manage and cultivate healthy relationships (Porter et al., 2020). The condition can affect the ability to manage emotions and control behavior. I believe practitioners should not express stigma during diagnosis, assessment, and treatment. Mental health nurses should understand the negative effects of the condition and seek to restore the positive behavior.
I believe as a professional it is vital for a medical checkup at a young age to provide opportunities for early intervention. Early treatment will eliminate the risk of adverse symptoms as patients age. The symptoms of borderline personality disorder affect individuals as they age leading to negative behavior and inability to manage healthy relationships (Porter et al., 2020). Parents should observe the growth of their children to avoid adverse health outcomes when it is too late (Porter et al., 2020). For instance, if a child has symptoms that are related to borderline personality disorder, it is crucial to take the child to a pediatrician or mental health nurse for diagnosis. Early diagnosis is vital to facilitate the normal growth of children.
Strategies for Maintaining Therapeutic Relationship
One of the strategies of maintaining a therapeutic relationship with patients is to maintain professional boundaries with patients. It is vital to keep the boundaries to eliminate the risk of compromising relationships with patients (Chanen et al., 2020). Despite efforts to establish rapport, maintaining professional boundaries is necessary. It is important to maintain privacy during the provision of medical services. A patient should be assured of professional boundaries to protect them from third parties that can undermine their confidence to share confidential information (Chanen et al., 2020). Another approach is to use active questions to engage a patient. Using positive questions will encourage a patient to share information about their behavior.
I will strive to establish the therapeutic relationship by assuring a patient about their confidentiality. I would lay the ground rules such as assuring the patient that their information will not be shared by any third party without their consent (Temes et al., 2019). Another approach is to show empathy and communicate clearly. Empathy will involve sharing and understanding the feelings of a patient without sympathizing with the patient. The communication should be clear to enhance adherence to the treatment plan (Temes et al., 2019). I will allow the patient to share feelings, emotions, and beliefs and explore their views. Expressing feelings and emotions is healthy for a patient.
Ethical and Legal Considerations
Patients with borderline personality disorder have a tendency of acting before thinking. The impulsive behavior will prompt a patient to engage in risky behavior. A practitioner should take precautions to avoid harm to a patient. Maleficence and beneficence involve the assurance that the treatment will be professional and without any harm (Haugom et al., 2019). In case the behavior of a patient is risky to an extent of costing their life, it is legal to report without consulting. For instance, if a patient wants to commit suicide, I would seek Helpance from parents, guardians, or police to avert the risk of death. The second ethical and legal issue is fairness and justice (Haugom et al., 2019). It will be important to take care of the patient without discrimination. For instance, practitioners should not discriminate against patients with borderline personality behavior.
Involuntary hospitalization is another legal and ethical issue in practice. Patients with borderline personality disorder can express impulsive behavior that can be risky at home or the clinic. It is essential to consult a parent or guardian to seek consent before hospitalizing a patient against their wish (Haugom et al., 2019). I will strive to use other methods of making a patient cool down such as medication unlike involuntary hospitalization (Haugom et al., 2019). Another issue is the high rate of suicide among patients undergoing treatment. The ethical issue should be addressed to prevent medical practices that put a patient at risk of suicide. Addressing ethical and legal issues is essential in maintaining a professional relationship with patients.

References
Chanen, A. M., Nicol, K., Betts, J. K., & Thompson, K. N. (2020). Diagnosis and treatment of borderline personality disorder in young people. Current psychiatry reports, 22(5), 1-8.
Haugom, E. W., Ruud, T., & Hynnekleiv, T. (2019). Ethical challenges of seclusion in psychiatric inpatient wards: a qualitative study of the experiences of Norwegian mental health professionals. BMC Health Services Research, 19(1), 1-12.
Porter, C., Palmier‐Claus, J., Branitsky, A., Mansell, W., Warwick, H., & Varese, F. (2020). Childhood adversity and borderline personality disorder: a meta‐analysis. Acta Psychiatrica Scandinavica, 141(1), 6-20.
Temes, C. M., Frankenburg, F. R., Fitzmaurice, G. M., & Zanarini, M. C. (2019). Deaths by suicide and other causes among patients with borderline personality disorder and personality-disordered comparison subjects over 24 years of prospective follow-up. The Journal of clinical psychiatry, 80(1), 0-0.
Trull, T. J., Freeman, L. K., Vebares, T. J., Choate, A. M., Helle, A. C., & Wycoff, A. M. (2018). Borderline personality disorder and substance use disorders: an updated review. Borderline personality disorder and emotion dysregulation, 5(1), 1-12.

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