Personality and Paraphilic Disorders Essay

Personality and Paraphilic Disorders Essay

Personality disorders are diagnoses usually controversial following the stigmatization of various personality and paraphilic disorders. For this assessment, I have selected borderline personality disorder. According to (Campbell et al., 2020), many patients and healthcare providers tend to avoid diagnosing patients with personality disorders following increased stigmatization of the disease. Diagnosis of borderline disorder leads to family stigmatization as family treatment appears to have a role in the causation of the borderline disorders. Many healthcare providers do not believe in effective cure rates for borderline disorders leading to a therapeutic nihilism among many healthcare providers toward borderline behaviors.

Professional Beliefs

Borderline personality disorders have a vital family risk factor. The disease occurs primarily when there is a family disability leading to increased patient fear and efforts to avoid abandonment (Campbell et al., 2020). Most patients with borderline disorder have poor interpersonal relationships, which can impair healthcare services delivery and the development of patient-centered care. According to DSM V, the disease is characterized by impaired self-image and self-confidence. The condition can have additional effects on the mood leading to mood disorders (Hennings, 2020). Borderline personality disorder can be effectively managed by health care providers following the implementation of patient-centered care and psychotherapies (Fassbinder et al., 2018). Implementation of family therapy is essential to increase family support to the patient, effectively reducing the patient’s symptoms. The disease can present additional features such as depression, eating disorders, and self-mutilation. Patient counseling and admission to address these secondary effects are essential.

Strategies to Maintain a Therapeutic Relationship

Following increased patient skepticism and lack of faith in the family, maintaining patient healthcare interactions in borderline personality disorders is challenging. Cognitive-behavioral therapy, counseling, and patient education help patients open up and establish relationships with healthcare providers. Healthcare providers can better understand and support patients through effective communication and empathic listening (Fassbinder et al., 2018). Involvement of patients’ relatives during patient treatment allows healthcare providers to avoid close interpersonal attachment that goes beyond the therapeutic relationship. Healthcare practitioners can use family education to implement patient-centered care while maintaining the recommended patient-provider relationship.

Ethical and Legal Consideration

Diagnosis of borderline personality disorder among the pediatric population is mainly linked to child maltreatment. Maltreatment accounts for over 70% of all childhood personality problems (Chapman et al., 2019). Healthcare providers should provide effective family counseling. If child maltreatment is confirmed, legal action is taken to assure child protection. The child’s and parents’ treatment should be considered when causal variables such as maternal separation, inadequate maternal bonding, or parental psychopathologies exist. Borderline personality disorder in a child caused by the death of a parent may necessitate the use of community welfare programs to find the youngster a suitable home.

All healthcare services provided to the patient should adhere to the medical ethics guidelines (Chapman et al., 2019). To resolve personality problems, healthcare services should foster to alleviate family distress and improve intrafamily relationships. Healthcare professionals may require patient restriction rules to address complications of borderline personality disorder, such as participating in risky behaviors and growing legal and forensic misconduct. Patients with the severe borderline condition should not be allowed to engage in activities like driving since they are more likely to cause accidents and property damage.

Conclusion

Borderline personality disorder is characterized by problems controlling emotions and behavior and concerns with self-image and unstable relationships. Although borderline personality disorder usually manifests itself in early adulthood, it can also affect children. Maltreatment in children must be ruled out in the pediatric population. Management of the condition has been controversial due to the stigma connected with the diagnosis and the therapeutic pessimism held by practitioners who encounter persons with this condition in acute settings.

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References.

Campbell, K., Clarke, K. A., Massey, D., & Lakeman, R. (2020). Borderline Personality Disorder: To diagnose or not to diagnose? That is the question. International journal of mental health nursing, 29(5), 972–981. https://doi.org/10.1111/inm.12737

Chapman, J., Jamil, R. T., & Fleisher, C. (2019). Borderline Personality Disorder, StatPearls.

Fassbinder, E., Assmann, N., Schaich, A., Heinecke, K., Wagner, T., Sipos, V., … & Schweiger, U. (2018). PRO* BPD: effectiveness of outpatient treatment programs for borderline personality disorder: a comparison of Schema therapy and dialectical behavior therapy: study protocol for a randomized trial. BMC psychiatry, 18(1), 1-17. https://link.springer.com/article/10.1186/s12888-018-1905-6

Hennings, J. M. (2020). Function and psychotherapy of chronic suicidality in borderline personality disorder: using the reinforcement model of suicidality. Frontiers in psychiatry, 11, 199. https://doi.org/10.3389/fpsyt.2020.00199

 

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

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Rubric Detail

 

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Name:  Rubric

 

	Excellent 90%–100%	Good 80%–89%	Fair 70%–79%	Poor 0%–69%
In 2–3 pages, address the following: • Explain the controversy that surrounds your selected personality or paraphilic disorder.	14 (14%) – 15 (15%) The response includes an accurate and concise explanation of the controversy within the field related to the disorder.	12 (12%) – 13 (13%) The response includes an accurate explanation of the controversy within the field related to the disorder.	11 (11%) – 11 (11%) The response includes a somewhat vague or inaccurate explanation of the controversy within the field related to the disorder.	0 (0%) – 10 (10%) The response includes a vague or inaccurate explanation of the controversy within the field related to the disorder. Or the response is missing.
• Explain your professional beliefs about your selected disorder, supporting your rationale with at least three scholarly references from the literature.	23 (23%) – 25 (25%) The response includes a thorough and well-organized explanation of the student’s professional beliefs about the disorder. Rationale demonstrates critical thinking and is strongly supported with three scholarly references.	20 (20%) – 22 (22%) The response includes a well-organized explanation of the student’s professional beliefs about the disorder. Rationale is clear and appropriately supported with three scholarly references.	18 (18%) – 19 (19%) The response includes a somewhat vague explanation of the student’s professional beliefs about the disorder. Rationale is somewhat unclear and references either provide weak support for the rationale or are not scholarly/current.	0 (0%) – 17 (17%) The response includes a vague explanation of the student’s professional beliefs about the disorder. Rationale is unclear and references are inappropriate. Or the response is missing.
• Explain strategies for maintaining the therapeutic relationship with a client that may present with the disorder.	27 (27%) – 30 (30%) The response includes an accurate and concise explanation of strategies for maintaining the therapeutic relationship with a client that may present with the disorder.	24 (24%) – 26 (26%) The response includes an accurate explanation of strategies for maintaining the therapeutic relationship with a client that may present with the disorder.	21 (21%) – 23 (23%) The response includes a somewhat vague or incomplete explanation of strategies for maintaining the therapeutic relationship with a client that may present with the disorder.	0 (0%) – 20 (20%) The response includes a vague or inaccurate explanation of strategies for maintaining the therapeutic relationship with a client that may present with the disorder. Or the response is missing.
• Finally, explain ethical and legal considerations related to the disorder that you need to bring to your practice and why they are important.	14 (14%) – 15 (15%) The response includes an accurate and concise explanation of ethical and legal considerations related to the disorder that are important to clinical practice and why they are important.	12 (12%) – 13 (13%) The response includes an accurate explanation of ethical and legal considerations related to the disorder that are important to clinical practice and why they are important.	11 (11%) – 11 (11%) The response includes a somewhat vague or incomplete explanation of ethical and legal considerations related to the disorder that are important to clinical practice and why they are important.	0 (0%) – 10 (10%) The response includes a vague and inaccurate explanation of ethical and legal considerations related to the disorder that are important to clinical practice and why they are important. Or, response is missing.
Written Expression and Formatting – Paragraph Development and Organization: Paragraphs make clear points that support well-developed ideas, flow logically, and demonstrate continuity of ideas. Sentences are carefully focused—neither long and rambling nor short and lacking substance. A clear and comprehensive purpose statement and introduction are provided that delineate all required criteria.	5 (5%) – 5 (5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.	4 (4%) – 4 (4%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time. Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.	3.5 (3.5%) – 3.5 (3.5%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time. Purpose, introduction, and conclusion of the assignment are vague or off topic.	0 (0%) – 3 (3%) Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time. No purpose statement, introduction, or conclusion were provided.
Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation	5 (5%) – 5 (5%) Uses correct grammar, spelling, and punctuation with no errors	4 (4%) – 4 (4%) Contains 1-2 grammar, spelling, and punctuation errors	3.5 (3.5%) – 3.5 (3.5%) Contains 3-4 grammar, spelling, and punctuation errors	0 (0%) – 3 (3%) Contains five or more grammar, spelling, and punctuation errors that interfere with the reader’s understanding
Written Expression and Formatting – The paper follows correct APA format for title page, headings, font, spacing, margins, indentations, page numbers, parenthetical/in-text citations, and reference list.	5 (5%) – 5 (5%) Uses correct APA format with no errors	4 (4%) – 4 (4%) Contains 1-2 APA format errors	3.5 (3.5%) – 3.5 (3.5%) Contains 3-4 APA format errors	0 (0%) – 3 (3%) Contains five or more APA format errors
Total Points: 100