[ANSWERED 2024] Explain your professional beliefs about this disorder, supporting your rationale with at least three scholarly references from the literature

Written By: Dan Palmer, RN

Explain your professional beliefs about this disorder, supporting your rationale with at

Explain your professional beliefs about this disorder, supporting your rationale with at least three scholarly references from the literature

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.

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:

By Day 7 of Week 7

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REQUIRED SOURCES

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

Buchanan, N. T. (2020, April 13). Lecture 14 part 3: Paraphilic disorders [Video]. YouTube.

MDedge. (2020, January 22). Personality disorders with Dr. Frank Yeomans [Video]. YouTube.

GRADING RUBRIC

In 2–3 pages, address the following:

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

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.

Written Expression and Formatting – English writing standards:

Correct grammar, mechanics, and proper punctuation

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.

Expert Answer and Explanation

Controversy associated with Antisocial Personality Disorder

Antisocial Personality Disorder (APD) is one of the different forms of personality disorders, and for the therapists, working with a client with this condition can be a challenge. A significant number of people with APD do not feel their condition is harmful to themselves or even to people close to them, and this is the reason why it can be a challenge for psychotherapists to treat such as client.

For the psychotherapist to succeed in working with APD client, they need to build relationship with the client. They can accomplish this by building trust and behaving well towards the client. However, there are various strategies which a provider can adopt to build therapeutic relationships (Buchanan, 2020).

It is important to examine these strategies, assess the controversy pertaining to the APD, and provide personal professional beliefs concerning the condition. It is equally important to determine the ethical and legal considerations based on the APD.

Controversy that Surrounds the Disorder

The APD is controversial, and the treatment of this disorder can be a problem to the therapists. A key reason why the APD raises controversy is that it causes the stigmatization of the patient. The thought of having this disorder can be a stigmatizing experience to the patient, and it can cause the patient not to seek treatment.

The individual working with the patient can also contribute to this stigma. The controversy, still, occurs because the APD does not consider the social context or the factors which can influence one’s capacity to cope. A traumatic event during one’s early years can alter an individual’s ability to cope, and because the APD does not take this into account, it can be a challenge to treat someone with the disorder (National Institute for Health and Care Excellence: NICE Guidelines. 2010). Furthermore, there is lack of agreement among experts on the elements and features of the disorder, and this also presents controversy.

Professional Beliefs Concerning the Disorder

I have personal professional beliefs regarding the disorder. I believe that the condition can be chronic, and a person can live with it for many years. Unless one gets help, the symptoms may continue manifesting up to the point when they age. This, I believe is the reason why symptoms are more visible when a person is in their mid-age, than when they age.

This is one of the characteristics that makes the APD different from the other disorders. I also believe that a number of factors including one’s environment and their genetic characteristics determine their risk of developing the APD. From the professional perspective, a child is likely to develop APD or some personality disorders if they have abusive parents.

Because the APD is hereditary, chances of developing the APD can be high among individuals if they have history of the disease in their family (Sadock, Sadock, & Ruiz, 2015). My rationale for this is that an individual’s upbringing is indeed a factor that determines their risks of having various personality conditions.

Strategies for maintaining Therapeutic Relationship with a Client with the Disorder

A therapist has various options when it comes to the strategies they can choose to help maintain therapeutic relationship with the client. They can achieve this by helping the APD patient to feel welcome, and comfortable. This is done during the introduction phase, and the therapist may smile and show friendly gestures.

It may take time to connect with the client, and the therapist should take this into account when working with them. It is also important for the psychotherapist to manage their emotions, and let the patient know it is about them and not the therapist. Instead of using harsh words or statements which may cause stigma, they can speak in a respectful manner, and be emotionally sensitive (Zakhari, 2021). Doing all these can lead to a situation in which the client trusts the therapist, and they may therefore open up.

Ethical and Legal Considerations Related to the Disorder and their Importance

There are legal and ethical considerations which an individual needs to consider when working with APD person. Consent is an example of such considerations, and before starting the assessment, the provider must seek the patient’s consent so that they can assess the patient and conduct the treatment. Confidentiality is another consideration.

This applies when it comes to disclosure or sharing of the information with the patient’s family or another third party (MDedge, 2020). Another consideration is the competence, and this is important because the therapist needs to be competent enough to administer assessment and treatment based on the existing clinical protocols.

Conclusion

In conclusion, the issue of APD is controversial because of the stigma linked to it, and this explains the reason why diagnosis the condition and treating it can be a problem. Some of the personal professional beliefs concerning this condition are; the disease is hereditary; and the environment in which one is brought up can determine the risk of developing it. A therapist has to be competent, and seek the patient’s consent when working with the patient. Doing this can help prevent adverse legal and ethical consequences.

References

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.

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.

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.

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

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FAQs

What are the controversies surrounding the diagnosis of personality disorders?

The diagnosis of personality disorders is a topic that has generated controversy and debate within the field of psychiatry and mental health. Some of the key controversies include:

  1. Categorical vs. Dimensional Approach:
    • One major debate revolves around whether personality disorders should be diagnosed categorically (as distinct disorders) or dimensionally (on a continuum). The categorical approach, as found in the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition), identifies specific personality disorders with distinct criteria. Some argue that a dimensional approach might better capture the complexity and variability of personality traits.
  2. Overlap and Comorbidity:
    • Personality disorders often coexist with each other and with other mental health disorders. Critics argue that the current diagnostic system may not adequately account for the overlap and comorbidity, leading to challenges in accurately capturing the clinical picture and determining appropriate treatment.
  3. Cultural and Social Bias:
    • The diagnostic criteria for personality disorders may be culturally and socially biased. Some critics argue that these criteria may not be universally applicable and that cultural differences in expressions of personality should be considered to avoid pathologizing normative behavior.
  4. Stigmatization:
    • The diagnosis of personality disorders can carry a significant social stigma. People with these diagnoses may face discrimination and negative stereotyping, both within and outside the healthcare system. Critics argue that stigmatization may hinder individuals from seeking help and contribute to a negative perception of personality disorders.
  5. Reliability and Validity Issues:
    • Critics have raised concerns about the reliability and validity of the diagnostic criteria for personality disorders. Some argue that these disorders can be difficult to differentiate from each other, leading to issues with inter-rater reliability and diagnostic consistency.
  6. Evolving Nature of Personality:
    • Personality is considered a dynamic and evolving construct. Critics argue that a diagnosis of a personality disorder might not adequately capture the potential for positive change and growth in an individual’s personality over time, potentially limiting opportunities for rehabilitation and recovery.
  7. Treatment Implications:
    • The controversy extends to the implications of diagnosis for treatment. Some argue that a focus on specific personality disorder diagnoses might overshadow the importance of addressing individual symptoms and functional impairments, potentially limiting the effectiveness of treatment planning.

Revision Policy

What is the controversy surrounding dissociative identity disorder?

Dissociative Identity Disorder (DID), formerly known as Multiple Personality Disorder, is a condition characterized by the presence of two or more distinct identity states that control an individual’s behavior, consciousness, and memory. The controversy surrounding DID encompasses various aspects, including diagnosis, etiology, and treatment. Some key points of contention include:

  1. Validity of the Diagnosis:
    • There is ongoing debate about the validity of DID as a distinct diagnostic category. Skeptics argue that the disorder may be a result of suggestion, suggestion by mental health professionals, or iatrogenic factors (caused inadvertently by the treatment itself), and that it may be overdiagnosed or misdiagnosed.
  2. Trauma and Etiology:
    • The relationship between trauma and the development of DID is a subject of controversy. While many clinicians and researchers associate DID with a history of severe childhood trauma, there are differing views on the role of trauma in the etiology of the disorder. Some critics argue that the emphasis on trauma may lead to the creation of false memories.
  3. Controversy Surrounding Recovered Memories:
    • DID is often associated with the recovery of repressed or dissociated memories, particularly memories of childhood trauma. However, the validity and reliability of recovered memories have been questioned. Critics argue that memories recovered in therapy may be influenced by suggestion and may not accurately represent past events.
  4. Sociocultural Influences:
    • The presentation of DID can be influenced by cultural and societal factors. Critics argue that the disorder may manifest differently in various cultural contexts, leading to challenges in cross-cultural diagnosis and understanding.
  5. Media Portrayals:
    • Media representations of DID, often sensationalized in movies and television, have contributed to public misconceptions and skepticism. Some argue that these portrayals may influence both public and professional perceptions of the disorder, potentially leading to bias and stigma.
  6. Overlap with Other Disorders:
    • There is debate about the distinction between DID and other psychiatric disorders, such as borderline personality disorder and certain forms of schizophrenia. Critics argue that the symptoms of DID may overlap with those of other disorders, raising questions about the specificity of the diagnosis.
  7. Treatment Controversies:
    • The optimal treatment approach for DID is a subject of controversy. While some clinicians advocate for psychotherapy, including techniques such as integration therapy, others question the efficacy of these treatments and express concerns about potential harm associated with therapeutic practices.

Why are personality disorders the most difficult to treat?

Treating personality disorders can be challenging for several reasons, and it’s important to note that the degree of difficulty can vary depending on the specific personality disorder and individual characteristics. Here are some factors contributing to the challenges associated with treating personality disorders:

  1. Complexity and Heterogeneity:
    • Personality disorders are complex and heterogeneous conditions, encompassing a range of symptoms and behaviors. Individuals with personality disorders may present with different combinations of traits and patterns, making it challenging to develop standardized treatment approaches.
  2. Co-occurring Disorders:
    • Many individuals with personality disorders often have co-occurring mental health conditions, such as mood disorders, anxiety disorders, or substance use disorders. Treating these coexisting conditions alongside the personality disorder requires a comprehensive and integrated approach.
  3. Resistance to Treatment:
    • Individuals with personality disorders may be resistant to treatment, and building therapeutic rapport can be challenging. Trust issues, fear of abandonment, and difficulties forming stable relationships may hinder the therapeutic alliance, making it harder to engage individuals in the treatment process.
  4. Long-Term Nature:
    • Personality disorders are often considered chronic conditions that persist over the long term. Achieving lasting change can be a gradual and ongoing process, and individuals may require sustained therapeutic support to address deep-seated patterns of thinking and behavior.
  5. Limited Insight:
    • Some individuals with personality disorders may have limited insight into their condition or may be unaware of the impact of their behavior on themselves and others. Lack of insight can hinder motivation for treatment and the willingness to engage in self-reflection and change.
  6. Interpersonal Challenges:
    • Many personality disorders involve difficulties in interpersonal relationships. Individuals may struggle with attachment, have fears of rejection or abandonment, or engage in patterns of behavior that strain relationships. Addressing these interpersonal challenges requires a nuanced and relational approach.
  7. Transference and Countertransference:
    • Transference (the projection of past experiences onto the therapist) and countertransference (the therapist’s emotional reactions to the client) dynamics can be more pronounced in the treatment of personality disorders. Managing these dynamics is essential for effective therapy but can be challenging.
  8. Limited Treatment Guidelines:
    • Compared to some other mental health conditions, there are fewer established treatment guidelines for personality disorders. The diversity of presentations and the limited evidence for specific interventions make it challenging to determine a one-size-fits-all approach.

civil rights

What are the 10 paraphilic disorders?

Paraphilic disorders are classified in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5). It’s important to note that updates or changes to diagnostic criteria may have occurred since then. The DSM-5 lists several paraphilic disorders. The 10 paraphilic disorders identified in the DSM-5 are:

  1. Voyeuristic Disorder:
    • Arousal from observing others undressing or engaging in sexual activity without their consent.
  2. Exhibitionistic Disorder:
    • Arousal from exposing one’s genitals to others without their consent.
  3. Frotteuristic Disorder:
    • Arousal from touching or rubbing against a nonconsenting person.
  4. Sexual Masochism Disorder:
    • Arousal from the act of being humiliated, beaten, bound, or otherwise made to suffer.
  5. Sexual Sadism Disorder:
    • Arousal from the physical or psychological suffering of another person.
  6. Pedophilic Disorder:
    • A primary sexual interest in prepubescent children.
  7. Fetishistic Disorder:
    • Arousal from nonliving objects or highly specific body parts.
  8. Transvestic Disorder:
    • Arousal from cross-dressing, often associated with distress or impairment.
  9. Autogynephilia:
    • A paraphilic interest in being or becoming a woman, typically experienced by a male.
  10. Other Specified Paraphilic Disorder and Unspecified Paraphilic Disorder:

What are the personality disorders in the DSM 5?

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) recognizes 10 specific personality disorders, grouped into three clusters based on shared characteristics. Here’s a brief overview of each cluster and the disorders within them:

Cluster A: Odd and Eccentric Disorders

  • Paranoid personality disorder: Individuals with this disorder have a pervasive distrust and suspicion of others, often believing they are being persecuted or harmed. They may be overly sensitive to criticism and quick to anger.
Paranoid personality disorder

 

  • Schizoid personality disorder: People with schizoid personality disorder lack interest in social relationships and prefer to be alone. They may seem detached and emotionally unresponsive, and have difficulty expressing their feelings.
  • Schizotypal personality disorder: Individuals with schizotypal personality disorder have odd beliefs and eccentric behaviors, often involving magical thinking, unusual perceptions, and social awkwardness. They may also experience mild hallucinations or delusions.

Cluster B: Dramatic, Emotional, or Erratic Disorders

  • Antisocial personality disorder: People with antisocial personality disorder disregard the rights and feelings of others, often engaging in manipulative, deceitful, and impulsive behaviors. They may lack remorse or empathy for their actions.
  • Borderline personality disorder: Individuals with borderline personality disorder experience intense emotions and unstable relationships. They may have difficulty managing their emotions, leading to self-harm, impulsivity, and fear of abandonment.
  • Histrionic personality disorder: People with histrionic personality disorder crave attention and seek to be the center of focus. They may be overly dramatic and theatrical in their emotions and behaviors, and may use their appearance or sexuality to manipulate others.
  • Narcissistic personality disorder: Individuals with narcissistic personality disorder have an inflated sense of self-importance and a need for admiration. They may lack empathy for others and exploit them to achieve their own goals.

Cluster C: Anxious or Fearful Disorders

  • Avoidant personality disorder: People with avoidant personality disorder are intensely shy and fear social rejection or criticism. They may avoid close relationships and public settings due to their anxieties.
  • Dependent personality disorder: Individuals with dependent personality disorder rely excessively on others for guidance and support. They may fear being alone and have difficulty making decisions on their own.
  • Obsessive-compulsive personality disorder: People with obsessive-compulsive personality disorder have a need for order and perfectionism. They may engage in repetitive behaviors or rituals to reduce anxiety and maintain control.

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