Personality and Paraphilic Disorders Week 7 NRNP 6675
Personality and Paraphilic Disorders Week 7 NRNP 6675
Personality and Paraphilic Disorders Sample Approach
Paraphilic disorders are defined as intense, recurrent, sexually arousing fantasies and behaviors that distress and involve inanimate objects, children, and nonconsenting adults. These can also include suffering the humiliation of oneself or a partner with the potential to cause harm (Zakhari, 2021). This paper will discuss paraphilic disorders, the controversies surrounding the disorder, professional beliefs about the disorder, and strategies for maintaining therapeutic relationships with patients with the disorder. These behaviors also include sex with excrements, animals, and corpses.
Controversies Surrounding the Disorder
The main controversy about paraphilic disorders is that individuals can seriously impair reciprocal and affectionate sexual activity capacity (Zakhari, 2021). The partners of individuals with the disorders may feel like objects since they are unimportant in the sexual relationship (MDedge, 2020). The disorder is controversial because it mainly involves fantasies of abusing a helpless individual (Buchanan, 2020). For instance, paraphiliacs have fantasies about abusing a person who is drunk, asleep or unconscious, or urinating or defecating on their partners. Some individuals get aroused by spying on others and having sex, violating privacy.
Professional Beliefs about the Disorder
Studies indicate that paraphilic behavior may be learned. Paraphilia is more common in men than women and often begins between 8-and 12 years. The individuals often have underlying mental disorders. Paraphilia is an emotional disorder defined by sexually arousing urges and behaviors that have been recurrent and intense for more than six months. These often lead to significant distress and interfere with important areas of functioning.
While the condition is not innately pathological, the disorder can evolve if paraphilia invokes harm, distress, or functional impairment in the lives of the affected individuals (MDedge, 2020). The DSM-IV lists paraphilia as including conditions such as pedophilia, voyeurism, exhibitionism, sexual masochism, fetishism, frotteurism, sexual sadism, and transvestic fetishism. Paraphilic disorders are thought to be caused by cognitive, neurobiological, and interpersonal processes.
Strategies For Maintain the Therapeutic Relationship with Patients
To maintain a therapeutic relationship with the patients, developing a safe care environment is important. This will ensure the patient is comfortable opening up about their issues (Buchanan, 2020). They will also be able to trust that the clinical will uphold their privacy and provide them with the best solutions for their situation. Since there is a lot of shyness and controversy around the issues, likely, the patient may not be comfortable speaking about the issue (Zakhari, 2021).
Therefore, it is essential to listen to the patient without judging. It is also essential to develop professional boundaries in therapy (MDedge, 2020). It will ensure that the patients can discuss their issues to get help, medication, and coping strategies. Clinicians should consistently demonstrate empathy for therapeutic relationships. Empathy ensures the healthcare provider can recognize and understand the patient’s situation.
Ethical and Legal Considerations
Informed consent is a critical ethical consideration. It ensures that the patient understands the treatment course and is willing to adhere to all the recommended treatment processes. Clinicians also have an ethical and legal obligation to protect the privacy and confidentiality of patients (Buchanan, 2020). Patients need to know that their information will not be shared with third parties without their consent. The ethical principle of beneficence should also be upheld. The healthcare provider needs to act in the patient’s best interest at all times.
Personality and Paraphilic Disorders Week 7 NRNP 6675 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
Zakhari, R. (2021). The psychiatric-mental health nurse practitioner certification review manual. Springer Publishing Company.
NRNP 6675 Week 7: Personality and Paraphilic Disorders Instructions
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.
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.
Personality and Paraphilic Disorders Week 7 NRNP 6675 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
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
Controversy Associated with Borderline Personality Disorder Example 2
Most psychiatric diagnoses have had considerable controversy surrounding their diagnoses. Personality and paraphilic disorder are some of the diagnoses that have been debated among mental health professionals and other healthcare specialists (Paris, 2020). A borderline personality disorder is one of the most debated personality disorders. The purpose of this paper is to explain the controversies surrounding borderline personality disorder and provide my professional stance regarding these differing professional views.
Borderline Personality Disorder Personality Controversy
A borderline personality disorder is a DSM-5 recognized personality disorder. The basis for diagnosing BPD is a clinical constellation of symptoms, including pervasive patterns in self-image, impulsivity, affect, and interpersonal relationships (American Psychiatric Association, 2013). Therefore, BPD can present with abandonment fears, aggression, intense mod shifts, anger problems, suicidal behaviors, self-injurious behaviors, and unstable relationships.
Controversies associated with BPD are due to the stigma surrounding its diagnosis and the nihilistic attitudes of some professionals who encounter many patients with BPD clinical presentations in acute care settings (Campbell et al., 2020). BPD is misunderstood because of the heterogeneity in its presentation (Paris, 2020). The aforementioned symptoms can be nonspecific and can present in various psychiatric illnesses such as schizophrenia, bipolar disorder, and mood disorders.
Constructs of BPD differ in different cultures of the world, and culture dictates what is considered normal or abnormal behavior and thinking. Opposing schools of thought argue that BPD could result from various socio-cultural and environmental contexts. Culture and environment shape how people think and behave (Choudhary & Gupta, 2020). Therefore, different cultures interpret interpersonal functioning, self-image, and emotions differently. Therefore, distinguishing between normal and abnormal behavior, thinking and interactions would rely solely on the caregiver and the clinician’s interpretations. This concept is one of the factors that lead to confusion when diagnosing BPD in different settings of care, thus the controversy.
My Professional Stance
I acknowledge the scientific basis for the opposing and supporting ideas for BPD. My professional opinion is in support of the diagnosis of BPD. However, clinicians must take care to avoid overdiagnosis due to overenthusiasm, which may complicate the existing controversies. BPD can coexist with other illnesses, such as eating disorders, bipolar disorders, anxiety disorders, substance use disorders, and depression (American Psychiatric Association, 2013; Choudhary & Gupta, 2020). Therefore, a clinician can easily miss the diagnosis due to similarities in the presentations of the coexisting illness.
Evidently, some mental health specialists will intentionally ignore the diagnosis and treat other coexisting illnesses. There is also the stigma that has been associated with BPD and its management (Campbell et al., 2020). No medication has been approved for the treatment of BPD. However, off-label management has shown an excellent therapeutic response to treatment (Levy, 2019). This can make patients who have symptoms and had obtained information from elsewhere before seeing clinicians hopeless and avoid providing accurate information to avoid having this diagnosis. This denial makes the accuracy of its diagnosis debatable.
Maintaining Therapeutic Relationships with patients with BPD.
Therapeutic alliance in therapy is vital in improving the outcomes of the treatment. Patients with BPD present with emotional and mood lability that can interfere with a therapeutic alliance when not anticipated and maintained properly. My crucial strategy when managing patients with BPD will involve supportive psychotherapy. Reassurance, active listening, encouragement, education, and reinforcement are some of the strategies that I would use to build and maintain a therapeutic relationship with these patients. Supportive psychotherapy would work to maintain their mood and support their emotions during the process of treatment.
Ethical and Legal Considerations in BPD
Lability in mood, instability in social relationships, and impulsivity are some behaviors that implicate these patients in legal problems. These patients’ abilities to shift self-image and emotions can make them manipulative and attention-seeking, as also seen in patients with histrionic personalities. Suicidal behaviors have ethical implications for the caregiver. Ethically, the clinicians are in a dilemma whether to tell these patients their diagnoses, whether to explain their suicidal risks, and whether to involuntarily admit them for inpatient care (Warrender, 2018). The clinicians guiding ethical principles should always aim to do good for the patient. However, attempting to do good in the above situations may cause harm and risk suicidal behaviors among BPD patients.
Conclusion
Personality disorders still pose controversies, ethical and legal implications, and the need for therapeutic vigilance among clinicians and therapists. Borderline personality disorder has been one of the most debated and controversial personality disorders. The controversy about this DSM-5-recognized disorder arises from the similarities of its clinical presentation with other established psychiatric diagnoses. Other clinicians argue that this disorder is a construct that results from cultural, social, and environmental influences on the person’s emotions, mood, self-image, and behavior.
Despite these controversies, BPD has been diagnosed in various settings, and recent advancements in psychiatric treatments have shown good clinical responses to the patients diagnosed with this disorder. Due to mood, thinking, and emotional instability in these patients, a positive therapeutic relationship would be maintained by supportive psychotherapy. The stigma surrounding this diagnosis and the suicidal risks also pose ethical and legal challenges to clinicians.
Personality and Paraphilic Disorders Week 7 NRNP 6675 References
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5 (R)) (5th ed.). American Psychiatric Association Publishing.
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
Choudhary, S., & Gupta, R. (2020). Culture and borderline personality disorder in India. Frontiers in Psychology, 11, 714. https://doi.org/10.3389/fpsyg.2020.00714
Levy, K. N. (2019, October 27). Evidence-Based Treatment of Borderline Personality Disorder: Clinical and Ethical Considerations – Istfp.org. Istfp.org. https://istfp.org/evidence-based-treatment-of-borderline-personality-disorder-clinical-and-ethical-considerations-2/
Paris, J. (2020). Controversies in the classification and diagnosis of personality disorders. In The Cambridge Handbook of Personality Disorders (pp. 103–110). Cambridge University Press.
Warrender, D. (2018). Borderline personality disorder and the ethics of risk management. Nursing Ethics, 25(7), 969733016679467. https://doi.org/10.1177/0969733016679467
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