In this week case, 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.
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-TR 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.
In 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.
Reading Resources
National Institute for Health and Care Excellence: NICE Guidelines. (2010). Antisocial personality disorder: Prevention and managementLinks to an external site..
https://www.nice.org.uk/guidance/cg77
Personality disorders are a group of mental health conditions characterized by enduring patterns of behavior, cognition, and inner experience that deviate from cultural norms and cause distress or impairment. The DSM-5-TR (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition, Text Revision) classifies personality disorders into three clusters: Cluster A (Odd or Eccentric), Cluster B (Dramatic, Emotional, or Erratic), and Cluster C (Anxious or Fearful).
Paraphilic disorders, on the other hand, involve intense and persistent sexual interest or behavior patterns that deviate from societal norms. These disorders are classified in the DSM-5-TR and include conditions such as exhibitionistic disorder, voyeuristic disorder, pedophilic disorder, and fetishistic disorder.
Controversies often arise when diagnosing and treating personality and paraphilic disorders due to various factors, including the subjective nature of diagnosing personality disorders, potential stigmatization, and the ethical implications of certain treatments. Some controversies surrounding personality disorders include:
- Overdiagnosis and Misdiagnosis: Personality disorders can be challenging to diagnose accurately due to overlapping symptoms and comorbidity with other mental health conditions. There is debate among professionals regarding the potential overdiagnosis or misdiagnosis of personality disorders, which can lead to inappropriate treatment or labeling.
- Borderline Personality Disorder (BPD): BPD has been a subject of controversy and debate for many years. There are differing opinions on the diagnostic criteria, with concerns about the inclusion of subjective and judgmental criteria. Some argue that BPD is stigmatized and misunderstood, while others advocate for more precise diagnostic criteria.
- Sociocultural Factors: Critics argue that personality disorders are heavily influenced by sociocultural factors, leading to cultural bias in diagnosis and treatment. They assert that certain behaviors or traits considered “disordered” in one culture may be accepted or even valued in another.
Regarding maintaining the therapeutic relationship with a patient presenting with a personality or paraphilic disorder, several strategies can be helpful:
- Empathy and Non-judgmental Attitude: Building a therapeutic alliance requires empathy, acceptance, and a non-judgmental approach. Demonstrating genuine understanding and compassion can help establish trust and enhance the therapeutic relationship.
- Boundaries and Clear Communication: Setting clear boundaries and maintaining professional boundaries is crucial. Establishing expectations, discussing treatment goals, and openly communicating about potential challenges can help manage the therapeutic relationship effectively.
- Collaborative Approach: Involving the patient in treatment planning and decision-making empowers them and enhances their sense of autonomy. Collaborative goal-setting and treatment planning foster a sense of partnership and shared responsibility.
Ethical and legal considerations related to personality and paraphilic disorders include:
- Informed Consent: It is essential to obtain informed consent from patients before initiating any treatment. This includes providing information about the nature of the disorder, potential risks and benefits of treatment, and available alternatives.
- Confidentiality and Privacy: Maintaining patient confidentiality is crucial, except in cases where there is a duty to warn or protect someone from potential harm. Therapists must adhere to legal and ethical guidelines regarding privacy and confidentiality.
- Duty to Report: In cases involving paraphilic disorders that may pose a risk to others, therapists may have a legal and ethical duty to report such situations to relevant authorities. This duty varies based on jurisdiction, so therapists should familiarize themselves with the applicable laws and regulations.
- Dual Relationships and Personal Bias: Therapists need to be aware of potential dual relationships and personal biases that may affect their objectivity and judgment. It is essential to maintain professional boundaries and seek supervision or consultation when needed.