Controversy Associated with Personality and Paraphilic Disorders

Pedophilia is a classified paraphilic disorder in the DSM-5-TR. It is a condition that causes recurring and intense sexually arousing thoughts, urges, or behaviors that entail sexual activity with a prepubescent child or children below the age of 13 years. Regardless of its clinical definition, this disorder is currently considered very controversial, as the issues of morals, laws, and society revolve around the problems of child abuse, sexually speaking. This paper will discuss a significant controversy connected with this disorder, my professional stance on the diagnosis and treatment of this disorder, the ways to create a therapeutic alliance with the people who have this disorder, and current ethical and legal duties: Controversy Associated with Personality and Paraphilic Disorders.

Contralateral Surrounding Pedophilic Disorder

Pedophilia is quite controversial because it deals with thoughts and acts that have to be regarded as abhorrent and criminal by society. Among the areas of controversy is whether someone with such urges, which are not acted upon, is to be considered mentally ill. According to the DSM-5-TR, the difference is made between the pedophilic interests and the disorder itself, which needs the presence of distress or acted-upon urges to be established. The other important area of debate is the utilization of such a diagnosis in the criminal justice system, which can be used to fix sentencing, the granting of parole, or civil commitment.

This convergence of psychiatry and the law brings an issue of bias, overdiagnosis, and medicalization of crime (Münch et al., 2020). Additionally, the stigma attached to pedophilic disorder usually leads to inaccessibility to treatment, given that providers might not want to receive such patients, and those affected might fail to treat themselves, fearing rejection or criminal investigation.

Professional Beliefs about This Disorder

As a clinician, I feel that it is essential to recognize pedophilic disorder as a serious psychiatric illness that should be treated without judgment with evidence-based practices instead of using exclusively punitive methods. Although disturbing impulses characterize the condition, not everyone acts upon them, and most get assistance to cope with their impulses responsibly. Notably, psychological treatment at an early stage could mitigate offending risk by increasing self-control and correcting cognitive distortions through cognitive behavioral therapy (CBT) (Chand et al., 2023).

In addition, pharmacologic treatment, including SSRIs or anti-androgens, has proved to be effective in reducing sexual interest and intrusive thoughts (Landgren et al., 2022). Clinicians should adopt a harm-reduction attitude to such clients to assist them morally and lessen the prospect of mistreatment (Chang et al., 2023). Denying or stigmatizing these individuals exposes the population to greater risk and blocks advancement toward therapeutic interventions based on empathy and responsibility.

Strategies for Maintaining the Therapeutic Relationship

The treatment of clients with pedophilic disorder involves an excellent level of emotional maturity and professional boundaries. Building a therapeutic relationship starts with ensuring that the environment is nonjudgmental and secure and that clients feel understood even though behaviors may not be condoned. It is essential to clarify any limitations of confidentiality early, particularly as far as the risk of harming minors is concerned. Therapists should employ the motivational interviewing approach, which aims to assist clients in gaining insight into the condition and building control over their urges (Bischof et al., 2021).

Clients will slowly open up and eradicate shame through consistency, respect, and empathy. It is also critical that clinicians are reflectively supervised because they should be sensitive to their biases and countertransference. Through the maintenance of evidence-based practice and compassion, therapists can assist clients in progressing toward healthier behavior and gaining self-regulation.

Ethical and Legal Considerations

Treatment of pedophilic disorder imposes serious ethical and legal responsibilities. Clinicians need to be aware of mandatory reporting legislation, especially if a client expresses the intent or takes action against a child. Confidentiality is trumped by the duty to warn and protect when there is a danger of immediate harm. Risk assessments, safety plans, and consultation with colleagues must be accurately documented to provide legal defense and ethical practice.

Clinicians also have to contend with the tension between safeguarding the general population’s security and maintaining clients’ dignity. Denying anybody care out of moral judgment is against professional standards and can cause harm (Haddad & Geiger, 2023). In forensic cases, extra caution should be employed to avoid dual relationships or biases where assessment can impose legal outcomes. The most important aspect of ethical care is upholding objectivity and client autonomy, ensuring children’s safety.

References

Bischof, G., Bischof, A., & Rumpf, H.-J. (2021). Motivational interviewing: An evidence-based approach for use in medical practice. Deutsches Aerzteblatt Online, 118(7), 109–115. https://doi.org/10.3238/arztebl.m2021.0014

Chand, S. P., Kuckel, D. P., & Huecker, M. R. (2023, May 23). Cognitive behavior therapy. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK470241/

Chang, J. E., Lindenfeld, Z., & Hagan, H. (2023). Integrating harm reduction into medical care: Lessons from three models. The Journal of the American Board of Family Medicine, 36(3), 449–461. https://doi.org/10.3122/jabfm.2022.220303R3

Haddad, L. M., & Geiger, R. A. (2023, August 14). Nursing ethical considerations. StatPearls – NCBI Bookshelf. https://www.ncbi.nlm.nih.gov/books/NBK526054/

Landgren, V., Savard, J., Dhejne, C., Jokinen, J., Arver, S., Seto, M. C., & Rahm, C. (2022). Pharmacological treatment for pedophilic disorder and compulsive sexual behavior disorder: A review. Drugs, 82(6). https://doi.org/10.1007/s40265-022-01696-1

Münch, R., Walter, H., & Müller, S. (2020). Should Behavior harmful to others be a sufficient criterion of mental disorders? Conceptual problems of the diagnoses of antisocial personality disorder and pedophilic disorder. Frontiers in Psychiatry, 11. https://doi.org/10.3389/fpsyt.2020.558655

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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.

Controversy Associated with Personality and Paraphilic 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-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.

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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