Understanding and Addressing the Challenges of Treating Personality Disorders

Understanding and Addressing the Challenges of Treating Personality Disorders

The Controversy Surrounding Personality Disorder

The controversy surrounding this disorder is based on the general understanding of the disorder as a mental illness, the classification of the disorder, and the nature of the disorder. For starters, there are controversies over the understanding of this personality disorder. Some people argue that disorders like borderline personality disorder are not mental disorders but normal human behavior and reactions toward daily stress (Connors, 2023). As such, these people believe that classifying their response to stress as a mental illness causes unnecessary stigma. On the other hand, some accept that personality disorders are a form of mental disorders, and the diagnosis process serves to help them understand their feelings and manage them effectively. They also use this understanding to explain themselves to others.

Paraphiliac disorders also create controversy. Some claim that paraphiliac disorders are simply vices and crimes in society. Such claims, when used, mean that society is encouraged to look at these individuals not as mentally ill people but as criminals (Assumpção et al., 2014). Moreover, such perspectives also lead to prejudice and discrimination against such individuals in society. On the other hand, some professionals, especially mental disorder experts, consider paraphiliacs as disorders and thus treat such individuals as mentally ill people (Assumpção et al., 2014). This perspective means that these individuals are not considered criminals but are considered to be mentally ill people. This approach to such mental illnesses also creates controversy on how sexual crimes should be handled by society and the criminal justice system in general.

The second level of controversy is in the expert classification of these disorders. A section of mental health experts argue that both personality disorders and paraphiliac disorders have several overlapping symptoms, even in the DSM-5. Unlike other conditions that have direct symptoms, making them clearly defined in a certain way, personality disorders like borderline personality disorder (BPD) do not fit any specific category of diseases. Connors (2023) supports this observation by noting that patients who are diagnosed with BPD do not fit a specific class of mental disorders. In many cases, they are also diagnosed with other disorders. Other experts believe that the focus should not be on categorizing the patient but on understanding the special needs of each patient with personality and paraphiliac disorders and helping them cope. This is a controversy since the larger society considers paraphiliac disorders to be criminal offenses and vices.

The third source of controversy when focusing on personality disorders is the nature of these disorders. Some argue that many things make a person feel stressed and overwhelmed with unbearable emotions (Connors, 2023). For instance, childhood trauma, situations, and environments like poverty, as well as stigma and discrimination, can all be challenges to deal with. Therefore, it is not enough to use the social context to conclude that one has a personality disorder. The opposing group, on the other hand, classifies BPD by examining how the patient reacts in a social setting or socializes with others around them. Similarly, some experts argue that paraphiliac behaviors are caused by childhood trauma and other events in life that are outside the control of the person. This is controversial since society argues that people can control their urges, especially sexual urges.

Professional Belief about Personality Disorders and Paraphiliac Disorders

Professionally, personality and paraphiliac disorders are believed to be disorders that are manifested through a person’s inability to control their emotions. The lack of control can result in impulsive conduct and further affect how a person feels about themselves and responds to others in society (Goes, 2023). This lack of control also affects the way a person with these disorders relates to others. Psychiatric professionals believe that people with such disorders experience intense mood swings, have uncertainty about their self-image, and respond to others based on their mental and emotional challenges. According to Nierenberg et al. (2023), a person with personality and paraphiliac disorder will often look at things from extremes. Bobo (2017) also argues that these individuals quickly change their values and interests and may act recklessly based on impulse.

Maintaining a Therapeutic Relationship

When dealing with a patient with such disorders, one must consider maintaining a therapeutic relationship that is characterized by five components. The strategy involves creating rapport, cultivating empathy, building effective communication, encouraging collaboration, and keeping to the professional boundaries. According to Bolsinger et al. (2020), the five components of the relationship are empathy, respect, genuineness, unconditional positive regard, and active listening. Empathy helps understand a person’s feelings, and respect helps the client accept treatment, knowing they are not judged for their beliefs. Genuineness applies honesty even when dealing with the client. Unconditional positive regard helps the therapist accept the patient as they are regardless of what they say or do during therapy as long as it is not harmful. Effective communication characterized by active listening helps show the client that one is giving full attention.

With these five components, the therapeutic relationship with a bipolar disorder patient can be built by beginning with creating rapport and trust. The rapport is built between the patient and the psychiatrist when the psychiatrist shows genuine interest and remains consistent. Also, one can build trust by being confidential during the sessions’ discussions (Bolsinger et al., 2020). Another important thing when building rapport is having empathy when listening to the patient. The second step in the strategy is to strengthen empathy and understanding. Empathy and understanding are strengthened through being fully present, reflecting emotions, and avoiding judging the patients even if they are of a contrary opinion or belief. At the same time, the psychiatrist should also consider communicating effectively (Bolsinger et al., 2020). Effective communication also involves listening. Therefore, the psychiatrist should ask questions that help them gather the information needed and, at the same time, listen attentively. The psychiatrist collaborates with the patient. This is achieved by creating an environment where patients can ask questions and speak openly. An open dialogue helps the patient open up and feel unjudged. Finally, the psychiatrist should ensure that the relationship remains professional and everyone knows their boundaries.

Ethical and Legal Considerations

Beneficence is an ethical consideration that should be included in the treatment of personality and paraphiliac disorders. This is the ethics that demands that the psychiatrist should put the patient’s interests first. When dealing with personality and paraphiliac disorder patients, there is enough evidence to show that the diagnosis of these disorders might have issues because their symptoms overlap with the other disorders or, in some cases, they overlap with criminal offenses (Srivastava, 2011). Also, it is possible to find personality and paraphiliac disorder patients having other mental disorders. As such, a psychiatrist can have the patient’s interests and avoid creating other additional disorders while failing to inform or treat the patient of other subsequent disorders.

The second ethical and legal consideration would be maleficence. In this case, the psychiatrist treating these patients should make sure that they give them proper treatment. The reason for this observation is that these disorders can be caused by childhood trauma (Srivastava, 2011). As such, some psychiatric treatments may lead to patients reenacting traumatic moments, which can be avoided. Similarly, when giving prescriptions, the patient should be given prescriptions based on the symptoms of their bipolar condition. However, in some instances, some medications worsen the situation.

References

Assumpção, A. A., Garcia, F. D., Garcia, H. D., Bradford, J. M., & Thibaut, F. (2014). Pharmacologic treatment of paraphilias. The Psychiatric Clinics of North America, 37(2), 173–181. https://doi.org/10.1016/j.psc.2014.03.002

Bobo W. V. (2017). The diagnosis and management of bipolar I and II disorders: Clinical practice update. Mayo Clinic Proceedings, 92(10), 1532–1551. https://doi.org/10.1016/j.mayocp.2017.06.022

Bolsinger, J., Jaeger, M., Hoff, P., & Theodoridou, A. (2020). Challenges and opportunities in building and maintaining a good therapeutic relationship in acute psychiatric settings: A narrative review. Frontiers in Psychiatry, 10, 965. https://doi.org/10.3389/fpsyt.2019.00965

Connors M. H. (2023). Paediatric bipolar disorder and its controversy. Acta Neuropsychiatrica, 35(2), 96–103. https://doi.org/10.1017/neu.2022.28

Goes F. S. (2023). Diagnosis and management of bipolar disorders. BMJ (Clinical research ed.), 381, e073591. https://doi.org/10.1136/bmj-2022-073591

Nierenberg, A. A., Agustini, B., Köhler-Forsberg, O., Cusin, C., Katz, D., Sylvia, L. G., Peters, A., & Berk, M. (2023). Diagnosis and treatment of bipolar disorder: A review. JAMA, 330(14), 1370–1380. https://doi.org/10.1001/jama.2023.18588

Srivastava, S. (2011). Ethics commentary: Bipolar disorder: Ethical considerations in the treatment of bipolar disorder. Psychiatry Online.https://doi.org/10.1176/

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WK7 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.

Understanding and Addressing the Challenges of Treating Personality Disorders

Paraphilic disorders are far more common in men than in women and are 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.