NRNP-6675 – Week 7: Assignment – Controversy Associated with Personality and Paraphilic Disorders
Introduction
Personality disorder poses a significant challenge to psychiatric practice because of their heterogeneity nature. Over the years, people with personality disorders remain in denial and do not seek help. The functional impairment associated with a personality disorder is ignored, and as a result, the outcome of Axis 1 disorder is affected. People suffering from personality disorders lack awareness of the consequences of their behavior and frequently remain indifferent or blame others for the distress caused by their actions and interactions. Diagnosing personality disorder is challenging due to its cluster and variable presentations. Generally, the individual diagnostic criteria of personality disorder are very similar in ICD-10 and DSM-IV, but it differentiated Axis II from mental state disorders Axis I. The personality disorder I chose for this paper is antisocial personality disorder (ASPD) type B (Borderline type). It is described as a heterogeneity disorder and classified into four types: Impulsive borderline personality disorder, discouraged borderline personality disorder, self-destructive borderline personality disorder, and petulant borderline personality disorder. Differentiating personality disorders from other forms of disorders is complex due to the similarities in their presentations. The above four categories have not been updated in the DSM-5, but the criteria for their diagnosis are spelled out in the American Psychiatric Association. They present with fear of being abandoned by family and friends, have unstable relationships, have a poor self-image, are very self-critical, have impulsive behaviors, engage in excessive spending, unsafe sex, reckless driving, or misuse or overuse of substances, and self-harming behavior with the risk of threatening or attempting suicide. The person may experience outbursts of anger, mood swings, and feelings of shame and guilt.
Explain the controversy that surrounds your selected personality or paraphilic disorder.
Some of the controversy surrounding ASPD personality disorder is on the classification. Clinicians need to know and understand the best way to classify it as a category or dimension. Depression and schizophrenia can be categorically approached, but it is challenging to approach ASPD similarly due to its heterogeneity characteristics. Another issue or controversy surrounding borderline personality is how to determine which personality variable to assess in the personality disorder assessment. How does the clinician diagnose a personality disorder in the regular or abnormal personality continuum? What instruments or parameters will the clinician use since there are many inconsistencies in assessment across both instruments and raters? If the clinician chooses to use cross-instrument reliability between self-report and interview assessments, the outcome is usually inferior in personality disorders. Referencing the DSM-5, which states the diagnosis of personality disorder is pervasive, but current overwhelming evidence shows that its symptoms are unstable, it appears questionable whether its diagnosis is stable. The confusion as to whether ASPD personality disorder can be graded by severity is another concern or controversy.
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Explain your professional beliefs about this disorder, supporting your rationale with at least three scholarly references from the literature
.
An antisocial personality disorder is genetically linked; however, some environmental contributors like childhood trauma and abuse (sexual, physical, neglect ), behavioral anomalies such as conduct disorder, ADHD, and psychopathology may play a role (Fisher & Hany, 2019). Patients diagnosed with ASPD also indulge in substance abuse which occurs co-currently and is always why they seek medical help. The lack of insight and functional impairment associated with ASPD makes psychological intervention therapy inefficient. It is, therefore, crucial for the clinician to focus on symptomatic relief and treatment of the co-occurring illness while educating them to be insightful. Patience, empathy, understanding, and psychological support are needed by clinicians and caregivers while caring for a person with ASPD because of their ability to push their limits without taking responsibility for them. They are stigmatized as ‘’con men’’ with insensitive and annoying personalities NRNP-6675 – Week 7: Assignment – Controversy Associated with Personality and Paraphilic Disorders.
Explain strategies for maintaining the therapeutic relationship with a patient that may present with this disorder.
People diagnosed with ASPD pose many challenges with their care. Caregivers tend to be frustrated and overwhelmed by their inability to take responsibility for their actions. Adequate training of caregivers and strategic management of the patients will foster therapeutic alliance. Due to the imbalance in the mental process of a person with this condition, the mentalizing tool is used to tackle, enhance or fix the mental imbalance. It uses the four dimensions of self and other, cognitive and affective, automatic and controlled, and external and internal, to reset the thought process (Bateman, 2022) NRNP-6675 – Week 7: Assignment – Controversy Associated with Personality and Paraphilic Disorders
Finally, explain ethical and legal considerations related to this disorder that you need to bring to your practice and why they are essential.
The ethical implication of classifying ASPD in legal luminary for defense is filled with controversy, with many stating that it does not meet the current justice system insanity defense (Jurjako et al., 2018). The controversy results from less than one percent using the diagnosis for defense in criminal cases, recording a 26% success rate. However, according to Jurjako et al.,2018 about 90% of those who ever had ASPD as a defense in criminal cases end up being diagnosed with a significant mental health disorder later in life.
References.
Guilé, J. M., Boissel, L., Alaux-Cantin, S., & Rivière, L. (2017). Borderline personality disorder in adolescents: Prevalence, diagnosis, and treatment strategies. Adolescent Health, Medicine and Therapeutics, 9, 199-210. https://doi.org/10.2147/AHMT.S156565
Bateman, A. W. (2022). Mentalizing and group psychotherapy: A novel treatment for antisocial
personality disorder. American Journal of Psychotherapy, 75(1), 32–37.
https://doi.org/10.1176/appi.psychotherapy.20210023
Jurjako, M., Malatesti, L., & Brazil, I. A. (2018). Some ethical considerations about the use of
biomarkers for the classification of adult antisocial individuals. International Journal of
Forensic Mental Health, 18(3), 228–242.
https://doi.org/10.1080/14999013.2018.1485188
Fisher, K., & Hany, M. (2019). Antisocial Personality Disorder. Europe PMC.
https://europepmc.org/article/nbk/nbk546673#free-full-text
Kim, Y. R., & Tyrer, P. (2010). Controversies surrounding the classification of personality disorder.
Psychiatry investigation
,
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(1), 1–8.
https://doi.org/10.4306/pi.2010.7.1.1
American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders
(DSM-5®) (5th ed.). American Psychiatric Publishing, Inc
Boland, R., Verdiun, M., & Ruiz, P. (2021). Kaplan & Sadock’s synopsis of psychiatry (12th ed.)
NRNP-6675 – Week 7: Assignment – Controversy Associated with Personality and Paraphilic Disorders
[ebook]. Wolters Kluwer Health
Kim, Y. R., & Tyrer, P. (2010). Controversies surrounding the classification of personality disorder. Psychiatry investigation, 7(1), 1–8.
https://doi.org/10.4306/pi.2010.7.1.1
Grant BF, Hasin DS, Stinson FS, Dawson DA, Chou SP, Ruan WJ, et al. Prevalence, correlates, and disability of personality disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry. 2004;65:948–958. [
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Oran P, Jenkins R, Tylee A, Blizard R, Mann A. The prevalence of personality disorder among UK primary care attenders. Acta Psychiatr Scand. 2000;102:52–57. [
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American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th edition. Washington, DC: American Psychiatric Association; 1994. [
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World Health Organization. ICD 10 Classification of mental and behavioral disorders: Clinical descriptions and diagnostic guidelines. Geneva: World Health Organization; 2020. [
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Tyrer P, Alexander J, Ferguson B. Personality Assessment Schedule. In: Tyrer P, editor. Personality disorders: diagnosis, management, and course. 2nd ed. London: Arnold, London; 2000. [
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Moran P, Jenkins R, Tylee A, Blizard R, Mann A. The prevalence of personality disorder among UK primary care attenders. Acta Psychiatr Scand. 2000;102:52–57. [
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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-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.
Resources
Be sure to review the Learning Resources before completing this activity.
Click the weekly resources link to access the resources.
WEEKLY RESOURCES
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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NRNP-6675 – Week 7: Assignment – Controversy Associated with Personality and Paraphilic Disorders
Rubric
NRNP_6675_Week7_Assignment_Rubric
NRNP_6675_Week7_Assignment_Rubric
Criteria
Ratings
Pts
This criterion is linked to a Learning Outcome
In 2–3 pages, address the following: • Explain the controversy that surrounds your selected personality or paraphilic disorder.
15
to >
13.0
pts
Excellent 90%–100%
The response includes an accurate and concise explanation of the controversy within the field related to the disorder.
13
to >
11.0
pts
Good 80%–89%
The response includes an accurate explanation of the controversy within the field related to the disorder.
11
to >
10.0
pts
Fair 70%–79%
The response includes a somewhat vague or inaccurate explanation of the controversy within the field related to the disorder.
10
to >
0
pts
Poor 0%–69%
The response includes a vague or inaccurate explanation of the controversy within the field related to the disorder. Or the response is missing.
NRNP-6675 – Week 7: Assignment – Controversy Associated with Personality and Paraphilic Disorders
15
pts
This criterion is linked to a Learning Outcome
• Explain your professional beliefs about your selected disorder, supporting your rationale with at least three scholarly references from the literature.
25
to >
22.0
pts
Excellent 90%–100%
The response includes a thorough and well-organized explanation of the student’s professional beliefs about the disorder. Rationale demonstrates critical thinking and is strongly supported with three scholarly references.
22
to >
19.0
pts
Good 80%–89%
The response includes a well-organized explanation of the student’s professional beliefs about the disorder. Rationale is clear and appropriately supported with three scholarly references.
19
to >
17.0
pts
Fair 70%–79%
The response includes a somewhat vague explanation of the student’s professional beliefs about the disorder. Rationale is somewhat unclear and references either provide weak support for the rationale or are not scholarly/current.
17
to >
0
pts
Poor 0%–69%
The response includes a vague explanation of the student’s professional beliefs about the disorder. Rationale is unclear and references are inappropriate. Or the response is missing.
25
pts
This criterion is linked to a Learning Outcome
• Explain strategies for maintaining the therapeutic relationship with a client that may present with the disorder.
30
to >
26.0
pts
Excellent 90%–100%
The response includes an accurate and concise explanation of strategies for maintaining the therapeutic relationship with a client that may present with the disorder.
26
to >
23.0
pts
Good 80%–89%
The response includes an accurate explanation of strategies for maintaining the therapeutic relationship with a client that may present with the disorder.
23
to >
20.0
pts
Fair 70%–79%
The response includes a somewhat vague or incomplete explanation of strategies for maintaining the therapeutic relationship with a client that may present with the disorder.
20
to >
0
pts
Poor 0%–69%
The response includes a vague or inaccurate explanation of strategies for maintaining the therapeutic relationship with a client that may present with the disorder. Or the response is missing.
30
pts
This criterion is linked to a Learning Outcome
• Finally, explain ethical and legal considerations related to the disorder that you need to bring to your practice and why they are important. NRNP-6675 – Week 7: Assignment – Controversy Associated with Personality and Paraphilic Disorders
15
to >
13.0
pts
Excellent 90%–100%
The response includes an accurate and concise explanation of ethical and legal considerations related to the disorder that are important to clinical practice and why they are important.
13
to >
11.0
pts
Good 80%–89%
The response includes an accurate explanation of ethical and legal considerations related to the disorder that are important to clinical practice and why they are important.
11
to >
10.0
pts
Fair 70%–79%
The response includes a somewhat vague or incomplete explanation of ethical and legal considerations related to the disorder that are important to clinical practice and why they are important.
10
to >
0
pts
Poor 0%–69%
The response includes a vague and inaccurate explanation of ethical and legal considerations related to the disorder that are important to clinical practice and why they are important. Or, response is missing.
15
pts
This criterion is linked to a Learning Outcome
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.
5
to >
4.0
pts
Excellent 90%–100%
Paragraphs and sentences follow writing standards for flow, continuity, and clarity…. A clear and comprehensive purpose statement, introduction, and conclusion are provided that delineate all required criteria.
4
to >
3.5
pts
Good 80%–89%
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 80% of the time…. Purpose, introduction, and conclusion of the assignment are stated, yet they are brief and not descriptive.
3.5
to >
3.0
pts
Fair 70%–79%
Paragraphs and sentences follow writing standards for flow, continuity, and clarity 60%–79% of the time…. Purpose, introduction, and conclusion of the assignment are vague or off topic.
3
to >
0
pts
Poor 0%–69%
Paragraphs and sentences follow writing standards for flow, continuity, and clarity < 60% of the time…. No purpose statement, introduction, or conclusion were provided.
5
pts
This criterion is linked to a Learning Outcome
Written Expression and Formatting – English writing standards: Correct grammar, mechanics, and proper punctuation
5
to >
4.0
pts
Excellent 90%–100%
Uses correct grammar, spelling, and punctuation with no errors
4
to >
3.5
pts
Good 80%–89%
Contains 1-2 grammar, spelling, and punctuation errors
3.5
to >
3.0
pts
Fair 70%–79%
Contains 3-4 grammar, spelling, and punctuation errors
3
to >
0
pts
Poor 0%–69%
Contains five or more grammar, spelling, and punctuation errors that interfere with the reader’s understanding
5
pts
This criterion is linked to a Learning Outcome
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.
5
to >
4.0
pts
Excellent 90%–100%
Uses correct APA format with no errors
4
to >
3.5
pts
Good 80%–89%
Contains 1-2 APA format errors
3.5
to >
3.0
pts
Fair 70%–79%
Contains 3-4 APA format errors
3
to >
0
pts
Poor 0%–69%
Contains five or more APA format errors
5
pts
Total Points:
100
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