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 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.
Navigating the Labyrinth: Understanding and Treating Borderline Personality Disorder
Borderline Personality Disorder (BPD) is a complex and often misunderstood mental health condition characterized by pervasive instability in mood, interpersonal relationships, self-image, and behavior. While significant advancements have been made in its diagnosis and treatment, BPD continues to be surrounded by considerable controversy, posing unique challenges for both patients and clinicians.
The Controversy Surrounding Borderline Personality Disorder
The controversies surrounding BPD are multifaceted and deeply rooted in its history, diagnostic criteria, and the profound stigma associated with it. Historically, the term "borderline" itself originated from the idea that these patients existed on the "border" between neurosis and psychosis, implying a chaotic and perhaps untreatable state (Gunderson & Links, 2013). This early conceptualization contributed to a persistent perception of BPD as a severe, intractable disorder, leading to therapeutic pessimism among some clinicians and a reluctance to treat.
One of the most significant controversies revolves around
stigma and the "difficult patient" label.
Individuals with BPD are often perceived as manipulative, attention-seeking, or deliberately challenging, a stereotype that is deeply damaging and can lead to inadequate care or even avoidance by healthcare providers (National Institute of Mental Health, n.d.). This stigma is fueled by the fluctuating and intense emotions, impulsivity, and relational instability characteristic of the disorder, which can be profoundly challenging to navigate in clinical settings. Consequently, patients with BPD may face discrimination, receive less empathetic care, or be denied services.
Another area of debate concerns
gender bias in diagnosis.
Historically, BPD has been disproportionately diagnosed in women, leading to questions about whether the diagnostic criteria inadvertently pathologize feminine emotional expression or if societal biases influence diagnostic patterns (American Psychiatric Association, 2022). While recent epidemiological studies suggest a more balanced prevalence between genders in community samples, the diagnostic disparity in clinical settings persists, raising concerns about potential misdiagnosis in men or overlooking BPD in favor of other conditions like antisocial personality disorder.
Furthermore, there is ongoing discussion about the
categorical versus dimensional approach to personality disorders within diagnostic manuals like the DSM-5-TR. Some argue that BPD, like all personality disorders, would be better understood along a continuum of personality traits rather than as a distinct category (Gunderson & Links, 2013). This perspective suggests that the current categorical system may oversimplify the complexities of human personality and its deviations, potentially leading to artificial boundaries between disorders and hindering a more nuanced understanding of individual presentations.