Controversy Associated with Personality and Paraphilic Disorders-A Comprehensive Nursing Paper Example

Controversy Associated with Personality and Paraphilic Disorders-A Comprehensive Nursing Paper Example

Antisocial Personality Disorder

Antisocial personality disorder (ASPD) is marked by social exploitative, delinquent, and criminal acts and behavior and a lack of remorse or regret for these behaviors or their impact on other people. ASPD is categorized as a cluster-B personality disorder with the DMS-V (Fisher & Hany, 2023). Other diseases in the same category include histrionic personality disorder, borderline, and narcissistic personality disorder. Most people experiencing the disease demonstrate socially irresponsible disorder caused by a highly rigid and deeply ingrained dysfunctional thought process (Fisher & Hany, 2023). This paper discusses ASPD, its controversies, professional beliefs, strategies for maintaining a therapeutic relationship with a client with this disorder, and the ethical and legal considerations associated with the disease. (Controversy Associated with Personality and Paraphilic Disorders-A Comprehensive Nursing Paper Example)

The Controversy that Surrounds ASPD

Social irresponsibility associated with ASPD raises controversy concerning whether the disease is a psychiatric condition or a legal-ethical problem, although managing ASPD is part of mental health services. Often, diseases are harmful to the person experiencing them, and harm to others comes secondary, for instance, financial or social harm. However, ASPD is marked by behaviors harmful to others (Münch et al., 2020). The behaviors associated with this disorder are also dependent on cultural and social norms and often conflict with the cultural and social norms or legal provisions. When harming others is pathologized, it becomes a problem when dealing with such individuals because it is difficult to determine whether to take a legal course or a mental health course, especially when harm to others includes physical injuries or stealing (Münch et al., 2020). Notably, there have been discussions on whether to eliminate the disorder from the ICD and DSM because the diagnosis criteria are based on morally wrong, socially unacceptable, and criminal behavior. (Controversy Associated with Personality and Paraphilic Disorders-A Comprehensive Nursing Paper Example)        

Professional Beliefs About ASPD

I believe that mental health professionals struggle with ASPD because it is complex, hard to diagnose, and creates ethical and treatment dilemmas. First, the disease is not diagnosable during childhood, but the patient must have been diagnosed with conduct disorder before they were 15 to warrant an ASPD diagnosis (Fisher & Hany, 2023). However, in some cases, an individual was not diagnosed with conduct disorder before 15 but displays behaviors that evidence ASPD, creating a diagnosis dilemma. Moreover, ASPD behaviors significantly overlap other disorders like psychopathy, making diagnosis difficult. This complexity requires characterizing people with ASPD biologically and cognitively for a more accurate diagnosis (Fisher & Hany, 2023). I also believe that cultural factors and family values should be evaluated in-depth when assessing an individual with ASPD. The social environment, especially the family environment substantially affects early childhood, which affects the ability to trust adulthood, contributing to an increased risk of ASPD. Lastly, I believe that the individualism associated with the American culture and the widespread media violence have created an environment that increases the risk of developing ASPD. Addressing these social and cultural issues would be essential in managing the disease.     (Controversy Associated with Personality and Paraphilic Disorders-A Comprehensive Nursing Paper Example)       

Strategies for Maintaining the Therapeutic Relationship with an ASPD Client

People with ASPD are highly sensitive and reactionary. Several strategies can help maintain a therapeutic relationship with these clients, including finding the right balance between personal closeness and professional distance in the therapeutic link (Aerts et al., 2023). Losing the attachment is easy with ASPD clients; hence the need to not turn the thermostat too high or too low. Professionals should also balance between being restrictive and permitting space. It is challenging to maintain a good relationship with ASPD clients because of the high likelihood of boundary violations (Aerts et al., 2023). Being too restrictive toward a particular behavior can mean you lose the bond, while also giving a lot of space increases the risk of losing the client. Therefore, finding the right balance is recommended.(Controversy Associated with Personality and Paraphilic Disorders-A Comprehensive Nursing Paper Example)

Additionally, professionals should learn how to deal with resistance and trust because of the multiple attitude issues ASPD clients present with, including motivational problems, inconsistent progress, and resistance to treatment (Aerts et al., 2023). Professionals should recognize and understand these issues or behaviors as part of the client’s psychopathology to effectively manage them. Lastly, professionals should understand how to deal with sensitivity. Understanding emotionality and sensitivity is integral to addressing the disease (Aerts et al., 2023). These clients are sensitive to judgment, rejection, and lack of engagement from their therapists. Actively engaging these patients and their perspectives or worldviews is highly recommended. (Controversy Associated with Personality and Paraphilic Disorders-A Comprehensive Nursing Paper Example)

Ethical and Legal Considerations

About 50% of the world’s prison population includes people with behaviors linked to ASPD (Howard & Duggan, 2022). Dealing with ASPD might involve involuntary detention for treatment, which raises ethical and legal issues. The detention is both to protect other people from harm and also to increase treatment adherence (Howard & Duggan, 2022). This approach raises the issue of informed consent toward treatment. It would be more appropriate if conviction and treatment are uncoupled to separate custodial and therapeutic realms. Moreover, there have been many legal cases where the diagnosis of ASPD has been relevant (Lyon et al., 2022). However, the disorder is marked with untreatability and risk, which raises ethical and legal issues in addressing the disease and ensuring victims receive justice or reduced risk of harm. Conclusively, addressing the disease is challenging for mental health and legal professionals.(Controversy Associated with Personality and Paraphilic Disorders-A Comprehensive Nursing Paper Example)    

Conclusion

ASPD is a complex disorder that challenges mental health professionals concerning its diagnosis, treatment, and management. Controversies exist about whether the disease is a psychiatric or an ethical-legal problem because its diagnosis involves morally wrong, socially unacceptable, and criminal behaviors. Regarding managing the disease, maintaining a therapeutic relationship with the clients is key and requires one to balance between personal closeness and professional distance, being restrictive and giving space, resistance and trust, and understanding sensitivity. ASPD also raises ethical and legal issues because most cases lead to detention for criminal behavior or require detention for treatment.  (Controversy Associated with Personality and Paraphilic Disorders-A Comprehensive Nursing Paper Example)

References

Aerts, J. E., Rijckmans, M. J., Bogaerts, S., & Van Dam, A. (2023). Establishing an optimal working relationship with patients with an antisocial personality disorder. Aspects and processes in the therapeutic alliance. Psychology and Psychotherapy: Theory, Research and Practice. https://doi.org/10.1111/papt.12492(Controversy Associated with Personality and Paraphilic Disorders-A Comprehensive Nursing Paper Example)

Fisher, K. A., & Hany, M. (2023). Antisocial Personality Disorder. In: StatPearls [Internet]. StatPearls Publishing. https://www.ncbi.nlm.nih.gov/books/NBK546673/(Controversy Associated with Personality and Paraphilic Disorders-A Comprehensive Nursing Paper Example)

Howard, R., & Duggan, C. (2022). Legal and Ethical Issues in ASPD and Psychopathy. In Antisocial Personality: Theory, Research, Treatment (pp. 125-142). Cambridge: Cambridge University Press. doi:10.1017/9781911623892.009(Controversy Associated with Personality and Paraphilic Disorders-A Comprehensive Nursing Paper Example)

Lyon, D. R., Ogloff, J. R. P., & Shepherd, S. M. (2022). Legal and ethical issues in the assessment of psychopathy. In C. B. Gacono (Ed.), The clinical and forensic assessment of psychopathy: A practitioner’s guide (pp. 193–216). Routledge/Taylor & Francis Group. (Controversy Associated with Personality and Paraphilic Disorders-A Comprehensive Nursing Paper Example)

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(Controversy Associated with Personality and Paraphilic Disorders-A Comprehensive Nursing Paper Example)

https://www.ncbi.nlm.nih.gov/