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.
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.
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.
Stigmatization and Pejorative Labeling: Historically, BPD was viewed as a diagnosis of last resort for patients (often women) who were deemed "difficult," "manipulative," or "treatment-resistant" by clinicians. The term "borderline" itself was coined to describe patients at the border between neurosis and psychosis. Even today, the diagnosis carries heavy stigma among healthcare providers, which can lead to negative countertransference and poorer quality of care (Rizvi et al., 2017).
Gender and Cultural Bias: BPD is diagnosed in women approximately 75% of the time, leading to significant debate about whether the criteria are inherently biased toward feminine expressions of distress (e.g., self-harm, emotional lability) while overlooking male expressions (e.g., aggression, substance abuse, which may lead to Antisocial Personality Disorder diagnoses). This bias suggests that the diagnosis may be a social construction rather than a purely objective reflection of psychopathology (APA, 2022).
Trauma vs. Temperament: The role of childhood trauma (particularly emotional abuse and neglect) in the development of BPD is undeniable, leading some experts to argue that BPD should be conceptually reframed as a complex post-traumatic stress disorder (PTSD) or a disorder of emotional regulation rather than a personality disorder, thereby reducing the stigma associated with the term "personality disorder" (Herman & van der Kolk, 2018).
Professional Beliefs about BPD
My professional belief is that BPD is a severely impairing, biologically and environmentally rooted disorder of dysregulated emotion that is highly responsive to specialized, structured treatment. This belief is supported by three key areas of scholarly literature:
Neurobiological and Emotional Dysregulation: Research strongly supports that individuals with BPD experience hyper-reactivity in the amygdala and reduced activity in the prefrontal cortex, leading to heightened emotional sensitivity, intense emotional responses, and slow return to emotional baseline (Leichsenring et al., 2011). This neurobiological evidence validates the patient's experience as a genuine physiological struggle, not merely a willful behavioral choice.
Efficacy of Dialectical Behavior Therapy (DBT): The effectiveness of DBT, developed by Marsha Linehan, is a cornerstone of my belief. Numerous randomized controlled trials demonstrate that DBT significantly reduces self-harm, suicidal behavior, hospitalization rates, and improves treatment retention better than standard treatment (Kliem et al., 2010). This evidence refutes the historical claim that BPD is untreatable, confirming that structured skills training (mindfulness, distress tolerance, emotion regulation) can create stability.
Sample Answer
Exploring Borderline Personality Disorder and Paraphilic Disorders
This exploration focuses on Borderline Personality Disorder (BPD)—a personality disorder—and Paraphilic Disorders, examining the controversies, professional considerations, and critical ethical and legal challenges presented by both in clinical practice.
Part I: Borderline Personality Disorder (BPD)
Borderline Personality Disorder is one of the most studied and frequently diagnosed personality disorders, characterized by a pervasive pattern of instability in interpersonal relationships, self-image, affects, and marked impulsivity (American Psychiatric Association [APA], 2022).
The Controversy Surrounding BPD
The primary controversy surrounding BPD is rooted in its etiology, gender bias in diagnosis, and historical stigmatization.