Assignment: Controversy Associated with Personality and Paraphilic Disorders

NRNP 6675 Assignment: Controversy Associated with Personality and Paraphilic Disorders

Personality disorders are defined as how a person’s personality constantly causes problems for themselves or others. They are characterized by chronic patterns of inner experience and inflexible behaviors, but the affected persons have no insight into the problem. Borderline personality disorder (BPD) is characterized by self-image problems, unstable interpersonal relationships, feelings of emptiness, and self-mutilating behavior (Storebø et al., 2020). The purpose of this paper is to discuss controversies surrounding BPD, personal beliefs about BPD, strategies to maintain a therapeutic relationship, and ethical and legal considerations.

Controversy That Surrounds Borderline Personality Disorder

BPD has been controversial since it was identified as a diagnosis due to the stigma associated with the disorder and the therapeutic negativity held by health providers who encounter patients with the disorder in acute settings. Clinical controversies have previously cropped up about whether BDP is a legitimate diagnosis, leading to some insurance companies refusing to acknowledge BPD treatment for reimbursement matters (Choudhary & Gupta, 2020). In addition, some practitioners have raised controversies about the theories used in developing BPD. Consequently, many health providers do not regard BPD as a genuine diagnosis and consider it self-induced or chosen. This has led to numerous cases of mental health practitioners declining to treat BPD patients (Campbell et al., 2020). Furthermore, many mental health practitioners believe that individuals with BPD use a disproportionate portion of mental health services and that the disorder is not compliant with treatment even with contrary evidence.

Professional Beliefs about Borderline Personality Disorder

I believe that BPD is a real diagnosis, and mental health practitioners should be keen to identify patients with odd

Assignment Controversy Associated with Personality and Paraphilic Disorders

Assignment Controversy Associated with Personality and Paraphilic Disorders

and eccentric personalities. Campbell et al. (2020) assert that diagnosis is vital in identifying the appropriate treatment for individuals with symptoms suggesting BPD. I also believe that BPD can be identified by looking at the culture and social norms, which help to distinguish normal from abnormal patterns. According to Choudhary and Gupta (2020), culture and social norms are the two vital factors that distinguish between normal and abnormal behavioral patterns in BPD. The social norms influence and drive a person’s interpersonal functioning, and emotions are experienced and expressed within the cultural context.

Furthermore, I believe that BPD becomes evident in adolescence and early adulthood. Thus, practitioners should be observant of problems in personality in this population. Bozzatello et al. (2021) explain that, similar to all PDs, BPD emerges during adolescence or young adulthood. Thus, it is crucial to detect the presence of BPD in its early stages to initiate treatment and improve its prognosis.

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Strategies for Maintaining the Therapeutic Relationship with a Client with BPD

A positive therapeutic relationship is extensively acknowledged as a crucial factor that promotes the effectiveness of clinical outcomes in treating patients with BPD. However, a positive therapeutic relationship is usually slow to develop, challenging to maintain, and inconsistent (Flora, 2018). The provider can maintain a positive therapeutic relationship by cultivating emotional awareness since the patient’s or the provider’s emotional sensitivity, and reactivity can hinder the therapeutic process. Therapists who often strain with moderating their intense reactions should seek to recognize and accept their emotional experiences.

Assignment Controversy Associated with Personality and Paraphilic Disorders

Assignment Controversy Associated with Personality and Paraphilic Disorders

The therapist should be responsive by tailoring interventions to a patient’s characteristics and behaviors. Furthermore, the provider’s attitude, communication style, and intent are crucial to creating an effective therapeutic relationship. Empathic validation is another o important strategy for maintaining the therapeutic relationship (Flora, 2018). Patients with BPD are emotionally sensitive to actual or perceived rejection or criticism, which hinders effective therapeutic relationships. Lastly, the therapist should avoid being authoritative or controlling when handling BPD clients (Flora, 2018). They should rather be highly collaborative and treat the patient as capable, competent, and an active participant in therapy.

Ethical and Legal Considerations Related To BPD

BPD patients have high rates of discontentment due to unmet needs, like access to services and adequate treatments, which lead to ethical issues. Patients’ right to autonomy should be upheld by educating individuals with BPD about their diagnosis and available treatment options to alleviate them. Campbell et al. (2020) found that individuals with BPD are not told about their diagnosis or are informed they have a different condition, such as bipolar disorder, which compromises the principle of veracity. Furthermore, beneficence and nonmaleficence should be considered through correct diagnosis and treatment interventions. Correct diagnosis is crucial to ensure patients receive the appropriate treatment (Storebø et al., 2020). It is undoubtedly evident that errors in diagnosis or failure to tell patients of their BPD diagnosis can cause significant preventable harm.


Controversies surrounding BPD on whether it is legitimate have led to some practitioners declining to offer treatment and insurers failing to compensate. The correct diagnosis of BPD alleviates possible harm, which may occur from inadequate treatment or treatment linked with marked iatrogenic harms. All therapy approaches for BPD stress the significance of the therapeutic relationship. Strategies to maintain a therapeutic relationship with BPD clients include cultivating emotional awareness, being responsive, having a positive attitude and communication style, and empathic validation.


Bozzatello, P., Garbarini, C., Rocca, P., & Bellino, S. (2021). Borderline Personality Disorder: Risk Factors and Early Detection. Diagnostics (Basel, Switzerland)11(11), 2142.

Campbell, K., Clarke, K., Massey, D., & Lakeman, R. (2020). Borderline Personality Disorder: To diagnose or not to diagnose? That is the question. International Journal of Mental Health Nursing. doi:10.1111/inm.12737

Choudhary, S., & Gupta, R. (2020). Culture and borderline personality disorder in India. Frontiers in Psychology11, 714.

Flora, K. (2018). The therapeutic relationship in Borderline kPersonality Disorder: A cognitive perspective. Journal of Evidence-Based Psychotherapies, 18(2), 19–33.

Storebø, O. J., Stoffers-Winterling, J. M., Völlm, B. A., Kongerslev, M. T., Mattivi, J. T., Jørgensen, M. S., Faltinsen, E., Todorovac, A., Sales, C. P., Callesen, H. E., Lieb, K., & Simonsen, E. (2020). Psychological therapies for people with borderline personality disorder. The Cochrane database of systematic reviews5(5), CD012955.