Controversy Associated with Personality and Paraphilic Disorders
Controversy of Borderline Personality Disorder
The controversy of borderline personality disorder (BPD) is related to the diagnosis, classification, assessment, and treatment. One of the critical issues is the stigma related to the diagnosis of the condition (Trull et al., 2018). Recent research has highlighted the ongoing debate regarding the classification of BPD, with some clinicians arguing for its reclassification as a trauma disorder (The Guardian, 2024). This perspective stems from observations that many individuals diagnosed with BPD, particularly women, have a history of abuse. It is not clear if the diagnostic method is an evidence-based practice or it should be changed. The stigma affects how practitioners tolerate the emotions and thoughts of individuals with the condition. The diagnostic process may lead to a negative view of patients with borderline personality disorder (Trull et al., 2018). For instance, practitioners may overlook strengths or minimize the symptoms. In some cases, the patients can be thought to be lazy and unable to participate in daily activities. Practitioners indicate that therapeutic nihilism is a major concern in addressing borderline personality disorder (Trull et al., 2018). The diagnosis is controversial since some practitioners believe it should not be diagnosed. Another controversy related to borderline personality disorder is how to differentiate the disease from other mental illnesses. Recent neuroimaging studies have identified a potential neural signature for BPD, which could advance diagnosis and treatment approaches (Science Daily, 2023). This discovery may help address some of the controversies surrounding the disorder’s diagnosis and differentiation from other mental health conditions. The ongoing research in neuroimaging and biological mechanisms of BPD continues to shape our understanding of this complex disorder, potentially leading to more precise diagnostic criteria and targeted interventions.
Professional Beliefs about the Disorder
My professional belief is that borderline personality disorder is another mental health condition that can affect any person. Borderline personality disorder can affect individuals and their ability to participate in daily activities and ability to manage and cultivate healthy relationships (Porter et al., 2020). Recent research has shed light on the genetic components of BPD, with a Swedish population-based study estimating heritability at 46% (Leichsenring et al., 2024). This finding underscores the complex interplay between genetic and environmental factors in the development of BPD. The condition can affect the ability to manage emotions and control behavior. I believe practitioners should not express stigma during diagnosis, assessment, and treatment. Mental health nurses should understand the negative effects of the condition and seek to restore the positive behavior.
I believe as a professional it is vital for a medical checkup at a young age to provide opportunities for early intervention. Early treatment will eliminate the risk of adverse symptoms as patients age. The symptoms of borderline personality disorder affect individuals as they age leading to negative behavior and inability to manage healthy relationships (Porter et al., 2020). A comprehensive review by Leichsenring et al. (2024) highlights the importance of early intervention, noting that long-term studies show a mean remission rate of 60% for BPD, albeit with high heterogeneity. Parents should observe the growth of their children to avoid adverse health outcomes when it is too late (Porter et al., 2020). For instance, if a child has symptoms that are related to borderline personality disorder, it is crucial to take the child to a pediatrician or mental health nurse for diagnosis. Early diagnosis is vital to facilitate the normal growth of children. Ongoing research in cognitive, behavioral, and pathological aspects of BPD continues to inform our understanding of the disorder’s progression and potential interventions. This evolving knowledge base emphasizes the importance of a multidisciplinary approach to BPD treatment, incorporating insights from various fields of study.
Strategies for Maintaining Therapeutic Relationship
One of the strategies of maintaining a therapeutic relationship with patients is to maintain professional boundaries with patients. It is vital to keep the boundaries to eliminate the risk of compromising relationships with patients (Chanen et al., 2020). Recent studies have explored the efficacy of various therapeutic approaches for BPD, with dialectical behavior therapy (DBT) showing promising results (Focus, 2022). Understanding the effectiveness of different treatment modalities can help practitioners tailor their approach to individual patients. Despite efforts to establish rapport, maintaining professional boundaries is necessary. It is important to maintain privacy during the provision of medical services. A patient should be assured of professional boundaries to protect them from third parties that can undermine their confidence to share confidential information (Chanen et al., 2020). Another approach is to use active questions to engage a patient. Using positive questions will encourage a patient to share information about their behavior.
I will strive to establish the therapeutic relationship by assuring a patient about their confidentiality. I would lay the ground rules such as assuring the patient that their information will not be shared by any third party without their consent (Temes et al., 2019). Another approach is to show empathy and communicate clearly. Empathy will involve sharing and understanding the feelings of a patient without sympathizing with the patient. The communication should be clear to enhance adherence to the treatment plan (Temes et al., 2019). I will allow the patient to share feelings, emotions, and beliefs and explore their views. Expressing feelings and emotions is healthy for a patient. Recent research has emphasized the importance of a trauma-informed approach when working with individuals with BPD, given the high prevalence of past trauma in this population (The Guardian, 2024). Incorporating this perspective into therapeutic relationships can enhance trust and promote healing. Additionally, staying informed about the latest research findings, such as those related to the neurobiology of BPD, can help practitioners develop more targeted and effective treatment strategies.
Ethical and Legal Considerations
Patients with borderline personality disorder have a tendency of acting before thinking. The impulsive behavior will prompt a patient to engage in risky behavior. A practitioner should take precautions to avoid harm to a patient. Maleficence and beneficence involve the assurance that the treatment will be professional and without any harm (Haugom et al., 2019). Recent research has highlighted the importance of considering the long-term course of BPD when making ethical decisions about treatment (Leichsenring et al., 2024). This perspective can inform how practitioners approach risk management and treatment planning. In case the behavior of a patient is risky to an extent of costing their life, it is legal to report without consulting. For instance, if a patient wants to commit suicide, I would seek assistance from parents, guardians, or police to avert the risk of death. The second ethical and legal issue is fairness and justice (Haugom et al., 2019). It will be important to take care of the patient without discrimination. For instance, practitioners should not discriminate against patients with borderline personality behavior.
Involuntary hospitalization is another legal and ethical issue in practice. Patients with borderline personality disorder can express impulsive behavior that can be risky at home or the clinic. It is essential to consult a parent or guardian to seek consent before hospitalizing a patient against their wish (Haugom et al., 2019). Recent studies have explored alternative approaches to crisis management for individuals with BPD, emphasizing community-based interventions where possible (Liu et al., 2024). These findings may influence ethical considerations regarding involuntary hospitalization. I will strive to use other methods of making a patient cool down such as medication unlike involuntary hospitalization (Haugom et al., 2019). Another issue is the high rate of suicide among patients undergoing treatment. The ethical issue should be addressed to prevent medical practices that put a patient at risk of suicide. Addressing ethical and legal issues is essential in maintaining a professional relationship with patients. Ongoing research into the neurobiology and genetics of BPD may also raise new ethical questions about privacy, genetic testing, and personalized medicine approaches. Practitioners must stay informed about these developments to navigate the evolving ethical landscape of BPD treatment.
References
Chanen, A. M., Nicol, K., Betts, J. K., & Thompson, K. N. (2020). Diagnosis and treatment of borderline personality disorder in young people. Current psychiatry reports, 22(5), 1-8.
Focus. (2022). Borderline and Other Personality Disorders: New Directions in Research and Practice. Focus, 20(4). https://focus.psychiatryonline.org/doi/10.1176/appi.focus.22020015
Haugom, E. W., Ruud, T., & Hynnekleiv, T. (2019). Ethical challenges of seclusion in psychiatric inpatient wards: a qualitative study of the experiences of Norwegian mental health professionals. BMC Health Services Research, 19(1), 1-12.
Leichsenring, F., Steinert, C., & Ioannidis, J. P. (2024). Borderline personality disorder: a comprehensive review of epidemiology, course, and treatment. World Psychiatry, 23(1), 66-86.
Liu, Y., Zeng, X., Jiang, F., Xiao, Z., & Yao, S. (2024). Twenty years of research on borderline personality disorder: A bibliometric analysis. Frontiers in Psychiatry, 15, 1361535.
Porter, C., Palmier‐Claus, J., Branitsky, A., Mansell, W., Warwick, H., & Varese, F. (2020). Childhood adversity and borderline personality disorder: a meta‐analysis. Acta Psychiatrica Scandinavica, 141(1), 6-20.
Science Daily. (2023, June 27). Neural signature for borderline personality disorder identified. ScienceDaily. https://www.sciencedaily.com/releases/2023/06/230627191521.htm
Temes, C. M., Frankenburg, F. R., Fitzmaurice, G. M., & Zanarini, M. C. (2019). Deaths by suicide and other causes among patients with borderline personality disorder and personality-disordered comparison subjects over 24 years of prospective follow-up. The Journal of clinical psychiatry, 80(1), 0-0.
The Guardian. (2024, May 12). Is this actually PTSD? Clinicians divided over redefining borderline personality disorder. The Guardian. https://www.theguardian.com/society/article/2024/may/12/is-this-actually-ptsd-clinicians-divided-over-redefining-borderline-personality-disorder
Trull, T. J., Freeman, L. K., Vebares, T. J., Choate, A. M., Helle, A. C., & Wycoff, A. M. (2018). Borderline personality disorder and substance use disorders: an updated review. Borderline personality disorder and emotion dysregulation, 5(1), 1-12.
