ASSIGNMENT:CONTROVERSY ASSOCIATED WITH PERSONALITY AND PARAPHILIC DISORDERS

Controversy Associated with Personality and Paraphilic Disorders

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Personality disorders are some of the mental health disorders that affect a significant proportion of the population globally. Personality disorders develop from dysfunction and inflexibility in personalities. Antisocial personality disorder (ASD) is one of the types of personality disorders. Patients with ASD have symptoms such as being exploitative, manipulative, dishonest, lacking remorse, and being involved in activities that violate norms and laws. Controversies surround ASD diagnosis and its legitimacy as a clinical problem. Therefore, this paper examines the controversies associated with ASD, my professional beliefs about it, strategies for maintaining a therapeutic relationship with patients diagnosed with it, and ethical and legal considerations that inform their care.

Significant controversies surround ASD. Firstly, ASD is a source of problems for psychiatric mental health nurse practitioners. Specifically, psychiatric practice targets the human capacity to produce positive behavioral and attitudinal change. However, ASD has ego-syntonic traits. The traits are so unconscious that it becomes difficult for patients to acknowledge that they have a mental health problem that should be addressed. Similarly, effective management of mental health problems requires the development of therapeutic relationships between practitioners and their patients. This is a challenge in ASD since most patients consider therapeutic relationships as a weakness and disregard any intervention to promote their recovery. Consequently, it makes ASD a non-mental health problem (Anderson & Kelley, 2022; Schnittker et al., 2020). Instead, ASD appears an intentional behavior aimed at causing harm to others.

The other controversy surrounding ASD relates to its classification and diagnosis. The DSM-5 was developed for use in ASD diagnosis and other personality disorders. However, ASD and other personality disorders have heterogeneous descriptions. The heterogeneity means that most patients who are diagnosed with ASD or other personality disorders will qualify for the diagnostic criteria for other personality and paraphilic disorders. There is also the lack of well-defined variables for use in diagnosing patients with ASD or any other personality disorder in the normal or abnormal personality continuum. The lack of well-defined variables can be seen in the inconsistencies in assessment tools and rates for ASD and other personality disorders (Münch et al., 2020). Consequently, most tools for the diagnosis of personality disorders disagree on reliability scores, which affect the accuracy of ASD and its determination as a mental health problem.

I believe that ASD is a mental health disorder. ASD affects the patient’s social, occupational, academic, and other areas of functioning. Psychiatric mental health nurse practitioners should approach ASD the same way they address other mental health problems. Patients with ASD should access the mental healthcare services they need for their health and well-being. Psychiatric mental health nurse practitioners should select evidence-based interventions to help patients to overcome their mental health issues. I also believe that ASD can coexist with other mental health problems. Psychiatric mental health nurse practitioners should not only focus on ASD but also seek to determine if patients have other underlying mental health problems (van Dam et al., 2022). The selected treatments should address multiple patient’s needs for optimum care outcomes.

I believe that psychiatric mental health nurse practitioners are competent in providing patient-centered care to those diagnosed with ASD. The care should address the actual and potential needs of the patients. Psychiatric practitioners should focus on ensuring holistic care that addresses physical, psychosocial, and emotional needs is offered. I also believe that psychiatric mental health practitioners should provide professional care to patients diagnosed with ASD. They should demonstrate empathy, be non-judgmental, and encourage therapeutic relationships with their patients for the realization of the desired care outcomes. Practitioners should also approach discussions related to ASD diagnoses with their patients in a manner that demonstrates understanding and appreciation of the complexities associated with the condition. Lastly, nurses should act as advocates for ASD patients. They should create public awareness about its effects and available treatments to increase the uptake of ASD care (Johansson, 2020). Nurses should also advocate the adoption of strategies that address the stigma that ASD patients undergo in their societies.

Psychiatric mental health nurse practitioners should aim at maintaining a therapeutic relationship with a patient who presents with ASD. The nurse can consider several strategies to achieve this objective. Firstly, the nurse should adopt a non-judgmental attitude when working with patients with ASD. Nurses and other mental health practitioners should acknowledge the challenges that these patients experience. They should also demonstrate understanding and empathy, which will facilitate the creation of a therapeutic relationship between them and the patients. Psychiatric mental health practitioners should also encourage active patient involvement in ASD assessment and treatment. Patients should be actively involved in assessing their problems and developing solutions to overcome them (Hartley et al., 2020). Active patient involvement would strengthen the patient-provider relationship and encourage ownership of the treatment interventions.

Interprofessional collaboration can also be adopted as a strategy to maintain a therapeutic relationship with a patient with ASD. Interprofessional collaboration ensures that different healthcare providers work together in developing patient-centered care plans. Collaboration also empowers the patients and those involved in their care to be proactively involved in identifying effective and efficient care interventions that can be adopted to improve outcomes. Psychiatric mental health practitioners should also encourage open and honest communication with their patients for a therapeutic relationship. Patients with ASD should be free to express their views and concerns about their health needs. Providers should also seek information and offer feedback on how to improve goal achievement in the care process (Kwame & Petrucka, 2021). Open and honest communication will strengthen trust between providers and ASD patients, hence, strengthening therapeutic relationships.

Healthcare providers should consider ethical and legal issues that inform the care of patients diagnosed with ASD. Firstly, healthcare providers should be aware of their dedication to promoting autonomous care. Healthcare providers respect patient preferences and values. As a result, they must respect the decisions that patients with ASD make related to their care. Healthcare providers must also be aware of the importance of informed consent. They should provide patients with adequate and accurate information about their diagnoses, available treatments, treatment goals, benefits, and risks for them to make informed decisions. Informed consent must be obtained from patients before initiating any treatment. ASD diagnosis might predispose patients to stigma and isolation in their societies. As a result, healthcare providers must always strive to ensure confidentiality and privacy of the patient’s information is maintained. Practitioners should ensure that patient information is not accessible to unauthorized parties. They should also seek consent from their patients before sharing their information with others (Opitz-Welke & Konrad, 2020). The consideration of these ethical and legal issues will ensure that ASD patients receive high-quality, safe, and efficient care.

ASD is a personality disorder associated with controversies in its diagnosis and consideration as a mental health problem. I believe that ASD is a mental health disorder that should be treated like any other psychiatric condition. Healthcare providers should strive to maintain a therapeutic relationship with patients diagnosed with ASD. Ethical and legal considerations inform care that ASD patients receive.

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Anderson, J. L., & Kelley, S. E. (2022). Antisocial personality disorder and psychopathy: The AMPD in review. Personality Disorders: Theory, Research, and Treatment, 13(4), 397–401. https://doi.org/10.1037/per0000525

Hartley, S., Raphael, J., Lovell, K., & Berry, K. (2020). Effective nurse–patient relationships in mental health care: A systematic review of interventions to improve the therapeutic alliance. International Journal of Nursing Studies, 102, 103490. https://doi.org/10.1016/j.ijnurstu.2019.103490

Johansson, J. A. (2020). Nursing strategies for working with patients perceived to be challenging and difficult: A discourse analysis [PhD Thesis, University of Saskatchewan]. https://harvest.usask.ca/bitstream/handle/10388/13092/JOHANSSON-THESIS-2020.pdf?sequence=1

Kwame, A., & Petrucka, P. M. (2021). A literature-based study of patient-centered care and communication in nurse-patient interactions: Barriers, facilitators, and the way forward. BMC Nursing, 20(1), 158. https://doi.org/10.1186/s12912-021-00684-2

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

Opitz-Welke, A., & Konrad, N. (2020). Ethical Considerations Involving Psychopathic Disorders. In The Wiley International Handbook on Psychopathic Disorders and the Law (pp. 597–604). John Wiley & Sons, Ltd. https://doi.org/10.1002/9781119159322.ch73

Schnittker, J., Larimore, S. H., & Lee, H. (2020). Neither mad nor bad? The classification of antisocial personality disorder among formerly incarcerated adults. Social Science & Medicine, 264, 113288. https://doi.org/10.1016/j.socscimed.2020.113288

van Dam, A., Rijckmans, M., & van den Bosch, L. (2022). Explaining the willingness of clinicians to work with patients with antisocial personality disorder using the theory of planned behaviour and emotional reactions. Clinical Psychology & Psychotherapy, 29(2), 676–686. https://doi.org/10.1002/cpp.2661