Controversy Associated with Personality and Paraphilic Disorders

Controversy Associated with Personality and Paraphilic Disorders

Controversy Associated with Borderline Personality Disorder

Most psychiatric diagnoses have had considerable controversy surrounding their diagnoses. Personality and paraphilic disorder are some of the diagnoses that have been debated among mental health professionals and other healthcare specialists (Paris, 2020).

A borderline personality disorder is one of the most debated personality disorders. The purpose of this paper is to explain the controversies surrounding borderline personality disorder and provide my professional stance regarding these differing professional views.

Borderline Personality Disorder Personality Controversy

A borderline personality disorder is DSM-5 recognized personality disorder. The basis for diagnosing BPD is a clinical constellation of symptoms, including pervasive patterns in self-image, impulsivity, affect, and interpersonal relationships (American Psychiatric Association, 2013). Therefore, BPD can present with abandonment fears, aggression, intense mod shifts, anger problems, suicidal behaviors, self-injurious behaviors, and unstable relationships.

Controversies associated with BPD are due to stigma surrounding its diagnosis and nihilistic attitudes by some professionals that encounter many patients with BPD clinical presentations in acute care settings (Campbell et al., 2020). BPD is misunderstood because of the heterogeneity in its presentation (Paris, 2020). The aforementioned symptoms can be nonspecific and can present in various psychiatric illnesses such as schizophrenia, bipolar disorder, and mood disorders.

Constructs of BPD differ in different cultures of the world, and culture dictates what is considered normal or abnormal behavior and thinking. Opposing schools of thought argue that BPD could be a result of various socio-cultural and environmental contexts. Culture and environment shape how people think and behave (Choudhary & Gupta, 2020). Therefore, different cultures interpret interpersonal functioning, self-image, and emotions differently.

Therefore, distinguishing between normal and abnormal behavior, thinking and interactions would rely solely on the caregiver and the clinician’s interpretations. This concept is one of the factors that lead to confusion when diagnosing BPD in different settings of care, thus the controversy.

My Professional Stance

I acknowledge the scientific basis for the opposing and supporting ideas for BPD. My professional opinion is in support of the diagnosis of BPD. However, clinicians must take care to avoid overdiagnosis due to overenthusiasm, which may complicate the existing controversies.

BPD can coexist with other illnesses such as eating disorders, bipolar disorders, anxiety disorders, substance use disorders, and depression (American Psychiatric Association, 2013; Choudhary & Gupta, 2020). Therefore, its diagnosis can be easily missed by a clinician owing to similarities in the presentations of the coexisting illness.

Therefore, some mental health specialists will intentionally ignore the diagnosis and treat other coexisting illnesses. There is also the stigma that has been associated with BPD and its management (Campbell et al., 2020). No medication has been approved for the treatment of BPD.

However, off-label management has shown an excellent therapeutic response to treatment (Levy, 2019). This can make patients who have symptoms and had obtained information from elsewhere before seeing clinicians hopeless and avoid providing accurate information to avoid having this diagnosis. This denial makes the accuracy of its diagnosis debatable.

Maintaining Therapeutic Relationships with patients with BPD.

Therapeutic alliance in therapy is vital in improving the outcomes of the treatment. Patients with BPD present with emotional and mood lability that can interfere with a therapeutic alliance when not anticipated and maintained properly. My key strategy when managing patients with BPD will involve supportive psychotherapy.

Reassurance, active listening, encouragement, education, and reinforcement are some of the strategies that I would use to build and maintain a therapeutic relationship with these patients. Supportive psychotherapy would work to maintain their mood and support their emotions during the process of treatment.

Ethical and Legal Considerations in BPD

Lability in mood, instability in social relationships, and impulsivity are some behaviors that implicate these patients in legal problems. These patients’ abilities to shift self-image and emotions can make them manipulative and attention-seeking, as also seen in patients with histrionic personalities. Suicidal behaviors have ethical implications for the caregiver.

Ethically, the clinicians are in a dilemma whether to tell these patients their diagnoses, whether to explain their suicidal risks, and whether to involuntarily admit them for inpatient care (Warrender, 2018). The clinicians guiding ethical principles should aim at doing good for the patient at all times. However, attempting to do good in the above situations may cause harm and risk suicidal behaviors among BPD patients.


Personality disorders still pose controversies, ethical and legal implications, and the need for therapeutic vigilance among clinicians and therapists. Borderline personality disorder has been one of the most debated and controversial personality disorders. The controversy about this DSM-5-recognized disorder arises from the similarities of its clinical presentation with other established psychiatric diagnoses.

Other clinicians argue that this disorder is a construct that results from cultural, social, and environmental influences on the person’s emotions, mood, self-image, and behavior. Despite these controversies, BPD has been diagnosed in various settings, and recent advancements in psychiatric treatments have shown good clinical responses to the patients diagnosed with this disorder.

Due to mood, thinking, and emotional instability in these patients, a positive therapeutic relationship would be maintained by supportive psychotherapy. The stigma surrounding this diagnosis and the suicidal risks also pose ethical and legal challenges to clinicians.


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (DSM-5 (R)) (5th ed.). American Psychiatric Association Publishing.

Campbell, K., Clarke, K.-A., Massey, D., & Lakeman, R. (2020). Borderline Personality Disorder: To diagnose or not to diagnose? That is the question. International Journal of Mental Health Nursing29(5), 972–981.

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

Levy, K. N. (2019, October 27). Evidence-Based Treatment of Borderline Personality Disorder: Clinical and Ethical Considerations –

Paris, J. (2020). Controversies in the classification and diagnosis of personality disorders. In The Cambridge Handbook of Personality Disorders (pp. 103–110). Cambridge University Press.

Warrender, D. (2018). Borderline personality disorder and the ethics of risk management. Nursing Ethics25(7), 969733016679467.

Controversy Associated with Personality and Paraphilic Disorders Assignment Instructions

Assignment: Controversy Associated with Personality and Paraphilic Disorders

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.

In this Assignment, you will 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.

To Prepare
Review this week’s Learning Resources and consider the insights they provide on assessing, diagnosing, and treating personality and paraphilic disorders.
Select a specific personality or paraphilic disorder from the DSM-5-TR to use for this Assignment.
Use the Walden Library to investigate your chosen disorder further, including controversial aspects of the disorder, maintaining the therapeutic relationship, and ethical and legal considerations. 
The Assignment
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.