DSM-5-TR 2
Personality Disorders
Worldview
A personality disorder is defined by enduring patterns of thoughts and behaviors that
differ from cultural norms. It usually starts in adolescence or early adulthood and can cause
significant distress or dysfunction (APA, 2022).
Individuals with personality disorders often struggle to find direction in their lives, but
self-transcendent aspects or religious beliefs can provide purpose (Steen et al., 2023). Many face
difficulties in setting clear goals, leading to feelings of emptiness.
Research shows that individuals with Parkinson's disease who have religious or spiritual
beliefs report greater significance, increased self-transcendence, and less emptiness compared to
those who are atheists or lack a specific worldview (Steen et al., 2023).
Biases
A person's core beliefs about themselves and others significantly shape their identity,
emotional well-being, relationships, and behaviors. In adulthood, persistent self-harm and
suicidal thoughts may indicate borderline personality disorder (BPD), distinguishing it from
typical teenage disorders. Factors such as impulsive risk-taking and difficulties managing
negative emotions can further exacerbate BPD symptoms (Sharp & Fonagy, 2015).
Numerous healthcare providers harbor negative attitudes—both explicit and implicit—
toward marginalized groups, particularly racial and ethnic minorities. These biases can adversely
affect patient care by shaping clinician interactions, influencing clinical decision-making, and
guiding institutional practices. As a result, they ultimately contribute to disparities in treatment
and health outcomes (Widiger, 2003).
ACA Code of Ethics
DSM-5-TR 3
Section E of the American Counseling Association (ACA) Code of Ethics highlights the
need for caution in diagnosing mental disorders. Assessments aim to collect vital information for
decision-making and treatment planning. Combining qualitative and quantitative methods
provides a clearer picture of clients' needs (ACA, 2014, E.1.a). Effective counseling relies on
careful assessment practices.
Disposition
My objective is to promote social responsibility, self-reflection, dedication, honesty, and
professionalism among my clients with personality disorders (CACREP, 2015). We cultivate a
strong connection with our clients by providing invaluable guidance and support as advisors.
Although research and assessment play a crucial role in enhancing clinical decision-making, they
should not be the sole considerations in this process. In evaluating a personality disorder, we
analyze cognitive, emotional, social, and behavioral patterns according to established diagnostic
criteria.
ASERVIC Competency
Individuals with personality disorders should have access to essential support. ASERVIC
Competency 10 emphasizes the need for counselors to gather clients' spiritual or religious beliefs
during intake (ASERVIC, 2024). Effective treatment options include Dialectical Behavior
Therapy (DBT), Mentalization-Based Treatment (MBT), Transference-Focused Psychotherapy
(TFP), General Psychiatric Management (GPM), and schema-focused therapy, known as the "big
five" in the field (Tusiani-Eng & Yeomans, 2018).
References
DSM-5-TR 4
American Counseling Association. (2014). 2014 ACA code of ethics.
https://www.counseling.org/docs/default-source/default-document-library/2014-code-of-
ethics-finaladdress.pdf.
American Psychiatric Association, ed. (2022).BDiagnostic and Statistical Manual of Mental
Disorders, Fifth Edition, Text Revision (DSM-5-TR). Washington, DC, USA: American
Psychiatric Publishing.BISBNB978-0-89042-575-6.
Association for Spiritual, Ethical, and Religious Values in Counseling (ASERVIC) (2024).
https://aservic.org/spiritual-and-religious-competencies/.
Counsel for Accreditation of Counseling and Related Educational Programs [CACREP] (2015).
2016 CACREP Standards. Alexandria, VA: Author. Retrieved
from https://www.cacrep.org/for-programs/2016-cacrep-standards/.
Sharp, Carla, and Peter Fonagy. (2015). Practitioner Review: Borderline personality disorder in
adolescence - recent conceptualization, intervention, and implications for clinical
practice. Journal of Child Psychology and Psychiatry, 56, 12, 1266–1288,
https://doi.org/10.1111/jcpp.12449.B
Steen, A., Braam, A., Berghuis, H., & Glas, G. (2023). Meaning in life in personality disorder:
An empirical approach considering self-direction, self-transcendence and
spiritual/religious worldviews.BJournal of Spirituality in Mental Health,B26(3), 202–217.
https://doi.org/10.1080/19349637.2023.2199172.
Tusiani-Eng, P., & Yeomans, F. (2018). Borderline Personality Disorder.BPsychiatric Clinics of
North America.,B41(4), 695–709. https://doi.org/10.1016/j.psc.2018.07.006
Widiger TA. (2003). Personality disorder diagnosis. World Psychiatry. (3):131-5. PMID:
16946918; PMCID: PMC1525106.
