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DSM Axis II - Personality Disorders and Intellectual disabilities
Axis II is part of the DSM "multiaxial" system for assessment. The five axis model is designed to provide a comprehensive diagnosis that includes a complete picture of not just acute symptoms but of the entire scope of factors that account for a patient's mental health. This page explains DSM Axis II.
Axis II is for assessing personality disorders and intellectual disabilities. These disorders are usually life-long problems that first arise in childhood, distinct from the clinical disorders of Axis I which are often symptomatic of Axis II. For example, a adult patient might have depression (an Axis I disorder) that is largely a result of a paranoid personality disorder (an Axis II disorder).
Axis II disorders are accompanied by considerable social stigma because they are suffered by people who often fail to adapt well to society; Axis II disorders can seem untreatable and be difficult to pinpoint. It is often disupted whether Axis II disorders are caused primarily by genetic influences or environmental causes. In fact, it has been suggested that,
"...the diagnosis 'personality disorder' should be replaced by the diagnosis 'adaptation disorders'. This reflects the real nature of the disorder more accurately, and is likely to reduce the stigmatizing component of the personality disorder diagnosis as it places emphasis on positive efforts to improve adaptation. The suggested revisions of the personality disorder diagnosis and dimensional approach to these disorders are likely to advance treatment and research - we discuss these aspects in some detail."1
Another indication of the nebulous, difficult to categorize distinguish nature of Axis II disorders is the categorization of autism. Autism used to be on Axis II but was moved to Axis I. This is because some cases of autism are transient - they respond well to treatment and/or diminish over time. Axis II disorders are regarded as more permanent and less responsive to treatment.
Here is a list of some more commonly diagnosed Axis II disorders. Click on each to learn more.
- Antisocial Personality Disorder
- Avoidant Personality Disorder
- Borderline Personality Disorder
- Dependent Personality Disorder
- Histrionic Personality Disorder
- Mental Retardation
- Narcissistic Personality Disorder
- Obsessive-Compulsive Personality Disorder
- Paranoid Personality Disorder
- Personality Disorder Not Otherwise Specified
- Schizoid Personality Disorder
- Schizotypal Personality Disorder
Axis II in the DSM-5
The next edition of the DSM is scheduled for publication in May, 2013. Working groups are reviewing the multiaxial system to try to bring it more into line with international reporting standards (as opposed to U.S. standards) with the goal of having a global approach to mental health diagnosis. Regarding Axis II, the American Psychiatric Association states,
The subgroup has recommended that DSM-5 collapse Axes I, II, and III into one axis that contains all psychiatric and general medical diagnoses. This change would bring DSM-5 into greater harmony with the single-axis approach used by the international community in the World Health Organization’s (WHO) International Classification of Diseases (ICD).
An example of a Five axis diagnosis
Axis II is only one of five axes used in a DSM assessment. The following is an example of a multiaxial diagnosis from Edward Pierce, LCSW:
- Axis I: Major Depressive Disorder, Single Episode, Severe Without Psychotic Features / Alcohol Abuse
- Axis II: Dependent Personality Disorder Frequent use of denial
- Axis III: None
- Axis IV: Threat of job loss
- Axis V: GAF = 35 (current)
- "DSM axis II: personality disorders or adaptation disorders?", Curr Opinion Psychiatry, 2009, Svrakic DM, Lecic-Tosevski D, Divac-Jovanovic M., Washington University School of Medicine
Click below to articles related to Axis II and the DSM
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