Axis II, what to do?

[Psyclops]

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Some have proposed that the diagnosis of personality disorder should be moved to Axis I, others think that it should stay on Axis 2 but become a dimensional model, and the list goes on of issues dealinng with Axis 2. I would like to start a thread for people exchanging their opinions regarding where it should go, what should change, if anything at all. Please, share your feelings.

 

[soaringheights]

Hi
Could anyone quote studies where they've seen the prevalance of Axis II? In my clinical practice so far I'v only come across Cluster A disorders, that too very rarely. Only borderline for Cluster B (only 1 case, although others seem to diagnose it a lot). What I wonder is the utility of including Cluster C coz I'v not come across any cases, but again that might be due to my limited clinical experience so far. How does the research literature support Cluster C?

 

[psychgeek]

Hi
In my clinical practice so far I'v only come across Cluster A disorders, that too very rarely. Only borderline for Cluster B (only 1 case, although others seem to diagnose it a lot).

I envy you 🙂

 

[soaringheights]

I envy you 🙂

🙂
So psychgeek, what has been your experience with Axis II, and why should I consider myself to be luckier than thou?

 

[Psyclops]

SH, Axis II tends to be a controversial issue state side. Many clinicians tend to roll thier eyes and lose their famed empathetic demeanors when they have to work those who cary an Axis II diagnosis. The problem is further compounded by a lack of response to treatment that is characteristic of the disroders, and consequently the lack of third part (i.e., inssurance) funding. I personally feel that personality in last vestige that only psychology can claim to do a good job understanding. Other disciplines for a variety of reasons are ill equipped to handle PDs. But regardless, many clinicians shun working with them if they can.

 

[PsyDGrrrl]

SH, Axis II tends to be a controversial issue state side. Many clinicians tend to roll thier eyes and lose their famed empathetic demeanors when they have to work those who cary an Axis II diagnosis. The problem is further compounded by a lack of response to treatment that is characteristic of the disroders, and consequently the lack of third part (i.e., inssurance) funding. I personally feel that personality in last vestige that only psychology can claim to do a good job understanding. Other disciplines for a variety of reasons are ill equipped to handle PDs. But regardless, many clinicians shun working with them if they can.

Personally, I love working with Axis II clients. Well, borderlines. Narcissists can be challenging, and I generally refuse to work with sociopaths, but I find borderlines to be some of the most rewarding clients I've had.

 

[psychgeek]

🙂
So psychgeek, what has been your experience with Axis II, and why should I consider myself to be luckier than thou?

I was kind of joking … but only kind of.

Working with severe personality disorders is both incredibly rewarding and incredibly difficult. Right now I am the individual therapist for two people with BPD, one with NPD, one person with schizoid PD, and one patient suffering from schizotypal PD. The problem with this is that there is just too much instability for one clinician to stay on top of. It has not been an infrequent occurrence for me to have two patients in serious crises at the same time. Things can change so quickly for people suffering from these severe personality disturbances and it is really anxiety provoking to be constantly concerned about a suicide attempt or life-threatening self-harm. They are also just a lot of work. Most of my patients may contact me by phone once a month at most. My patients with PD will often call me 2 or 3 times a day if they are in crisis and at least twice a week if they are doing well. In the future I will limit myself to no more than two serious PDs at one time.

 

[soaringheights]

I was kind of joking … but only kind of.

Working with severe personality disorders is both incredibly rewarding and incredibly difficult. Right now I am the individual therapist for two people with BPD, one with NPD, one person with schizoid PD, and one patient suffering from schizotypal PD. The problem with this is that there is just too much instability for one clinician to stay on top of. It has not been an infrequent occurrence for me to have two patients in serious crises at the same time. Things can change so quickly for people suffering from these severe personality disturbances and it is really anxiety provoking to be constantly concerned about a suicide attempt or life-threatening self-harm. They are also just a lot of work. Most of my patients may contact me by phone once a month at most. My patients with PD will often call me 2 or 3 times a day if they are in crisis and at least twice a week if they are doing well. In the future I will limit myself to no more than two serious PDs at one
time.

Hmm...that does sound exasperating. I recently had a pt with alcohol dependence with a comorbid ASPD and I was quite stuck with how to go about with him after a point of time, as he wasn't responding to most of the things tried with him.
But psychgeek, you have my sympathies 🙂 🙂