Question: What makes a Personality DO different from an Axis I DO?

[whopper]

EOM

Your thoughts?

Reason why I bring this up is therapists tend to say that Axis I in general have more a biochemical component while Axis II has more of an environmental component.

True, but there is new data suggesting some biological/physiological mechanisms to Axis II DOs and of course Axis I DOs are also influenced by environment.

One def:

Personality disorders are seen by the American Psychiatric Association as an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the culture of the individual who exhibits it. These patterns are inflexible and pervasive across many situations. The onset of the pattern can be traced back at least to the beginning of adulthood. To be diagnosed as a personality disorder, a behavioral pattern must cause significant distress or impairment in personal, social, and/or occupational situations

Hmm, don't several Axis I DOs follow the same suit?

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[Atilla]

This was exactly the DSM-III panel was afraid of-placing personality d/o on axis II would be taken as a marker that they are really different from axis I disorders. The original purpose of placing Personality disorders on Axis II was that they are not overlooked by the clinicians in the presence of more florid Axis I disorders. One way to look at it is that mental disorders lie on a continium with mild cases being labelled as Axis II and severe as Axis I.

 

[nitemagi]

I used to think of it as Axis I is more treatable than Axis II, though with DBT and BPD, I guess that's somewhat less true.

 

[toby jones]

One notion is that axis I disorders are categorically different from normal functioning whereas axis II disorders might be better conceptualised as being on a continuum (dimensional).

Another notion is that axis I disorders seem to be better treated by psychiatric medication whereas axis II disorders seem to be better treated by psychotherapy.

Still another notion is that axis I disorders can be episodic (with periods of relatively normal functioning in between episodes) whereas axis II disorders tend to persist without remittance (since they are habitual ways of coping).

I guess all of the above can be questioned.

But that was my take, anyway.

I really had thought... That we had moved away from the genetic vs environmental debate and towards arguing about precise causal mechanisms (both genetic and environmental) and how they interact.

Concordance rates for schizophrenia (identical twin studies): 48%

Yet schizophrenia is considered one of the paradigmatically 'genetic' mental disorders...

 

[whopper]

If you look at the above responses (and I'm in the same category with my own opinions on this), it appears that the distinction between I & II really isn't very well defined by DSM nor understood by clinicians.

Our opinions on the differences are more about flavors of mental dos and not based on more objective reasoning.

Which is a shame. If anyone can give us a better and more objective reasoning as to why there's a distinction please explain.

 

[MBK2003]

To quote a faculty member in response to a similar question

The Axis I/Axis II separation in DSM-III was created for pragmatic reasons. It was felt that personality disorders and developmental disorders like Mental ******ation and Learning Disorders were often being overlooked by clinicians because of the more florid presentations of typical presenting disorders. For example, when patients were admitted with major depression, accompanying personality disorders would often be overlooked because all attention would be focused on treating the depression. Similarly, in children, diagnoses of Learning Disorders would be missed because all attention would be paid on the presenting Conduct Disorder. By having personality disorders and so-called developmental disorders on Axis II, the thought was that it would encourage clinicians to consider whether or not personality disorders and development disorder might be present for each and every patient being evaluated.

This faculty member went on to discuss the subsequent 2 most negative effects of this decision -
1) the mistaken assumption that there was an inherent difference in the pathophys or the treatment of the two different axes
2) insurance companies refusal to pay for treatment of axis II disorders.
And to predict that DSM V will handle these differently than 2 separate axes.

MBK2003

 

[50960]

MBK, that has always been my understanding too.

 

[Demosthenes]

One notion is that axis I disorders are categorically different from normal functioning whereas axis II disorders might be better conceptualised as being on a continuum (dimensional).

Another notion is that axis I disorders seem to be better treated by psychiatric medication whereas axis II disorders seem to be better treated by psychotherapy.

Still another notion is that axis I disorders can be episodic (with periods of relatively normal functioning in between episodes) whereas axis II disorders tend to persist without remittance (since they are habitual ways of coping).

The easy explanation I was given was that Axis I disorders were ego-dystonic, and Axis II tended to be ego-syntonic. (Like the differences between OCD and OCPD -- how often has anyone seen anyone come in asking for help with OCPD?)

 

[Chewbacca Jung]

The easy explanation I was given was that Axis I disorders were ego-dystonic, and Axis II tended to be ego-syntonic. (Like the differences between OCD and OCPD -- how often has anyone seen anyone come in asking for help with OCPD?)

But the manic phase of Bipolar is often ego-systonic, substance abuse disorders can be as well.

 

[Demosthenes]

But the manic phase of Bipolar is often ego-systonic, substance abuse disorders can be as well.

Hey -- I didn't say it was a *good* explanation, only an easy one...

😛

 

[Kluver Bucy]

Axis I = billable
Axis II = not billable

I'm joking, but that's a serious answer I got from a child psychiatrist after I asked the same question.