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

Discussion in 'Psychiatry' started by whopper, Mar 1, 2007.

  1. whopper

    whopper Former jolly good fellow Physician Faculty 10+ Year Member

    Feb 8, 2004

    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:
    Hmm, don't several Axis I DOs follow the same suit?
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  3. Atilla

    Atilla New Member 7+ Year Member

    Sep 5, 2005
    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.
  4. nitemagi

    nitemagi Senior Member Physician Faculty 10+ Year Member

    Oct 15, 2001
    Los Angeles, CA
    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.
  5. toby jones

    toby jones 2+ Year Member

    Jan 7, 2007
    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...
  6. whopper

    whopper Former jolly good fellow Physician Faculty 10+ Year Member

    Feb 8, 2004
    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.
  7. MBK2003

    MBK2003 Senior Member 7+ Year Member

    Oct 23, 2001
    Lobsta' Land
    To quote a faculty member in response to a similar question
    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.

  8. 50960

    50960 Guest

    Aug 20, 2004
    MBK, that has always been my understanding too.
  9. Demosthenes

    Demosthenes Member 2+ Year Member

    May 30, 2006
    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?)
  10. Chewbacca Jung

    Chewbacca Jung Walking Carpet 2+ Year Member

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

    Demosthenes Member 2+ Year Member

    May 30, 2006
    Hey -- I didn't say it was a *good* explanation, only an easy one...

  12. Kluver Bucy

    Kluver Bucy Gold Member 10+ Year Member

    Dec 26, 2001
    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.

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