Personality Disorders DSM IV Axis II

Axis II Personality Disorders

Borderline Personality Disorder

A pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of context, as indicated by five or more of the following:

(1)           Frantic efforts to avoid real or imagined abandonment.

(2)           Unstable and intense relationships, alternating between extremes of idealization and devaluation.

(3)           Unstable sense of self, self-image.

(4)           Impulsivity in at least two areas: reckless spending, sex, driving, binge eating.

(5)           Recurrent suicidal behaviour, gestures, threats, self-harm.

(6)           Rapid mood changes: intense episodic dysphoria, irritability, or anxiety lasting usually a few hours and rarely more than a few days.

(7)           Chronic feelings of emptiness.

(8)           Inappropriate intense anger or difficulty controlling anger.

(9)           Transient stress-related paranoid ideation or severe dissociative symptoms.

Life for the borderline can be painful, confusing, and pure hell. Much of their behaviour is the result of fear and a means of protecting themselves (defence mechanisms). Borderlines are often misunderstood and hated by mental health professionals who often refer to them as manipulative, demanding and difficult to treat. I will try to find the references of things I have read about mental health professionals in response to borderlines. At the end of the day, mental health professionals have trained to work with such people but they have this biased attitude about them. Often they will get a referral and see a borderline personality disorder (BPD) diagnosis and immediately decide what this person is like, or worse still they will refuse to treat them.

Links:

Why do Therapists Stigmatize People with Borderline Personality Disorder?

Borderline Personality Disorder Demystified

Mistreatment/ignorance of BPD patients

Hospital Worker Hates Borderlines

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Moods Disorders DMS IV Axis I

Axis IMood Disorders

Criteria for Major Depressive Episode

A.         Five or more of the symptoms listed below have to have been present during the same 2-week period and represent a change from previous functioning: at least one of the symptoms is either (1) depressed mood or (2) loss of interest or pleasure.

Note: Do not include symptoms that are clearly due to a general medical conditions, or mood-incongruent delusions or hallucinations.

(1)   Depressed mood most of the day, nearly every day, (e.g., appears tearful). Note: In children and adolescents, can be irritable mood.

(2)   Loss of interest or pleasure in most activities most of the day, nearly every day

(3)   Significant weight loss when not dieting, weight gain or decrease or increase in appetite nearly every day.

(4)   Not sleeping or sleeping more nearly every day.

(5)   Fidgety or restlessness or being slowed down.

(6)   Fatigue or loss of energy nearly every day.

(7)   Feelings of worthlessness, inappropriate guilt nearly every day.

(8)   Loss of ability to think or concentrate, or indecisiveness nearly every day.

(9)   Recurrent thoughts of death or suicidal ideation without a plan,  or suicide attempt, or a specific plan for committing suicide.

B.         The symptoms do not meet criteria for a Mixed Episode (depression and mania).

C.         Symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

D.         Symptoms are not due to physiological effects of drug abuse or medication or a general medical condition.

E.         Symptoms are not attributable to bereavement.  

Axis I

Mood Disorders

Criteria for Major Depressive Disorder, Single Episode

            To be diagnosed with having a single episode of major depressive disorder you need to meet the following criteria.

A.            Presence of a single major depressive episode according to the criteria

B.            The major depressive episode is not better accounted for by schizoaffective disorder, schizophreniform disorder, delusional disorder, or psychotic disorder not otherwise specified.

C.            There has never been a manic episode or mixed episode, or hypomanic episode.

 

             So this is interesting because you can have a single episode of major depression and earn the title of being called ‘disordered’. You may never have another episode but you have still graduated and earned that title. Hardly seem fair but that’s psychiatry for you. It is more acceptable (but still harsh) to be called disordered when you have recurrent major depressive episodes. The criteria is the same for major depressive disorder, recurrent episodes.

 

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Axes of the DSM IV

This post names all of the mental health conditions listed in the DSM IV. After reading a few of the names it will be obvious that psychiatrists and psychologists like to refer to their patients or clients as disordered. They would do well to remember that if they too are disordered according to the DSM IV because just about every imaginable human behaviour is listed in the manual. To label someone as disordered is both offensive and stigmatising. It tells the patient they are different or abnormal. Additionally, some of these ‘disorders’ can lead professionals to start treating the patient differently once the diagnosis has been given. Sometimes it is the mental health professionals themselves who treat patients so bad that they develop additional symptoms which have a detrimental effect on their overall wellbeing. When a mental health professional treats a patients worse than the general population does, you have to question why such a person when in for this line of career.

Axis I

Clinical Disorders

Other Conditions That May Be a Focus of Clinical Attention

These disorders are usually diagnosed in infancy, childhood, or adolescence and do not include mental retardation (that is diagnosed on Axis II).

Delirium, Dementia, and Amnestic and Other Cognitive Disorders

Mental Disorders Due to a General Medical Condition

Substance-Related Disorders

Mood Disorders

Anxiety Disorders

Somatoform Disorders

Factitious Disorders

Dissociative Disorders

Sexual and Gender Identity Disorders

Eating Disorders

Sleep Disorders

Impulse-Control Disorders Not Otherwise Classified

Adjustment Disorders

Other Conditions That May Be a Focus of Clinical Attention

 
Axis II

Personality Disorders

Mental Retardation

Paranoid Personality Disorder

Schizoid Personality Disorder

Schizotypal Personality Disorder

Antisocial Personality Disorder

Borderline Personality Disorder

Histrionic Personality Disorder

Narcissistic Personality Disorder

Avoidant Personality Disorder

Dependent Personality Disorder

Obsessive-Compulsive Personality Disorder

Personality Disorder Not Otherwise Specified

Mental Retardation

 

Axis III covers general medical conditions. General medical conditions in a manual for mental health disorders? According to the DSM IV, this is supposedly to cover medical conditions that are potentially relevant to the understanding or management of the individual’s mental disorder. Surely the patient either has a medical conditions and all of its associated symptoms (be they physiological or psychological) or they have a mental ‘disorder’ and all of its associated symptoms (be they physiological or psychological). For example, anxiety has psychological and physiological symptoms but is it covered under general medical conditions? No? General medical conditions do not need to be in the DSM. It just adds more conditions in which psychologists and psychiatrists can label people as ‘disordered’.

 
Axis III

General Medical Conditions

Infectious and Parasitic Diseases

Neoplasms

Endocrine, Nutritional, and Metabolic Diseases and Immunity Disorders

Diseases of the Blood and Blood-Forming Organs

Diseases of the Nervous System and Sense Organs

Diseases of the Circulatory System

Diseases of the Respiratory System

Diseases of the Digestive System

Diseases of the Genitourinary System

Complications of Pregnancy, Childbirth, and the Puerperium

Diseases of the Skin and Subcutaneous Tissue

Diseases of the Musculoskeletal System and Connective Tissue

Congenital Anomalies

Certain Conditions Originating in the Perinatal Period

Symptoms, Signs, and Ill-Defined Conditions

Injury and Poisoning

 

Axis IV

Psychosocial and Environmental Problems

Problems with primary support group

Problems related to the social environment

Educational problems

Occupational problems

Housing problems

Economic problems

Problems with access to health care services

Problems related to interaction with the legal system/crime

Other psychosocial and environmental problems

 

Axis V

Global Assessment of Functioning

This covers the severity of symptoms, how well the person is functioning with everyday life (i.e., at home, school, work, hygiene etc.), and if the person is a threat to themselves or others.

 In the next post I will cover some of the condition under Axis I. The post after that will cover some of the conditions under Axis II.

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Mental Health Disorder Diagnosis

When someone is diagnosed as having a particular mental illness, it is done so based on that person meeting the criteria for that illness as set out in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The DSM is a team effort produced from the work of doctors, psychologists, and psychiatrists and published by the American Psychiatric Association (APA). The fifth edition (DSM V) was released in May of this year (2013) but I am going to refer to the fourth edition (DSM IV) because it has been in use since 2000 meaning that most people currently living with a mental illness would have been diagnosed according to the DSM IV.The DSM IV is broken down into axes:

Axis I     Clinical Disorders

               Other Conditions That May Be a Focus of Clinical Attention

Axis II    Personality Disorders

               Mental Retardation

Axis III   General Medical Conditions

Axis IV  Psychosocial and Environmental Problems

Axis V   Global Assessment of Functioning

I will be covering some of the conditions in a later post but at this time I just want to make these statements:

If you were to look through the criteria of the various conditions within the DSM, then every human on this planet would be diagnosed with some type of mental illness. In order to be diagnosed with a particular disorder, a person must exhibit a certain number of the criteria listed for that disorder. Let us suppose five out of nine traits were required for diagnosis and then we can say “congratulations Jill, you are now the proud owner of the label Major Depressive Disorder”. You see often it is just a label. No every person has the same traits or to the same degree and yet they still get the same level. In this example, how important are the four out of nine traits that Jill doesn’t have? Another person may have those four traits and one that Jill has and get the same diagnosis.

Sometimes this is a tremendous issue because depending on the diagnosis, the patient can start to be treated in a way that is very detrimental to them. For example, some conditions have a lot of stigma attached to them and unfortunately it is often mental health professionals that cause the most problems by discriminating and handing out certain labels for patients they do not have the skill to treat. I will come back to this issue in a later post about personality disorders.

American Psychiatric Association (2000). Diagnostic and Statistical Manual of Mental Disorders (4^th ed.). Washington, DC: Author.

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