Axis II Disorders: Exploring Personality Disorders in Mental Health
Prior to the release of DSM-V, mental diseases were divided into 5 different axis. Listed in Axis II were the personality disorders. DSM began differentiating the mental diseases by axis in DSM-III (1980). According to the APA, the axis designations was to identify disorders, such as the personality disorders, that had received inadequate clinical and research focus. With the release of DSM-V, the APA felt that the personality disorders no longer needed this designation (Grohal, 2013).
Most of the mental disorders are placed on Axis I, whereas the personality disorders (and mental retardation) was placed on Axis II. The Axis system brought increased medical and research attention to little known personality disorders.
With the separation of personality disorders from the Axis I, clinicians began to diagnoses personality disorders. The separation indicated that the Axis II personality disorders were not mutually exclusive from Axis 1 disorders, meaning a clinician could first diagnose an Axis I illness then shift attention to Axis II and identify a possible co-occurring personality disorder (Widiger, 2010).
Personality Disorders and Previous Axis I Disorders
Lack of clarity on personality disorders hindered early research. Early physicians and psychiatrists roughly divided clustering of behaviors into distinct syndromes (Besteiro-González et al., 2004). However, the lack of clarity blurred the dividing lines. Accordingly, physicians diagnosing mental illness would subjectively place a patient in the diagnosis they felt best represented the symptoms.
Robert Hirschfeld, Professor of Psychiatry Weill Cornell Medical College at Cornell University, explains, “It is not completely clear from this [DSM III-R] definition [of mental disorder] whether personality disorders are mental disorders because of the requirement that deviant behavior, often the hallmark of personality disorders, cannot be considered a mental disorder unless it is a symptom of dysfunction in the person” (Litvak, 2006).
Axis II disorders (personality disorders) still retain some differences. However, each personality disorders are not clearly distinct from each other with high comorbidity. The coexistence of several personality disorders makes research difficult, while casting doubt on each personality disorder actually existing as an independent condition.
​Besteiro-González et al. stated that the personality disorders and their groupings have “a high degree of intercorrelation among DSM PD cluster scores and, in general, variability in cluster groupings were not predictable from self-report measures of the features thought to characterize disorder within clusters” (Besteiro-González, 2004, p. 100).
Diagnosing mental illness has never been a perfect science, and this is especially true with the personality disorders. Although scientists and universities have conducted plenty of research since the 1980 on structure of the multi axels structure, we still have much left to understand, requiring further research for diagnosing personality disorders.
Defining Mental Illnesses
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is now in the revised 5th edition. The DSM is pretty much the bible for diagnosing mental illnesses in the United States. European countries primarily use the International Classification of Diseases (ICD) for defining mental disease on their side of the ocean. The standard definitions these resources provide are necessary for research, care standards, and insurance purposes. Communication in technical matters needs clarity. Generally accepted terms allows for clarity and continued meaningful research.
If one university is studying, for example, schizoid personality disorder, we can only replicate or disprove their results if there is an agreement on the definition of the disorder. Despite similarities, the smallest deviation will nullify the results for comparison.
Associated Concepts
- Personality Disorders: These are characterized by enduring patterns of behavior, cognition, and inner experience that deviate markedly from the expectations of the individual’s culture. They are typically grouped into three clusters: A (odd or eccentric), B (dramatic, emotional, or erratic), and C (anxious or fearful).
- Cognitive-Behavioral Models: These models suggest that personality disorders arise from maladaptive thought patterns and behaviors learned over time.
- Attachment Theory: This theory posits that early relationships with caregivers can influence later personality development, which may contribute to the development of certain personality disorders.
- Interpersonal Theory: This theory focuses on the role of interpersonal relationships and social interactions in the development and maintenance of personality disorders.
- Biopsychosocial Model: This model integrates biological, psychological, and social factors to explain the development of personality disorders.
- Schema Therapy: This therapeutic approach is often used for treating personality disorders and is based on the concept of maladaptive schemas developed during childhood.
A Few Words by Psychology Fanatic
As we’ve explored, Axis II disorders are a complex and diverse group of mental health conditions that can significantly impact an individual’s life. While they may not always be as immediately apparent as Axis I disorders, their enduring nature can have profound consequences for relationships, work, and overall well-being. It’s crucial to recognize the importance of seeking professional help if you or someone you know is struggling with an Axis II disorder. Early diagnosis and appropriate treatment can make a substantial difference in managing these conditions and improving quality of life.
Last Update: January 27, 2026
References:
Besteiro-González, J., Lemos-Giráldez, S., & Muñiz, J. (2004). Neuropsychological, Psychophysiological, and Personality Assessment of DSM-IV Clusters of Personality Disorders. European Journal of Psychological Assessment, 20(2), 99-105. DOI: 10.1027/1015-5759.20.2.99
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Grohal, John (2013). DSM-5 Changes: Personality Disorders (Axis II). Psych-Central. Published: 5-29-2013; Accessed: 9-4-2022. Website: https://psychcentral.com/pro/dsm-5-changes-personality-disorders-axis-ii#1
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Litvak, S. (1994/2006). Abrasive personality disorder: Definition and diagnosis. Journal of Contemporary Psychotherapy, 24(1), 7-14. DOI: 10.1007/BF02306580
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Widiger, T. (2010). Cluster A Personality Symptomatology in Youth. Journal of Psychopathology and Behavioral Assessment, 32(4), 551-556. DOI: 10.1007/s10862-010-9204-7
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