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, 1994).
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” (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 axel 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 replicated or disprove their results if their is agreement on the definition of the disorder. Despite similarities, the smallest deviation will nullify the results for comparison.
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.
Grohal, John (2013). DSM-5 Changes: Personality Disorders (Axis II). PsychCentral. 5-29-2013. Accessed 9-4-2022
Litvak, S. (1994/2006). Abrasive personality disorder: Definition and diagnosis. Journal of Contemporary Psychotherapy, 24(1), 7-14.
Scrimali, T., & Grimaldi, L. (1996). Schizophrenia and Cluster A Personality Disorders. Journal of Cognitive Psychotherapy, 10(4), 291-304.
Widiger, T. (2010). Cluster A Personality Symptomatology in Youth. Journal of Psychopathology and Behavioral Assessment, 32(4), 551-556.
