Axis II Personality Disorders and Mental Retardation

On Axis II are listed Personality Disorders and Mental Retardation. These disorders, by definition, are present for a substantial period of time (i.e., years). Although Axis I disorders may also be present for similar lengths of time, enduring symptoms are fundamentally part of these Axis II disorders. Also listed on Axis II are other traits or prominent features of a person's personality that a clinician deems maladaptive (e.g., frequent use of denial, excessive impulsivity).

In addition to the Personality Disorders, Mental Retardation appears on Axis II and is defined by

(a) significantly below average intellectual abilities;

(b) significant problems with adaptive functioning, defined as serious problems in carrying out duties expected for the person's age (e.g., self-care, interpersonal skills, work); and (c) an onset of these symptoms before the age of 18. Mental Retardation is placed on Axis II because of its pervasive and persistent effects on a person's function. It is worth noting that in the previous version of the DSM (DSM-III-R), other developmental disorders such as Autism and learning disorders were also listed on Axis II; these disorders, however, are listed on Axis I in DSM-IV.

As the term Personality Disorder implies, people with these disorders have characterological features that create difficulties. DSM-IV defines a Personality Disorder as follows:

A Personality Disorder is an enduring pattern of inner experience and behavior that deviates markedly from the expectations of the individual's culture, is pervasive and inflexible, has an onset in adolescence or early adulthood, is stable over time, and leads to distress or impairment (p. 629).

Upon a casual reading of the criteria for the various personality disorders, one may see many descriptions that may seem applicable to oneself or others at times. Symptoms of various personality disorders include, as examples, emotional lability, feelings of emptiness, bearing grudges, lacking close friends, suspiciousness, impulsivity, suggestibility, feeling envious, concern with criticism or rejection, difficulty in making everyday decisions, and perfectionism. In fact, many writers have criticized the DSM series' Personality Disorders for pathologizing anyone who simply may be


different, or difficult. A Personality Disorder, however, can (in theory) be distinguished from what might be considered normal variation in personality because a Personality Disorder is persistent, pervasive, and pathological.

By persistent, it is meant that the pattern of behavior in Personality Disorders is consistent over time. Whereas people without personality disorders may from time to time, after a bad day or following certain triggering events, display some of the features of certain personality disorders (e.g., difficulty controlling anger), such persons do not do so often or with any consistency.

By pervasive, it is meant that the behavior in Personality Disorders is seen across many different situations in the person's life. Whereas people without personality disorders may demonstrate some features of certain personality disorders in restricted situations (e.g., one is extremely suspicious of a difficult coworker; e.g., one doubts the fidelity of a spouse or sexual partner after a previously difficult and unfaithful relationship), such persons do not do so across situations (e.g., with coworkers, with spouse or partner, and with neighbors).

By pathological, it is meant that the severity of the symptom in Personality Disorders exceeds that which would be considered acceptable or normal by most people. Hot tempers, while not well-liked, are not necessarily pathological, but repeatedly getting into physical fights could be considered excessive. Daydreaming of a life more fantastic than one's own may be an occasional brief escape, but losing hours lost in fantasy could be considered excessive. Impulsive spontaneity can be fun, but impulsivity that results in overextended spending sprees, sexual indiscretions, or reckless driving could be considered excessive. Feeling empty and lonely are a part of the human condition, but suicide attempts that result from these feelings could be considered excessive. In each of these examples, what makes the behavior pathological in Personality Disorders involves the intensity of the subjective feeling, an impairment in judgment, and the degree to which the subjective feeling is translated into unacceptable or problematic behavior.

The personality disorders are organized by their apparent similarity into three clusters. Cluster A, the odd and eccentric cluster, includes the Paranoid, Schizoid, and Schizotypal Personality Disorders. Cluster B, the dramatic, emotional, and erratic cluster, includes the Antisocial, Borderline, Histrionic, and

Narcissistic Personality Disorders. Finally, Cluster C, the anxious and fearful cluster, includes the Avoidant, Dependent, and Obsessive-Compulsive Personality Disorders. In addition to general criteria for Personality Disorders, each disorder has its own polythetic criterion where an individual must have some minimum number (ranging from 3 to 5 for various disorders) from among a larger number (ranging from 7 to 9 across disorders) of symptoms.

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