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					Axes of Personality Disorders

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562

Summary:
Personality disorders are like tips of icebergs. They rest on a
foundation of causes and effects, interactions and events, emotions and
cognitions, functions and dysfunctions that together form the patient and
make him or her what s/he is.


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Article Body:
Personality disorders are like tips of icebergs. They rest on a
foundation of causes and effects, interactions and events, emotions and
cognitions, functions and dysfunctions that together form the patient and
make him or her what s/he is.
The DSM uses five axes to analyze, classify, and describe these data. The
patient (or subject) presents himself to a mental health diagnostician,
is evaluated, tests are administered, questionnaires fulfilled, and a
diagnosis rendered. The diagnostician uses the DSM's five axes to "make
sense" and meaningfully organize of the information he had gathered in
this process.

Axis I demands that he specify all the patient's clinical mental health
problems that are not personality disorders or mental retardation. Thus,
Axis I includes issues first diagnosed in infancy, childhood, or
adolescence; cognitive problems (e.g., delirium, dementia, amnesia);
mental disorders due to a medical condition (for instance, dysfunctions
caused by brain injury or metabolic diseases); substance-related
disorders; schizophrenia and psychosis; mood disorders; anxiety and
panic; somatoform disorders; factitious disorders; dissociative
disorders; sexual paraphilias; eating disorders; impulse control problems
and adjustment issues.

We will discuss Axis II at length in our next articles. It comprises
personality disorders and mental retardation (interesting conjunction!).

If the patient suffers from medical conditions that affect his state of
mind and mental health, these are noted under Axis III. Some
psychological problems are directly caused by medical issues
(hyperthyroidism causes depression). In other cases, the latter are
concurrent with or exacerbate the former. Virtually all biological
illnesses may provoke changes in the patient's psychological make-up,
behavior, cognitive functioning, and emotional landscape.

But the machinery of life - both body and "soul" - is reactive as well as
proactive. It is molded by one's psychosocial circumstances and
environment. Life crises, stresses, deficiencies, and inadequate support
all conspire to destabilize and, if sufficiently harsh, ruin one's mental
health. The DSM enumerates dozens of adverse influences that should be
recorded by the diagnostician under Axis IV: death in the family or of a
close friend; health problems; divorce; remarriage; abuse; doting or
smothering parenting; neglect; sibling rivalry; social isolation;
discrimination; life cycle transition (such as retirement); unemployment;
workplace bullying; housing or economic problems; limited or no access to
health care services; incarceration or litigation; traumas and many more
events and situations.

Finally, the DSM recognizes that the clinician's direct impression of the
patient is at least as important as any "objective" data he may gather
during the evaluation phase. Axis V allows the diagnostician to record
his judgment of "the individual's overall level of functioning". This,
admittedly, is a vague remit, open to ambiguity and bias. To counter
these risk, the DSM recommends that mental health professionals use the
Global assessment of Functioning (GAF) Scale. Merely administering this
structured test forces the diagnostician to formulate his views
rigorously and to weed out cultural and social prejudices.

Having gone through this long and convoluted process, the therapist,
psychologist, psychiatrist, or social worker now has a complete picture
of the subject's life, personal history, medical background, environment,
and psyche. She is now ready to move on and formally diagnose a
personality disorder with or without co-morbid (concurrent) conditions.

But what is a personality disorder? There are so many of them and they
strike us as either so similar or so dissimilar! What are the strands
that bind them together? What are the common features of all personality
disorders?

				
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