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The DSM-IV organizes each psychiatric diagnosis into five levels (axes) relating to different aspects of disorder or disability:

* Axis I: clinical disorders, including major mental disorders, as well as developmental and learning disorders
* Axis II: underlying pervasive or personality conditions, as well as mental retardation
* Axis III: Acute medical conditions and physical disorders.
* Axis IV: psychosocial and environmental factors contributing to the disorder
* Axis V: Global Assessment of Functioning or Children’s Global Assessment Scale for children under the age of 18. (on a scale from 100 to 0)

Common Axis I disorders include depression, anxiety disorders, bipolar disorder, ADHD, and schizophrenia.

Common Axis II disorders include borderline personality disorder, schizotypal personality disorder, antisocial personality disorder, narcissistic personality disorder,paranoid personality disorder and mild mental retardation.

Common Axis III disorders include brain injuries and other medical/physical disorders which may aggravate existing diseases or present symptoms similar to other disorders.

Ettina, that’s definitely not what I’m suggesting. Indeed, many people diagnosed with a personality disorder also have at least one Axis I diagnosis as well, so clearly there is some “disorder” present. However, I question whether patients are actually helped by an additional Axis II diagnosis. For starters, there is sex/gender bias in both the constructs themselves, as well as how they’re applied by (some) mental health professionals, which I discussed very briefly above.

There are other issues, too, that I didn’t address here. For example, receiving a diagnosis of mental illness is stigmatizing enough, but I would argue that it’s even more so to receive a personality disorder diagnosis than an Axis I diagnosis. Someone with an Axis I label “has” a disorder; I have generalized anxiety disorder. But someone with an Axis II diagnosis - a personality disorder - is disordered. Think about it: you are telling the patient that their personality, the essence of who they are, is broken, disordered. So yes, I would say that’s especially marginalizing.

And then there’s the question as to whether Axis II labels are even useful; everyone has a personality, and it would behoove mental health prof’s to take a patient’s personality into consideration whether or not s/he has been diagnosed with a personality disorder. So really, what added usefulness does a PD label provide? More useful than a categorical model (where the patient either has a PD or doesn’t) would be a continuum model for Axis II, where all personality traits are assessed and taken into consideration during the course of treatment.

When you consider the stigmatizing nature of mental disorder labels, particularly PD labels, add in the potential for misuse (because of biased criteria and application), and then subtract their practical use (which some say is not very), I think you have a sound argument for thinking the way in which Axis II is constructed.

The way it’s applied, it is a maladaptive thing. I’ve even heard of people threatening to kill themselves (and actually trying) to win someone back.
I agree that there’s sex bias. But why is it that anyone who talks about sex bias in psychiatric diagnoses always seems to be trying to make out that the person is really normal? I think a much worse case of sex bias is when a man is diagnosed with Antisocial personality when he’d be better called borderline, or vice versa, and therefore their problems are not dealt with. Or when something is causing a problem for a person that in the other gender would be diagnosed, but in their gender is treated as normal.
Regarding Schizoid PD, it’s probably a mild form of autism. And autism clearly is more of a male condition, probably because of X-linked genes.