Axis II

Axis II

Axis II is a classification in the Diagnostic and Statistical Manual of Mental Disorders (DSM), which was used to categorize personality disorders and intellectual disabilities. This axis was part of a multi-axial system introduced in the DSM-III and continued in the DSM-IV, but was eliminated in the DSM-5.

Overview

Axis II was specifically designed to capture long-standing issues that might not be the primary focus of treatment but could influence the course of treatment and prognosis. It included two main categories:

• Personality Disorders: These are enduring patterns of inner experience and behavior that deviate markedly from the expectations of the individual's culture, are pervasive and inflexible, have an onset in adolescence or early adulthood, are stable over time, and lead to distress or impairment. Examples include Borderline Personality Disorder, Antisocial Personality Disorder, and Obsessive-Compulsive Personality Disorder.

• Intellectual Disabilities: Previously referred to as "mental retardation," this category includes conditions characterized by significant limitations in both intellectual functioning and in adaptive behavior, which covers many everyday social and practical skills.

Historical Context

The multi-axial system was introduced in the DSM-III in 1980 to provide a comprehensive diagnosis that considered multiple factors affecting a patient's mental health. Axis I included clinical disorders, Axis II included personality disorders and intellectual disabilities, Axis III covered general medical conditions, Axis IV addressed psychosocial and environmental problems, and Axis V provided a global assessment of functioning.

Changes in DSM-5

In the DSM-5, published in 2013, the multi-axial system was removed. Personality disorders and intellectual disabilities are now diagnosed in the same way as other mental disorders, without the separate axis. This change was made to simplify the diagnostic process and reflect the understanding that personality disorders and intellectual disabilities are not fundamentally different from other mental disorders.

Clinical Implications

Understanding Axis II disorders is crucial for clinicians as these conditions often require long-term treatment strategies and can significantly impact the management of Axis I disorders. For example, a patient with Major Depressive Disorder (an Axis I disorder) and Borderline Personality Disorder (an Axis II disorder) may require a different therapeutic approach than a patient with depression alone.

Also see

• DSM-IV
• DSM-5
• Personality Disorder
• Intellectual Disability
• Multi-axial System