Axis II & Personality Disorders

Definition: Technically, a line on the five-line multiaxial diagnostic system for two types of diagnoses: personality disorders and mental retardation. Colloquially (within psychology), Axis II usually means personality disorders only.

Axis II = Personality Disorders

Axis II = personality disorders in most professionals' minds. This is so prevalent that in all of my references to Axis II below (and elsewhere on the site), I mean personality disorders. In fact, when professionals mean mental retardation, they usually say MR/DD, which stands for Mental Retardation/Developmental Disabilities.

Most people who have Axis II disorders also have Axis I symptoms, so it's rare to have a diagnosis only on Axis II.

Caveat: DID/MPD ≠ Axis II PD

Please note that Dissociative Identity Disorder, formerly Multiple Personality Disorder, is not an Axis II disorder, nor is it classified as a personality disorder. The old name makes that confusing, but DID is always an Axis I diagnosis. However, some alters ("personalities") may get Axis II diagnoses because they meet the criteria.

Absolutely crucial Axis II information

Laypersons tend to want to call things that aren't personality disorders Axis II. That's why there are so many italics on this page. All axis II diagnoses are extreme versions of normal personality traits; therefore, people with the traits don't get an axis II diagnosis -- only people whose entire personalities are dominated by the pathology.

If people do not meet these criteria, they do not get Axis II diagnoses!

Personality disorders refer to 10 different long-standing characterological patterns that cause problems in the person's interactions and relationships with other people. In other words, these behaviors pervade the individual's entire personality and affect most behavior.

There are 10 different personality disorders, but most people with an Axis II diagnosis meet the criteria for more than one, often but not always in the same cluster.

Personality disorders tend to be ego-syntonic; in other words, people who have them don't believe the problem is theirs. Everyone else has the problem.

By contrast, most disorders, ie most Axis I disorders, are ego-dystonic. The person experiences the problem as a problem, and the problem is usually perceived to be separate from them. That is, they see the problem as removable, rather than an integral part of who they are.

Usually these people don't come to therapy unless someone else makes them or they're having trouble with an Axis I issue. The ego-syntonic nature of the disorders means these can be some of the hardest disorders to work with and treat. Because they have traditionally been difficult to treat, the Axis II diagnosis is one of the most stigmatizing within the psychological community. Psychological professionals should be careful not to make the diagnosis if they don't have good evidence.