Limitations of Axis II in Diagnosing Personality Pathology in Clinical Practice

Objective:DSM-IV’s axis II is limited to severe personality disturbances, posing difficulty for diagnosing less severe but nonetheless clinically significant personality pathology. The authors examined the percentage of patients treated in clinical practice for personality pathology who are diagnosable with DSM-IV. Method:Psychiatrists and psychologists from a random national sample provided diagnostic data on 714 patients treated for enduring, maladaptive personality patterns.Results:Only 39.4% of the patients had diagnosable axis II disorders. This percentage was relatively stable across clinicians’ theoretical orientations and did not vary substantially when axis I diagnosis was controlled for.Conclusions:DSM-IV cannot be used to diagnose most patients being treated for personality problems. The range of axis II should be broadened to encompass the range of personality pathology seen in clinical practice. Am J Psychiatry 1998; 155: 1767-1771