Disordered Personalities 2ed

Disordered Personalities — Second Edition
Answers to Review Questions
1. Yes. Multiple diagnoses are permitted on Axis II in the DSM-IV. This situation
is not that uncommon, and when it does occur, the personality disorders remain
discrete and intact, and tend to be expressed at different times. Take, for example,
a patient with both an obsessive-compulsive and a schizoid personality
disorder. He or she would at one point manifest the driven, inflexible, perfection¬
seeking characteristics of the former, and at another time demonstrate the strong
desire for solitude, anhedonia and indifference to others encompassing the latter.
In such cases, the personality characteristics most interfering with the person’s
functioning are addressed first in treatment. In some cases, there are restrictions
placed on the Axis II diagnosis; these are presented in the individual personality
chapters.
References
American Psychiatric Association
Diagnostic and Statistical Manual of Mental Disorders, 4th Edition
American Psychiatric Association, Washington D.C., 1994
T. Millon with R.D. Davis
Disorders of Personality: DSM-IV and Beyond
Wiley & Sons, Inc., New York, 1996
2. No, personality disorders were not considered part of the original
psychoanalytic formulation for neurotic disorders. Those with personality
disorders do not feel distressed by their behaviors (egosyntonic), and they
often see the locus of responsibility as being outside themselves. They rigidly
employ their patterns of interacting with others in spite of the repeated
difficulties they engender. Neurotic patients were seen as being quite
distressed (anxious) by their symptoms (egodystonic). There is no present
classification system involving neurotic disorders. In the DSM-IV they are
included among the anxiety disorders, somatoform disorders, sexual
disorders, dissociative disorders and dysthymic disorder.
Reference
H. Kaplan & B. Sadock, Editors
Synopsis of Psychiatry, Eighth Edition
Williams & Wilkins, Baltimore, Maryland, 1998
3. From left to right:
• Axis I: Major Psychiatric Syndromes/Clinical Disorders
• Axis II: Personality Disorders/Mental Retardation/Ego Defenses
• Axis III: General Medical Conditions
• Axis IV: Psychosocial and Environmental Problems
• Axis V: Global Assessment of Functioning Scale (GAF Scale) scored from 0
to 100; there is also a Global Assessment of Relational Functioning Scale (GARF
Scale) which is also scored from 0 to 100.
Reference
American Psychiatric Association, DSM-IV, 1994
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