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Readers Respond: Should Borderline Personality Disorder Belong on Axis II?

Responses: 7

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Updated October 19, 2009

Borderline personality disorder and other personality disorders are on a separate axis, axis II, in the Diagnostic and Statistical Manual of Mental Disorders multi-axial diagnostic system. But, does BPD belong on Axis II? Or is it actually better captured if it is recognized as an Axis I clinical disorder? What do you think - is BPD a "personality disorder" or is it a disorder that deserves recognition just like major depression, or bipolar disorder?

no

BPD should be an Axis I disorder. I have told many of my psychs that and they just say it doesn't matter if it's Axis I or II. I think BPD has more common symptoms of an Axis I disorder and that's where it should be classified.
—Janey38

yes, it should stay on Axis II

I believe BPD needs to stay on Axis II because, objectively speaking, it truly is a personality disorder, and therefore, is far more difficult to effectively treat than Axis I disorders. Although there may be biological aspects intertwined, I believe the bulk of the disorder of BPD has to do with distorted personality development, and the subsequent consequences of that. That is what causes the problems associated with it to be persistent, and span all areas of a person's life. We really need to call it what it is. That doesn't mean we have to stigmatize, but we should be accurate in identifying the nature of what we're dealing with.
—Guest rose

Should be moved to Axis I and renamed

The idea that BPD should be an axis II disorder simply because of a pervasiveness or consistency is wrong. There are several disorders that are Axis I disorders that are every bit as pervasive as BPD. Bipolar, anxiety and severe depression are not only reactions to or caused by atypical situations and can persist throughout much of a person's life. Also, a large number of people diagnosed with BPD have many Axis I symptoms. Not to mention the fact that there is a stigma that personality disorder simply means a flawed personality or character that can't be changed. There's been a lot of recent research that shows significant differences in brain activity and function of those diagnosed BPD. I agree with some that the name Emotion Regulation Disorder is much more fitting.
—Guest John

It Is and Should Be an Axis II Disorder

BPD is characterlogical in nature and therefore belongs on Axis II. Axis I is reserved for disorders that are, primarily, mood disorders - many of which are reactions to atypical situations; these are not characterlogical in nature. Also, "moving" a disorder to a different axis does not mean that more researchers will study the disorder. Researchers generally study topics in which they have expertise. In fact, much research is conducted on Axis IV issues - yet no one has mentioned moving BPD to that axis.....a little bit of critical thought and reading makes it apparent why BPD is on axis II and why it should remain so.
—Guest Psych Doc Student

Definitely Axis I

I believe that BPD definitely belongs in Axis I. It is a disease as devastating as bipolar disease and depression and causes a lot of havoc in the family. It is harder to treat and requires much more research and understanding. Maybe in Axis I, it will get the medical recognition it deserves. This would be a major step in helping so many people and their families, who are suffering so much.
—Guest Nannette1pr

maybe someday I can find med support

I am finding that many people do not "believe" in BPD. This is the exact invalidation that got me here in the first place. If this was in Axis I, I think treatment would be more effective - and just plain-old offered to the sufferer. Right now, I'm on my own.
—Guest Sarah

Keep it there

I think it needs to stay on there, because it seems to fit with the ongoing, chronic nature of Axis II diagnoses.
—jackie.h
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