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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 16 of 16. This is the beginning of the thread.
Posted by violette on July 25, 2010, at 14:08:02
I've heard people here mention differences in Axis I vs. Axis II mental disorders in regard to treatment.
What's the real difference between Social Anxiety Disorder (Axis I) and Avoidant Personality Disorder (Axis II)? The both point to the same fears, and interference with activities or overall functioning, though the Avoidant description is more detailed.
Although the descriptions are different, they point to the same feelings and behavior effects. The only difference that I know of is that Axis II is for prolonged mental illness patterns and also sometimes assigned to people who are unaware of the issue itself being a problem in one's life--but the descriptions contradict that, as it seems the Axis II person is MORE aware of the feelings underlying the fears..
The descriptions here both point to the same level of intensity where a person avoids things due to the fears.
I just don't see how having a category of Axis I and Axis II is helpful to anyone's treatment. Does anyone think it is helpful, and in what way (curious)?
Axis I
Social Anxiety DisorderThe Current DSM-IV Definition (Abridged):
A. A persistent fear of one or more social or performance situations in which the person is exposed to unfamiliar people or to possible scrutiny by others.
The individual fears that he or she will act in a way (or show anxiety symptoms) that will be embarrassing and humiliating.
B. Exposure to the feared situation almost invariably provokes anxiety, which may take the form of a situationally bound or situationally pre-disposed Panic Attack.
C. The person recognizes that this fear is unreasonable or excessive.
D. The feared situations are avoided or else are endured with intense anxiety and distress.
E. The avoidance, anxious anticipation, or distress in the feared social or performance situation(s) interferes significantly with the person's normal routine, occupational (academic) functioning, or social activities or relationships, or there is marked distress about having the phobia.
F. In individuals under age 18 years, the duration is at least 6 months.
G. The fear or avoidance is not due to direct physiological effects of a substance (e.g., drugs, medications) or a general medical condition not better accounted for by another mental disorder...
http://www.socialanxietyinstitute.org/dsm.html
=============================================
Axis II
Avoidant Personality DisorderSymptoms
DSM-IV-TR specifies seven diagnostic criteria for avoidant personality disorder:The person avoids occupational activities that require significant interpersonal contact. Job interviews or pro motions may be turned down because the person's own perceptions of his or her abilities do not match the job description.
The person is reluctant to participate in social involvement without clear assurance that they will be accept ed. People with this disorder assume other people are not safe to trust until proven otherwise. Others must offer repeated support and encouragement in order to persuade them to participate in a social event.The person fears being shamed or ridiculed in close relationships. As a result, people with this disorder become overly alert to behavioral cues that may indicate disapproval or rejection. They will flee a situation in which they believe that others might turn against them.
The person is preoccupied with being criticized or rejected. Much mental and physical energy is spent brooding about and avoiding situations perceived as "dangerous."
The person is inhibited in unfamiliar social situations due to feelings of inadequacy. Low self-esteem undermines their confidence in meeting and conversing with new acquaintances.
The person regards him- or herself as socially inept. This self-disparagement is especially apparent when the person must make social contacts with strangers. People with avoidant personality disorder perceive themselves as unappealing or inferior to others.
The person is reluctant to take social risks, in order to avoid possible humiliation. Avoidant people seek interactions that promise the greatest amount of acceptance while minimizing the likelihood of embarrassment or rejection. They might go to a school dance, for example, but remain in one corner chatting with close friends rather than going out on the dance floor with someone they do not know well.http://www.minddisorders.com/A-Br/Avoidant-personality-disorder.html
Posted by Phillipa on July 25, 2010, at 14:26:54
In reply to Diagnosis Problems, posted by violette on July 25, 2010, at 14:08:02
Axis I is the Primary Psychiatric Disorder Axis II is personality disorder secondary and contributing to the primary disorder. Then Axis III medical conditions contributing to about and IV & V also. Phillipa
Posted by Phillipa on July 25, 2010, at 14:32:54
In reply to Diagnosis Problems, posted by violette on July 25, 2010, at 14:08:02
Violette here's an article with all five listing. Phillipa
DSM-IV Multi-Axial System
By Nancy Schimelpfening, About.com GuideDefinition: Mental disorders are diagnosed according to a manual published by the American Psychiatric Association called the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). A DSM-IV diagnosis has five parts. Each part, called an axis, gives a different type of information about the diagnosis.
Axis I provides information about clinical disorders. Any mental health conditions, other than personality disorders or mental retardation, would be included here.
Axis II provides information about personality disorders and mental retardation.
Axis III provides information about any medical conditions that are present.
Axis IV is used to describe psychosocial and environmental factors affecting the person.
Axis V is a rating scale called the Global Assessment of Functioning; the GAF goes from 0 to 100 and provides a way to summarize in a single number just how well the person is functioning overall.
Posted by ed_uk2010 on July 25, 2010, at 14:42:02
In reply to Diagnosis Problems, posted by violette on July 25, 2010, at 14:08:02
>I just don't see how having a category of Axis I and Axis II is helpful to anyone's treatment. Does anyone think it is helpful, and in what way (curious)?
I think an Axis II diagnosis is more stigmatizing. After all, what could be more stigmatizing than the term 'personality disorder'?
You are absolutely right that AvPD and SP are very similar. In contrast, OCPD is not at all the same as OCD.
Posted by violette on July 25, 2010, at 15:29:36
In reply to Re: Diagnosis Problems, posted by ed_uk2010 on July 25, 2010, at 14:42:02
Thanks, Phillipa, I had read that before too.
Ed, I had noticed the difference with OCD and OCPD as well. I know someone with OCD who has some of the traits of OCPD. I agree it's stigmatizing, which is one of the reasons those diagnises are not used as often. Personally I think they should get rid of the term PD and somehow combine the 2-but have no idea how that could be accomplished in a practical way.
Anyway, the conventional system just doesn't seem as useful to treatment outcomes as it could be. I had always been given diagnoses such as "generalized anxiety disorder" and "major depressive disorder" and fed meds for years...
Having a psychodynamically-thinking PDoc who doesn't use those diagnoses for treatment has been most helpful to my situation, and I no longer take antidepressants as a result.
Posted by Christ_empowered on July 25, 2010, at 15:55:35
In reply to Re: Diagnosis Problems, posted by violette on July 25, 2010, at 15:29:36
Diagnosis is odd. Mental illnesses (and personality disorders) are literally voted into and out of existence. Think about it...do we do that with other health problems? Could a committee vote out lung cancer, for instance? I don't entirely agree with "The Myth of Mental Illness" anymore, but I do see some Dr.Szasz's points.
I've been diagnosed with both Axis I and II. The difference for me was in how the diagnosing shrink viewed me and my problems. When I had a shrink who wanted to dismiss me entirely, it was a personality disorder. When I had a shrink who thought I was too weird and disordered to possibly be a functioning human being, it was schizophrenia. When I had a shrink who viewed me as a person with problems, it was a variant of Bipolar I.
The problem isn't just the diagnoses; sometimes the problem is the therapeutic relationship and the person doing the diagnosing.
Posted by ed_uk2010 on July 25, 2010, at 15:57:43
In reply to Re: Diagnosis Problems, posted by violette on July 25, 2010, at 15:29:36
I wouldn't say that the problem with psychiatric diagnosis is due to the division between Axis I and Axis II disorders, it's more of a general problem due to the difficulty in categorizing mental health problems into discreet illnesses. In the real world, psychiatric problems frequently don't fit into neat little categories.
Posted by bleauberry on July 25, 2010, at 19:49:38
In reply to Diagnosis Problems, posted by violette on July 25, 2010, at 14:08:02
I don't find much use in the diagnosis names for a couple reasons. First, they aren't very helpful in actually getting the person well. Second, there is a fair amount of overlap between them, as you have noticed. The worst thing is that they are subjective definitions that will vary depending on the eye of the beholder. One doctor will say one thing, another something else, none really sure, no way to test it or prove it, and in the end is only minimally helpful in choosing the med that is going to get the patient feeling better.
My Mom asked me recently, "do you think you might be bipolar?" I smiled and said heck yeah no doubt about it. Then I continued. But what does that mean? What does bipolar mean? How is that term helpful in me choosing treatments that will work? Many years have proven it isn't helpful. Again, what is bipolar? Could it be the Lyme organisms in the brain going through their cycles? Could it be a messed pituitary gland from heavy metals or infections? Is there some kind of brain damage done? I mean, no one knows what bipolar is, where it came from, or how to make it disappear. Some people get lucky with trial and error, but you know what I mean.
All I know for sure is that all of the psychiatric spectrums present themselves in a difficult-to-treat or treatment-resistant pattern when there is immune pathology or toxicity involved. Almost everyone here fits that description, is the only reason I mention it. When I focus on treating those, progress is made.
Very familiar with all the diagnostics, I would probably fit into personality disorder, schizophrenic spectrum, depression, anxiety, chronic fatigue, dysphoria, and bipolar II and III. Send me to 10 different doctors I will get a different take from each one. I just don't find any of that productive or useful. What is useful is to just try stuff and see what happens, and then use the clues from those trials to make future decisions.
Posted by ace on July 26, 2010, at 1:44:35
In reply to Diagnosis Problems, posted by violette on July 25, 2010, at 14:08:02
I give only a small amount of credence to the psychiatric diagnostic system. It is much better to see a person as a totality, rather than put their symptoms into these holes.
These diagnosis, ultimately, from a rigid scientific perspective, mean absolutely nothing.
Treatment in psychiatric is non-specific and very much a 'hit or miss' affair.
It reminds me of the time I started getting obsessed that I did not have OCD, which became a huge problem....i.e. all therapy aimed at my 'OCD' was fruitless as I obsessively doubted that I truly had the diagnosis.
So now I see a person as having a psychiatric problem which is peculiar to THEMSELVES, although certain characteristics maybe shared with other people who are suffering similiar problems.I don't like all these labels, although they are somewhat necessary.
I fear I may have contradicted myself somewhere here!
God Bless You!
Ace
Posted by violette on July 26, 2010, at 9:29:18
In reply to Re: Diagnosis Problems » violette, posted by ace on July 26, 2010, at 1:44:35
> I wouldn't say that the problem with psychiatric diagnosis is due to the division between Axis I and Axis II disorders, it's more of a general problem due to the difficulty in categorizing mental health problems into discreet illnesses. In the real world, psychiatric problems frequently don't fit into neat little categories.
Ed UK, yes, I agree with what you said..and it's not that I think this division in the only source of this problem, but emphasized it because the research, including numerous case studies, associated with Axis II explains alot of the source behind the symptoms as patients range in a continum of Axis II traits to the actual disorders. I posted this link somewhere else here, but it shows how a psychodynamic formulation (as opposed to a diagnostic DSM code) can improve patient outcomes:
http://jppr.psychiatryonline.org/cgi/content/full/7/1/35
> I don't find much use in the diagnosis names for a couple reasons. First, they aren't very helpful in actually getting the person well. Second, there is a fair amount of overlap between them, as you have noticed. The worst thing is that they are subjective definitions that will vary depending on the eye of the beholder.
> I've been diagnosed with both Axis I and II. The difference for me was in how the diagnosing shrink viewed me and my problems. When I had a shrink who wanted to dismiss me entirely, it was a personality disorder. When I had a shrink who thought I was too weird and disordered to possibly be a functioning human being, it was schizophrenia. When I had a shrink who viewed me as a person with problems, it was a variant of Bipolar I.
> Mental illnesses (and personality disorders) are literally voted into and out of existence. Think about it...do we do that with other health problems?
Christ Emplowered, I have heard similar stories about the diagnostic issue you experienced, and am sorry to hear you were treated that way. There are very well-meaning psychiatrists and therapists out there who view patients as a person and not a disorder. I agree with everything you said...and that's one reason I point this out here-as people sometimes seem very focused on their curren diagnosis..which of course is helpful overall in some ways, but leaves so much unaddressed..and I wonder if the unhelpfulness outweighs the helpfulness of that type of thinking. The subjectivity in it all probably makes it more difficult to 'classify' as you pointed out.
> Almost everyone here fits that description, is the only reason I mention it. When I focus on treating those, progress is made.
> Very familiar with all the diagnostics...Send me to 10 different doctors I will get a different take from each one. I just don't find any of that productive or useful.
Blueberry-I agree with you about treating the source to alleviate the symptoms rather than just alleviating symptoms. I don't see it as physiological as you, but agree treating the source of the disorder will be more effective.
> I give only a small amount of credence to the psychiatric diagnostic system. It is much better to see a person as a totality, rather than put their symptoms into these holes.
> I give only a small amount of credence to the psychiatric diagnostic system. It is much better to see a person as a totality, rather than put their symptoms into these holes.
Ace, There are doctors who don't use this system, my PDoc is an example of one, and it's my hope the psychiatric system progresses toward this someday...I'm not convinced it will due to drug and other influences, but there are researches and clinicians who do recognize this.
No, I don't think you contradicted yourself :) Labels are necessary for research and discussion; but I see conventional psychiatry not including concepts described in literature and research that includes Axis II underlying causes.
> So now I see a person as having a psychiatric problem which is peculiar to THEMSELVES, although certain characteristics maybe shared with other people who are suffering similiar problems.
Ace-That's a really nice summary you pointed out. I do think patients would benefit if treatment is individualized through psychodynamic formulations rather than those diagnostic codes people keep referring to.
I'm glad to hear how you all recognized this as it took me a long time-and several psychiatrists who were only treating my anxiety and depression symptoms-to figure this out. And after having recognized this, my treatment outcome has been so much better. It has really benefited me and I hope it benefits others as much as it has helped me.
> God Bless You!
> AceI'm blessed by having found my PDoc...same to you!
Posted by ed_uk2010 on July 26, 2010, at 16:26:12
In reply to Re: Diagnosis Problems » violette, posted by ace on July 26, 2010, at 1:44:35
>So now I see a person as having a psychiatric problem which is peculiar to THEMSELVES, although certain characteristics maybe shared with other people who are suffering similiar problems.
Very well said! Excellent.
Posted by emmanuel98 on July 26, 2010, at 21:01:43
In reply to Re: Diagnosis Problems » ace, posted by ed_uk2010 on July 26, 2010, at 16:26:12
One of the issues with Axis I and Axis II diagnoses is that insurance companies, under mental health parity laws, pay for Axis I but not for Axis II. I have had severe depression and am considered Axis I, major depressive disorder. But I have also attempted suicide when I was not depressed (at least not according to the DSM criteria), but just emotionally distraught and dysregulated -- which would constitute a borderline personality disorder (Axis II). However, the insurance company won't pay for hospitalization or therapy if the docs don't classify it as MDD (Axis I)
Posted by Phillipa on July 26, 2010, at 22:06:57
In reply to Re: Diagnosis Problems, posted by emmanuel98 on July 26, 2010, at 21:01:43
Why wouldn't they? In your case sounds like the depression not a whim to hurt yourself. I feel for you. Phillipa
Posted by sigismund on July 26, 2010, at 23:29:44
In reply to Diagnosis Problems, posted by violette on July 25, 2010, at 14:08:02
This is an old thread that relates to a psychodynamic classificatory system, if my memory serves me well......
Posted by violette on July 29, 2010, at 8:27:17
In reply to Re: Diagnosis Problems » violette, posted by sigismund on July 26, 2010, at 23:29:44
Thanks for that, Sigismund!
I read the Amazon reviews about the book-it seems very positive to me. I'm sure it has its flaws too and I doubt it would ever go into mainstream use. It is a holistic view of a patient-and it outlines both strengths and weaknesses. The concept of personality patterns is helpful imo and emphasis on defense mechanisms. I also think it's important to emphasize a person's inner state-rather than symptoms.
This sort of makes up for the individuality ignored by the DSM. Most of the people who create the DSM have ties with drug companies (the evidence is online). And people are being steered to quick fixes, medications and the emphasis on behavior-CBT-which only scratches the surface of problems. Catch all diagnosis such as "Bipolar II" just direct people to drugs instead of treating someone as an individual.
I don't think there's some huge conspiracy going on, but there are various influences to the changes in mental health treatment-including the huge cost of health care. This movement from feelings/inner states to only addressing behavior/symptoms is very disturbing to me. But what's interesting is that what's deemed good for the masses-CBT-is not what mental health professionals think is most helpful to them as research shows the majority of therapists themselves choose psychodynamic therapy, practitioners who 'think' like this manual, over CBT. That says alot. :)
I just get down about this sometimes because I think it causes unnecessary suffering. Most 'pop psychology' mental health articles I find online suggest, in addition to drugs, CBT CBT CBT CBT CBT CBT CBT....ba-bomb, bomb, bomb bomb bomb...
"The new manual insists that personality be evaluated first, and symptoms considered as secondary, because symptoms cannot be understood, assessed, or treated in the absence of an understanding of the personality structure of the person who has the symptoms."
Posted by violette on July 29, 2010, at 8:38:34
In reply to Re: Diagnosis Problems » violette, posted by sigismund on July 26, 2010, at 23:29:44
Maybe I shouldn't say 'pop psychology'...
Psych Central has a huge following, and it pi#ses me off to see at the end of just about every article written by a mental health practitioner-"medications or CBT can help you with this", "CBT is the best treatment for this issue" while they completely omit even a mention psychodynamic therapy.
If that were true, why do most mental health professionals choose to NOT engage in CBT therapies? Again, the recommended remedies are good for 'the masses'.
It prolongs illnesses and just masks the inner feelings that cause many of the symptoms, that end up re-emerging later. This is not healing-it directs patients to quick fixes.
...stepping down from soap box now.
This is the end of the thread.
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