Behavioral vs. Personality disorders and their implications.

ImThatGuy, BSN, RN · May 25, 2011

Good question. I'm interested in the answer. Behavioral diagnoses are Axis I while personality disorders are Axis II, correct? That doesn't answer anything, but it would seem then that perhaps the behavioral disorders are, putting aside the nature v. nurture debate, rather organic in cause while the personality disorders may be more emotional exacerbations. That's kind of a relative viewpoint though.

Davey Do · May 25, 2011

What separates a behavioral disorder from a personality disorder?
Most importantly, what are the implications to me as a nurse? How does one recognizing the problem help?

The DSM-IV does not specifically identify anything as a "behavioral disorder". The DSM-IV identifies Adjustment, Mood, Psychosis, etc. as diagnosis. The DSM-IV does specifically identify "personality disorder(s)".

In referencing behaviors, you may be referring to symptoms which lead to a specific diagnosis. For example, an Adolescent diagnosis pertaining to behavior is "Oppositional Defiant Disorder". Some of the symptomatic criteria are: temper, arguing, defiance, blaming, anger, etc.

Personality Disorders come in various forms, such as Antisocial, Borderline, Narcisstic, etc. It is often said, when any Patient manifests "a pervasive pattern of excessive emotionality and attention seeking..." (DSM-IV pg. 714), that they are "Axis II" or "a borderline personality". Many people exhibit some symptoms of Mental Illness or Personality Disorders.

Some Patients, and People in general, manifest some symptoms that may or may not meet all the criteria for a specific diagnosis. Let's face it: Some Patients/People in general are just difficult to deal with.

Recognizing that a Patient, whether thay have been diagnosed with a Mental Illness/Personality Disorder or not, and is difficult to deal with, is the first step in a problem-solving process. We can, both in theory and reality, treat all Patients basically the same with therapeutic outcomes.

For example, whether we are dealing with someone who has a diagnosis of Borderline Personality or is just a PIA, we can: be direct and factual, set boundaries and limits, and allow them to have to deal with the ramifications of their actions or inactions. This method of dealing with Patients also has the added benefit of taking the emotional variable out of the equation and allows for an objective, systematic approach.

I could go on all night. This is some interesting stuff. But I'll direct you to check ot the DSM-IV. It has some good reading.

Dave

eriksoln, BSN, RN · May 25, 2011

The DSM-IV does not specifically identify anything as a "behavioral disorder". The DSM-IV identifies Adjustment, Mood, Psychosis, etc. as diagnosis. The DSM-IV does specifically identify "personality disorder(s)".
In referencing behaviors, you may be referring to symptoms which lead to a specific diagnosis. For example, an Adolescent diagnosis pertaining to behavior is "Oppositional Defiant Disorder". Some of the symptomatic criteria are: temper, arguing, defiance, blaming, anger, etc.
Personality Disorders come in various forms, such as Antisocial, Borderline, Narcisstic, etc. It is often said, when any Patient manifests "a pervasive pattern of excessive emotionality and attention seeking..." (DSM-IV pg. 714), that they are "Axis II" or "a borderline personality". Many people exhibit some symptoms of Mental Illness or Personality Disorders.
Some Patients, and People in general, manifest some symptoms that may or may not meet all the criteria for a specific diagnosis. Let's face it: Some Patients/People in general are just difficult to deal with.
Recognizing that a Patient, whether thay have been diagnosed with a Mental Illness/Personality Disorder or not, and is difficult to deal with, is the first step in a problem-solving process. We can, both in theory and reality, treat all Patients basically the same with therapeutic outcomes.
For example, whether we are dealing with someone who has a diagnosis of Borderline Personality or is just a PIA, we can: be direct and factual, set boundaries and limits, and allow them to have to deal with the ramifications of their actions or inactions. This method of dealing with Patients also has the added benefit of taking the emotional variable out of the equation and allows for an objective, systematic approach.
I could go on all night. This is some interesting stuff. But I'll direct you to check ot the DSM-IV. It has some good reading.
Dave

Kinda sounds like something I say: "The most powerful influence on human behavior often are natural consequences."

Ah, so there really is no such thing as a "behavioral disorder." Hmmmm, odd, where did I come up with that? IDK. Me memory banks need cleaned out a bit I guess.

Davey Do · May 25, 2011

Kinda sounds like something I say: "The most powerful influence on human behavior often are natural consequences."
Ah, so there really is no such thing as a "behavioral disorder." Hmmmm, odd, where did I come up with that? IDK. Me memory banks need cleaned out a bit I guess.

Point 1: Yes. I say, "Amen!"

Point 2: You know, eriksoln, "no such thing as a 'behavior disorder'" kinda surprised me, too. I grabbed a DSM-IV, to reference my response, and had a similar enlightenment. I guess diagnosis are primarily divided into Mental Illness and Personality Disorders. Behaviors must be "symptoms". Go figure.

Dave

eriksoln, BSN, RN · May 25, 2011

Point 1: Yes. I say, "Amen!"
Point 2: You know, eriksoln, "no such thing as a 'behavior disorder'" kinda surprised me, too. I grabbed a DSM-IV, to reference my response, and had a similar enlightenment. I guess diagnosis are primarily divided into Mental Illness and Personality Disorders. Behaviors must be "symptoms". Go figure.
Dave

I think thats where I got it from...............my teacher explaining the difference between "behaviors" and true personality disorders.

Whispera, MSN, RN · May 26, 2011

Here's how I see it, boiled down to basics, without considering exceptions.

Axis I disorders are those that could be helped by medications, and it's possible psychotherapy wouldn't help at all. Think clinical rather than situational depression, and schizophrenia, here.

Axis II disorders are personality and developmental disorders. Personality disorders are the big group here. Developmental disorders are lumped here because they had to be put somewhere. Personality disorders might be helped by medications, but require psychotherapy. They also are disorders the person has developed in response to their life-problems. Often they're a cluster of negative coping skills or behaviors. They are difficult to overcome unless the person sees a reason to overcome them, and wants to do so, and is willing to go through longggggg-term therapy.

Behaviors can fit into either axis. People behave in response to what's going on in their heads. Thoughts-->beliefs-->behavior.

I don't understand what your instructor was intending to tell you about behavioral vs. personality disorders...

I agree with DaveyDo, the DSM-IV can be fascinating, in small doses, anyway. There's a new version, DSM-V, out now. There should be a shortened version too, that condenses and explains things nicely. There's definitely a shortened version of the DSM-IV.

ImThatGuy, BSN, RN · May 26, 2011

I didn't know the DSM-V was published yet. I'd read back in December or so that some personality disorders were being dropped. I don't recall the article mention anything being added.

Whispera, MSN, RN · May 26, 2011

My apologies! Last year as I was searching for my DSM-IV and not finding it (I was off work for about a year and had piles of books all over the place), I went to the trusty old internet and read about the new version, and the article said the V version was to be published later in the year. Just now I looked on Amazon.com and found the new version is not out yet. I should learn not to count on my memory being accurate. It's planned that DSM-V will have some shuffling of personality disorders, and some information about "relational processes." I guess we'll know what that means when the book is published.

That being said (ahem) there has been a text revision of the DSM-IV, named DSM-IV-TR, of all things!

ImThatGuy, BSN, RN · May 27, 2011

My apologies! Last year as I was searching for my DSM-IV and not finding it (I was off work for about a year and had piles of books all over the place), I went to the trusty old internet and read about the new version, and the article said the V version was to be published later in the year. Just now I looked on Amazon.com and found the new version is not out yet. I should learn not to count on my memory being accurate. It's planned that DSM-V will have some shuffling of personality disorders, and some information about "relational processes." I guess we'll know what that means when the book is published.
That being said (ahem) there has been a text revision of the DSM-IV, named DSM-IV-TR, of all things!

Oh, yeah, the TR has been out for a while now.

pattyjo, MSN, RN · May 29, 2011

If interested, here is the page for DSM V which is due out in 2013. I believe right now APA is looking for comments from interested parties on the changes being made.

http://www.dsm5.org/Pages/Default.aspx

EMcGrady · May 31, 2011

Thanks for the information; I'm deciding where to start in mental health myself. Either cognative issues, males with Allen of 3-4, or with mixed sex Axis 1-2. I like to talk with people and find ways to help them figure out steps towards being as functional as possible. So maybe the Axis 1-2 is more my speed.