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Difference between axis 1 and axis 2

Axis 1 vs axis 2

Psychiatric disorders prevail in ever expanding numbers in today’s world. Many a times, the patients go undiagnosed as the symptoms seem to be very subtle and not enough to make any diagnosis. Axis 1 and axis 2 are the two parts of the five part, multi-axial classification system designed for mental/psychiatric disorders by the American Psychiatrists Association (APA). It was introduced in the Diagnostic and Statistical Manual of Mental Disorders-IV (DSM-IV) that was published in 1994 by the APA. The categories are made to define prototypes of mental conditions.

Axis 1 enlists clinical conditions that are psychological except personality disorders and mental retardation. Axis 2, on the other hand, deals with mental retardation and personality disorders. Axis 1 has more so acute conditions which are easily diagnosed. In Axis 1, the conditions listed are more amenable to treatment and can be cured by vigorous treatment. Axis 2 has major conditions which arise in childhood and have become a way of living, a mutated personality, one may say. Axis 2 disorders are more permanent and very resistant to treatment. One has to be vigilant while dealing with such patients and even while diagnosing Axis 2 disorders. Even after diagnosing them, they are much less responsive to treatment. Axis 2 disorders are considered as a social block, a stigma due to something lacking in the person’s social skills that makes it difficult for them to adapt to society norms. Even after a lot of adaptation they never quite reach ‘normalcy’.

Axis 1 consists of lot of clinical conditions combined with developmental and learning disorders. Anxiety disorders, cognitive disorders, eating disorders, mood disorders, sexual disorders and schizophrenia are listed under axis 1. Anxiety disorders consist of all types of phobic personalities, i.e. people having fear of open places, fear of narrow closed places, fear of being suffocated in a crowd etc. Cognitive disorders are dementia (loss of memory), learning disability, Autism spectrum disorders, etc. Eating disorders are bulimia nervosa and binge eating (eating at frequent intervals due to depression). Sexual disorders like vaginismus (vagina becoming spasmodic and causing pain during intercourse) and dysparunia (painful intercourse) are a part of Axis 1. The diagnosis can be made only after the general causes are ruled out. Axis 2 has more adaptation disorders like anti-social personality disorder in which one avoids being with people and is comfortable doing things alone. Obsessive compulsive personality disorder ia another of an axis 2 disorder in which one repeats some actions without realizing what makes them behave that way, for example one may have a habit of cleaning hands every time they touch some object. This may lead to the person washing hands over 50-60 times each day causing chapping of skin and dryness. The person is obsessed with the idea of cleanliness and it manifests in the form of hand washing repeatedly. This kind of behavior is akin to a social stigma as one will never overcome it even after counseling. Mental retardation cases are also listed under axis 2 classification. Though axis 1 has many clinical conditions, they are temporary and can be overcome with multiple treatment options as against axis 2 disorders which people develop gradually since childhood and are difficult to change or leave behind completely.

Summary: Axis 1 and Axis 2 differentiation helps classify conditions and hence treatment and handling becomes much easier. Axis 1 disorders consist of psychological diagnoses excepting condition of mental retardation (MR) and various personality disorders. Axis 2 disorders encompass personality disorders like avoidant personality, narcissistic personality, etc and true mental retardation.


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