Stability as a distinction between Axis I and Axis II disorders.

Area of Science:

• Psychiatry and Clinical Psychology
• Longitudinal Study of Mental Disorders
• Diagnostic and Statistical Manual of Mental Disorders (DSM) Conceptualization

Background:

• Temporal stability traditionally distinguishes Axis I (e.g., mood, anxiety) from Axis II (personality) disorders.
• Axis II disorders are conceptualized as lifelong, enduring patterns.
• Empirical comparisons of temporal stability between Axis I and Axis II disorders are limited.

Purpose of the Study:

• To compare the temporal stability and course of personality, depressive, and anxiety disorders.
• To examine remission and recurrence rates across different diagnostic categories using naturalistic longitudinal data.

Main Methods:

• Review of three naturalistic longitudinal studies: Collaborative Longitudinal Personality Disorders Study (CLPS), Collaborative Depression Study (CDS), and Harvard/Brown Anxiety Research Program (HARP).
• Utilized a consistent definition of remission/recovery: no or minimal symptoms for 8 consecutive weeks.
• Compared recovery and recurrence rates at 2-year and 5-year follow-ups.

Main Results:

• Mood disorders showed the highest remission/recovery rate at 2 years but also a high probability of recurrence.
• Personality disorders demonstrated higher remission rates than anxiety disorders, suggesting less stability than conceptualized.
• Anxiety disorders exhibited remarkably low recovery rates, persisting even beyond 5 years of prospective follow-up.

Conclusions:

• The findings challenge the traditional view of personality disorders as entirely lifelong, enduring patterns.
• Anxiety disorders present significant challenges regarding long-term recovery.
• Results have implications for the future conceptualization and diagnostic criteria within the DSM framework.