Re: What is the symptom ?

In the Navy, we make the diagnosis of Personality Disorder far more frequently than the "general population" of practitioners. This could be due to the greater incidence in this population, or due to the greater pressure of living in a small area with 40 others for six months out at sea (how many of US would express borderline or anti-social features!) or possibly because we don't worry as much about stigmatizing the patient and so don't set as high a bar for the DX. After all, it is not an exact science:

Borderline features
R/O Borderline Personality Disorder
Borderline Personality Disorder

And if there are 5 criteria met, how strong must each one be? Strong enough to cause dysfunction? Well, in some work situations (e.g. Navy ship) the dysfucntion becomes more apparent than with someone working as a gardener. Even an MCMI would not always acruately pick up this distinction, since it asks about social disruption, etc.

But the axis II formulation is VERY helpful, whether in a Primary Care setting or a mental health setting - since we find that the more refractory a patient to treatments that usually work (or begin to work and then revert with each "success") is often fueled by the presence of a personality disorder. When this can be clearly identified, we can target the personality factors that drive the life-crisis, rather than continually "putting out fires."

We could (and apparently are) devote an entire dialogue to the role of Axis-2 in Primary Care settings.

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