Background Elucidation of aetiological processes leading to development of
Axis II disorders is important in category validation and could lead to new
treatments.
Aims To establish aetiological associations between Axis II disorders and s
pecific risk factors.
Method Male and female subjects (n = 260) in maximum security hospitals and
prisons were interviewed to determine DSM - III Axis II and lifetime Axis
I diagnoses. Aetiological risk factors were obtained at interview and from
case files. Independent statistical associations were established by logist
ic regression.
Results Axis II categories were divided into four groups: (a) disorders of
character development, secondary to an adverse early environment: antisocia
l, self-defeating and paranoid; (b) disorder; of temperament, secondary to
constitutional aetiology: avoidant, dependent, schizoid and schizotypal; (c
) a 'mixed' disorder of constitutional and environmental aetiology: borderl
ine; and (d) aetiological associations not established: narcissistic, histr
ionic, compulsive and passive-aggressive.
Conclusions The study validates several Axis II categories but challenges t
he inclusion of others within Axis II of DSM - IV, in particular schizoid,
schizotypal, avoidant and borderline personality disorders. The findings ha
ve implications for future treatment interventions.