To the Editor.—
Drs Bond and Vaillant1 compared patients' defense styles with their diagnoses on axes I, II, and IV of DSM-III2 and came to the conclusion that DSM-III diagnosis could not predict defense style. This finding led them to suggest that diagnosis and defense style are two independent dimensions. They suggest introducing a sixth axis for psychodynamic formulation and therapeutic planning.Actually, the lack of correlation between axes I and II of DSM-III comes as no surprise, since DSM-III was formulated explicitly on a descriptive basis with elimination of psychodynamics.In DSM-II,3 there was no doubt that personality disorders belonged in toto to the medical model in psychiatry. In DSM-III,2 personality disorders are to be coded under nonmedical axis II with the proviso that personality traits, although not coded, may also be listed in axis II. Thus arises a confusion between personality traits, which are
Nussbaum K. An Empirical Study of the Relationship Between Diagnosis and Defense Style. Arch Gen Psychiatry. 1987;44(1):94. doi:10.1001/archpsyc.1987.01800130106015
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