Manual Single National Disability Rating to Colombia - Decree 917 of 1999 (Part II of II) - Chapter X II 12. MENTAL AND BEHAVIORAL DISORDERS 2.1 GENERAL

MANUAL SINGLE NATIONAL DISABILITY
(PART II OF II)

CHAPTER XII
12. MENTAL AND BEHAVIORAL DISORDERS

2.1 GENERAL

This chapter has been prepared based on the fifth chapter of the Tenth International Classification of Diseases (ICD - 10) and fourth version of the Diagnostic and Statistical Manual of Mental Disorders American Psychiatric Society (DSM IV) .

In ICD-10 are proposed either 11 groups of mental disorders, the DSM IV, in turn, these groups of disorders located in two different axes of multiaxial classification: the pictures or Axis I clinical syndromes and Axis II personality disorders and mental retardation.

The classification of mental disorder based on clinical characteristics of the respective disorder, however, to specify the severity of it, and its forecast, the assessor need additional information about the different areas of activity of the person (family, social, academic, work, recreation, etc.).

To qualify axis I disorders is of particular importance to know the person's functioning in different areas of activity, especially during pre-qualification, to proceed to describe personality disorders and axis II, is necessary to have information on areas of activity of the person throughout his life, in order to clarify the existence of jet or impairment in social, occupational, or otherwise. Also, this information will facilitate the quantification of disability and handicap, which in the case of mental disorder has unique characteristics.

12.2 CLASSIFICATION

For the purposes of this manual of mental disorders are divided into two groups: axis I and axis II, as follows:

Axis I Disorders Axis II disorders

1. Organic mental disorders, including symptomatic.

2. Mental and behavioral disorders due to psychoactive substance use.

3. Schizophrenia, schizotypal and delusional disorders.

4. Mood (affective).

5. Neurotic, stress-related disorders and somatoform disorders.

6. Mental retardation

7. Psychological development

1. Personality disorders and behavior in adults.

· Paranoid · Schizoid · schizotypal · histrionic · Asocial · From unstable personality (border) · Narcissistic · Anxious (avoidant) · Per dependence · anancastic (obsessive compulsive) • Changes

enduring personality

12.3. SCORING PROCEDURE

12.3.1 Quantification of impairment

In determining the deficiency resulting from clinical (Axis I) is taken into account only the disorder of major deficiency and this is quantified. For the rating of impairment resulting from personality disorder (axis II), is also considered a single disorder, but a person may have traits from more than one. Where relevant, each patient was graded on the deficiency of each of the axes, and their percentages are added together in a simple arithmetic, according to what is noted below.

In the case of deficiency is found only in one axis, this is the unique value of the overall deficit. For personality disorders (axis II) has been considered a unique category, whose value will vary depending on whether or not a deficiency in the axis, as explained in the following table:

DEFICIENCY IN THE AXIS I AXIS II DEFICIENCY VALUE

No 20% deficiency

If 10% deficiency

40% failure is not qualified

12.3.2 Criteria for classifying the deficiency arising from the Clinical Mental Syndromes (Axis I) For the classification of the deficiency arising from the different clinical syndromes or will be taken into account the following criteria:

Clinical diagnostic · Printing: Refers to the type of alteration (or disorganization) of mental activity characteristic of each clinical.

• Forms of Evolution: The clinical evolve in an episodic (with or without relapses) or persistently, taking the form of state, posing significant differences in the definition of the deficiency.
• Current clinical · Assessment: At this point you consider the time period preceding qualifying, and in which there are clinical manifestations of the disorder. Includes assessing the duration of the last episode intercritical period that precedes or follows, in order to determine the presence or absence of residual symptoms, partial remission, symptoms, or behaviors resulting from alterations. In the case of non-episodic disorders, including evaluation of the state (persistent) current in order to determine the severity of the findings. In addition to the clinical features that occur in this time period, determine its duration.
• Evolution of the disorder: one takes into account the time between the onset of clinical changes characteristic of the first and the time of qualification. Includes the definition of the number of previous episodes and / or quantification of the total time of evolution. The definition of the number of previous episodes is a measure of the complications in the overall adaptation of the individual during the course of his life and, moreover, its prognosis, then, in general, a greater number of episodes greater the chance of recurrence.
• Assessment of the current findings: seeking to clarify the severity of the disorder itself the clinical and deficiencies arising therefrom in relation to the different areas of activity of the person (family, work, social, etc.).. The significance of these criteria will vary according to the clinical picture.

12.3.3 Criteria for rating the impairment resulting from personality disorders (axis II) For the rating of impairment resulting from personality disorders will be considered:

· Diagnosis: ie the clinical features of these disorders, or personality change lasting. These characteristics are defined by traits or behavior patterns prevalent.

· Disorder severity or intensity, determined by the persistence and rigidity of these features, as well as the difficulty in adapting resulting therefrom.

12.3.2.1. Diagnostic tests: psychological and neuropsychological studies A wide range of psychological tests that are not only useful for the diagnosis of a mental disorder, but also to determine the severity, prognosis and personal characteristics, work and family member of a particular case . Among the psychological tests that may be useful for the characterization of the loss of earning capacity, is the evidence on personality traits, scales of depression and anxiety, the stress level assessment and intelligence tests, for its part, evaluation of psychosocial factors at work and outside work is of paramount importance in qualifying origin of diseases and to quantify disability and handicap.

On the other hand, neuropsychological studies are useful for determining the location of brain injury, mental functions and processes altered the prognosis and the level at which occupational performance is affected, according to the characteristics of the subject, education level and occupation.

12.4 Mental Disorders Axis I (Clinical Syndromes)

12.4.1. Organic mental disorders, including symptomatic.

Includes a variety of disorders in which it has been established as an etiological factor the presence of "brain disease, injury, or other disturbance of the brain leading to brain dysfunction." The resulting brain dysfunction may be primary or secondary, as it results from direct and selective brain disorder or systemic disease that attacks various organs or systems, including the brain, also can be induced by substance use psychodysleptics. Here we consider the following syndromes:

• The amnestic syndrome and dementia;

Homepage More organic mental disorders (delusional or schizophreniform hallucinosis, organic mood disorder, organic anxiety disorder, dissociative, emotional lability, mild cognitive, other specified and unspecified).

· The personality disorders and behavioral disorders due to organic disease (organic personality disorder, postconfusional syndrome, emotional right hemisphere syndrome and organic personality disorder not otherwise specified.

12.4.1.1. Dementia and amnestic syndrome

Dementia may be primary and dementia in Alzheimer's disease or vascular dementia caused by strokes associated with vascular disease and those associated with other diseases. For these conditions, the deficiency is given by the alteration of different cognitive processes, and consequently by the disorganization of the conscious and voluntary. Its course is usually chronic. To assess the impairment caused by dementia and amnestic syndrome must meet two conditions: first, to clarify the existence of brain damage found, secondly, that the disorders have more than one year later. The disorders listed in this classification are: Alzheimer's disease, vascular dementia, dementia in other diseases classified elsewhere, dementia unspecified organic amnesic syndrome not induced by alcohol or other psychoactive substances, alcohol-induced delirium or other substances psychoactive and other mental disorders due to injury and brain dysfunction and physical illness.

TABLE No. 12.4.1 DEMENTIA AND CRITERIA% amnesic syndrome DEFICIENCY CATEGORY

I Presence of mild deficits in attention, concentration, memory or other mental functions, which can be offset with adequate support. 10%

II moderate addition to the above, there are changes in orientation, cognitive and sensorimotor disturbances (aphasia, apraxia, agnosia). 20%

III Grave addition to the previous deficits, the person has altered the organization of behavior, intellectual operations, decreased level of abstraction, learning ability, which hinder the conscious and voluntary organization of behavior. 30%

IV severe major presence of some or all of the above changes and marked deterioration of sensory-motor automatisms which are the basis of self-care. 40%

12.4.1.2. Other mental disorders due to injury and brain dysfunction and physical illness

This group consists of variety of diseases caused by primary brain disorders or systemic disease secondarily affecting the brain also can be caused by hormonal changes or exogenous toxic substances.

It includes organic hallucinosis or organic delusional disorder schizophreniform (organic psychosis for DSM IV), organic mood disorders (affective), organic anxiety disorder and dissociative disorder organic.

To qualify for the deficiency by organic hallucinosis and organic delusional disorder should be considered below the criteria for schizophrenia, schizotypal and delusional disorders (Table 12.3.3), to qualify organic mood disorders, are taken into account the criteria for major mood disorders (Table 12.3.4), and finally, the classification of anxiety disorders and organic dissociative will take into account the criteria for neurotic and somatoform disorders (Table 12.4.7 .)

12.4.1.3. Organic personality disorder and behavior

For ICD-10 disorder may take the form of "personality seudorretrasada pseudopsicopática or organic," which may be related to frontal lobe damage (frontal lobe syndrome, postleucotomía, lobotomy), limbic epilepsy (limbic epilepsy personality) or injured in the right hemisphere. In this group of disorders of deficiency is given by the deterioration of the consent and voluntary organization of behavior, either by altering cognitive processes, and consequently the programming itself, or by altering the organization of impulses under

Interests and values ​​of culture.

The rating of impairment caused by these disorders is done for diseases with more than a year later.

TABLE No.12.4.2 ORGANIC PERSONALITY DISORDER SEVERITY CLASS ALTERATION AND FINDINGS CURRENT GLOBAL GAP (%)

Class I (Mild) Especially reactive, episodic emotional lability, impaired impulse control and / or incipient cognitive impairment temporary difficulty in memory and concentration. In the interview situation presents distractibility. 10%

Class II (Moderate) Highly reactive, emotional lability, marked and frequent failures of impulse control and / or established cognitive deficits, especially perceptual level, alterations in the praxia and poor concentration. 20%

Class III (Severe) Apathy, indifference, depression or euphoria unrelated to specific events and / or difficulty maintaining consent and voluntary organization of behavior, deficits in higher cognitive processes. 30% Class IV (Severe) loss in the conscious and voluntary organization of behavior to serious disruption of the system of values ​​and interests sensorimotor dominance and impulsive activities, loss of own habits of everyday life, marked deficit of cognitive processes higher. 40%

12.4.2 Mental and behavioral disorders due to psychoactive substance use disorders include these components: intoxication, harmful use (or abuse) and dependence. It also includes consumer-related complications (usually long) of these substances, particularly those characterized by damage to brain structures or formations.

For the purposes of classifying the deficiency is taken into account the dependency syndrome, which will be assessed in cases in which the last period of dependency has a duration of at least two years. If coexisting deficiency resulting from the dependency syndrome resulting from impaired brain damage secondary to substance use

Psychodysleptics, will take the major deficiency in accordance with the statements in the general. Deficiency syndrome own dependence is given by the change in the organization and voluntary consent of the different types of activity, in this case, difficulty in managing what drives the consumption, which is manifested by different types of conduct .

TABLE No. 12.4.3 DEPENDENCY DISORDER DUE TO USE OF CATEGORY SUSTANCIASPSICOATIVAS GLOBAL OVERVIEW OF SIGNIFICANT DEFICIENCY (%) DISTURBANCE SEVERITY TIME EVOLUTION OF DISORDER

Class I (Mild) Loss of control over the use of substances. Increase in the number or frequency of use. Persistent use despite harmful consequences. Abandonment of family work and social responsibilities. Time-consuming in the acquisition and consumption of the substance. Sometimes physiological dependence (withdrawal)

Up to 10 years and / or less than four periods of dependency. The duration of the last period of dependency is up to two years including the period of partial remission. 10% Class II (Moderate) Loss of control over the use of substances. Increase in the number or frequency of use. Persistent use despite harmful consequences. Abandonment of job responsibilities, family and social. Time-consuming in the acquisition and consumption of the substance. Sometimes physiological dependence (withdrawal).

More than ten years and / or more than four periods of dependency The duration of the last period of dependency is more than two years, including partial remission period. . 20%

12.4.3. Schizophrenia, schizotypal and delusional disorders included in this group of schizophrenia, persistent delusional disorder, the acute and transient psychotic disorder and schizoaffective disorder. Schizotypal disorder and its clinical features will be considered with personality disorders, according to the issues raised by the DSM - IV deficiency in this group of disorders is characterized by severe disturbances in thought processes (delusions, hallucinations, affective disorders , motor, etc.) affecting conscious and voluntary organization of the different aspects of behavior, can evolve in an episodic, with or without recurrence, or persistent (psychotic state). In some cases the evolution is episodic to the onset and then becomes persistent.

There are two different types of episodes: acute, up to a month-long and subacute from one to six months, the psychotic state lasts longer than six months. Acute psychotic disorder and transitional by nature brief, not be taken into account for purposes of qualifying.

TABLE No. 12.4.4 Schizophrenia, schizotypal and delusional disorder CRITERIA CATEGORY DESCRIPTION OF DEFICIENCY (%)

Class I (mild) • The duration of the last episode and / or current is less than 6 months, and • In the intercritical period related to the last episode or the current state has been complete remission even without treatment, and • The individual has presented four episodes and / or the disorder is under 10 years of total duration, and • Current Finding: no significant signs and symptoms. Mental functions are preserved. 10% Class II (Moderate) • The duration of the last episode and / or current is up to 6 months, including the intercritical period, and • In the intercritical period the patient has difficulty maintaining the test of reality and • The individual has filed more than four episodes and / or disorder has more than 10 years of total duration, and • Find Current trends are in loss of reality testing. Other mental functions can be altered.

20%

Class III (severe) • The duration of the last episode and / or current is more than 6 months, and • In the intercritical period is persistent delusional content and / or negative symptoms, and • The person may have had or no previous episodes (number not relevant), and • Current Finding: delirium tends to be systematic and / or referral to various situations (delusional disorder). Negative psychotic symptoms and / or positive (schizophrenia and schizoaffective disorder). The person has trouble voluntary conscious development of their activities. There is a formal psychotic state. 30% Class IV (severe) • The duration of the last episode and / or current status is one year or more, and • In the intercritical period all areas of conscious and voluntary activity are deeply affected, and • Find now structured delusional disorder. Negative psychotic symptoms and / or persistent positive. The person has a deep deficit for the conscious development and volunteer activities. Presence of a schizophrenic process or a chronic delirium. 40%

12.4.4 Mood (affective)

Are characterized by an alteration of humor that tends to depression or euphoria. These disorders differ in major ways, which are generally episodic and recurrent (cyclic) and lesser forms, usually persistent (several years of evolution). Episodic forms include two types of mood disorders: bipolar disorder and recurrent depressive disorder. Persistent disturbances of mood, in turn, comprise two types of disorder, cyclothymic disorder and dysthymia. Two groups are established for the classification of the deficiency resulting from these disorders, a first group consisting of major mood disorders associated with minor alterations thereof and a second group consisting exclusively of minor mood disorders. Deficiency disorders resulting from the first group is given by the characteristics of its evolution and the total time of it.

TABLE No. 12.4.5 MAJOR DISORDERS OF MOOD (AFFECTIVE) DISORDERS ASSOCIATED OR NOT WITH JUVENILE HUMOR CATEGORY DESCRIPTION OF CRITERIA% DEFICIENCY

Class I (mild) • The duration of episodes is at least one to two weeks, and • In the intercritical period is complete remission, and • The person has made up to four episodes, or total time of evolution of the disorder be up to 10 years and • Current Finding: no significant symptoms. Mental functions are preserved. 10%

Class II (moderate) • The duration of episodes is at least one to two weeks, or the state lasts at least 6 months, including the intercritical period, and • In the intercritical period is complete remission or partial remission is greater disorder in the presence of minor alterations of humor, and • The individual has filed more than four episodes, or the total time course of the disorder is more than 10 years and • Current Finding: There is presence of some major symptoms of affection only, or there is moderate their intensity. 20%

Class III (severe) • The disorder lasts at least two years, including the intercritical period, and • In the intercritical period is partial remission of major episodes in the presence of minor alterations of humor, and • Find Current disturbances are present humor, of varying intensity. They are problems at the mental functions or some alteration of perception, thinking, reasoning or language. WITH RAPID CYCLING BIPOLAR DISORDER: • The disorder has a duration of one year or more, and • The person has submitted four or more episodes, and • Current Finding: There are major symptoms of mood (manic or depressive) with great severity, which interfere with mental function or alter perception, thought, motivation and / or language. 30% The following table qualify under mood disorders (persistent) and dysthymia or cyclothymia, which are defined by the absence of major alterations of mood, and only eligible cases whose duration is more than two years.

TABLE No. 12.4.6: MOOD DISORDERS UNDER THE CATEGORY CRITERIA% DEFICIENCY

Findings single class today: clinically significant distress, especially difficulties in motivational aspects and decision making. 10%

12.4.5. Neurotic, stress-related disorders and somatoform disorders differ order to classify three groups formed based on the characteristics of the deficiency involved, and not because they have similar characteristics from the descriptive point of view.

a) Group one: phobic disorders, panic disorder and posttraumatic stress disorder.

b) Group two: generalized anxiety disorder, neurasthenia, somatization disorder, hypochondriacal disorder, somatoform autonomic dysfunction and persistent somatoform pain. c) Group three: conversion disorder and obsessive-compulsive disorder.

In the corresponding table defines two types of deficiency for each of the three groups, according to the total duration of the disorder. On the other hand, sets out the clinical characteristics or severity that should have each of the groups of disorders to be awarded. In fact with mild disorders do not lead to any degree of impairment. For the purposes of impairment rating is only taken into account the post-traumatic stress disorder.

TABLE No. 12.4.7: Neurotic, Stress Related Disorders and Somatoform Disorders

Class I (mild): The duration of current symptoms and behaviors is high over a year, and total time of evolution of the disorder may be one to five years.

DIAGNOSTIC CRITERIA DESCRIPTION OF DEFICIENCY% severe or intense current symptoms GROUP ONE PRESENT FINDINGS

Phobias Posttraumatic Stress Disorder Panic Disorder · The symptoms may be related to different situations, or situations that the person must face daily (difficult avoidance), or symptoms may be multiple and of great severity, and • The anticipatory anxiety can be occupied by thinking much of the day, and / or lead to severe avoidance behaviors.

Concern about the possibility of occurrence of acute symptoms may be marked and / or isolation may be important. Symptoms during the past year can be significant and frequent. GROUP TWO-10% generalized anxiety disorder, neurasthenia symptoms (physiological and / or cognitive impairments can be many, or few but very intense and take thought for several hours a day, and / or hinder many of the activities person. The physiological and cognitive manifestations can be severe and affect both motivational and operational aspects of behavior. hypochondriacal disorder or dysmorphic. "somatization disorder Concern for the health and appearance can be consistent and present with structured content without constitute delusions.

Somatoform autonomic dysfunction, persistent somatoform pain, symptoms can be intense and motivating different laboratory examinations and treatments. GROUP THREE-conversion disorder · Can be very functional limitation or compromise of basic body systems (paralysis, anesthesia, muteness and blindness), and • There may be behaviors of indifference to the symptom. There is limited functional body system involved. Obsessive compulsive · The symptoms can be structured, persistent and cause great discomfort, and • The person may occupy much of the day in addressing the symptoms. The different areas of activity of the (motivational, cognitive and motor) may be committed to the symptoms of the disease and coping strategies.

Class II (moderate): The duration of current symptoms and behaviors is high over a year and the total time of evolution of the disorder is more than five years.

DIAGNOSTIC CRITERIA% DESCRIPTION OF DEFICIENCY SEVERITY OF SYMPTOMS OR CURRENT CURRENT CURRENT FINDINGS ONE GROUP

Phobias Posttraumatic Stress Disorder Panic Disorder · Symptoms related to wide range of situations, or situations that the person must face daily (difficult avoidance), or multiple symptoms of great severity, and Presence of anticipatory anxiety that takes the content thought much of the day, and / or leads to marked avoidance behavior. · Marked concern over the possibility of occurrence of acute symptoms and / or isolation important or Existence of significant and frequent symptoms during the past year. GROUP TWO-20% generalized anxiety disorder, neurasthenia symptoms (physiological and / or cognitive), many, or few but of great intensity that occupy the mind for several hours a day and / or hinder many of the activities of the individual. Cognitive and physiological manifestations are of such intensity that affects the motivational aspects of behavior and operational hypochondriacal disorder or somatization disorder dismórfico. "The concern for health or appearance is permanent, structured content manifests itself, without being delusions .

Somatoform autonomic dysfunction, pain, persistent somatoform symptoms are intense to the point that motivate different laboratory examinations and treatments.

GROUP THREE-conversion disorder · Great functional limitation or compromise of basic body systems (paralysis, anesthesia, muteness and blindness), and • Sometimes behaviors presence of indifference to the symptom. Apparent functional limitation compromised system. Obsessive compulsive · Symptoms clearly structured and persistent that produce great discomfort, and • In the clash of symptoms the person occupies much of the day. All or almost all areas of activity of the person (cognitive systems, motivational and motor) are committed to the symptoms of the disease, or conflict

12.4.6. Mental retardation is a state of incomplete or arrested mental development, characterized by deficiency in organizing skills that contribute to the overall level of intelligence such as cognitive function, language and motor skills or social. May be associated or not with other mental or physical impairment such as autism, other developmental disorders, conduct disorders, epilepsy or severe physical disability. Consequently, the resulting impairment of mental retardation is given mainly by the detention level of cognitive development.

TABLE No. 12.4.8 MENTAL RETARDATION APPROACHES% CATEGORY DESCRIPTION CURRENT DEFICIENCY DISORDER: DISORDER FEATURES:

Class I (mild) IQ of 50 to 69 (adult mental age of 9 to 12 years) I can present some difficulties in school learning, you can develop skills to perform everyday tasks without supervision. With appropriate stimuli can develop unskilled manual work and maintain appropriate social relationships. • With weak stimulation can only develop simple activities that require practical intelligence, with a minimum of abstraction. In this case, require continuous monitoring for work activities and even personal care.

10% Class II (moderate) IQ of 35 to 49 (adult mental age of 6 to 9 years) can take charge of their care under supervision. Moves only in a family environment. You can receive training in unskilled or semiskilled work (always with supervision) that imply the presence of organization in their body schema and motor to sensory manipulation.

20% Class III (severe) IQ of 20 to 34 (adult mental age of 3 to 6 years) can purchase a communicative language and little or no skills can be trained in basic care. In adulthood can perform simple tasks in closely supervised institutions. It can also adapt well to life of community, either in group homes or with their families.

30% Class IV (severe) IQ below 20. Severe restriction of personal care, continence, communication and mobility. Usually associated with neurological disease. Require continued assistance in all activities of daily living, including personal care

40% 12.4.7. Psychological development disorders

Includes conditions that a) invariably begin during infancy or childhood, b) there is deterioration or delay the development of functions closely related to biological maturation of the central nervous system are progressive course without remission or relapse. Within the developmental disabilities are two groups: pervasive developmental disorders and specific developmental disorders. This latter group will be considered for qualification for the loss of working capacity.

The group includes pervasive developmental disorders: infantile autism, Rett syndrome, childhood disintegrative disorder, Asperger disorder and other pervasive unclear. For these disorders are treated as such and qualifying requires that started before the three years of age.

This group of disorders should not be classified before making a comprehensive rehabilitation process.

Table 12.4.9 Pervasive Developmental Disorders DEFICIENCY CATEGORY CRITERIA%Severity of ED

Class I (Mild) Little interest in establishing interpersonal relationships, difficulty in establishing communication, little development of interests and activities.

10% Class II (Moderate) Defect in establishing interpersonal relationships, poor communication with others, poor communication on behavior.

20% Class III (Severe) Apparent failure to establish interpersonal relationships, poor development of communication with others, poor organization of behavior.

30% Class IV (Severe) Lack notorious for the establishment of interpersonal relationships; obvious deficiency in the communication (intelligible), not knowing and voluntary organization of behavior.

40% 12.5 Axis II mental disorders, personality disorders, and behavior in adults This group includes a variety of conditions and clinically significant behavioral traits (ie, individual produce discomfort or difficulty in social adaptation to the DSM IV -), which tend to be persistent and appear to be the expression of the typical lifestyle of the person and their way of relating to oneself and others.

For purposes of qualifying for disability consider the specific personality disorders, mixed disorders of personality and enduring personality changes, not attributable to brain injury or disease. To be considered as such and by the end of qualifying, personality disorders should have arisen at least since adolescence, and enduring personality change should be more than two years as a total evolution time. Also, in order to qualify these conditions must be evident in different life situations and at different stages of life.

Based on the DSM IV the specific personality disorders are classified into three groups:

· Group A (odd, eccentric) comprises the schizoid, paranoid, and schizotypal personality.

· Group B (dramatic, emotional): Includes histrionic, antisocial (or psychotic), emotionally unstable (borderline or borderline) and narcissistic personality. · Group C (anxious, fearful) includes anxiety disorders (or evasive)), dependent and anancastic (or obsessive compulsive disorder).

Lasting changes of personality, not attributable to brain injury or disease, however, appear not in relation to the development process, but "after exposure to prolonged stress, catastrophic or excessive" (sometimes post a picture posttraumatic stress disorder) or after a severe mental illness. It is important to consider behavioral disorders in the assessment of impairment of different personality disorders.

TABLE No. 04/12/1910: DISORDERS OF PERSONALITY AND ENDURING PERSONALITY CHANGES

(Axis II) CATEGORY DESCRIPTION OF DIAGNOSTIC CRITERIA% DEFICIT DISORDER SEVERITY OR INTENSITY OF GROUP A SINGLE CLASS

• Disorder Schizoid paranoid · Schizotypal Poverty · links interpersonal distrust major fantasy threat, or magical character. 20% (when only going to rate this axis) 10% (if it is also going to rate the axis I) 0% (when going to score a 40% deficiency in the axis I)
• GROUP B Histrionic · asocial disorder (psychopathy) · personality disorder emotionally unstable (border or borderline) · narcissistic disorder impulsivity, or strong or particularly labile emotionality, low frustration tolerance, poor organization of the system of interests and values ​​and interest notorious in his own person and disregard of others, expressed in fantasies, attitudes and behaviors.
• GROUP C ¢ anxious personality disorder (avoidant) · disorder dependence · anancastic Disorder (OCD) Markedly concern about interpersonal relationships and attitudes associated with anxiety and / or avoidance behavior, submission and control.
• ENDURING PERSONALITY CHANGES Marked hostility and mistrust, isolation notorious, anxiety and depression, or severe dependency and others demand to inability to maintain interpersonal relationships, notorious passivity and decrease in interest, attitude and behavior marked unhealthy.