Axis 2 disorders (personality disorders) are hard to diagnose in schizophrenia because of the swamping nature of schizophrenia and because schizophrenia itself has a devastating effect on personality.
Even mood disorders often cause serious personality changes. When they hit in adolescence, maturity is often frozen at whatever the age the illness hit. This is why you see people with chronic mental illness in their mid-50’s who still act like teenagers. They act that way because the chronic illness hit in adolescence and their maturation process for all intents and purposes froze in place.
You really need to treat the mood disorder and then see if there is anything left on Axis 2.
I don’t believe in diagnosing personality disorders that are caused by an Axis 1 symptomatic process (anxiety or mood disorder) because this violates the basic theory of Axis 2 – that these are illnesses at the very core or essence of the person, at the soul itself if you will – that usually have roots deep in childhood and adolescence and are always apparent by adolescence or early adulthood. Pathological personality change in later life violates the principles of Axis 2, but maybe we need a new DSM category for that, as it does occur sometimes.
