Personality disorder and mental retardation diagnoses are coded on Axis II because if these were included in the same axis with Axis I disorders, they might be overlooked ("DSM-IV-TR Classification," n.d., Multiaxial assessment). These disorders are more resistant to treatment because it is common for patients to have multiple personality disorders at the same time, and it is also common for patients with personality disorders to respond in "maladaptive ways" to other people or to stressful situations ("About Treatment Resistance," 2007). The very symptoms of personality disorders make it difficult for patients to respond appropriately to treatment. In Borderline Personality Disorder, for example, patients have "unstable and intense relationships, self-destructive behavior, uncertainty about one's identity and a substantial risk of suicide," and "personality disorders appear to play a major role in treatment resistance..." ("About Treatment Resistance," 2007). A patient with such a disorder has difficulty trusting a therapist, complying with therapy, or even viewing events in an objective light. The disorders themselves therefore tend to undermine the patient's attempts to regain equilibrium or relate successfully to other people-even to the therapist treating them.
The three Cluster A personality disorders-paranoid, schizoid, and schizotypal-all include "odd and eccentric behaviors, and their grouping together is due to the common symptom patterns and genetic/environmental risk factors that characterize them (Esterberg, Golding, & Walker, 2010, p. 515). The primary features of the paranoid personality are the tendency to see others as devious and secretly manipulative while viewing themselves as unfairly mistreated and exploited; they are afraid of being controlled or discriminated against, so they are constantly watching for signals of such treatment and have a suspicious attitude (Hay
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