An Empirical Study of the Relationship Between Diagnosis and Defense Style

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