The diagnoses mentioned in the medical records of community mental health centres rarely correspond to the diagnosis that the psychiatrist in charge of the case has in mind. The Author presents different hypotheses on this discrepancy. The epidemiologic data on personality disorders and severe personality disorders, compared with clinical data, reveal that such disorders appear under-diagnosed. The Author discusses this fact and highlights the therapeutic consequences of the lack of treatment: i.e. Axis II disorders would require specific and targeted psychotherapeutic techniques. The absence of treatment of severe personality disorders lead to chronic Axis I disorders. Finally, the Author proposes a clinical practice that can be integrated in the current activities of a mental health department.
Keywords: Epidemiology of personality disorders, comorbidity of Axis I and Axis II Disorders, Severe Personality Disorders, psychotherapy of Personality Disorders