The Five Axes of the DSM-IV Multi-Axial System

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Mental disorders are diagnosed according to a manual published by the American Psychiatric Association called the Diagnostic and Statistical Manual of Mental Disorders.  A diagnosis under the fourth edition of this manual, which was often referred to as simply the DSM-IV, had five parts, called axes.  Each axis of this multi-axial system gave a different type of information about the diagnosis.

Axis I provided information about clinical disorders.

Any mental health conditions, other than personality disorders or mental retardation, would have been included here.  Disorders which would have fallen under this axis include:

  • Disorders Usually Diagnosed in Infancy, Childhood or Adolescence
  • Delirium, Dementia and Amnestic and Other Cognitive Disorders
  • Mental Disorders Due to a General Medical Condition
  • Substance-Related Disorders
  • Schizophrenia and Other Psychotic Disorders
  • Mood Disorders
  • Anxiety Disorders
  • Somatoform Disorders
  • Factitious Disorders
  • Dissociative Disorders
  • Sexual and Gender Identity Disorders
  • Eating Disorders
  • Sleep Disorders
  • Impulse-Control Disorders Not Else Classified
  • Adjustment Disorders
  • Other Conditions That May Be a Focus of Clinical Attention

Axis II provided information about personality disorders and mental retardation.  Disorders which would have fallen under this axis include:

  • Paranoid Personality Disorder
  • Schizoid Personalty Disorder
  • Schizotypal Personality Disorder
  • Antisocial Personality Disorder
  • Borderline Personality Disorder
  • Histrionic Personality Disorder
  • Narcissistic Personality Disorder
  • Avoidant Personality Disorder
  • Dependent Personality Disorder
  • Obsessive-Compulsive Personality Disorder
  • Personality Disorder Not Otherwise Specified
  • Mental Retardation

Axis III provided information about any medical conditions that were present which might impact the patient's mental disorder or its management.

Axis IV was used to describe psychosocial and environmental factors affecting the person.  Factors which might have been included here were:

  • Problems with primary support group
  • Problems related to the social environment
  • Educational problems
  • Occupational problems
  • Housing problems
  • Economic problems
  • Problems with access to health care services
  • Problems related to interaction with the legal system/crime
  • Other psychosocial and environmental problems

Axis V was a rating scale called the Global Assessment of Functioning; the GAF went from 0 to 100 and provided a way to summarize in a single number just how well the person was functioning overall.  A general outline of this scale would be as follows:

100: No symptoms

90: Minimal symptoms with good functioning

80: Transient symptoms that are expected reactions to psychosocial stressors

70: Mild symptoms or some difficulty in social occupational or school functioning

60: Moderate symptoms or moderate difficulty in social,occupation or school functioning

50: Serious symptoms or any serious impairment in social occupational or school functioning

40: Some impairment in reality testing or communication or major impairment in several areas such as work or school, family relations, judgment, thinking or mood

30: Behavior is considerably influenced by delusions or hallucinations or serious impairment in communication or judgment or inability to function in almost all areas

20: Some danger of hurting self or others or occasionally fails to maintain minimal personal hygiene or gross impairment in communication

10: Persistent danger of severely hurting self or others or persistent inability to maintain minimal personal hygiene or serious suicidal act with clear expectation of death

When the fifth edition, the DSM-5, was compiled, it was determined that there was no scientific basis for dividing the disorders in this manner, so the multi-axial system was done away with. Instead, the new non-axial diagnosis combines the former Axes 1, II and III and include separate notations for the type of information which would have previously fallen into Axes IV and V.

Sources:

American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th edition. Washington, DC: American Psychiatric Association, 1994.

Kress, Victoria E. et. al.  "The Removal of the Multiaxial System in the DSM-5: Implications and Practice Suggestions for Counselors."  The Professional Counselor.  National Board for Certified Counselors and Affiliates, Inc.  Published:  July 2014.  Accessed:  June 9, 2015.

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