Multiaxial Diagnostic System of the DSM-IV-TR

The Five Axes

Psychiatrist and patient in counseling session
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The DSM-IV-TR uses a five level diagnostic system to classify illnesses and disorders. When considered together, these 5 levels give the treatment provider a complete diagnosis that includes factors influencing your psychiatric condition. This is important for effective treatment planning.

The five levels of the DSM are called “axes” and are defined as follows:

Axis I

Axis I is reserved for clinical disorders and developmental and learning disorders.

Disorders that may be present on Axis I include:

Axis II

Axis II is for personality disorders or mental retardation. Disorders that may appear on Axis II include:

Axis III

Axis III is for medical and/or physical conditions or disorders. For example:

Axis IV

Axis IV indicates factors contributing to, or affecting, the current psychiatric disorder and treatment outcomes. These include:

  • Lack of an adequate support system
  • Social issues
  • Educational problems
  • Problems with work
  • Financial difficulties
  • Legal problems
  • Other psychosocial and environmental problems

Axis V

Axis V is for the GAF or global assessment functioning.

This is a 100-point scale that the mental health professional uses to describe the patient’s overall level of performance in usual daily activities and social, occupational, academic and interpersonal functioning.


American Psychiatric Association. "Diagnostic and Statistical Manual of Mental Disorders, 4th ed., text revision" 2000 Washington, DC: Author.

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