The Five Axes of the DSM IV - TR
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The Five Axes of the DSM IV - TR

A clinician will make an assessment of a patient using the DSM for mental disorders. The DSM is a guideline for diagnosing different disorders. The manual is divided into five sections known as axes. What is considered mental disorders are notated on Axis I and II. The other Axes III and IV determine any medical or psychosocial problems which may affect the mental Illness; while Axis V provides an assessment form for the patient’s general level of functioning.

We tackled the lack of a decent classification system for mental Illness before the DSM. We will now look at the DSM - Diagnostic and Statistical Manual of Mental Illness, which is the classification system for mental illness put out by American Psychiatric Association since 1952.

The DSM is sectioned into five sections called Axes. 

Axis I contains the listing of the major mental illnesses.  Here you will find:

Disorders originating in infancy, childhood and adolescence such as:

Mental Retardation

Learning Disorders

Motor skills Disorders

Pervasive Developmental Disorders such as autism

Disruptive Behaviors and Attention Deficit e Disorders

Feeding and Eating Disorders of infancy or Early Childhood

Tic Disorders such as Tourette’s Disorder

Communication Disorders such as Language disorders

Elimination Disorders

Other Disorders of Infancy, Childhood, or Adolescence such as selective mutism

Afterwards we have the adult disorders:

Delirium, Dementia, Amnestic and other Cognitive Disorders

Substance Related Disorders

Schizophrenia and other Psychotic Disorders

Mood Disorders

Anxiety Disorders

Somatoform Disorders

This is a particularly interesting group of disorders with deal with body image, unexplained pain, and physical symptoms such as loss of speech (conversion disorder) and so on.

Factitious Disorders (producing medical symptoms for an imagined illness)

Dissociative Disorders such as dissociative amnesia, or multiple personalities

Sexual and Gender Identity Disorders

Eating Disorders

Sleep Disorders

Impulse Control Disorders Not Elsewhere Classified

Axis II contains the various personality disorders

These first two axes together will include what is considered to be abnormal behavior.

The other three axes are not included into the diagnosis of abnormal behavior but are needed in the assessment.  It is well recognized that environmental factors often influence mental illness. For example, a person suffering from cancer or other medical conditions may become severely depressed.

Axis III

General Medical Conditions

Axis IV

Axis IV takes into consideration the environmental issues and psychosocial issues that could affect a mental disorder.

These issues include:

Problems arising from a support group such as family, Parent-Child etc.

Problems related to the social environment such as lack of friends

Problems concerning education

Problems with job or occupations

Problems with housing

Economic problems

Problems accessing heath care services

Problems with the legal system

Other psychosocial problems

Axis V

This axis is required for the assessment.  The clinician will notate the patient’s current level of functioning.

Having a guideline such as the DSM does not eliminate the possibility of error in assessment but helps to standardize the field, allowing clinicians more opportunity to come up with the same diagnosis.

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Comments (4)
Ranked #3 in Psychology

Your information is well detailed and valuable.Thank you.

Ranked #2 in Psychology

Its a pleasure Roberta

Ranked #17 in Psychology

It'smy pleasure reading and learning from your articles Carol, thank you and have a great day.

Ranked #2 in Psychology

thank you Ron for your support