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AXELE DSM (Diagnostic-and-Statistical-Manual-of-Mental-Disorders)

(Diagnosticul multiaxial)
Axa 1 descrie tulburrile clinice i "alte stri psihice care pot intra n centrul ateniei
clinice". Acestea sunt de obicei probleme care necesit o atenie imediat din partea
unui clinician.
Axa 2 se centreaz pe tulburrile de personalitate i pe evaluarea retardului mintal,
cu ajutorul unei scale specifice. Aceste probleme nu pot solicita asisten imediat,
dar ele pot complica tratamentul i ar trebui luate n considerare de ctre orice
clinician care trateaz un pacient.
Axa 3 eticheteaz orice problem medical general. Acestea sunt importante chiar
i atunci cnd o problem doar pare ca fiind mental sau comportamental, pentru
c, uneori, problemele psihologice sunt produsul secundar al unei boli cum ar fi
diabetul sau bolile de inim.
Axa 4 specific "probleme psihosociale i de mediu", cum ar fi srcia, familiile
disfuncionale, precum i ali factori din mediul pacientului, care ar putea avea un
anumit impact asupra capacitii de funcionare (psihologic, social i profesional)
a persoanei.
Axa 5 este denumit "Scala Evalurii Globale a Funcionrii". Este o evaluare de
ansamblu a capacitii unei persoane de a face fa problemelor vieii normale.
(Funcionarea psihologic, social i profesional este considerat pe un continuum
ipotetic de sntate-maladie mental). Evaluarea merge de la scoruri mici, cum ar fi
10 ("pericol persistent de vtmare grav a sa sau a altora"), pn la 100
("funcionarea superioar ntr-o gam larg de activiti").

Axis I: Clinical Syndromes


This is what we typically think of as the diagnosis (e.g., depression, schizophrenia,
social phobia)

Axis II: Developmental Disorders and Personality Disorders


Developmental disorders include autism and mental retardation, disorders which are
typically first evident in childhood
Personality disorders are clinical syndromes that tend to have longer lasting symptoms
and encompass the individuals way of interacting with the world. They include
Paranoid, Antisocial, and Borderline Personality Disorders.

Axis III: Physical Conditions


which play a role in the development, continuance, or exacerbation of Axis I and II
Disorders
Physical conditions such as brain injury or HIV/AIDS that can result in symptoms of
mental illness are included here.

Axis IV: Severity of Psychosocial Stressors


Events in a persons life, such as death of a loved one, starting a new job, college,
unemployment, and even marriage can impact the disorders listed in Axis I and II.
These events are both listed and rated for this axis.

Axis V: Highest Level of Functioning


On the final axis, the clinician rates the persons level of functioning both at the present
time and the highest level within the previous year. This helps the clinician understand
how the above four axes are affecting the person and what type of changes could be
expected.

Axis I: Clinical Disorders


This is the top-level of the DSM multiaxial system of diagnosis. It represents acute symptoms
that need treatment; Axis I diagnoses are the most familiar and widely recognized (e.g.,
major depressive episode, schizophrenic episode, panic attack). Axis I terms are classified
according to V-codes by the medical industry (primarily for billing and insurance purposes).
Clinical Disorders are grouped into categories listed below with examples of each.

Major Categories of DSM Clinical Disorders


Adjustment Disorders

With Anxiety
With Depressed Mood

With Disturbance of Conduct

With Mixed Anxiety and Depressed Mood

With Mixed Disturbance of Emotions and Conduct

Unspecified.

Anxiety Disorders

Acute Stress Disorder


Agoraphobia
Agoraphobia Without History of Panic Disorder
Anxiety Disorder Due to a General Medical Condition
Anxiety Disorder Not Otherwise Specified (Anxiety Disorder NOS)

Generalized Anxiety Disorder (GAD)


Obsessive-Compulsive Disorder (OCD)
Panic Attack
Panic Disorder With Agoraphobia
Panic Disorder Without Agoraphobia
Posttraumatic Stress Disorder
Social Phobia
Specific Phobia
Substance-Induced Anxiety Disorder

Cognitive Disorders (Delirium, Dementia, and Amnestic).

Amnestic
Delirium
Dementia

Dissociative Disorders.

Depersonalization Disorder

Dissociative Amnesia

Dissociative Fugue

Dissociative Identity Disorder

Dissociative Disorder Not Otherwise Specified (NOS)

Eating Disorders.

Anorexia Nervosa

Bulimia Nervosa
Eating Disorder Not Otherwise Specified (NOS)

Factitious Disorders.

With Combined Psychological and Physical Signs and Symptoms

With Predominantly Physical Signs and Symptoms

With Predominantly Psychological Signs and Symptoms

Impulse-Control Disorders (Not Classified Elsewhere).

Impulse-Control Disorder Not Otherwise Specified (NOS)

Intermittent Explosive Disorder

Kleptomania

Pathological Gambling
Pyromania

Trichotillomania

Mental Disorders Due to a General Medical Condition

Catatonic Disorder Due to a General Medical Condition

Personality Change Due to a General Medical Condition

Mood Disorders

Bipolar I Disorder

Bipolar II Disorder
Bipolar Disorder Not Otherwise Specified (NOS)
Cyclothymic Disorder
Depressive Disorder Not Otherwise Specified (NOS)
Depression (General Overview)
Dysthymic Disorder
Major Depressive Disorder
Mood Disorder Due to a General Medical Condition
Mood Disorder Not Otherwise Specified (NOS)
Substance-Induced Mood Disorder

Schizophrenia and other Psychotic Disorders

Paranoid Type
Disorganized Type
Catatonic Type
Undifferentiated Type
Residual Type
Brief Psychotic Disorder
Delusional Disorder
Psychotic Disorder Due to a General Medical Condition

Psychotic Disorder Not Otherwise Specified

Schizoeffective Disorder

Schizophreniform Disorder

Substance-Induced Psychotic Disorder

Sexual and Gender Identity Disorders.


Paraphilias:

Exhibitionism

Fetishism

Frotteurism

Pedophilia

Sexual Masochism

Sexual Sadism

Transvestic Fetishism

Voyeurism

Paraphilia Not otherwise Specified


Sexual Dysfunction:

Hypoactive Sexual Desire Disorder

Female Orgasmic Disorder (Inhibited Female Orgasm)

Female Sexual Arousal Disorder

Male Erectile Disorder

Male Orgasmic Disorder (Inhibited Male Orgasm)

Premature Ejaculation

Sexual Aversion Disorder

Sexual Dysfunction Due to a General Medical Condition

Substance-Induced Sexual Dysfunction

Sexual Dysfunction Not Otherwise Specified (NOS)


Sexual Pain Disorders:

Dyspareunia (Not Due to a General Medical Condition)

Vaginismus (Not Due to a General Medical Condition)

Sleep Disorders.
Breathing-Related Sleep Disorder

Circadian Rhythm Sleep Disorder

Dyssomnias Not Otherwise Specified. (NOS)

Insomnia Related to Another Mental Disorder

Nightmare Disorder (Dream Anxiety Disorder)

Primary Sleep Disorders:


o

Primary Insomnia

Primary Hypersomnia

Narcolepsy

Sleep Disorder Due to a General Medical Condition

Sleep Disorder Related to Another Mental Disorder

Sleep Terror Disorder

Sleepwalking Disorder

Substance-Induced Sleep Disorder

Somatoform Disorders.

Somatization Disorder

Undifferentiated Somatoform Disorder

Conversion Disorder

Pain Disorder

Hypochondriasis.Body Dysmorphic Disorder

Somatoform Disorder not Otherwise Specified (NOS)

Substance-Related Disorders.

Substance-Induced Anxiety Disorder.


Substance-Induced Mood Disorder.
Substance-Induced Psychotic Disorder.

Substance-Induced Sleep Disorder.

An example of a multiaxial diagnosis


From Edward Pierce, LCSW

Axis I: Major Depressive Disorder, Single Episode, Severe Without Psychotic Features
Axis II: Dependent Personality Disorder; Frequent use of denial
Axis III: None
Axis IV: Threat of job loss
Axis V: GAF = 35 (last year)

DSM Axis II - Personality Disorders and Intellectual disabilities


Axis II is for assessing personality disorders and intellectual disabilities. These disorders are
usually life-long problems that first arise in childhood, distinct from the clinical disorders of Axis
I which are often symptomatic of Axis II. For example, a adult patient might have depression (an
Axis I disorder) that is largely a result of a paranoid personality disorder (an Axis II disorder).
Axis II disorders are accompanied by considerable social stigma because they are suffered by
people who often fail to adapt well to society; Axis II disorders can seem untreatable and be
difficult to pinpoint. It is often disupted whether Axis II disorders are caused primarily by genetic
influences or environmental causes. In fact, it has been suggested that,
"...the diagnosis 'personality disorder' should be replaced by the diagnosis 'adaptation
disorders'. This reflects the real nature of the disorder more accurately, and is likely to reduce
the stigmatizing component of the personality disorder diagnosis as it places emphasis on
positive efforts to improve adaptation. The suggested revisions of the personality disorder
diagnosis and dimensional approach to these disorders are likely to advance treatment and
research - we discuss these aspects in some detail."1
Another indication of the nebulous, difficult to categorize distinguish nature of Axis II disorders is
the categorization of autism. Autism used to be on Axis II but was moved to Axis I. This is
because some cases of autism are transient - they respond well to treatment and/or diminish
over time. Axis II disorders are regarded as more permanent and less responsive to treatment.

Here is a list of some more commonly diagnosed Axis II disorders. Click on each
to learn more.

Antisocial Personality Disorder


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

An example of a Five axis diagnosis


Axis II is only one of five axes used in a DSM assessment. The following is an example of a
multiaxial diagnosis from Edward Pierce, LCSW:

Axis I: Major Depressive Disorder, Single Episode, Severe Without Psychotic Features /
Alcohol Abuse
Axis II: Dependent Personality Disorder Frequent use of denial
Axis III: None
Axis IV: Threat of job loss
Axis V: GAF = 35 (current)

Axis III - General Medical Conditions


Axis III describes physical problems that may be relevant to diagnosing and treating mental
disorders.
For example, a patient with an Axis I diagnosis of mood disorder who also had glaucoma, would
have the glaucoma recorded on Axis III; the pain and increasing blindness of glaucoma could be
a relevant factor influencing depression.
General medical conditions can be regarded in basically three ways. First, as being directly
related to mental disorders; second, as being important to the overall diagnostic picture; third,
as not having a sufficient relationship.

An example of a multiaxial diagnosis


From Edward Pierce, LCSW

Axis I: Mood Disorder Due to Hypothyroidism, With Depressive Features


Axis II: No diagnosis, histrionic features
Axis III: Hypothyroidism, Chronic angle-closure glaucoma
Axis IV: None
Axis V: GAF = 45 (on admission) GAF=65 (current)

Axis IV Psychosocial and Environmental Problems


Axis IV is for, "reporting psychosocial and environmental stressors that may affect the
diagnosis, treatment, and prognosis of mental disorders" (quote from DSM IV).
Axis IV is fairly easy to understand: essentially, it is for recording life events - e.g. marriage, new
job, death of a loved one - that may affect a patient's mental health diagnosis and treatment. For
example, someone with an Axis I diagnosis of depression who had recently lost their job would
ave "jobh loss" or "unemployment" recorded on Axis IV.
Generally, only those stressors from the past 12 months are recorded on Axis IV; clinicians are
encouraged to only list those problems which are relevant to the patient's current situation. In
some cases, severe psychosocial and environmental problems such as sexual abuse may be
part of an Axis I diagnosis.

Axis IV Categories
Axis IV problems are grouped into categories as follows;

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

An example of a multiaxial diagnosis

From Edward Pierce, LCSW


Axis I: Partner Relational Problem
Axis II: No diagnosis
Axis III: None
Axis IV: Unemployment
Axis V: GAF = 83 (last year)

Axis V - Global Assessment of Functioning Scale


Axis V is for Global Assessment of Functioning (GAF), a reflection of the evaluating clinician's
judgement of a patient's ability to function in daily life. The 100 point scale measures
psychological, social and occupational functioning.
From a diagnostic perspective, the GAF takes a practical view of a patient's mental health. GAF
ratings are not only applied to the time the patient enters the doctor's office but are applied over
time to monitor progress; ratings are given for different time frames such as "current" or "past
week" along with relative ratings such as "highest level in past year."
From a healthcare management perspective, the GAF provides quantifiable information that is
used to measure eligibility for treatment programs, insurance benefits, disability benefits, etc.

Range of Axis V GAF ratings


The 100 point scale regardes the top rating level of 91-100 as "superior functioning," which
essentially identifies a person without symptoms.
At the middle of the scale, a rating of 41-50 is for symptoms that lead to antisocial behavior
(kleptomania) or social dysfunction (inability to keep a job).
The bottom of the scale, 1-10, rates those who pose a threat to themselves or others, who
cannot maintain their personal hygiene, or who are suicidal - these patients are mostly
dysfunctional on a daily basis and in need of serious help.

An example of a Five axis diagnosis

Axis V is only one of five axes used in a DSM assessment. Here is an example of a five-axis
diagnosis from Substance Abuse Assessment and Diagnosis: A Comprehensive Guide for
Counselors and Helping Professionals by Gerald A. Juhnke, Routledge, 2002
Axis I: Adjustment Disorder with Depressed Mood, Alcohol Abuse, Cannabis Abuse
Axis II: No Diagnosis of Axis II
Axis III: Hypothyroidism
Axis IV: None
Axis V: GAF = 50 (on admission), GAF = 62 (on discharge)