Demystifying The Diagnosis

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When we receive a psychiatric or psychological diagnosis, we often hear “You have Depression” or a similar statement. What we don’t hear is the rest of the diagnosis.

The diagnosis that is made is standardized according the Diagnostic and Statistical Manual of Mental Disorders, 4th edition (DSM-IV). With this manual, there is a 5 Axis system of diagnosis that is used. The five axes are as follows:

Axis I: Clinical Disorders

This includes:

  • Disorders usually diagnosed in infancy, childhood or adolescence (Autism, ADHD, Etc.)
  • Delerium, dementia and other cognitive disorders (Dementias, Alzheimer’s Disease, etc.)
  • Mental disorders due to a general medical condition
  • Substance-related disorders (such as alcohol or drugs)
  • Schizophrenia and other psychotic disorders
  • Mood disorders (Depression, Bipolar)
  • Anxiety disorders
  • Somatoform disorders (Conversion Disorder, Hypochondriasis, etc.)
  • Factitious disorders
  • Dissociative disorders (Dissociative Identity Disorder, etc.)
  • Sexual and gender identity disorders
  • Eating disorders (Anorexia, Bulimia, etc.)
  • Sleep disorders (Insomnia, Sleep Terrors, etc.)
  • Impulse-control disorders (Intermittent Explosive Disorder, Kleptomania, etc.)
  • Adjustment disorders

Axis II: Personality Disorders and Mental Retardation

Examples:

  • Paranoid personality disorder
  • Borderline personality disorder
  • Antisocial personality disorder
  • Dependent personality disorder
  • Mental retardation

Axis III: General Medical Condition

Listed here are general medical (physical) concerns that may have a bearing on understanding the client’s mental disorder, or in the management of the client’s mental disorder

Axis IV: Psychosocial and Environmental Problems

  • Problems with the primary support group (divorce, abuse, deaths, births, etc.)
  • Problems related to social environment (retirement, living alone/friendships, etc.)
  • Educational problems (illiteracy, academic problems, conflict with teachers, etc.)
  • Occupational problems (unemployment, difficult work conditions, job dissatisfaction, etc.)
  • Housing problems (homelessness, unsafe neighborhood, problems with neighbors, etc.)
  • Economic problems (poverty, insufficient finances, etc.)
  • Problems with access to health care services (inadequate health care, transportation to health care, health insurance, etc.)
  • Problems related to interaction with the legal system/crime (arrest, incarceration, or victim of crime, etc.)
  • Other psychosocial and environmental problems (Disasters, problems with health care providers, etc.)

Axis V: Global Assessment of Functioning

This is a number from 1-100 that reflects the caregiver’s judgment of the overt level of functioning. A general outline of the levels is:

100: No symptoms
90: Minimal symptoms, 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

We hope this helps to explain why some of those questions seem like they have nothing to do with “what is wrong” with us when they ask them. They really are for a reason. When taken all together, these 5 Axes comprise a complete diagnosis. When you hear “You have depression”, there really is much more that goes into what is behind that statement. And when they formulate your care plan for treating you, they have a large database about you with which to treat you, all for your benefit.

Derek Wood is a Nationally Board Certified Psychiatric/Mental Health Nurse, and holds a Master's degree in Psychology. His experience in the online arena of mental health can be traced back to 1997, when he was a host for Online Psych on AOL. He joined Get Mental Help, Inc. as Clinical Content Director for Mental Health Matters. Derek, with his wife Lisa, developed the original version of psychTracker (then called A Mood Journal), after his diagnosis with Schizo-Affective Bipolar, when they could not find a system available that was robust enough to help him effectively manage his symptoms and accurately interpret his charting. Derek has worked in the field of mental health since 2001, as a Unit Manager of an adult long-term treatment facility, a charge nurse in an adolescent short-term inpatient facility and long-term residential facility, and as a School Psychologist. He has also written several articles which are being used as CEU for nurses and educators.
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