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:

Axis II: Personality Disorders and 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.