DSM IV-TR: Multiaxial Classification
Descriptive Approach: atheoretical with regard to causes.
Diagnostic Criteria: are provided for each specific mental disorder. These criteria
include a list of features that must be present for the diagnosis to be made (increases the
reliability of the process of diagnosis).
Systematic Description: systematically describes each disorder in terms of its associated
features: specific age-, culture-, and gender-related features; prevalence, incidence, and
risk; course; complications; predisposing factors; familial pattern; and differential
Diagnostic Uncertainties: DSM IV TR provides explicit rules to be used when the
information is insufficient (diagnosis to be deferred or provisional) or the patient’s
clinical presentation and history do not meet the full criteria of a prototypical category
(an atypical, residual, or not otherwise specified type within the general category).
Axis I and II make up the entire classification of mental disorder : 17 major
classifications and more than 300 specific disorders.
In many instances, patients have a disorder on both axes.
Axis I: consists of clinical disorders and other conditions that may be a focus of clinical
Axis II: consists of personality disorders and mental retardation. The habitual use of a
particular defense mechanism can be indicated on Axis II.
Axis III: lists any physical disorder or general medical condition that is present in
addition to the mental disorder. The physical condition may be causative (ie. Kidney
failure causing delirium), the result of a mental disorder (ie. Alcohol gastritis secondary
to alcohol dependence), or unrelated to the mental disorder. When a medical condition is
causative or causally related to a mental disorder, a mental disorder due to a general
condition is listed on Axis I, and the general medical condition is listed on both Axis I
and Axis III.
Axis IV: is used to code the psychosocial and environmental problems that contribute
significantly to the development or exacerbation of the current disorder. The evaluation
of stressors is based on a clinician’s assessment of the stress that an average person with
similar sociocultural values and circumstances would experience from the psychosocial
stressors. This judgment is based on the amount of change that the stressor causes in the
person’s life, the degree to which the event is desired and under the person’s control, and
the number of stressors. Stressors maybe positive (job promotion) or negative (loss of a
loved one). Information about stressors may be important in formulating a treatment plan
that includes attempts to remove the psychosocial stressors or to help the patient cope
Axis V: a global assessment of functioning (GAF Scale) in which clinicians judge
patients’ overall levels of functioning during a particular time (ie. At the time of the
evaluation or the patient’s highest level of functioning or at least a few months during the
past year). Functioning is considered a composite of three major areas: social functioning,
occupational functioning, and psychological functioning. The GAF scale, based on a
continuum of mental health and mental illness, is a 100-point scale, 100 representing the
highest level of functioning in all areas. Persons who had a high level of functioning
before an episode of illness generally have a better prognosis than do those who had a
low level of functioning.
Rating Scales used in DSM-IV-TR
The rating scales used are broad and measure the overall severity of a patient’s illness.
GAF Scale: used to report the clinician’s judgment of a patient’s overall level of
functioning. The information is used to decide on a treatment plan and later to measure
the plan’s effectiveness. (provides a baseline for comparative analysis)
Social and Occupational functioning assessment scale: This scale can be used to track
a patient’s progress in social and occupational areas. It is independent of the psychiatric
diagnosis and the severity of the patient’s psychological symptoms.
Other scales: two other scales that may be useful are the Global Assessment of
Relational Functioning (GARF) Scale and the Defensive Functioning Scale.
Indicating Severity of a Disorder
Mild—the client has few symptoms other than the minimum criteria needed.
Moderate—Intermediate between mild and severe
Severe—the client has many more symptoms than the minimum criteria specify, or some
symptoms are especially severe, or functioning in society or at work is especially
In Partial Remission—the client previously met full criteria for the diagnosis; although
some of them now remain, they are too few to fulfill criteria currently.
In Full Remission—the client has been symptom-free for a period of time that seems
clinically relevant to the diagnosis.
Prior History—the client appears to have recovered from the disorder, but you feel that
it is important to mention it.