The Five Axes of DSM-IV

To diagnose and describe a patient using DSM-IV, a clinician rates the patient on five dimensions or axes. (Axes is the plural of axis and is pronounced AK-seez.)

What are the five axes of DSM-IV?

Axis 1 describes clinical disorders and "other conditions which may be a focus of clinical attention." These are typically problems that require immediate attention from a clinician.

Axis 2 focuses on personality disorders and contains a rating scale for mental retardation. These problems may not require immediate care, but they can complicate treatment and should be taken into account by any clinician who treats a patient.

Axis 3 labels any general medical conditions. These are important even when a problem seems to be mental or behavioral, because sometimes psychological problems are the byproduct of an illness such as diabetes or heart disease.

Axis 4 specifies "psychosocial and environmental problems" such as poverty, dysfunctional families, and other factors in the patient's environment that might have some impact on the person's ability to function.

Axis 5 is labeled the "Global Assessment of Functioning Scale." It is an overall rating of a person's ability to cope with normal life. The rating goes from low scores such as 10 ("Persistent danger of severely hurting self or others") to 100 ("Superior functioning in a wide range of activities").

What is a major advantage of DSM-IV?

In addition to encouraging a comprehensive evaluation, DSM-IV provides a standardized format for exchanging clinical descriptions with other health care professionals. DSM-IV provides a way for psychiatrists, psychologists, and other mental health care workers to communicate in a common language that all can understand.

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