DIAGNOSTIC AND
STATISTICAL MANUAL OF
MENTAL DISORDERS
(DSM-IV-TR)
(DSM-V coming this May)
What do we use it for?
Education
 Diagnosis
 Treatment Planning

Multiaxial Reporting

Assessment that focuses on several
domains that may help a clinician plan
treatment and predict outcomes.

Provides a convenient format for
organizing and communicating clinical
information.

5 Axis areas…
Axis I
Clinical Disorders & Other Conditions That May Be a
Focus of Clinical Attention

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Examples…
Substance-Related Disorders
Mood Disorders
Anxiety Disorders
Schizophrenia and Other Psychotic Disorders
Eating Disorders
Axis II
Personality Disorders & Mental Retardation

Examples…

Paranoid Personality Disorder
Borderline Personality Disorder
Obsessive-Compulsive Personality Disorder
Mental Retardation

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Axis III
General Medical Conditions
Examples…
 Infections & Parasitic Diseases
 Immunity Disorders
 Diseases of the Respiratory System
 Injury and Poisoning

Axis IV
*Used to report problems that may affect the diagnosis, treatment, and
prognosis of mental disorders.
Psychosocial and Environmental Problems
*These problems can develop as a consequence of a
diagnosis
*May be problems that should be considered in treatment
plan

Problems with primary support group
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Death of a family member
Disruption of family by divorce, estrangement
Parental overprotection
Birth of a sibling
Axis IV, cont.

Educational problems
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Economic problems

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Illiteracy
Academic problems
Extreme Poverty
Professional/Job problems

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Unemployment
Stressful work schedule
Axis V
Global Assessment of Functioning
*Used to report clinician’s judgment of an
individual’s level of functioning
*Useful in planning treatment, measuring its
impact, and predicting outcome
GAS Scale
Example Multiaxial Report


Axis I:
296.4 Bipolar 1 Disorder, Mixed, Severe
with Psychotic Features
314.01 Attention-Deficit/Hyperactivity
Disorder, Combined Type
Axis II: 799.9 Diagnosis Deferred (pending gathering
of info)
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Axis III: 343.9 Palsy, cerebral
Axis IV: Psycho-social stressors, early childhood
abuse and neglect, academic difficulties
Axis V: 70
Diagnostic Criteria

There are 2 areas of diagnostic criteria
that must be met for each diagnosis in the
DSM

Inclusion Criteria


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“Must-have” symptoms
Length of time symptoms exhibited
Exclusion Criteria

“Cannot-have” symptoms or related diagnoses
Example Diagnostic Criteria

307.42 Primary Insomnia

Criterion A (inclusion):


Criterion B (inclusion):


Causes clinically significant distress or impairment in
social, occupational, or other important ares of
functioning
Criteria C & D (exclusion):


Nonrestorative sleep that lasts for at least 1 month
Does not occur exclusively during the course of
another sleep disorder (C) or mental disorder (D)
Criterion E (exclusion):

Is not due to the direct physiological effects of a
substance or a general medical condition