Use And Application
The DSM establishes diagnoses along five axes. These axes are as follows:
Axis I: Clinical disorders
Axis II: Personality disorders and mental retardation
Axis III: General medical conditions
Axis IV: Psychosocial environmental problems (rated with descriptive categories, such as economic problems associated with job loss)
Axis V: Global assessment of functioning (rated from 1 [persistent danger to self or others] to 100 [superior functioning in a wide range of activities])
The axis that has received the most attention has been axis I. This axis is composed of the following categories: schizophrenia and other psychotic disorders, mood disorders, anxiety disorders, somatoform disorders, disorders usually first diagnosed in childhood, eating disorders, delirium, dementia, amnestic and other cognitive disorders, factitious disorders, dissociative disorders, sleep disorders, impulse control disorders, and adjustment disorders. These categories of disorders have enjoyed high reliability.
Recently, researchers have turned their attention to axis II, particularly the personality disorders. The personality disorders are currently classified into three The Diagnostic and Statistical Manual of Mental Disorders (DSM) is a compendium of all the known forms of psychopathology published by the American Psychiatric Association. Currently in its fourth edition, the DSM is utilized in both research and mental health settings for the purposes of reliably identifying psychological disorders and providing information to third-party payers.
Beginning with the third edition, the DSM has been organized atheoretically. That is, each disorder has a set of objectively identified symptoms that would allow diagnostic identification by clinicians with diverse theoretical backgrounds. This stands in contrast to prior editions, which were based on a psychodynamic interpretation of each diagnosis. The change to an atheoretical approach to diagnosis has allowed for greater reliability between raters who use this guide for establishing the presence of psychopathology.
broad areas, or clusters, as follows: cluster A, odd and eccentric (paranoid, schizoid, and schizotypal); cluster B, expressive/labile (antisocial, borderline, histrionic, and narcissistic); and cluster C, anxious (avoidant, dependent, and obsessive-compulsive). Placing personality disorders on a separate axis from other axis I disorders serves two functions. Principally, it serves as a guide for diagnosticians to consider whether a personality disorder is present in addition to any axis I disorders. Second, it underscores the chronic and inflexible nature of this class of disorders.
Axis III accounts for medical conditions that may influence treatment outcome or for which psychological factors may play a role in their ongoing presence. For example, the absence of menstruation may have implications for the diagnosis and treatment of an eating disorder.
Axis IV accounts for environmental problems. This may represent areas that can limit the effectiveness of treatment for disorders on the previous three axes. For example, treatment of an anxiety disorder would be complicated in an individual who has recently lost his or her job and suffers economic stress in addition to the presenting disorder.
Axis V presents a global numerical assessment intended to represent the overall functioning level of the client or patient. In typical use, this axis is rated for the functioning level at the time of diagnosis, as well as for the highest level estimated for the year prior to evaluative contact.
The DSM represents, in a single detailed document, a way for the diversity of mental health providers and researchers to communicate with one another regarding the nature of various psychological problems. Moreover, the atheoretical approach to diagnosis circumvents barriers to communication among mental health professionals who have varied theoretical backgrounds.
- American Psychiatric (2000). Diagnostic and statistical manual of mental disorders (4th ed., text revision). Washington, DC: Author.
- Online Psychological Services, http://www.psychologynet.org/dsm.html
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