Axis I Clinical Disorders
Other Conditions That May Be a Focus of Clinical Attention
Axis II Personality Disorders
Mental Retardation
Axis m General Medical Conditions
Axis IV Psychosocial and Environmental Problems
Axis V Global Assessment of Functioning
Appendix 4.5
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Brief explanation of a 5 Axis Diagnosis from Mental-Health-Matters website.
For further information on mental health disorders, refer to the DSM-IV or find many good resources available free from the National Institute of Mental Health website at http://www.nimh.nih.gov/. 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:
• Disorders usually diagnosed in infancy, childhood or adolescence (Autism,
ADHD, Etc.)
• Delerium, dementia and other cognitive disorders (Dementias, Alzheimer's
Disease, etc.)
• Mental disorders due to a general medical condition
• Substance-related disorders (such as alcohol or drugs)
• Schizophrenia and other psychotic disorders
• Mood disorders (Depression, Bipolar)
• Anxiety disorders
• Somatoform disorders (Conversion Disorder, Hypochondriasis, etc.)
• Factitious disorders
• Dissociative disorders (Dissociative Identity Disorder, etc.)
• Sexual and gender identity disorders
• Eating disorders (Anorexia, Bulimia, etc.)
• Sleep disorders (Insomnia, Sleep Terrors, etc.)
• Impulse-control disorders (Intermittent Explosive Disorder, Kleptomania, etc.)
• Adjustment disorders
Axis II: Personality Disorders and Mental Retardation Appendix 4.5
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Examples:
• Paranoid personality disorder
• Borderline personality disorder
• Antisocial personality disorder
• Dependent personality disorder
• 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 Appendix 4.5
Page 3 of 3 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