Diagnosis jargon: Axis I–V and DSM-IV and -V
My previous blog post mentioned Global Assessment of Functioning (GAF), which is one component of a psychiatric diagnosis. This seems like a good time to talk about the other parts of the standard documentation for diagnoses.
Over the years we received written diagnostic evaluations of Nathan from different professionals, but none of them offered an explanation of the mysterious-looking lists with five axes. The second or third time “Axis I – Axis V” showed up as part of the documentation, I decided it was time to learn a little about the “multi-axial system” on my own.
The axis system originates from the Diagnostic and Statistical Manual of Mental Disorders (DSM). Much of what follows is extracted from the Wikipedia article on the DSM. Published by the American Psychiatric Association, the DSM provides standard criteria for the classification of mental disorders. It is used by clinicians, health insurance companies, and policymakers, among others. The first DSM came out in 1952. DSM-IV was released in 1994, and the text revision (DSM-IV-TR) that came out in the year 2000 is the current version. DSM-V will be released in May 2013 (more about that in a minute).
Now, regarding those axes: DSM-IV organizes the overall diagnosis an individual might receive into five dimensions, or axes. Each axis corresponds to different aspects of disorder or disability.
Axis I covers all diagnostic categories except mental retardation and personality disorder. This is where you’ll see autism, bipolar disorder, ADHD, depression, anxiety disorder, schizophrenia, and others.
[By the way, on the paperwork you receive, each individual diagnosis may have a number after it. This number is part of what’s known as the ICD-9, like the coding system you also see on medical forms. For example, “Bipolar 1 disorder, single manic episode, mild” has a code of 296.01, while “Bipolar 1 disorder, most recent episode (or current) manic, moderate” is 296.42. And, to make things even more complicated, it looks like there is an ICD-10 out now. What was 296.01 in ICD-9 is now known as F30.11 in ICD-10. (People in the medical and health insurance professions must get a lot of headaches dealing with this!)]
Axis II covers personality disorders and mental retardation. Things like paranoia, OCD, narcissism, and antisocial personality disorders will show up here. In the past this axis included developmental disabilities such as autism, but at some point, those were moved to Axis I. (This explains why one of Nathan’s evaluations lists Asperger’s on Axis II, while on another it shows up on Axis I.)
Axis III covers medical conditions and physical disorders. This was included in case a chronic or severe disease or condition impacts the patient’s mental health, or leads to symptoms similar to those of a psychiatric condition. Brain injuries are noted here also.
Axis IV covers psychosocial or environmental factors contributing to the disorder. This might include having been in combat, coming from an abusive home, being homeless, etc.
Axis V is where Global Assessment of Functioning fits in. I see that for patients under the age of 18, the Children’s Global Assessment Scale (CGAS) is used. It seems to be the same basic idea as the GAF.
Do we all understand the multi-axial system now? Too bad, because the DSM-V, coming out in two months, is doing away with it! According to John Grohol, PsyD, writing at PsychCentral, clinicians never fully embraced all those axes. They mostly focused on Axes I and II. So now, the diagnosis will be documented by combining what used to be listed in Axes I, II, and III, with separate notations for what used to appear under Axes IV and V. Sounds like it’ll be the same information, just in a different format.
What is more controversial are the changes in DSM-V involving the diagnoses themselves. New diagnoses may be viewed by some observers as bogus (or better dealt with under a broader umbrella), while the removal of others upsets the people who have been given those diagnoses and whose health insurance may no longer cover the costs of treatment.
Here are some of the changes that may be of particular interest for Cinder Cone readers. From what I gather, DSM-V has a section (Section 3) for disorders needing more research before they can be considered valid diagnoses. New to Section 3 are “Internet use gaming disorder” and “Non-suicidal self-injury,” among others. “Sensory processing disorder” was considered for inclusion in DSM-V but was rejected.
You may have heard some rumblings about Asperger’s Syndrome no longer being included in the DSM. As Dr. Grohol explains in another post titled “Has Asperger’s Gone Away?,” it really is still there, but has been put under the broader category of “autism spectrum disorder.” And, Dr. Grohol concludes by noting that although the Asperger’s label is going away, treatment for individuals with Asperger’s should continue to be covered by health insurance.
Comments, corrections, or updates on the information presented above (since I am SO not the expert) are welcomed.