|Assessment and Diagnosis (cont'd)|
When you make a complete diagnosis according to the
DSM-IV, you are asked to fill in information on 5 "axes." (This word is
the plural of axis, not to be confused with the plural of axe.) Each "axis"
is really an area of information in which information should be provided.
The process of assessment is designed to collect the information that is
needed on each axis. The five axes are listed in the table below.
|Axis I:||Clinical Disorders|
|Axis II:||Personality Disorders
|Axis III:||General Medical Conditions which may be related to Axis I and Axis II conditions|
|Axis IV:||Psychosocial and Environmental Problems (Current and Recent Stressors)|
|Axis V:||Global Assessment of Functioning (GAF)|
|Highest GAF in the past year|
Axes I and II are where you put information about the psychological diagnoses the person might have. (A person may have more than one disorder, and may have disorders that are listed on both Axes I and II.) Almost ALL psychological diagnoses are listed on Axis I. The only disorders that are listed on Axis II are mental retardation and personality disorders, if present. (A personality disorder is one of a specific group of disorders that are characterized by long-lasting (typically lifelong), maladaptive patterns of thought and behavior that cause distress for the person and for those around him or her.) Conceptually, the Axis II disorders are separated out because they are "lifelong" disorders. However, some of the Axis I disorders (e.g., schizophrenia, autism) may be equally persistent, so this distinction is somewhat artificial. Information related to Axis I and Axis II diagnoses may be obtained as part of the clinical interview or from results of specialized psychological tests.
Axis III is where you enter information about general medical conditions that may be related to the psychological disorders listed on Axes I and II. For example, if a person is depressed because she has terminal cancer, the depression would be listed on Axis I, and the cancer would be listed on Axis III. Remember that psychologists are not physicians, and they do not directly obtain medical information. Generally, a psychologist will obtain information relevant to Axis III from the patient at interview. In some settings where physicians and psychologists work together closely, physicians may provide relevant information directly to psychologists.
Axis IV is where you enter information related to current and recent stressors in the person's life. For example, if a patient has recently lost his job, the job loss would be entered on Axis IV. Other common stressors include (but are not limited to) work or academic pressure, marital difficulties, death of a parent, spouse, or child. Information relevant to Axis IV is usually obtained from the patient as part of the clinical interview.
Axis V is where you enter your impression of the patient's overall level of functioning. Overall level of functioning is measured by matching up your information about the patient's overall level of functioning with descriptions on the Global Assessment of Functioning (GAF) Scale. The information used to make this judgment is obtained from the interview with the patient, and sometimes from results of psychological testing. Remember that most people that decide to seek treatment for psychological problems will not be rated at the top of the GAF scale. However, sometimes it is useful to have a basis of comparison between the current GAF and the GAF at times when the patient was functioning better. Therefore, clinicians often try to figure out what the highest GAF within the past year would have been, based on information available from the interview with the patient. A reasonable goal of psychotherapy would be to restore the patient's functioning to at least the highest level of functioning achieved within the last year. The GAF Scale is summarized below.
Global Assessment of Functioning (GAF) Scale (DSM - IV Axis V)
Note: This version of the GAF scale is intended for academic use only. Although it is based on the clinical scale presented in the DSM - IV, this summary lacks the detail and specificity of the original document. The complete GAF scale on page 32 of the DSM - IV should be consulted for clinical use.
|Code||Description of Functioning|
|91 - 100||Person has no problems OR has superior functioning in several areas OR is admired and sought after by others due to positive qualities|
|81 - 90||Person has few or no symptoms. Good functioning in several areas. No more than "everyday" problems or concerns.|
|71 - 80||Person has symptoms/problems, but they are temporary, expectable reactions to stressors. There is no more than slight impairment in any area of psychological functioning.|
|61 - 70||Mild symptoms in one area OR difficulty in one of the following: social, occupational, or school functioning. BUT, the person is generally functioning pretty well and has some meaningful interpersonal relationships.|
|51 - 60||Moderate symptoms OR moderate difficulty in one of the following: social, occupational, or school functioning.|
|41 - 50||Serious symptoms OR serious impairment in one of the following: social, occupational, or school functioning.|
|31 - 40||Some impairment in reality testing OR impairment in speech and communication OR serious impairment in several of the following: occupational or school functioning, interpersonal relationships, judgment, thinking, or mood.|
|21 - 30||Presence of hallucinations or delusions which influence behavior OR serious impairment in ability to communicate with others OR serious impairment in judgment OR inability to function in almost all areas.|
|11 - 20||There is some danger of harm to self or others OR occasional failure to maintain personal hygiene OR the person is virtually unable to communicate with others due to being incoherent or mute.|
|1 - 10||Persistent danger of harming self or others OR persistent inability to maintain personal hygiene OR person has made a serious attempt at suicide.|
This page was last updated on Tuesday June 10, 2008.