Multiaxial Classification

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.
 

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.

This page was last updated on Tuesday June 10, 2008.