Table of ContentsView AllTable of ContentsHistoryUsesAxis IAxis IIAxis IIIAxis IVAxis VPitfalls
Table of ContentsView All
View All
Table of Contents
History
Uses
Axis I
Axis II
Axis III
Axis IV
Axis V
Pitfalls
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The DSM has gone through many changes over the years. The shift from the previous version of the manual (DSM-IV) to the most recent version (DSM-5) included a number of significant changes, including the removal of the multi-axial system.
A diagnosis under the fourth edition of this manual, the DSM-IV, had five parts calledAxes. Each Axis of this multi-axial system provided a different type of information about a diagnosis.
The Axes were categorized as such:Axis I: Mental Health andSubstance Use DisordersAxis II: Personality Disorders and Mental Retardation (now Intellectual Development Disorder)Axis III: General Medical ConditionsAxis IV: Psychosocial and Environmental ProblemsAxis V: Global Assessment of Functioning (GAF)
The Axes were categorized as such:
However, the multi-axial system was done away with starting with the DSM-5.
âVerywell / Nusha Ashjaee
History of the Multi-Axial System
The APA instituted the multi-axial system in the third edition of the DSM (DSM-III). The Axes were introduced as a way for clinicians to record additional diagnostic information.
In other words, a person diagnosed with major depressive disorder (found in Axis I) may have additional information added to their diagnosis, say, if they lacked a support system (Axis IV) and they posed a risk to themselves or others (Axis V).
It was determined that there was no scientific basis for dividing the disorders in this manner, so the APA stopped using the multi-axial system, starting with the DSM-5 in 2013.
Uses for the Multi-Axial System
Organizing diagnostic information into the separate Axes was meant to help clinicians more efficiently diagnose patients and collect comprehensive data.
However, there was controversy that surrounded the multi-axial system, including confusion surrounding the distinction between mental health and medical disorders.
Axis I: Mental Health and Substance Use Disorders
Axis I provided information about clinical disorders. Any mental health conditions, other thanpersonality disordersor intellectual development disorders, would have been included here. Disorders which would have fallen under this Axis include:
Changes in the DSM-5
In the DSM-5, the classification of Mental Disorders Due to a General Medical Condition was dropped, as was Factitious Disorders and Adjustment Disorders. This means that conditions listed under those categories were recategorized in the DSM-5. Eating Disorders was renamed to Feeding and Eating Disorders.
In addition, Mood Disorders was broken out into two separate categories:Bipolarand Related Disorders and Depressive Disorders. Sexual and Gender Identity Disorders was revised to Sexual Dysfunctions,Gender Dysphoria, and Paraphilic Disorders.
The following categories were added:
Which Mental Health Conditions Were Axis I Disorders?
Axis II: Personality Disorders and Mental Retardation
Axis II provided information about personality disorders and mental retardation.Disorders which would have fallen under this Axis include:
The categories listed above were kept in the DSM-5 with the exception of Mental Retardation. The DSM-5 changed this toIntellectual Disability.
However, the updated version of the DSM-5, called the DSM-5-TR (text revision), changed Intellectual Disability to Intellectual Development Disorder. Intellectual disability is still included in parentheses for continued use.
Axis III: General Medical Conditions
Axis III provided information about any medical conditions present which might affect a patient’s mental health.
For instance, someone who has cancer and is undergoing chemotherapy may experience mental health issues likeanxietyanddepression. Their cancer would be considered an Axis III condition because it is a health issue that influences mental health.
Any conditions that were previously categorized in Axis III are still documented as mental health concerns in the DSM-5. Clinicians can simply make note of this in order of priority.
Axis IV: Psychosocial and Environmental Problems
Axis IV was used to describe psychosocial and environmental factors affecting the person.Factors which might have been included here were:
Changes in DSM-5
Information from Axis IV is now included in separate notations in the DSM-5. These notations can be added on to diagnoses as needed.
Axis V: Global Assessment of Functioning (GAF)
Axis V was a rating scale called the Global Assessment of Functioning; the GAF went from 0 to 100 and provided a way to summarize in a single number just how adaptively a person was functioning overall.A general outline of this scale would be as follows:
Similar to information previously in Axis IV, information in Axis V is now included in the DSM-5 as separate notations of psychosocial and contextual factors.
Pitfalls of the Multi-Axial System
There were a number of reasons that healthcare professionals found that the multi-axial system was unnecessary.
Many felt that the distinction was arbitrary between diagnoses in Axis I and Axis II. There were concerns that some diagnoses didn’t fit “cleanly” into either category. In addition, there was concern that the GAF (Axis V) didn’t take into accountsuicide riskanddisabilitiesin individual patients.
Overall, healthcare professionals can successfully diagnose patients—and account for the nuances of each person they diagnose—without the use of the multi-axial system.
Changes in the DSM-5-TRThe most recent update to the DSM, theDSM-5-TR (text revision), updated the criteria for more than 70 disorders and added new codes for documenting suicidal behavior and non-suicidal self-injury. It also updated language to avoid confusion and address racial and cultural bias.
Changes in the DSM-5-TR
The most recent update to the DSM, theDSM-5-TR (text revision), updated the criteria for more than 70 disorders and added new codes for documenting suicidal behavior and non-suicidal self-injury. It also updated language to avoid confusion and address racial and cultural bias.
Takeaways
The multi-axial system was previously used as a way to record additional diagnostic information for people with mental health conditions. However, there was a lack of scientific support for this system and it led to confusion for many professionals, which is why it was removed in the fifth edition of the diagnostic manual. While no longer used, understanding how it worked can provide some historical context for how conditions were previously diagnosed and why changes were made in the DSM-5.
List of Psychological Disorders
5 SourcesVerywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, DC; 2013.American Psychiatric Association.Highlights of changes from DSM-IV-TR to DSM-5.Substance Abuse and Mental Health Services Administration.DSM-IV to DSM-5 changes: Overview. DSM-5 changes: implications for child serious emotional disturbance.American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders.5th ed, text revision. Washington, D.C.; 2022.Centers for Disease Control and Prevention.Common feelings after cancer treatment.Additional ReadingKress, VE. et al.The removal of the multiaxial system in theDSM-5: implications and practice suggestions for counselors.The Professional Counselor. 2014;4(3).Substance Abuse and Mental Health Services Administration. DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet]. Rockville (MD):Substance Abuse and Mental Health Services Administration (US); 2016 Jun. 2, DSM-IV to DSM-5 Changes: Overview.American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders. 4th edition. Washington, DC: American Psychiatric Association, 1994.
5 Sources
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, DC; 2013.American Psychiatric Association.Highlights of changes from DSM-IV-TR to DSM-5.Substance Abuse and Mental Health Services Administration.DSM-IV to DSM-5 changes: Overview. DSM-5 changes: implications for child serious emotional disturbance.American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders.5th ed, text revision. Washington, D.C.; 2022.Centers for Disease Control and Prevention.Common feelings after cancer treatment.Additional ReadingKress, VE. et al.The removal of the multiaxial system in theDSM-5: implications and practice suggestions for counselors.The Professional Counselor. 2014;4(3).Substance Abuse and Mental Health Services Administration. DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet]. Rockville (MD):Substance Abuse and Mental Health Services Administration (US); 2016 Jun. 2, DSM-IV to DSM-5 Changes: Overview.American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders. 4th edition. Washington, DC: American Psychiatric Association, 1994.
Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read oureditorial processto learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, DC; 2013.American Psychiatric Association.Highlights of changes from DSM-IV-TR to DSM-5.Substance Abuse and Mental Health Services Administration.DSM-IV to DSM-5 changes: Overview. DSM-5 changes: implications for child serious emotional disturbance.American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders.5th ed, text revision. Washington, D.C.; 2022.Centers for Disease Control and Prevention.Common feelings after cancer treatment.
American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders, 5th ed. Washington, DC; 2013.
American Psychiatric Association.Highlights of changes from DSM-IV-TR to DSM-5.
Substance Abuse and Mental Health Services Administration.DSM-IV to DSM-5 changes: Overview. DSM-5 changes: implications for child serious emotional disturbance.
American Psychiatric Association (APA).Diagnostic and Statistical Manual of Mental Disorders.5th ed, text revision. Washington, D.C.; 2022.
Centers for Disease Control and Prevention.Common feelings after cancer treatment.
Kress, VE. et al.The removal of the multiaxial system in theDSM-5: implications and practice suggestions for counselors.The Professional Counselor. 2014;4(3).Substance Abuse and Mental Health Services Administration. DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet]. Rockville (MD):Substance Abuse and Mental Health Services Administration (US); 2016 Jun. 2, DSM-IV to DSM-5 Changes: Overview.American Psychiatric Association.Diagnostic and Statistical Manual of Mental Disorders. 4th edition. Washington, DC: American Psychiatric Association, 1994.
Kress, VE. et al.The removal of the multiaxial system in theDSM-5: implications and practice suggestions for counselors.The Professional Counselor. 2014;4(3).
Substance Abuse and Mental Health Services Administration. DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet]. Rockville (MD):Substance Abuse and Mental Health Services Administration (US); 2016 Jun. 2, DSM-IV to DSM-5 Changes: Overview.
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