From the Research
The DSM-IV-TR utilized a multiaxial system with five axes for comprehensive mental health assessment, including Axis I for clinical disorders, Axis II for personality disorders and intellectual disabilities, Axis III for general medical conditions, Axis IV for psychosocial and environmental problems, and Axis V for the Global Assessment of Functioning (GAF) scale, but this system was discontinued in the DSM-5. The DSM-IV-TR multiaxial system provided clinicians with a structured framework to evaluate multiple aspects of a patient's condition simultaneously, as seen in a study published in the Journal of psychiatric and mental health nursing 1. The axes were defined as follows:
- Axis I: clinical disorders like depression and anxiety disorders
- Axis II: personality disorders and intellectual disabilities
- Axis III: general medical conditions that might affect mental health
- Axis IV: psychosocial and environmental problems such as housing issues or unemployment
- Axis V: the Global Assessment of Functioning (GAF) scale, rating psychological functioning from 0-100 However, the DSM-5 moved to a non-axial documentation approach, combining the former Axes I, II, and III, with separate notations for psychosocial factors and disability, as noted in various studies 2, 3, 4, 5. Some key points to consider when evaluating the DSM-IV-TR multiaxial system include:
- The reliability and validity of the axes, particularly Axis IV, which was evaluated in a study published in the Journal of psychiatric and mental health nursing 1
- The relationship between personality disorders and disability in patients with major depressive disorder, as investigated in a study published in The Israel journal of psychiatry and related sciences 4
- The diagnostic criteria for depressive episode in adults with intellectual disabilities, as reviewed in a study published in the Journal of intellectual disability research 5
- The use of selective serotonin reuptake inhibitors in major depression disorder treatment, as assessed in an umbrella review published in the International journal of psychiatry in clinical practice 3. Overall, the DSM-IV-TR multiaxial system provided a comprehensive framework for mental health assessment, but its discontinuation in the DSM-5 reflects a shift towards a more streamlined and simplified approach to diagnosis.