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The Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition™ (DSM IV) is the manual physicians, psychiatrist, psychologists, therapists, and social workers use in order to diagnose mental illness. This manual spells out the specific diagnostic criteria. An example of this can be seen in the diagnosis of a major depressive episode. A person must exhibit at least five or more of the listed nine characteristics and the symptoms must be evident for at least the last two weeks for that person to be diagnosed with this disorder. When diagnosing a client the American Psychological Association recommends that the clinician use a multiaxial Assessment System. As follows:

Axis I Clinical Disorders
Axis II Personality Disorders and Mental Retardation
Axis III General Medical Condition
Axis IV Psychosocial and Environmental Factors
Axis V Global Assessment of Functioning

Axis I includes all the mental health conditions except personality disorders and mental retardation. If the client does not have a mental health diagnosis that belongs on Axis I, V71.09 is placed in the diagnosis spot to show there is no diagnosis. A person could suffer from more than one Axis I disorders and all are listed. Axis II is for reporting Mental Retardation and personality disorders. Axis III is used for reporting any major medical conditions that may be relevant to treatment of the mental health disorder. Axis IV is used to report psychosocial and environmental factors affecting the person. Some of examples of these factors include: (1) problems with primary support group (divorce); (2) problems with social environment (death of a friend); (3) educational problems; (4) housing problems; (5) economic problems; (6) occupational difficulties; (7) legal difficulties; and (8) transportation difficulties. These are some categories a clinician will look at to see how the client is doing in life situations. And Axis V, Global Assessment of Functioning, is the clinicians best guess of the client’s overall level of functioning. For example you would not expect a depressed severely retarded client to keep an elaborate journal of his feelings. An example of what a typical diagnostic assessment might be helpful.

Axis I 296.21 Major Depressive Disorder , Single Episode
Axis I 303.90 Alcohol Dependence
Axis II 301.6 Dependent Personality Disorder
Axis III None
Axis IV Recent Divorce, unemployment
Axis V 58