Axis IV in the DSM: Disorders, Diagnosis & Examples

Lesson Transcript
Instructor: Yolanda Williams

Yolanda has taught college Psychology and Ethics, and has a doctorate of philosophy in counselor education and supervision.

The Axis IV in the DSM-IV refers to environmental and psychosocial factors around an individual. Discover the five axes of the DSM-IV, take a closer look at the categories in the Axis IV through some examples, and learn about environmental and psychosocial factors and how they are related to the treatment and diagnosis of mental disorders. Updated: 09/06/2021

An Example of the Axis Scale

Imagine that you are a clinician, and a 50-year-old male client walks into your office and reports feeling extremely sad and empty for the past month. He also says that he spends most of the day in his room crying and has no interest in any activities. You may immediately think he's experiencing symptoms of depression and consider diagnosing him with major depressive disorder; however, you find out that the client's wife of 30 years died one month ago, right around the time the client's symptoms started. Since the client's symptoms can be accounted for by the normal grieving process associated with losing a spouse, he no longer qualifies for a diagnosis of major depressive disorder, which is an Axis I disorder. Instead, you record death of spouse, which is an Axis IV disorder.

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  • 0:00 An Example of The Axis Scale
  • 0:45 The Five Axes of The DSM
  • 1:50 Environmental &…
  • 3:55 Categories & Examples
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The Five Axes of the DSM

Please note that the DSM-V no longer uses the five-axis system of the DSM-IV. However, an understanding of the axes provides useful context to the current non-axial diagnostic practices of the DSM-V.

The fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM) was used by psychologists and other mental health professionals throughout the United States to assist with the classification and diagnosis of mental health disorders.

The DSM-IV categorizes disorders according to the following five axes:

  • Axis I: Clinical disorders, such as panic disorder and bipolar disorder
  • Axis II: Personality disorders and mental retardation, including narcissistic personality disorder and avoidant personality disorder
  • Axis III: General medical conditions, including cystic fibrosis and glaucoma, which can result in mental health issues
  • Axis IV: Environmental and psychosocial factors, including unemployment and sexual abuse, which can result in mental health issues
  • Axis V: Global Assessment of Functioning - a numerical scale that ranges from 0 to 100 and is used to indicate at what level the client is functioning

Axis IV: Environmental and Psychosocial Factors

Environmental and psychosocial factors are negative life events and difficulties that may affect a client's mental health. Such factors are important to the understanding, treatment and diagnosis of mental disorders, and these factors can also affect the client's prognosis.

In the example above, the client reported symptoms of major depressive disorder; however, there is a bereavement exclusion that states that major depressive disorder should not be diagnosed in individuals who have lost a loved one in the past two months. Without knowing that the client had recently lost a loved one, you might have diagnosed him with a major depressive disorder, even though what he is experiencing is a typical reaction to the death of a spouse. By understanding the relationship between the client's grief and depressive symptoms, you can assist your client in finding healthy ways to cope with the loss of his wife instead of prescribing him antidepressants that he does not need.

Environmental and psychosocial factors don't always appear before the mental illness, as in the example above. These factors can also be a consequence of the client's mental disorder. For example, a person with schizophrenia could hear voices telling him not go to work or else he will die. As a result, the person may stop going to work, and, in this case, the unemployment is a direct result of the auditory hallucinations that accompany schizophrenia.

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