Abnormal Psychology

80 CHAPTER 3

the criteria were not changed, but the text discussion of the disorders was

revised. DSM-IV and DSM-IV-TR defi ne 17 major categories of psychologi-

cal problems, listed in Table 3.1, and nearly 300 specifi c men-

tal disorders—almost triple the number in DSM-III. As work

progresses on the fi fth edition of DSM, some researchers and

clinicians support the inclusion of additional disor ders, such as

“Internet addiction” (Block, 2008) and “night eating syndrome”

(Stunkard, Allison, & Lundgren, 2008).

DSM-III introduced fi ve axes(which is why it is called mul-

tiaxial), each of which delineates specifi c kinds of information to

be noted about a patient. These axes are still included in DSM-

IV-TR (see Table 3.2), and they may be used for diagnosing a

patient, for planning treatment, for prognosis, or for research

purposes. In addition to these axes, an appendix in DSM-IV-

TR outlines aspects of the cultural context that clinicians should

consider when making a diagnosis for a particular patient.

The fi rst two axes specify the diagnosed disorders. Disorders

listed on Axis I include most of the disorders in DSM-IV-TR and

in this book, such as social phobia and bulimia nervosa. If an

individual has comorbid Axis I disorders, all of the disorders are

listed. For instance, if an individual has both social phobia and

bulimia nervosa, both disorders would be listed on Axis I.

Disorders listed on Axis II include mental retardation and personality

disorders—personality traits that are so infl exible and self-defeating that they impair

functioning (discussed in detail in Chapter 13). The authors of DSM-III’s multiaxial

system believed that the presence of mental retardation or a personality disorder in

a patient could signifi cantly affect the expression of symptoms of other disorders—

those on Axis I. Having a separate axis—Axis II—to specify such disorders ensures

that these types of symptoms receive special attention. For example, suppose that

a man who has moderate mental retardation lately seems to be “not himself”—

he’s been crying often, but when asked why, he says he doesn’t know. His mental

retardation makes it diffi cult for him to express himself well. The clinician diagnos-

ing the man would need to determine how his mental retardation affects the way

he expresses symptoms of a comorbid psychological disorder, such as depression

or anxiety. Moreover, the presence of mental retardation may indicate that certain

treatments would be more appropriate than others.

On Axis III, mental health clinicians or researchers list any physical disorders

or disabilities that might be relevant to the disorders on Axis I or II. For instance, an

elderly woman with poor eyesight who recently suffered a hip fracture after a fall

may now feel so anxious about leaving home that she has panic attacks—episodes

of extreme fear, terror, or dread. In order to diagnose and treat this woman’s prob-

lems appropriately, a clinician would need to know about both her visual problems

and her recent hip fracture; both medical problems would be noted on Axis III.

The first three axes focus on current psychological and medical disorders.

Axis IV focuses on the wider context of the disorder: social and environmental

problems that could affect the diagnosis, treatment, and prognosis of a disorder.

Knowing that a depressed patient’s mother recently died, for instance, may infl u-

ence both the diagnosis and recommended treatment, if any. Social problems that

affect a person’s psychological state are often called psychosocial problems. Such

psychosocial and environmental problems include (American Psychiatric Associa-

tion, 2000, pp. 31–32):

1. problems with the person’s primary support group (e.g., marital confl ict or
   divorce, or some type of maltreatment);


2. problems with the social environment (e.g., the death of a friend or discrimination);


3. educational problems (e.g., academic problems or diffi culties with a teacher);

Axis I: Clinical Disorders

Axis II: Personality Disorders and Mental

Retardation

Axis III: General Medical Conditions

Axis IV: Psychosocial and Environmental

Problems

Axis V: Global Assessment of Functioning

Source: Reprinted with permission from the Diagnostic

and Statistical Manual of Mental Disorders, Text

Revision, Fourth Edition, (Copyright 2000) American

Psychiatric Association.

Table 3.2 • The Fives Axes of

DSM-IV-TR

cal

tal

pro

clin

“In

(Stu

tiax

be

IV-

pat

pur

TR

con

list

int

ind

list

Adjustment Disorders

CHAPTER 7 Anxiety Disorders

Delirium, Dementia, and Amnestic and Other Cognitive Disorders

Disorders Usually First Diagnosed in Infancy, Childhood, or Adolescence

Dissociative Disorders

Eating Disorders

Factitious Disorders

Impulse-Control Disorders

Mental Disorders Due to a General Medical Condition

Mood Disorders

Other Conditions That May Be a Focus of Clinical Attention

Personality Disorders

Schizophrenia and Other Psychotic Disorders

Sexual and Gender Identity Disorders

Sleep Disorders

Somatoform Disorders

Substance-Related Disorders

Source: Reprinted with permission from the Diagnostic and Statistical Manual of Mental

Disorders, Text Revision, Fourth Edition, (Copyright 2000) American Psychiatric Association.

Table 3.1 • The 17 Categories of Psychological

Disorders in DSM-IV-TR