Classification 29Table 2.2The multi-axial schemes of ICD-10 and DSM-IV
ICD-10 axis DSM-IV axis What this axis covers
1 I Psychiatric disorder, for example, separation anxiety disorder
2 I Specific delays in development, for example, reading disorder
3 II Intellectual level, for example, mild intellectual disability
4 III Medical conditions, for example, epilepsy
5 IV Psychosocial adversity, for example, institutional upbringing
6 V Adaptive functioning, for example, serious social disability
classification set out in Table 2.1: early-onset schizophrenia, anorexia
nervosa, disinhibited attachment disorder, Tourette syndrome, and many
others. In addition, child mental health professionals may spend much of
their time on tasks that do not necessarily involve a psychiatric disorder.
This is often the case, for example, when assessing dysfunctional families,
juvenile offenders, or the victims of abuse.
Multiaxial diagnosis
Diagnostic labels are a useful aid to clinical and research work, allowing
similar cases to be grouped together. Sometimes, however, being forced
to settle on just one label is too restricting. Should this patient be labelled
as having autism or an intellectual disability? Often it will be essential to
record both. This idea has been taken further in the multiaxial assessment
that is an optional part of DSM-IV, and by the multiaxial version of ICD-
- In these multiaxial schemes, each axis reflects one important aspect of
a child or adolescent’s presentation (see Table 2.2).
Though many people would regard five or six axes as rather too much
of a good thing, the scheme does have advantages. For instance, it is
not necessary to decide whether a child has conduct disorder, specific
reading disorder or intellectual disability; if the child has all three, each
can be coded. Equally, it is not necessary to decide if one or more of these
problems is due to the child’s epilepsy or institutional upbringing: these are
coded whether or not they seem to be causes (thereby capturing data that
can eventually be used to explore the association statistically). The final
axis provides a means for recording how far psychiatric and developmental
problems interfere with the individual’s everyday life. The five axes of
DSM-IV do the same job as the six axes of ICD-10 because DSM-IV allows
multiple diagnoses on its axis I, an axis that encompasses both psychiatric
disorders and specific developmental disorders.
Subject review
Taylor E, Rutter M. (2008) Classification.In: Rutter Met al.(eds)Rutter’s
Child and Adolescent Psychiatry, 5th edn. Wiley-Blackwell, Chichester,
pp. 18–31.