Multi-axial diagnosis (this isn’t about car trouble)

In an article in our most recent newsletter I referred to a multi-axial diagnosis. I went on to say I’d do a blog post on the subject in a day or so. Well, here we go.

Okay, you’ve decided to see a therapist, psychologist, or psychiatrist for the first time. And so for about an hour you participate in an assessment, responding to tons of questions and statements from your clinician. Well, you’ve survived, your next appointment is scheduled, and you’re out of there.

Sometime before your next visit your clinician will draft an initial treatment plan, which the two of you will review and approve. Part of this process for the clinician is formulating initial, or provisional, diagnoses. And after a session or two they’ll be revisited, adjusted, and finalized…at least for now. A quality clinician will adjust your diagnoses as indicated over time.

Now, diagnoses are curious things. Certainly, they provide a point of reference and treatment planning guide for your clinician; and insurance companies would croak without them. But, in a funny sort of way…yada, yada, yada. Don’t ever forget, diagnoses are like tushies in that everyone has one (and everyone has their preferences). And tossed about loosely diagnoses can cause problems because they may frighten you or make you feel labeled. And whether you know it or not, you may actually attempt to fulfill specific diagnostic criteria.

When a formal diagnosis has to be assigned, a biopsychosocial model paints the best picture. That is, it’s important to take into account your medical, physical, mental/emotional, and social/environmental circumstances. And within the context of the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision (DSM-IV-TR), published by the American Psychiatric Association in 2000, the preferred method of accomplishing this is creating a multi-axial diagnosis.

A multi-axial diagnosis contains five axes, the first two noted in a digital code…

Axis I: The “clinical” disorders, including the major mental, emotional, and cognitive disorders. eg: Alcohol Dependence (303.90), Major Depressive Disorder, Recurrent, Severe Without Psychotic Features (296.33), Dementia Due To Parkinson’s Disease (294.1).

Axis II: The personality disorders and mental retardation. eg: Antisocial Personality Disorder (301.7), Mental Retardation (317, with a specifier for mild, moderate, severe, profound, or unknown severity).

Axis III: Medical conditions and physical disorders. I typically record these in text format.

Axis IV: Contributing social and environmental issues. So let’s say you’re facing home foreclosure, you’ve lost your job, and you have piles of bills you can’t pay. I’d note: living situation, occupational, financial – severe.

Axis V: A numeric assessment of your overall functioning. If you’re an adult, a Global Assessment of Functioning (GAF) score is assigned from 0 (all but dead) to 100 (God-like). For a child/adolescent, the Children’s Global Assessment Scale (CGAS) is used. Same scoring as the GAF.

I could write volumes on pieces of what you just read, but that’s the big-picture scoop on multi-axial diagnosis.

So what say you? What are your thoughts or questions? How ’bout commenting on the post page itself?

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