The 5 Axes of the DSM-IV Multi-Axial System

Mental disorders are diagnosed according to a manual published by the American Psychiatric Association called the Diagnostic and Statistical Manual of Mental Disorders. A diagnosis under the fourth edition of this manual, which was often referred to as simply the DSM-IV, had five parts, called axes. Each axis of this multi-axial system gave a different type of information about the diagnosis.

Five Axes of the DSM-IV

​Verywell / Nusha Ashjaee

Changes With DSM-5

When the fifth edition, the DSM-5, was compiled, it was determined that there was no scientific basis for dividing the disorders in this manner, so the multi-axial system was done away with. Instead, the new non-axial diagnosis combines the former Axes I, II and III and include separate notations for the type of information which would have previously fallen into Axes IV and V.

DSM-IV Types of Axes By Disorder

Axis I provided information about clinical disorders. Any mental health conditions, other than personality disorders or mental retardation, would have been included here. Disorders which would have fallen under this axis include:

  • Disorders Usually Diagnosed in Infancy, Childhood or Adolescence
  • Delirium, Dementia and Amnestic and Other Cognitive Disorders
  • Mental Disorders Due to a General Medical Condition
  • Substance-Related Disorders
  • Schizophrenia and Other Psychotic Disorders
  • Mood Disorders
  • Anxiety Disorders
  • Somatoform Disorders
  • Factitious Disorders
  • Dissociative Disorders
  • Sexual and Gender Identity Disorders
  • Eating Disorders
  • Sleep Disorders
  • Impulse-Control Disorders Not Else Classified
  • Adjustment Disorders
  • Other Conditions That May Be a Focus of Clinical Attention

Axis II provided information about personality disorders and mental retardation. Disorders which would have fallen under this axis include:

  • Paranoid Personality Disorder
  • Schizoid Personality Disorder
  • Schizotypal Personality Disorder
  • Antisocial Personality Disorder
  • Borderline Personality Disorder
  • Histrionic Personality Disorder
  • Narcissistic Personality Disorder
  • Avoidant Personality Disorder
  • Dependent Personality Disorder
  • Obsessive-Compulsive Personality Disorder
  • Personality Disorder Not Otherwise Specified
  • Mental Retardation

Axis III provided information about any medical conditions that were present which might impact the patient's mental disorder or its management.

Axis IV was used to describe psychosocial and environmental factors affecting the person. Factors which might have been included here were:

  • Problems with a primary support group
  • Problems related to the social environment
  • Educational problems
  • Occupational problems
  • Housing problems
  • Economic problems
  • Problems with access to health care services
  • Problems related to interaction with the legal system/crime
  • Other psychosocial and environmental problems

Axis V was a rating scale called the Global Assessment of Functioning; the GAF went from 0 to 100 and provided a way to summarize in a single number just how well the person was functioning overall. A general outline of this scale would be as follows:

  • 100: No symptoms
  • 90: Minimal symptoms with good functioning
  • 80: Transient symptoms that are expected reactions to psychosocial stressors
  • 70: Mild symptoms or some difficulty in social occupational or school functioning
  • 60: Moderate symptoms or moderate difficulty in social, occupation or school functioning
  • 50: Serious symptoms or any serious impairment in social occupational or school functioning
  • 40: Some impairment in reality testing or communication or major impairment in several areas such as work or school, family relations, judgment, thinking or mood
  • 30: Behavior is considerably influenced by delusions or hallucinations or serious impairment in communication or judgment or inability to function in almost all areas
  • 20: Some danger of hurting self or others or occasionally fails to maintain minimal personal hygiene or gross impairment in communication
  • 10: Persistent danger of severely hurting self or others or persistent inability to maintain minimal personal hygiene or serious suicidal act with clear expectation of death
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  1. Substance Abuse and Mental Health Services Administration. DSM-IV to DSM-5 Changes: Overview. DSM-5 Changes: Implications for Child Serious Emotional Disturbance [Internet].

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