Thursday, August 25, 2011

General Notes Regarding Multiaxial Diagnosis

  • Using the 5 axes for recording:
    • Axis I: clinical disorders & other conditions that may be a focus of clinical attention – Here you record most clinical disorders (depressive disorders, schizophrenia/psychotic disorders, substance-related disorders, v-codes that are the main reason for a visit).  You should put them in order by which is the main reason for a visit or the principal diagnosis.  You can note parenthetically if there is any confusion about which is the principal diagnosis vs which is the main reason for the visit.
    • Axis II: personality disorders & mental retardation – Hopefully self explanatory
    • Axis III: general medical conditions – If you want to get fancy here you can use ICD-9 codes.  Otherwise, just write any medical problems.
    • Axis IV: psychosocial and environmental problems – The DSM offers a few general categories of psychosocial/environmental stressors & you can write either the specific stressor (recent death of mother, marital discord, recent expulsion from school) or the general category (problems with primary support group, educational problems) or both.  If one of these problems is going to be the primary focus of treatment, you can also include it as a v-code on Axis I.
    • Axis V: the dreaded GAF score – a scale of 0 – 100 that gives you a way to score the person’s overall level of functioning at a point in time.
  • The following are the general categories of disorders included in the DSM:
    • Disorders usually first 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 & gender identity disorders
    • Eating disorders
    • Sleep disorders
    • Impulse-control disorders not elsewhere classified
    • Adjustment disorders
    • Personality disorders
    • Other conditions that may be a focus of clinical attention
  • Now that I have essentially typed up the Table of Contents from the DSM, I will obviously not be able to summarize each & every disorder in the DSM, and I may not even cover each category.  I will attempt to hit the high points.  I may focus a bit more on personality disorders, simply because I am a bit weak in that area.  If you want more information on any of these general categories of disorders, I strongly recommend you read your DSM.  I know it may not be the most exciting reading you’ve ever done, but it really is the best place to learn about the DSM.
  • Lastly a few critiques: As social workers, we’re trained in the business of empowerment & finding strengths.  As you can see if the 5 axes above, there isn’t anywhere to focus on strengths.  Some social workers like to make a little note underneath their 5 axes listing client strengths.  Additionally, I find that for some clients, the diagnosis itself can sometimes be an empowering thing.  I’m thinking of people who find out that they have depression or bipolar disorder and say, “That’s what’s wrong with me?  All this time, I just thought I was lazy/stupid/crazy/whatever.  That explains it all!”  Alternatively, some clients will hide behind their diagnoses, as in, “Oh, I can’t do that, I have [insert diagnosis here].”  However you look at it, this is the system we have to work within, and this is surely going to be on our exam.

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