How to Use Axis I of the DSM-IV-TR

The Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition-Text Revision, or DSM-IV-TR, was published by the American Psychiatric Association in 2000. It is the manual mental health professionals use to diagnose disorders. The DSM-IV-TR uses five levels of classification. The axes are Axis I clinical disorders, Axis II personality disorders and mental retardation, Axis III General Medical Conditions, Axis IV Psychosocial and Environmental Problems and Axis V Global Assessment of Functioning. Axis I is used for all of the DSM-IV-TR disorders except personality disorders and mental retardation.

Instructions

• 1

  Read and become familiar with Axis I disorders and their criteria. It is impossible and impractical to read the entire DSM-IV-TR each time you are diagnosing a client. Having a general understanding of each diagnosis and its criteria make an Axis I diagnosis more efficient and accurate.

• 2

  Evaluate the client's symptoms. Typically a psychosocial assessment is conducted that includes many diagnostic criteria including mood and anxiety symptoms, disruptive behaviors, thinking patterns, history of abuse or trauma and family history. Responses from this assessment are important for determining an Axis I diagnosis.

• 3

  Review the responses from the psychosocial assessment. Based on the client's responses, determine the symptoms, or diagnostic criteria, that are present. Based on your knowledge of Axis I disorders, identify all disorders that would include these criteria. For example, difficulty concentrating, difficulty falling asleep and irritability could indicate mood disorders, attention-deficit hyperactivity disorder or anxiety disorders.

• 4

  Explore the Axis I conditions that relate to the symptoms, or criteria, that you identified. Determine the conditions that fit most accurately according to the diagnostic criteria indicated by the DSM-IV-TR. To rule out alternative conditions, read the differential diagnosis section for each Axis I diagnosis you consider. Use more than one diagnosis if appropriate.

• 5

  Identify necessary specifiers. Many diagnoses include specifiers that further indicate the type of symptoms the client has experienced. For example, specifiers for attention-deficit-hyperactivity disorder include combined type -- predominantly inattentive type and predominantly hyperactive-impulsive type. Other specifiers indicate severity of symptoms such as mild, moderate or severe. Refer to the DSM-IV-TR criteria to determine if a specifier is necessary.