The DSM explicitly "strives to be atheoretical, using merely observationally referent terms. The hope with this is to make the manual as acceptable as possible to professionals with different theoretical orientations (Gilles-Thomas 1989, Lecture 2). Specific criteria and systematic descriptions are offered as guidance for making diagnoses. "Essential features, associated features, prevalence rates, sex ratios, family patterns, and differential diagnoses are listed" and it is noted when "alternative or additional diagnoses…should be considered," such as the possibility that a manic episode could mask itself as schizophrenia (Gilles-Thomas 1989, Lecture 2). This might occur if the clinician was unacquainted with the patient and the patient's past history of depression, for example, and/or mood disorders in the patient's family.
Also key to the efficacy of the DSM in approaching the ideologically and theoretically charged world of abnormal psychology is its multiaxial system. The multiaxial system "allows for a more holistic and comprehensive account of an individual" and his or her psyche (Gilles-Thomas 1989, Lecture 2). An individual, for example, can be both manic depressive and a substance abuser, or a person with an eating disorder can have borderline personality disorder and other medical conditions that exacerbate the major clinical disorder he or she suffers. The patient is assessed not as abnormal or normal, but upon "several different axes or dimensions, each focusing on a different type of information" as follows:
Axis I: Clinical Syndromes
Axis II: Developmental disorders and Personality disorders
Axis III: Physical disorders and conditions
Axis IV: Severity of psychosocial stressors
Axis V: Global assessment of functioning (Gilles-Thomas 1989, Lecture 2).
Axis I and II comprise the entire classification of mental disorders, plus 'V codes' (codes which indicate conditions not attributable to a mental disorder but that are a focus of attention or treatment. E.g.: Academic, interpersonal or occupational problem I, II and III)" and all of the five components "together constitute the official, complete…diagnostic assessment" for the client (Gilles-Thomas 1989, Lecture 2).
Axis I involves clinical syndromes, what are often thought of as major psychological disorders, such as major depression or schizophrenia -- disorders that can overtake a person's entire life and call for immediate intervention. Axis II or developmental and personality disorders are also extremely serious, although often entail less direct, immediate intervention, unless a person also has an Axis I condition. Axis II types of disorders are "pervasive, long standing disorders, typically beginning in childhood or adolescence," and are not necessarily mental disorders so much as they are abnormalities or deviations from the norm, including "mental retardation or borderline personality disorder," although, of course, "a person can have a diagnosis on both Axis I and II (Gilles-Thomas 1989, Lecture 2). Both Axis I and II disorders require intensive treatment, but treatment of different types -- one may be more direct and immediate (such as drug therapy to bring an individual 'down' from a manic phase) while the other may be more supportive in nature, such as cognitive behavioral therapy to manage borderline personality disorder.
Axis III comprises "Physical disorders/conditions: Current physical complaints that may be relevant to understanding or managing the case. E.g.: Neurologic disorders or diabetes." A person with binge eating disorder may have additional complications, for example, because of his or her diabetes. A stroke, Alzheimer's disease, birth trauma, and other disorders may be connected to the mental conditions suffered by the individual. Additionally, the mental illness itself can cause physical distress for the client, such as the complications of alcoholism, eating disorders, or the lack of self-care manifest in someone with schizophrenia.
Axis IV measures the "severity of psychosocial stressors: Overall severity of life stress for the past year" (Gilles-Thomas 1989, Lecture 2). Axis IV recognizes that certain types of stressors can exacerbate preexisting conditions and even cause abnormal behaviors to manifest themselves in individuals without full Axis I or Axis II diagnoses. Stressors can be marital, financial, legal, developmental (like going away to college or having a baby), job-related, physical, interpersonal or relate to major personal and even national disasters such as Hurricane Katrina or 9/11. "These stressors are rated on a six point scale, ranging from 'None' to 'Catastrophic' and are used to contextualize the overall assessment of the individual's state of mental health. For example, a person with borderline personality disorder and alcoholism may suffer even more complications relating to his or her disorder during a time of family crisis -- or even if the nation is going to war, simply by 'picking up' on these external stressors within the larger social environment (Gilles-Thomas 1989, Lecture 2). .
The final Axis V assessment is a so-called holistic of "Global Assessment of Functioning: This allows the clinician to give his/her judgment of the person's psychological, social and occupational functioning for two time periods: 1. Current: reflects need for treatment 2. Past Year-highest level of functioning…Each is rated on a 90 point scale, ranging from 1 (Suicidal acts, recurrent violence, etc.) to 90 (Absent or minimal symptoms)" (Gilles-Thomas 1989, Lecture 2).
The multiaxial system thus encompasses biological and social elements into a multifaceted, holistic definition of functioning and abnormality. Features of physically observable behaviors as well as attitudes and organic conditions are built into the DSM. This allows for a more comprehensive portrait of individual functioning and also enables theorists of most of the major schools of psychology to create a diagnosis they find suitable for the client.
Abnormal psychology. (2009). a2psychology. Retrieved September 23, 2009 at http://www.a2zpsychology.com/articles/abnormal.htm
Gilles-Thomas, David L. (1989). Definitions. Abnormal psychology: Lecture 1. University of Buffalo. Retrieved September 23, 2009 at http://ccvillage.buffalo.edu/Abpsy/lecture1.html