Evelyn C. Is a 36-Year-Old Homemaker and

Evelyn C. is a 36-year-old homemaker and mother of two children from a previous marriage. She has a drinking problem that frequently results in her being inebriated when her children return home from school. Her drinking was initially triggered by arguments with her husband, John. Recently, she failed to pick up her children from school because she was intoxicated, and created a tremendous scene at her children's school when she eventually went to pick them up.

She seems unaware of the impact that her behavior has on her children and seems to think that people are responding disproportionately to any inconvenience caused by her drinking. The DSM-IV-TR uses five different levels, or axes, to diagnose patients presenting with signs of mental illness or mental disorder. The five axes are meant to be used together to help paint a broad picture of the patient in order to develop the most comprehensive overall treatment plan.

Axis 1 is the axis one might most readily associate with a diagnosis of "mild" mental illness; it contains clinical, developmental and learning disorders. These disorders include: alcohol abuse, panic disorder, phobias, anxiety disorders, obsessive-compulsive disorder, and posttraumatic stress disorder. Axis 2 is for personality disorder and significant delays indicating mental retardation. The disorders on Axis 2 include: borderline personality disorder, histrionic personality disorder, dependent personality disorder, and obsessive-compulsive personality disorder. Axis 3 is not focused on disorders, but on medical problems or physical disorders.

Axis 4 refers to the context of the problems and includes the patient's environment, including support network, life stressors, and any other issues that one might think would impact functioning. Axis 5 is reported as a number and is the patient's global assessment functioning. Because of Evelyn's alcohol abuse and the evidence that her husband is making accommodations in their daily life that may actually reward or encourage Evelyn's alcohol consumption, it is difficult to make a diagnosis on her prior to her becoming sober.

This is particularly true on some of the axes that require an intake history, which is, at this time, incomplete. Her current diagnosis appears to be as follows: Axis I: 305.00 Alcohol Abuse; Axis II 301.6 Dependent Personality Disorder Frequent Use of Denial; Axis II: None; Axis IV: marital problems, raising her children as a single mom divorced from their father, isolation related to being a homemaker; and Axis V: GAF in the 31-40 range.

I believe that Evelyn would receive a diagnosis of alcohol abuse under 305.00 because she has a maladaptive pattern of alcohol use that has led to a failure to fulfill major role obligations at home (APA, 2000). I do not believe, with the information provided, that she would be diagnosed with alcohol dependence under 303.90 because there is no evidence of tolerance, withdrawal, or failure at real attempts to stop drinking (APA, 2000).

Instead, the case study suggests that her drinking is relatively recent in origin and began in response to fights with her husband. The Axis II diagnosis of 301.6 Dependent Personality Disorder Frequent Use of Denial is a subjective diagnosis. Essentially, this personality disorder is characterized by a dependence upon other people that does not result in normal levels of independence.

Though gender norms can play a role in the diagnosis, the fact that Evelyn is a homemaker who receives financial support, not only for herself, but also for her children from another marriage, from a spouse with whom she frequently fights suggests that she is either unwilling or unable to be self-supporting. Furthermore, she not only suggests that she has a problem, but denies the impact that problem has on those around her. Axis IV problems relate to life stressors.

Evelyn is divorced from the father of her school-age children, which is stressful. She is remarried, but.