Axis IV


Axis IV is part of the DSM "multiaxial" system for assessment. The five axis model is designed to provide a comprehensive diagnosis that includes a complete picture of not just acute symptoms but of the entire scope of factors that account for a patient's mental health. This page explains DSM Axis IV

Axis IV Psychosocial and Environmental Problems

Axis IV is for, "…reporting psychosocial and environmental stressors that may affect the diagnosis, treatment, and prognosis of mental disorders" (quote from DSM IV).

Axis IV is fairly easy to understand: essentially, it is for recording life events - e.g. marriage, new job, death of a loved one - that may affect a patient's mental health diagnosis and treatment. For example, someone with an Axis I diagnosis of depression who had recently lost their job would have "job loss" or "unemployment" recorded on Axis IV.

Generally, only those stressors from the past 12 months are recorded on Axis IV; clinicians are encouraged to only list those problems which are relevant to the patient's current situation. In some cases, severe psychosocial and environmental problems such as sexual abuse may be part of an Axis I diagnosis.

Axis IV Categories

Axis IV problems are grouped into categories as follows;

  • Problems with 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 IV in DSM-5

The next edition of the DSM is scheduled for publication in May, 2013. Working groups are reviewing the multiaxial system to try to bring it more into line with international reporting standards (as opposed to U.S. standards) with the goal of having a global approach to mental health diagnosis. Axis IV is part of this process and is being specifically reviewed to attempt to bring it into line with similar ideas that are contained in the ICD (the WHO International Classification of Diseases).

An example of a multiaxial diagnosis

From Edward Pierce, LCSW

Related Reading

Click below to find more related articles on Axis IV.


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