The DSM uses a "multiaxial" system for assessment. This assessment 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.
There are five axis in the DSM diagnostic system, each relating to a different aspect of a mental disorder:Axis I: This is the top-level diagnosis that usually represents the acute symptoms that need treatment; Axis 1 diagnoses are the most familiar and widely recognized (e.g., major depressive episode, schizophrenic episode, panic attack). Axis I terms are classified according to V-codes by the medical industry (primarily for billing and insurance purposes).Axis II: Axis II, is for personality disorders and developmental disorders such as mental retardation.
Axis II disorders, if present, are likely to influence Axis I problems. For example, a student with a learning disability may become extremely stressed by school and suffer a panic attack (an Axis I diagnosis)Axis II is for assessing personality disorders and intellectual disabilities. These disorders are usually life-long problems that first arise in childhood, distinct from the clinical disorders of Axis I which are often symptomatic of Axis II. For example, a adult patient might have depression (an Axis I disorder) that is largely a result of a paranoid personality disorder (an Axis II disorder).
Axis II disorders are accompanied by considerable social stigma because they are suffered by people who often fail to adapt well to society; Axis II disorders can seem untreatable and be difficult to pinpoint. It is often disupted whether Axis II disorders are caused primarily by genetic influences or environmental causes. In fact, it has been suggested that,"...
the diagnosis 'personality disorder' should be replaced by the diagnosis 'adaptation disorders'. This reflects the real nature of the disorder more accurately, and is likely to reduce the stigmatizing component of the personality disorder diagnosis as it places emphasis on positive efforts to improve adaptation. The suggested revisions of the personality disorder diagnosis and dimensional approach to these disorders are likely to advance treatment and research - we discuss these aspects in some detail.Another indication of the nebulous, difficult to categorize distinguish nature of Axis II disorders is the categorization of autism. Autism used to be on Axis II but was moved to Axis I. This is because some cases of autism are transient - they respond well to treatment and/or diminish over time.
Axis II disorders are regarded as more permanent and less responsive to treatment.Axis II is for Reporting Personality Disorders and Mental Retardation. It may also be used for noting prominent maladaptive personality features and defence mechanisms. The listing of personality Disorders and mental Retardation on a separate axis ensures that consideration will be given to the possible presence of Personality Disorders and Mental Retardation that might otherwise be overlooked when attention is directed to the usually more florid Axis I disorders. The coding of personality Disorders on Axis II should not be taken to imply that their pathogenesis or range of appropriate treatment is fundamentally different from that for the disorders coded on Axis I.
