How are people diagnosed with Attention Deficit Disorder (ADD/ADHD)? Where do mental health professionals find the criteria that are used to diagnose this biologically based disorder? Published by the American Psychiatric Association (APA), the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) has been the resource that mental health clinicians in the United States have used to diagnose mental health disorders beginning in 1994. In 2000, a text revision of this fourth edition gave clinicians the DSM-IV-TR to use for diagnosis. The DSM-V is under construction and is slated for publication in 2013.
The DSM-IV-TR looks at domains, called the axis, in the client’s life to make a mental health diagnosis. These five axes in the DSM-IV-TR help to sort and organize the information that the client brings to the clinician. Having a common system to consult for diagnosis helps the clinician to standardize the diagnostic criteria that are examined. This system of axes is also used to help with the billing for the mental health services.
Axis I-These disorders are clinical in nature. Their symptoms would typically be the ones that brought the client to the mental health professional for diagnosis and treatment. Some Axis I diagnosis include ADD/ADHD, anxiety disorders, autism spectrum disorders, bi-polar disorder, and schizophrenia.
Axis II-These disorders are separate from Axis I disorders, but they may influence the Axis I disorders. Often diagnosed at a young age, these disorders may be especially difficult to treat. Axis II disorders are intellectual disorders, such as mental retardation, and a wide variety of personality disorders. These include anti-social personality disorder, borderline personality disorder, and obsessive-compulsive disorder.
Axis III-These are medical diagnoses that affect psychological functioning. A brain injury could result in explosive behavior. Many people with diabetes have some level of depression. Physical problems often exacerbate mood disorders.
Axis IV-These are environmental problems that can impact the mental health functioning of the client. Some environmental factors that might be considered include the client’s human support system, housing, access to medical care, educational difficulties, economic problems, and social interactions, or lack of them. This is a broad category which can include many issues that would influence psychological functioning.
Axis V-This is the Global Assessment of Functioning or GAF. It gives a numerical value, from a scale of 1 (lowest) to 100 (highest) to show how the individual is functioning in his daily life. A person who is at the 91-100 level would show no symptoms and function well in most areas of their life. In contrast, the person who scores from 1-10 would be in danger of hurting himself or others. This score helps to compare current to past functioning and can help determine the effectiveness of the treatment that the person is receiving.
Using these five axes helps the mental health professional get a more complete picture of the client’s psychological functioning. Diagnosis and treatment is an art and a science that is developed over many years of study, training, and practice. The APA makes it clear in their “Cautionary Statement” that the DSM-IV-TR is for use by mental health professionals who have the background to use it effectively. While many people may want to look at the descriptions of mental disorders for informational purposes, they need to bring their concerns to a mental health professional who will be able to make an informed and unbiased conclusion. Working together, the client and clinician should be able to build a program that can help the client live well with their mental health diagnosis.
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Quick Reference to the Diagnostic Criteria from DSM-IV-TR