Mental disorders are diagnosed according to a manual published by the American Psychiatric Association called the Diagnostic and Statistical Manual of Mental Disorders. A diagnosis under the fourth edition of this manual, which was often referred to as simply the DSM-IV, had five parts, called axes. Each axis of this multi-axial system gave a different type of information about the diagnosis.

Axes of DSM-IV

DSM-IV Types of Axes By Disorder

Diagnostic and Statistical Manual of Mental Disorders (DSM) and the fifth chapter of the International Classification of Diseases (ICD).

When the fifth edition, the DSM-5, was compiled, it was determined that there was no scientific basis for dividing the disorders in this manner, so the multi-axial system was done away with. Instead, the new non-axial diagnosis combines the former Axes I, II and III and include separate notations for the type of information which would have previously fallen into Axes IV and V.

Cluster A (odd or eccentric disorders)

Cluster B (dramatic, emotional or erratic disorders)

Cluster C (anxious or fearful disorders)


Axis I provided information about clinical disorders. Any mental health conditions, other than personality disorders or mental retardation, would have been included here.1

Disorders which would have fallen under this axis include:

Disorders Usually Diagnosed in Infancy, Childhood or Adolescence

Delirium, Dementia and Amnestic and Other Cognitive Disorders

Mental Disorders Due to a General Medical Condition

Substance-Related Disorders

Schizophrenia and Other Psychotic Disorders

Mood Disorders

Anxiety Disorders

Somatoform Disorders

Factitious Disorders

Dissociative Disorders

Sexual and Gender Identity Disorders

Eating Disorders

Sleep Disorders

Impulse-Control Disorders Not Else Classified

Adjustment Disorders

Other Conditions That May Be a Focus of Clinical Attention


Axis II provided information about personality disorders and mental retardation.1 Disorders which would have fallen under this axis include:

Paranoid Personality Disorder

Schizoid Personality Disorder

Schizotypal Personality Disorder

Antisocial Personality Disorder

Borderline Personality Disorder

Histrionic Personality Disorder

Narcissistic Personality Disorder

Avoidant Personality Disorder

Dependent Personality Disorder

Obsessive-Compulsive Personality Disorder

Personality Disorder Not Otherwise Specified

Mental Retardation


Axis III provided information about any medical conditions that were present which might impact the patient’s mental disorder or its management.


Axis IV was used to describe psychosocial and environmental factors affecting the person.1 Factors which might have been included here were:

Problems with a 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 V was a rating scale called the Global Assessment of Functioning; the GAF went from 0 to 100 and provided a way to summarize in a single number just how well the person was functioning overall.1 A general outline of this scale would be as follows:

100: No symptoms

90: Minimal symptoms with good functioning

80: Transient symptoms that are expected reactions to psychosocial stressors

70: Mild symptoms or some difficulty in social occupational or school functioning

60: Moderate symptoms or moderate difficulty in social, occupation or school functioning

50: Serious symptoms or any serious impairment in social occupational or school functioning

40: Some impairment in reality testing or communication or major impairment in several areas such as work or school, family relations, judgment, thinking or mood

30: Behavior is considerably influenced by delusions or hallucinations or serious impairment in communication or judgment or inability to function in almost all areas

20: Some danger of hurting self or others or occasionally fails to maintain minimal personal hygiene or gross impairment in communication

10: Persistent danger of severely hurting self or others or persistent inability to maintain minimal personal hygiene or serious suicidal act with clear expectation of death



The 5 Axes of the DSM-IV Multi-Axial System

By Nancy Schimelpfening
Medically reviewed by Steven Gans, MD

#RobertReview: 9 | 10

Diagnostic and Statistical Manual of Mental Disorders (DSM) List of Personality Disorders

This is one of the best reference about Personality Disorders. This topic is heavy going but will prove useful in all types pf relationships

To learn the basic info on Personality Disorder, click here >>

Published: 11th March 2020.
Updated: 12th March 2020.


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