Axis III in the DSM: Diagnosis, Disorders & Examples
Explore Axis III of the Diagnostic and Statistical Manual of Mental Disorders. Learn about general medical conditions, how they are related to the treatment of mental disorders, and more.
Imagine that a client comes into your office experiencing symptoms of depression. After continuing your conversation, you find out that the client's depressive symptoms started right after the client was diagnosed with lung cancer. A review of the client's medical records also reveals that the client has asthma. Assume that you determined that the cancer is the cause of the client's depression. You decide that you should address the client's emotions surrounding his cancer diagnosis in your sessions. Like all general medical conditions, the client's cancer diagnosis would be recorded on Axis III.
The Five Axes of the DSM
The Diagnostic and Statistical Manual of Mental Disorders (DSM) is often referred to as the 'Bible' of psychology. The DSM contains the classification of mental disorders that are diagnosed in the United States, including the requirements for diagnosis. In order to include a complete picture of the factors that influence the client's mental health, the DSM is broken down into five axes:
- Axis I contains clinical disorders, such as anxiety and depression.
- Axis II contains mental retardation and personality disorders, such as anti-social personality disorder and obsessive-compulsive personality disorder.
- Axis III contains general medical conditions, such as cancer and Alzheimer's disease.
- Axis IV contains environmental and psychosocial factors that may affect the client's mental health, such as a recent divorce, inadequate social support, and the death of a parent.
- Axis V contains the global assessment of functioning, which is a numerical scale that measures the level of functioning of the client. The scale ranges from 0 (inadequate information) to 100 (high functioning with no symptoms of mental illness present).
For this lesson, we will focus on Axis III.
What Is a General Medical Condition?
A general medical condition is a physical problem that can potentially influence your client's mental illness. General medical conditions may be relevant to understanding and treating your client's mental disorder. There are three ways that you can view general medical conditions:
- They are directly related to your client's mental health problems.
- They are important in creating a comprehensive diagnosis of the client.
- There is not a significant relationship between the general medical condition and the client's mental health problems.
Whenever you determine that a mental disorder is a direct consequence of a general medical condition, you must record it as an Axis I diagnosis of a mental disorder due to a general medical condition and record the general medical condition on Axis III. In the example above, it was determined that the lung cancer was the cause of the client's depression. Therefore, a diagnosis of Mood Disorder Due to Lung Cancer, with Depressive Features goes on Axis I. Lung cancer is listed again on Axis III.
In instances when there is not a clear enough relationship between the general condition and the mental disorder to warrant a diagnosis of a mental disorder due to a general medical condition, the general medical condition is recorded on Axis III only. In the example above, there is not a clear relationship between the client's asthma and depression. Therefore, we record asthma on Axis III only.
Even if the general medical condition is completely unrelated to the mental disorder, it is still important to record it if the condition is important in understanding or treating the client. Let's say that you have a client with a diagnosis of diabetes and depression who is admitted to a psychiatric hospital for a suicide attempt. Listing diabetes on Axis III will let the hospital know that in addition to monitoring the client's behaviors, they also need to monitor his insulin levels. It also let's the hospital staff know that they need to make sure that the client's diabetes medication does not have any interactions with the medications that they prescribe for treatment of the depression.
If a client has more than one Axis III disorder that is clinically relevant, you should report them all. If you have determined that the client does not have an Axis III condition, you should report it as 'Axis III: None'. If you need to gather additional information in order to confirm whether or not there is an Axis III condition, you should report it as 'Axis III: Deferred'.
Here are some examples of common general medical conditions that are recorded on Axis III:
- Alzheimer's disease
- Carpal tunnel syndrome
- HIV infection
The DSM is broken down into five axes. Axis III is where we record general medical conditions that are potentially relevant to the client's mental disorder. It is important to record general medical conditions in order to get a complete picture of the client's condition and to prevent drug treatment interactions.
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