By David Joel Miller.
Five Axes Diagnosis Esoterica.
With the release of the DSM-5 using 5 axes may soon be a thing of the past. Professionals will be looking for this information or most of it. We just won’t be separating it and reporting it this way. I left this post up for those who would like to see the way things used to be.
So in a previous post we talked about some of the reasons clinicians might be reluctant to tell you about your diagnosis, how the diagnosis are based on the DSM-4 (soon to be the DSM-5) from the APA and how diagnosis are categories while people are on a continuum so sometimes people do not fit the diagnosis neatly. We left off with the ideas that there are 5 axis and that most people stop after knowing more or less their diagnosis on Axis one.
The DSM has over 400 diagnoses. Not just mental illnesses but all sorts of other problems that might take you in to see a counselor. They include mental illnesses, emotional and behavioral problems. This section covers about 750 pages of the DSM. My list below is VERY oversimplified
The major sections, not in order are things most of us have heard about:
1. Adjustment Disorders – life’s problems grown large.
3. Mood disorders meaning Depression and Bipolar.
4. Psychosis, like Schizophrenia and Schizoaffective.
5. Disorders first seen in childhood – like ADHD, learning disorders and Autism. (But NOT mental retardation!)
6. Sex, eating and sleeping.
7. Substance abuse.
8. Dementia, physical stuff caused by emotions.
There is a section in the back where other codes, mostly the “V” codes are listed. “V” codes are largely about relationships like parent-child conflicts and partner conflicts. While counselors work in these areas many insurance plans to not pay to treat these things.
The things we put on axis two are things that we used to think were untreatable – that is just the way you are stuff. This includes personality disorders and mental retardation, a strange mix. Both issues now have appropriate treatments.
Personality disorders are treated using therapies like DBT. Most women in prison are diagnosed with Borderline Personality Disorder. Sometimes in practice, the boundary between Borderline and Bipolar gets fuzzy.
Most men in prison get a diagnosis of Antisocial Personality Disorder. This is also generally treatable if the client wants to change.
Mental retardation can be treated using behavioral techniques as long as we have realistic expectations. The distinction between mental retardation and developmental delays can get fuzzy. Some people call all of this delays and avoid the politically sensitive issue of saying someone has mental retardation. It is also possible for someone with mental retardation to have an axis one problem like depression.
Did you know that medical conditions can cause symptoms that look like a mental illness? All good therapists like to have clients see a primary care doctor, specialists if needed, to make sure this the problem is not a brain tumor or hormone issue. Things like pregnancy, brain injury and poisoning all get confused with mental illness. In seniors, a lot of this dementia and cognitive decline is the result of side effects of medications the senior is taking. Please, however, do not start or stop meds without talking with your doctor first. Ideally, your doctor and your therapist should be talking and on the same page if you have any medical conditions that may affect your mental state.
Axis Four – Psychosocial and environmental problems
Stressors for short. Not having friends or a family or having a poor relationship with them can cause lots of emotional problems. We also include people with social and educational problems. Being arrested or a victim of crime might get you an Axis Four diagnosis, as would not having medical care or living in poverty. We don’t always talk with clients about these issues as much as we should but these issues are at the core of clients problems a lot of the time. Note that no matter how severe your unemployment problems are if you can’t qualify for an Axis One diagnosis like Depression you may have difficulty getting counseling for your employment or other problem.
If stressors are interacting with your mental health you might want to see a professional or clinician counselor who specializes in individual therapy centered on both these areas. In California, we call this specialty Licensed Professional Clinical Counselors (LPCC’s.)
This is a summary scale. Imagine how hard it is, to sum up, a client’s whole life on a 0-100 scale. Imagine getting a pass-fail grade on your life. Imagine trying to grade someone’s life. Lots of other scales have been suggested for this. Insurance types like it because if your GAF number goes up it shows the therapy is working. This makes them happier about paying. Mostly we use this in making decisions about hospitalization or urgent care.
I don’t ever remember telling a client their GAF because it does not much matter unless there is something that needs doing right now and in that case, I want to talk about what it is we need to do now.
So there we have it in two brief posts a very simplified look at the process of diagnoses.
Staying connected with David Joel Miller
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