Is it a medical problem or a mental health problem – Axis III

By David Joel Miller.

Which Axis does that go on?


Under the DSM-5 system, mental health professionals no longer separate the information onto five Axis. We do still look for this information.

Several questions have come in on the relationship between medical issues, physical symptoms and the five-axis system of the DSM. This is the lay version of that discussion. For a full discussion, you would need to consult the APA site or the full DSM-4-TR. I see from the search terms coming into that there are several questions about this.

The mental health profession is focused on mental illnesses. The DSM it the “Diagnostic and Statistical Manual of Mental Disorders” for a good reason. So if the problem is medical it is outside what we are doing. If you have ANY doubt, please see a medical doctor first and get any possible physical illness or condition ruled out before seeing a therapist. The DSM, however, does not see psychical and mental disorders as two separate things even though different professions may treat different aspects.

Some mental disorders can create symptoms that are physical. People who are depressed may not be able to sleep or they may sleep excessively. Nightmares can be a symptom of PTSD. These sorts of mind-body problems can be helped by therapy. Some disorders have elements of both physical illness and learned behavior. If a mental illness is caused by a medical problem it is diagnosed as a mental illness and goes on axis I. The DSM cites a thyroid condition that results in depression as an example of this. Drug induced hallucinations would be another.

Short answer – Mental illness goes on Axis I

(Axis II if it is long-term or hard to treat like Personality Disorders)

Some physical conditions can affect your mental health even though they are not the direct cause of the illness. If you become depressed as a result of a cancer diagnosis then the therapist and the psychiatrist would want to know about the cancer when treating your depression. Medical conditions affecting your mental health show up on Axis III. Which is a sort of “oh by the way” thing for therapists.

Medical condition that “influences” your mental health – AXIS III

One reader asked about coding Pregnancy. As I see it if I were treating a client for OCD and she gets pregnant, the pregnancy does not have to be coded. If I were treating this same person for depression and anxiety as a result of a rape and now she finds out she is pregnant, well the pregnancy may now have an effect on her mental health.

Sleep disorders are especially troubling. Poor sleep can be a symptom of a mental illness as in depression. Poor sleep can cause mental illness as in a breathing problem (sleep apnea) that prevents good sleep and creates depression or irritability. Intrusive nightmares can be a sign of PTSD. They can also be causing or maintain the symptoms.

There are some sleep disorders listed in the DSM but that list is not as inclusive as the list in the International Classification of Sleep Disorders. Sometimes there is a connection and sometimes people have a mental illness and sleep disorders that may influence each other but are not directly linked.

Sleep disorders are a highly specialized area. If you have a problem with sleep I recommend that you talk with your physician and you may need a referral to a sleep specialist.

In a future blog post or two, I want to discuss some conditions that get mistaken for other things and mixed up with mental health diagnosis.

More on Sleep Paralysis, Hypnagogic Hallucinations (Hypnagogia), Hypnopompic Hallucinations, Lucid Dreaming and their relationship to mental illness in posts to come.

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For more about David Joel Miller and my work in the areas of mental health, substance abuse and Co-occurring disorders see the about the author page. For information about my other writing work beyond this blog check out my Google+ page or the Facebook author’s page, up under David Joel Miller. Posts to the “books, trainings and classes” category will tell you about those activities. If you are in the Fresno California area, information about my private practice is at A list of books I have read and can recommend is over at Recommended Books


4 thoughts on “Is it a medical problem or a mental health problem – Axis III

  1. Pingback: Is it a medical problem or a mental health problem – Axis III | Stoning Demons

  2. Pingback: Five Axes Diagnosis Esoterica | counselorssoapbox

  3. Pingback: Do addict, mentally ill labels help or hurt? | counselorssoapbox

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