Axis I

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Axis I is part of the DSM "multiaxial" system for assessment. The five axis model is designed to provide a comprehensive diagnosis that includes a complete picture of not just acute symptoms but of the entire scope of factors that account for a patient's mental health. This page explains DSM Axis I

Axis I: Clinical Disorders

This is the top-level of the DSM multiaxial system of diagnosis. It represents acute symptoms that need treatment; Axis I diagnoses are the most familiar and widely recognized (e.g., major depressive episode, schizophrenic episode, panic attack). Axis I terms are classified according to V-codes by the medical industry (primarily for billing and insurance purposes).

Clinical Disorders are grouped into categories listed below with examples of each.

Major Categories of DSM Clinical Disorders

Adjustment Disorders

With Anxiety
With Depressed Mood
With Disturbance of Conduct
With Mixed Anxiety and Depressed Mood
With Mixed Disturbance of Emotions and Conduct
Unspecified.

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Anxiety Disorders

Cognitive Disorders (Delirium, Dementia, and Amnestic).

Dissociative Disorders.

Depersonalization Disorder
Dissociative Amnesia
Dissociative Fugue
Dissociative Identity Disorder
Dissociative Disorder Not Otherwise Specified (NOS)

Eating Disorders.

Anorexia Nervosa
Bulimia Nervosa
Eating Disorder Not Otherwise Specified (NOS)

Factitious Disorders.

With Combined Psychological and Physical Signs and Symptoms
With Predominantly Physical Signs and Symptoms
With Predominantly Psychological Signs and Symptoms

Impulse-Control Disorders (Not Classified Elsewhere).

Impulse-Control Disorder Not Otherwise Specified (NOS)
Intermittent Explosive Disorder
Kleptomania
Pathological Gambling
Pyromania
Trichotillomania

Mental Disorders Due to a General Medical Condition

Catatonic Disorder Due to a General Medical Condition
Personality Change Due to a General Medical Condition

Mood Disorders

Schizophrenia and other Psychotic Disorders

Paranoid Type
Disorganized Type
Catatonic Type
Undifferentiated Type
Residual Type
Brief Psychotic Disorder
Delusional Disorder
Psychotic Disorder Due to a General Medical Condition
Psychotic Disorder Not Otherwise Specified
Schizoeffective Disorder
Schizophreniform Disorder
Substance-Induced Psychotic Disorder

Sexual and Gender Identity Disorders.

Paraphilias:

Exhibitionism
Fetishism
Frotteurism
Pedophilia
Sexual Masochism
Sexual Sadism
Transvestic Fetishism
Voyeurism
Paraphilia Not otherwise Specified

Sexual Dysfunction:

Hypoactive Sexual Desire Disorder
Female Orgasmic Disorder (Inhibited Female Orgasm)
Female Sexual Arousal Disorder
Male Erectile Disorder
Male Orgasmic Disorder (Inhibited Male Orgasm)
Premature Ejaculation
Sexual Aversion Disorder
Sexual Dysfunction Due to a General Medical Condition
Substance-Induced Sexual Dysfunction
Sexual Dysfunction Not Otherwise Specified (NOS)

Sexual Pain Disorders:

Dyspareunia (Not Due to a General Medical Condition)
Vaginismus (Not Due to a General Medical Condition)

Sleep Disorders.

Breathing-Related Sleep Disorder
Circadian Rhythm Sleep Disorder
Dyssomnias Not Otherwise Specified. (NOS)
Insomnia Related to Another Mental Disorder
Nightmare Disorder (Dream Anxiety Disorder)
Primary Sleep Disorders:
- Primary Insomnia
- Primary Hypersomnia
- Narcolepsy
Sleep Disorder Due to a General Medical Condition
Sleep Disorder Related to Another Mental Disorder
Sleep Terror Disorder
Sleepwalking Disorder
Substance-Induced Sleep Disorder

Somatoform Disorders.

Somatization Disorder
Undifferentiated Somatoform Disorder
Conversion Disorder
Pain Disorder
Hypochondriasis.Body Dysmorphic Disorder
Somatoform Disorder not Otherwise Specified (NOS)

Substance-Related Disorders.

Substance-Induced Anxiety Disorder.
Substance-Induced Mood Disorder.
Substance-Induced Psychotic Disorder.
Substance-Induced Sleep Disorder.

Axis I in DSM-5

The next edition of the DSM is scheduled for publication in May, 2013. Working groups are reviewing the multiaxial system to try to bring it more into line with international reporting standards (as opposed to U.S. standards) with the goal of having a global approach to mental health diagnosis. Regarding Axis I, the American Psychiatric Association states,

The subgroup has recommended that DSM-5 collapse Axes I, II, and III into one axis that contains all psychiatric and general medical diagnoses. This change would bring DSM-5 into greater harmony with the single-axis approach used by the international community in the World Health Organization’s (WHO) International Classification of Diseases (ICD).

An example of a multiaxial diagnosis

From Edward Pierce, LCSW

Axis I: Major Depressive Disorder, Single Episode, Severe Without Psychotic Features
Axis II: Dependent Personality Disorder Frequent use of denial
Axis III: None
Axis IV: Threat of job loss
Axis V: GAF = 35 (last year)

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