Diagnosis of Psychological Disorders

The diagnosis of a psychological disorder requires evaluation by a trained mental‐health professional

and usually an interview, administration of a variety of personality tests (and in some cases,
neuropsy‐chological tests), and gathering of background (including medical) information about the
individual. The mental‐health professional arrives at a diagnosis by comparing this information to
that in the Diagnostic and Statistical Manual of Mental Disorders , the DSM‐IV (IV for fourth edition,
1994), which uses a system devised by the American Psychiatric Association to classify psychological
disorders. The classification system, which lists 16 categories of maladjustment and more than 200
subcategories, is designed to improve the reliability of diagnoses by using observable behaviors to
categorize disorders and to ensure that diagnoses are consistent with current information. Diagnosis
using this resource requires the use of five dimensions, or axes. Judgments must be made on each of
the five axes, and a diagnostician must consider a broad range of information in making the
diagnosis.

The classification of abnormal behavior is made on the basis of Axis I (Clinical Syndromes) and Axis II
(Personality Disorders). Patients may receive a diagnosis on both axes; the milder, long‐standing
personality disorders of Axis II may coexist with Axis I syndromes. The remaining three axes— Axis III
(General Medical Conditions), Axis IV (Psychosocial and Environmental Problems), and Axis V (Global
Assessment of Functioning)—are used to provide supplementary information. Use of the combined
axes, which include the individual's history and highest level of competent functioning in the past
year, ensures that a person not only will be assigned to a mental‐disturbance category but also will
be characterized by a number of relevant clinical factors.

Use of a classification system permits mental‐health professionals to communicate accurately, helps

in the determination of effective treatments, facilitates the use of research data on a particular
category, and assists in making predictions. Classification systems, however, are based upon
judgments of professionals and can change over time as new information is collected. Controversy
still exists over the DSM‐IV system; it is revised as new research information becomes available.
Diagnostic categories have been deleted or changed. For example, “homosexuality” has been
excluded as a mental‐disturbance category, and arguments about use of the category “premenstrual
syndrome” have resulted in the condition's being moved to the appendix, where it is called
“premenstrual dysphoric disorder” and listed as needing more study. The category termed “
neuroses” has not been included since the 1980 edition. The term “ psychosis” is still used for
conditions such as schizophrenia, which are characterized by bizarre behavior and beliefs, delusions,
and loss of contact with reality.