DSM-5 removes the multiaxial system, but clinicians still report medical conditions that the client self-reports or that the provider has obtained medical documentation for to verify its presence.
In DSM-5, all conditions are listed in hierarchy from the most severe then down to the least severe – and severity is now determined by using the Level 1 and Level 2 Cross-Cutting Symptom Measures. “The principal diagnosis is indicated by listing it first, and the remaining disorders are listed in order of focus of attention and treatment” (DSM-5, p. 23)
Axis I-III: DSM-5 combines the first three DSM-IV-TR axes into one list that contains all mental disorders, including personality disorders and intellectual disability, as well as other medical diagnoses.
Axis IV: Contributing psychosocial and environmental factors or other reasons for visits are now represented through an expanded selected set of V codes (ICD-9) or Z codes (ICD-10). The V/Z code can be used when it is more specific to the care being rendered than a psychiatric diagnosis.
Axis V: The GAF scale was previously used, in DSM-IV, to measure disability and functioning for determinations of medical necessity for treatment by many payers, and eligibility for short- and long-term disability compensation. Global assessment of functioning is still reported as it was on Axis V, but now using the World Health Organization’s Disability Assessment Schedule (WHODAS) in DSM-5 instead of GAF.
Click here to read the six WHODAS patient domains and the full article....