The main feature of this DSM-IV system is its five axis investigative system which is a scientific and logical process. This Axis I is Clinical Disorders which includes those disorders diagnosed in the infancy or childhood, Dementia and other Cognitive Disorders, Mental Disorders due to Medical Conditions and Mood Disorders. The Axis II is Personality Disorders and Mental Retardation e. g. Borderline Personality Disorder, Paranoid Personality Disorders, Dependent Personality Disorders, etc.
The Axis III is General Medical Condition which is about the patient’s mental disorders and its management. The Axis IV is Psychosocial and Environmental Problems which includes troubles with the main support groups e. g. educational problems, occupational problems, ill-treatment, etc. The Axis V is about Global Assessment of Functioning of patient which helps in evaluating one’s capability to adapt with the real life situation and is also used efficiently to determine a patient’s need to admit him in the hospital. (http://www. dhs.
state. or. us/caf/safety_model/procedure_manual/appendices/ch4-app/4-5. pdf) After publication of DSM-IV, considering its efficiency in diagnosing and categorization of a person’s problem, it is seen that some revision and additions are necessary. But at the same time it is also estimated that the publication of the next version of Diagnostic and Statistical Manual of Mental Disorders is not possible before 2011. So to cope with the immediate requirement, a text revision of DSM-IV, which is termed as DSM-IV-TR, was published in May, 2000.
In this version steps were taken to rectify the errors of DSM-IV. In addition to this, some diagnostic codes were changed to make it compatible with the ICD-9-CM coding system of the U. S. Government. (http://dsmivtr. org/) Moreover some major changes like “Clarification of the Definition of Pervasive Developmental Disorder Not Otherwise Specified” and “Removal of clinical significance criterion from the criteria sets for Tic Disorders” were also done. (http://dsmivtr. org/2-3changes. cfm)
Under the light of DSM – IV-TR multiaxial system when we consider the Susan’s case then we find that her case is an example of Dependent Personality Disorder which falls under Axis II: Personality Disorders and Mental Retardation. According to Dr. Halleck, who watched Susan very closely and talked to her, she always believed that she couldn’t live alone since she couldn’t do anything on her own. Actually she was of such a character who always needed love and badly needed someone’s support while going through her life.
She was terribly frightened about the idea of living alone and she was depressed only when she lived alone. From the family history of Susan it was found that this utter depression made her suicidal. Considering all these aspects of her psychological state it can be inferred that since personality disorders and mental retardation are excluded from Axis I, this case does not belong to Axis I which deals with Clinical Disorders. Again since Axis III includes Physical Diseases or in other words general medical condition, this case also has no relation with the Axis III diagnosis.
Again since Axis IV deals with the Psychosocial and Environmental Problems which have adverse effects on lives like educational and occupational hazards and finally Axis V is about Global Assessments of Functioning of patient which is actually helpful in planning the process of treatment, estimating the progress and anticipating the result. Though some features of Susan’s case may be associated discretely with any of the axis but when the case is considered as a whole giving equal importance to all characteristics then it can be concluded that the case belongs to Axis II which includes Personality Disorders and Mental Retardation.
If we look back into Susan’s life we will see starting from her childhood she had to face different adverse situations. At her childhood her father committed suicide which put her into utter loneliness. To get rid of this situation she tried to find someone who will give mental support to her and in this process she came across her step father who molested her day after day.