The American Psychiatric Association has a system for diagnosing abnormal behavior. It is the DSM, or Diagnostic and Statistical Manual of Mental Disorders. The most current DSM is the fourth edition, DSM-IV, which was published in 1994. It clarifies and organizes disorders according to observable behavior and serves as a guide for diagnosis of various mental disorders. It is composed of 16 categories and over 200 subcategories. The DSM shows the percentage of the population sufferering from each disorder and lifetime prevalence percentages for most disorders.
The DSM is divided into 5 dimensions, referred to as axes. These axes are considered regarding each individual patient so that a correct diagnosis can be made. These axes are as follows:
Disorders Usually First Diagnosed In Infancy, Childhood, or Adolescence
Delirium, Dementia, Amnestetic, and Other Cognitive Disorders
Substance-Related Diorders
Schizophrenia and Other Psychotic Disorders
Mood Disorders
Anxiety Disorders
Somatoform Disorders
Factitious Disorders
Dissociative Disorders
Sexual And Gender Identity Disorders
Eating Disorders
Sleep Disorders
Impulse-Control Disorders Not Elsewhere Classified
Adjustment Disorders
Personality Disorders
Disorders Due to a Medical Condition
Mark is a 56-year-old machine operator who was referred for treatment by his supervisor. The supervisor noted that Mark's performance at work had deteriorated during the past four months. Mark was frequently absent from work, had difficulty getting along with others, and often had a strong odor of liquor on his breath after his lunch break. The supervisor knew Mark was a heavy drinker and suspected that Mark's performance was affected by alcohol comsumption. In truth, Mark could not stay away from drinking. He consumed alcohol every day; during weekends, he averaged about 16 ounces of Scotch per day. Although he had been a heavy drinker for thity years, his consumption had increased after his wife divorced him six months ago. She claimed she could no longer tolerate his drinking, extreme jealousy, and unwarranted suspicions concerning her marital fidelity.
Co-workers avoided Mark because he was a cold, unemotional person who distrusted others.
During interviews with the therapist, Mark revealed very little about himself. He blamed others for his drinking problemsl; if his wife had been faithful or if others were not out to get him, he would drink less. Mark appeared to overreact to any perceived criticisms of himself. A medical examination revealed that Mark was developing cirrhosis of the liver as a result of his chronic and heavy drinking.
The evaluation:
Mark's heavy use of alcohol, which interfered with his functioning, resulted in an alcohol abuse diagnosis on Axis I. Mark also exhibited a personality disorder, which was diagnosed as paraniod personality on Axis II because of his suspiciousness, hypervigilance, and other behaviors. Cirrhosis of the liver was noted on Axis III. The clinician noted Mark's divorce and difficulties in his job on Axis IV. Finally, Mark was given a 54 on the Global Assessment of Functioning scale (GAF), used in Axis V to rate his current level of functioning, mainly because he was exhibiting moderate difficulty at work and in his social relationships. Mark's diagnosis, then, was as follows: