The CLINICIAN'S diagnostic process involves both the identification and classification of the disorder and the assessment of individual functioning. Both aspects are important for planning treatment and for evaluating outcomes. The multiaxial system of diagnosing mental disorders has arisen in recognition of the need for a standardized system of classification for communication among professionals. Hence, the classifications in DSM-IV (axes 1 through 3) are supplemented by the assessment of an individual's life stressors and functioning (axes 4 and 5).1 Axes 4 and 5, however, are wanting. Criteria for judgments are less specific than for the first three axes, and axes 4 and 5 occupy little attention in our manuals and do not take account of individual complexity.
See also pages 625, 633, 639, 642, 645, 646, 649, 651, and 654
The article by Horowitz and colleagues2 presents a method to bolster our systematic assessment of individual functioning. It