Which Mental Health Conditions Were Axis I Disorders?

While the most current version of the Diagnostic and Statistical Manual of Mental Disorders (DSM) is the fifth edition, the previous version (DSM-IV) used an axial system to categorize mental health disorders. Within that system, Axis I disorders included “mental health and substance use disorders.”

Learn more about this change and which mental health conditions fell into the category of Axis I disorders under the DSM-IV. Even though this axial system no longer exists, it helps give insight into the direction that psychiatric diagnosis is taking over time.

DSM-IV Axial System

Published by the American Psychiatric Association, the DSM is the manual mental health professionals use to diagnose mental health disorders. It provides the criteria required for diagnosis, also categorizing conditions based on certain similarities.

Under the DSM-IV, all psychiatric disorders and other mental health issues were organized into five different categories or axes. These five classifications helped mental health professionals give patients a proper diagnosis based on their symptoms and other factors related to their mental health.

The five axes within the DSM-IV’s multi-axial system were:

• Axis I: Mental health and substance use disorders
• Axis II: Personality disorders and mental retardation
• Axis III: General medical conditions
• Axis IV: Psychosocial and environmental problems
• Axis V: Assessment of overall functioning

The DSM-5 debuted in 2013 and adopted a nonaxial method of categorizing mental health disorders. In the fifth and latest edition, the first three axes within the DSM-IV were combined in the same category, with the last two axes being grouped together as well.

Axis I Disorders In the DSM-IV

Axis I disorders included both mental health and substance abuse disorders. Mental health conditions falling within the category of Axis I disorders were:

• Anxiety disorders (panic disorder, social anxiety disorder, post-traumatic stress disorder, etc.)
• Dissociative disorders (dissociative identity disorder, depersonalization-derealization disorder, etc.)
• Eating disorders (anorexia nervosa, bulimia nervosa, etc.)
• Mood disorders (major depression, bipolar disorder, etc.)
• Psychotic disorders (delusional disorder, schizophrenia, etc.)

PTSD Diagnosis Changed from DSM-IV to DSM-5

Axial I disorders within the DSM-IV included anxiety disorders, one of which was post-traumatic stress disorder (PTSD). People with PTSD tend to have other anxiety disorders, also commonly developing substance use disorders.

Despite this connection, in the DSM-5, PTSD was removed from the category of anxiety disorders. Instead, it was put into a classification called “Trauma- and Stressor-Related Disorders.”

People with a PTSD diagnosis have typically witnessed or experienced an event in which their own or someone else’s life or well-being was seriously put in danger. Members of the armed forces, sexual assault victims, and those living through major natural disasters are examples of people who commonly experience PTSD.

Other Axis Categories

Other mental health issues fell into the other axial categories. For instance, Axis II disorders included developmental disorders and personality disorders, the symptoms of which can usually be spotted in childhood and create lifelong challenges. Axis III disorders referred to medical or neurological issues with the potential to give rise to psychiatric problems.

Axis IV disorders referred to psychiatric problems caused by environmental and psychosocial stressors. This included the death of a loved one or a major life change, such as getting laid off or having a spouse leave. These stressors can compromise diagnosis and treatment of a mental health condition. 

Lastly, Axis V was used to classify an individual’s ability to function in life. It utilized a scale of 0 to 100, with a high score representing no effect on the person’s functional abilities and a low score representing severely reduced function and/or being a danger to themselves or others.

Seeking Help for Axial I Disorders

If you suspect that you or a loved one has a mental health disorder that was once an Axial I disorder, don’t hesitate to seek treatment. A mental health professional can provide strategies for coping with your condition.

These professionals may also sometimes prescribe drugs to help manage symptoms associated with that particular disorder. Simply speaking to a neutral party about your experiences can be uplifting as well.

What you discuss with a mental health provider is confidential. Reaching out for help is the first step in learning how to live your best life, and the beginning of your mental health recovery process.