Axis V). This revision is consistent with the DSM-IV text that states, ”The multiaxial dis- tinction among Axis I, Axis II, and Axis III disorders does not imply that there are funda- mental differences in their conceptualization, that mental disorders are unrelated to physical or biological factors or processes, or that general medical conditions are unrelated to behavioral or psychosocial factors or processes.” The approach of separately noting di- agnosis from psychosocial and contextual factors is also consistent with established WHO and ICD guidance to consider the individual’s functional status separately from his or her diagnoses or symptom status. In DSM-5, Axis III has been combined with Axes I and II.
Clinicians should continue to list medical conditions that are important to the understand- ing or management of an individual’s mental disorder(s).
diagnosis, treatment, and prognosis of mental disorders. Although this axis provided helpful information, even if it was not used as frequently as intended, the DSM-S Task
Force recommended that DSM-S should not develop its own classification of psychosocial and environmental problems, but rather use a selected set of the ICD—9—CM V codes and the new Z codes contained in ICD-IO-CM. The ICD-IO Z codes were examined to deter- mine which are most relevant to mental disorders and also to identify gaps.
DSM-IV Axis V consisted of the Global Assessment of Functioning (GAF) scale, repre- senting the clinician's judgment of the individual’s overall level of ”functioning on a hy- pothetical continuum of mental health—illness.” It was recommended that the GAP be dropped from DSM-5 for several reasons, including its conceptual lack of clarity (i.e., in- cluding symptoms, suicide risk, and disabilities in its descriptors) and questionable psy- chometrics in routine practice. In order to provide a global measure of disability, the WHO
Disability Assessment Schedule (WHODAS) is included, for further study, in Section III of
DSM—S (see the chapter ”Assessment Measures”). The WHODAS is based on the Interna- tional Classification of Functioning, Disability and Health (ICF) for use across all of medicine and health care. The WHODAS (version 2.0), and a modification developed for children/ adolescents and their parents by the Impairment and Disability Study Group were in- cluded in the DSM-S field trial.
It was challenging to determine what to include in the print version of DSM-S to be most clinically relevant and useful and at the same time maintain a manageable size. For this reason, the inclusion of clinical rating scales and measures in the print edition is limited to those considered most relevant. Additional assessment measures used in the field trials are available online (www.psychiatry.org/dsm5), linked to the relevant disorders. The
Cultural Formulation Interview, Cultural Formulation Interview—Informant Version, and supplementary modules to the core Cultural Formulation Interview are also available on- line at www.psychiatry.org/ dsm5.
DSM-5 is available as an online subscription at PsychiatryOnlineorg as well as an e— book. The online component contains modules and assessment tools to enhance the diag- nostic criteria and text. Also available online is a complete set of supportive references as well as additional helpful information. The organizational structure of DSM-S, its use of dimensional measures, and compatibility with ICD codes will allow it to be readily adapt- able to future scientific discoveries and refinements in its clinical utility. DSM-5 will be an- alyzed over time to continually assess its validity and enhance its value to clinicians.
Use of the Manual
The introduction contains much of the history and developmental process of the