Psychiatric Disabilities
Many years ago, the American Psychiatric Association created its own diagnostic manual because earlier versions of the ICD were not adequately descriptive for classifying mental conditions in America. The ICD covers all medical conditions and diseases, and is how these are usually reported to insurance companies, and by international treaty how nations report disease statistics to the World Health Organization.
In relation to psychiatric disabilities, ICD-X is a marked and dramatic improvement over ICD-IX, and in future years there may not be a need for a separate American manual. At the present time, however, the DSM-IV is far more widely employed by clinicians in America, and this category system for mental conditions will be used here. The American Psychiatric Association updates its diagnostic manual approximately every ten years.
Axis I: Clinical Disorders and Other Conditions That May Be a Focus of Clinical Attention
Axis II: Personality Disorders and Mental Retardation
Axis III: General Medical Conditions
Axis IV: Psychosocial and Environmental Problems
Axis V: Global Assessment of Functioning
In DSM-IV both personality disorders and mental retardation are classified on Axis II. This is only to give them special reecognition, and nothing more. The conditions have no relationship.
Paranoid Personality Disorder:
These individuals have a lifelong pattern of suspiciousness and mistrust of others. They are typically hostileand angry, and blame others for these feelings rather than taking responsibility themselves.
Schizoid Personality Disorder:
These individuals are withdrawn, isolated and have limited interpersonal relationship skills. They are lifelong "loners"
who do not really want close contact with others. There is frequently a rich fantasy life which compensates for the lack of social involvement.
Schizotypal Personality Disorder:
These individuals have unusual beliefs, and they are often seen as "odd," even by lay people. Their ideas and thinking are strange,
but not to the point of being blatantly psychotic. Dress and appearance may also be unusual.
***Cluster 2***
Antisocial Personality Disorder:
These individuals have a pattern of antisocial or criminal acts that go back to their adolescent years. They are pleasure-seeking,
impulsive, and unable to conform to social norms. In ICD-X this is called dissocial personality disorder.
Borderline Personality Disorder:
These individuals have highly unstable affect, mood, behavior, relationships with others, and self-image. They repeatedly
experience a great deal of emotional turmoil that overwhelms them, and episodes of depression are common. The ICD-X term for this is
emotionally unstable personality disorder.
Histrionic Personality Disorder:
These individuals are dramatic, emotional and excitable, and their behavior is extroverted and attention seeking. They are superficial and have difficulties forming deep and long-lasting relationships.
Narcissistic Personality Disorder:
These individuals feel superior or special, are self-absorbed, and they have a sense of being entitled to special treatment and/or privileges. Interpersonal relationships are typically exploitative, and they lack of genuine empathy for others.
***Cluster 3***
Avoidant Personality Disorder:
These individuals are very shy and extremely sensitive to any threat of rejection or disapproval. Unlike the person with schizoid personality disorder, they desire companionship. Their feelings of inferiority and fears of rejection, however, interfere with their ability to form relationships. In ICD-X this is called anxious personality disorder.
Dependent Personality Disorder:
These individuals subordinate their needs to the needs of others. They are insecure and allow others, often a spouse or parent, to
make major life decisions for them. They may be very uncomfortable when alone.
Obsessive-Compulsive Personality Disorder:
These individuals are very rigid and perfectionistic. They can also be quite stubborn and indecisive. They plan excessively and have strong needs for order and control. They control their emotions and typically show little affect. In ICD-X this is called anankastic personality disorder.
Personality Disorder NOS:
This category is for disorders of personality that do not fit into any of the above categories. NOS stands for "not otherwise specified."
Mental retardation is diagnosed when: (1) measured IQ is below 70 on an individually administered intelligence test such as the WAIS-R, (2) there are concurrent deficits in adaptive functioning, and (3) the condition began before 18 years of age.
What licensed professional counselors can diagnose or complete on the axis system used by DSM-IV varies between state laws that govern private practice and different employment situations. General medical conditions are only diagnosed by a physician. In private practice, the counselor would normally write "defer" in this area or leave it blank. In some cases a condition may be listed with "by history" afterwards in parentheses if there is a physician's report with the diagnosis on file.
Psychosocial and Environmental Problems:
Problems with primary support group.
Problems related to social environment.
Educational problems.
Occupational problems.
Housing problems.
Economic problems.
Problems with access to health care services.
Problems related to interactions with the legal system/crime.
Other psychosocial and environmental problems.
