Axis IV Psychosocial and Environmental Problems

Axis IV is included for detailing psychological, social, and environmental problems that may be relevant to the presenting mental disorder. Such problems may have influenced the development of the disorder, may have developed as a consequence of the disorder, may be relevant to the selection of an appropriate treatment, or may influence the prognosis for recovery. Although both positive (e.g., job promotion) and negative (e.g., job loss) life events can be perceived as stressful, typically only the negative events are detailed on Axis IV unless the positive event is clearly related to the mental disorder. Moreover, only events during the last year are typically noted, unless remote events still appear to be a significant influence on the mental disorder. Examples of problems that could be listed on Axis IV include death of a loved one, divorce, problems with school, unemployment or other job problems, homelessness or a difficult living situation, financial troubles, lack of insurance, legal troubles, or experiencing a natural disaster.

A careful assessment of the problems listed on Axis IV may suggest that, in some cases, the most appropriate intervention will not focus on the individual (as is the case with psychological counseling or the prescription of psychotropic medication), but rather on the broader social environment in which the individual must exist. In such cases, the primary intervention could involve not only mental health professionals (e.g., providing family therapy), but teachers, landlords, lawyers, insurance companies, and so on. On the other hand, some mental disorders may arise in the relative absence of psychosocial and environmental problems and suggest that the treatment might most fruitfully focus on the individual.

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