DSM-IV Definition:

The authoritative manual and cataloging of mental disorders originally published by the American Psychiatric Association ("APA") in 1994 and revised in 2000 (DSM-IV-TR; and to be revised again in 2010).

The DSM-IV manual is highly regarded around the world and often relied upon as a reliable medical reference in regards to mental disorders, by lawyers and, provided the evidence is introduced through a qualified, expert witness, courts of law. But note these judicial words:

"The inclusion or lack of inclusion in DSM IV is interesting but not fatal to the finding of mental disorder ... That is because the finding that the condition is a disease of the mind is a legal finding as opposed to a medical finding."¹

In addition to defining each mental disorder, the DSM-IV lists and catalogs mental disorders. The APA uses the word "axis" to delimit, by Roman numeral (as in Axis III) the various mental disorders. Axis 3 and Axis 4 relate to related issues and do not include mental disorders.

Here are some the categories and examples of each:

• Axis I: Clinical disorders (eg. dementia, delirium; schizophrenia, eating and sleeping disorders);
• Axis II: Personality disorders and mental retardation (eg. paranoia, antisocial and obsessive compusive disorder);
• Axis III: General medical conditions that might be relevant to understanding an individual's mental disorder (injury and poisoning); and
• Axis IV: Psychosocial and environmental problems (a negative life event such as intense grief over the death of a loved one).

There is a fifth axis ("Axis V") but rather than a category of mental disorder, Axis 5 is an assessment tool; "global assessment of functioning" on a scale of 1 to 100 (reporting and scoring of psychiatric assessment).

Here is an example¹ of a completed "final" DSM-IV diagnosis presented for sentencing purposes in a criminal matter:

• AXIS I: Polystubstance abuse in remission.
• AXIS II: Antisocial and dependent personality traits.
• AXIS III: Fetal Alcohol Spectrum Disorder.
• AXIS IV: Moderate stressors including incarceration, difficult relationships and living with fetal alcohol-related deficits.
• AXIS V: GAF 55 - 60.

REFERENCES:

• American Psychiatric Association, Diagnostic and Stastical Manual of Mental Disorders, 4th ed. (Washington, DC: American Psychiatric Association, 2000)
• Duhaime, Lloyd, Duhaime's Legal Dictionary
• R. v. D.J.R., 2006 BCCA 125 (note 1)
• R v Elaschuk, 2000 ABPC 139 (at ¶26)