DSM-5: No More Multiaxial System

By Heidi Tobe on September 27, 2019

The DSM-5 was published in 2013. Many social workers went to school learning the DSM-IV-TR and because of this, we still receive coaching questions about the differences between the DSM-IV-TR and the DSM-5. We know regardless of which DSM you went to school with, picking up the DSM-5 can feel daunting. The thought of learning and applying all of the DSM-5 information to LCSW exam questions can be overwhelming. But fear not: TDC's got you covered!

How am I supposed to memorize the DSM-5?

The good news is, you aren’t! The ASWB does not expect you to have the DSM-5 memorized. One of my favorite things about Therapist Development Center’s LCSW and LMSW exam prep programs (that helped me pass both my LMSW and LCSW exams) is that they only give you what you need. While TDC gives you everything you need to pass the exam, they also give you nothing you don’t need.

A lot of programs out there give you WAY more content than you need when the actual exam is primarily made up of reasoning based scenarios. Because of this, exam prep can feel incredibly overwhelming. So rather than having you memorize tedious lists of diagnostic criteria for every diagnosis (which is NOT how the ASWB tests you), we give you the differentials for the most commonly tested diagnoses. We also include an entire LCSW practice exam dedicated to LCSW practice questions exclusively on DSM-5 diagnoses. We do this for the LMSW as well!

What was the multiaxial system?

One of the biggest changes between the DSM-IV-TR and the DSM-5 is the removal of the multiaxial system. Prior to the DSM-5, the DSM-IV-TR utilized a multiaxial system of diagnosis. The DSM-III published in 1980 introduced this system, existing to ensure that psychological, biological, environmental, and psychosocial factors were all considered when making a mental health diagnosis. This system utilized diagnoses across five DSM axes to look at the different impacts and elements of disorders. The five axes included: 1. The primary diagnosis, 2. Personality disorders and/or mental retardation, 3. Medical and/or neurological problems impacting the individual’s psychological concerns, 4. The nine categories of environmental and psychosocial stressors impacting the client’s psychological functioning, (such as job loss, romantic separations, or deaths), and 5. A 0-100 rating called the Global Assessment of Functioning (or “GAF”), quantifying the person’s overall level of functioning.

Why was the multiaxial system removed?

The authors of the DSM-5 streamlined and simplified the diagnostic process by developing a single axis system for assessment and diagnosis of mental disorders. Information from the first four DSM axes are still taken into consideration, but are not separated as they were in previous editions of the DSM. Namely, the DSM-5 has combined axes 1-3 into a single axis that accounts for mental and other medical diagnoses. There are no longer distinct categories for mental health diagnoses, medical diagnoses, and personality disorders.

Prior to the combined axes, experts argued there were no fundamental differences between Axis 1 and Axis 2 diagnoses. Because of this, they believed separating them could lead to confusion and lack of adequate treatment. Contributing stressors that were previously accounted for on the fourth DSM axis are now taken into account through a broadened set of V and Z codes that clinicians can use to indicate additional areas of concern that could be impacting diagnosis and treatment, or that could require further clinical attention (Kress et al., 2014). The fifth DSM axis had long been criticized for lack of reliability and consistency amongst clinicians. It was because of that lack of reliability as well as poor clinical utility that the APA chose to remove this measure from the DSM-5. Moving forward the APA recommends clinicians find alternate ways to document an individual’s distress and impaired functioning (APA, 2013).

How will this impact client work?

The long term impact of these changes is yet to be seen, but will surely reveal itself over time. What are the possible impacts these changes may have? Well, it has been noted that removing the distinction of personality disorders from their own axis may help remove some of the stigma previously associated with these diagnoses (Kress et al., 2014). Experts cite both benefits and drawbacks to combining medical and mental health diagnoses. Possible benefits include decreased stigmatization of mental health disorders, because a single axis system points towards a shared biological basis for both mental health and medical conditions. The previous distinction between mental health and medical disorders led to unequal health care coverage for mental health treatment. Removing this division could prove helpful in equal coverage being provided for mental health conditions.

In terms of drawbacks, having a view of mental health disorders being rooted in biology could suggest those with mental health disorders are flawed biologically (Ben-Zeev, Young, & Corrigan, 2010). Some argue this view could result in a lessening of the consideration of environmental factors on mental health conditions. Further, some say it could lead to an increased use of psychopharmacology to treat mental health disorders (Frances, 2013).

Note for test-takers: Will the multiaxial system show up on my exam?

It will not! Neither our LCSW practice exam questions nor the test itself will include anything from the DSM-IV-TR, so because of this, you won't see the multiaxial system show up. The exam only reflects material from the DSM-5. 

Are you ready for the DSM-5?

Whether you went to school learning the DSM-IV, the DSM-IV-TR, or the DSM-5, TDC thoroughly prepares you so you're ready for both the content and structure of the DSM questions on your ASWB exams. With over 700 LCSW practice questions in the clinical program and 600 LMSW practice questions in the master’s level program, you will learn everything you need to know to PASS your exam with confidence. If you’re ever struggling to understand a question or rationale, you can email your TDC coach who will get back to you with a personalized response to ensure you are ready to PASS. We’ve helped thousands of social workers pass their ASWB licensure exams with a 95% pass rate. Are you next?


American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: Author.

Ben-Zeev, D., Young, M. A., & Corrigan, P. W. (2010). DSM-V and the stigma of mental illness. Journal of Mental Health, 19, 318–327. doi:10.3109/09638237.2010.492484

Frances, A. (2013). Essentials of psychiatric diagnosis: Responding to the challenge of DSM-5. New York, NY: Guilford Press.

Kress, V. C., Barrio Minton, C. A., Adamson, N. A., Paylo, M. J., & Pope, V. (2014). The removal of the multiaxial system in the DSM‐5: Implications and practice suggestions for counselors. The Professional Counselor, 4, 191‐201. doi: :10.15241/vek.4.3.191



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