Rhyme Of The Ancient Wanderer (Support for Dysthymia, BPD, and Depression)
Axis IV


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Descriptions of Axis IV.

Axis IV:
Psychosocial and Environmental Stressors is for reporting psychosocial and environmental problems that may affect the diagnosis, treatment, and prognosis of mental disorders. A psychosocial or environment problem may be a negative life event, an environmental difficulty or deficiency, a familial or other interpersonal stress, an inadequacy of social support of personal resources, or other problem relating to the context in which a person's difficulties have developed. Positive stressors, such as a job promotion, should be listed only if they constitute or lead to a problem, as when a person has difficulty adapting to the new situation. Psychosocial and Environmental Stressors fall into nine categories:


Primary Support Group

Problems Related to the Social Environment

Educational Problems

Occupational Problems

Housing Problems

Economic Problems

Problems with Access to Health Care Services

Problems Related to Interaction with the Legal System/Crime

Other Psychosocial and Environmental Problems



Primary Support Group

1. Engagement

2. Marriage

3. Discord

4. Death of a family member

5. Health problems in family

6. Physical or mental illness of a family member

7. Disruption of family by separation, divorce, or estrangement

8. Removal from the home

9. Remarraige of parent

10. Sexual or physical abuse

11. Parental overprotection

12. Becoming a parent

13. Unwanted pregnancy, out-of-wedlock birth, rape

14. Friction with child

15. Illness of child

16. Neglect of child

17. Inadequate discipline

18. Discord with siblings

19. Birth of sibling

20. Personal physical illness or injury (e.g., illness, accident, surgery, abortion)

21. Long-term mental illness

For children: cold, hostile, intrusive, abusive, conflictual, or confusingly inconsistent relationship between parents or toward child; physical or mental illness in a family member; lack of parental guidance or excessively harsh or inconsistent parental control; insufficient, excessive, or confusing social or cognitive stimulation; anomalous (deviation from the normal order or rule) family situation, e.g., complex or inconsistent parental custody and visitation arrangements; foster family; institutional rearing; loss of nuclear family members.


Problems Related to the Social Environment

1. Death or loss of friend

2. Illness of best friend

3. Inadequate social support

4. Living alone

5. Difficulty with acculturation (different cultures)

6. Discrimination

7. Adjustment to life-cycle transition (e.g., puberty, transition to adult status, menopause, "becoming 50", retirement)

8. Difficulties with interpersonal relationships


Educational Problems

1. Illiteracy

2. Academic problems

3. Discord with teachers or classmates

4. Inadequate school environment

5. School problems


Occupational Problems

1. Unemployment

2. Homemaking

3. Threat of job loss

4. Stressful work schedule

5. Difficult work conditions

6. Job dissatisfaction

7. Job change

8. Discord with boss or co-workers

Housing Problems

1. Homelessness

2. Inadequate housing

3. Change in residence

4. Immigration

5. Unsafe neighborhood

6. Threat to personal safety

7. Discord with neighbors or landlord

Economic Problems

1. Extreme poverty

2. Inadequate finances

3. Insufficient welfare support

4. Change in financial status


Problems with Access to Health Care Services

1. Inadequate health care services

2. Transportation to health care facilities unavailable

3. Inadequate health insurance


Problems Related to Interaction with the Legal System/Crime

1. Arrest

2. Incarceration

3. Litigation (lawsuit/trial)

4. Victim of crime


Other Psychosocial and Environmental Problems

1. Exposure to disasters, war, other hostilities (natural or manmade)

2. Persecution

3. Discord with non-family caregivers such as counselor, social worker, or physician

4. Unavailability of social service agencies

Information and or Criteria summarized from:
American Psychiatric Association. (1994). Diagnostic and statistical manual of mental disorders, fourth edition. Washington, DC: American Psychiatric Association.

This information is not intended to replace "traditional" mental health therapy. If you have questions or concerns about your physical and/or mental health ... contact your family physician and/or mental health professional in your area.