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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:
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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
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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.
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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
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Educational Problems
1. Illiteracy
2. Academic problems
3. Discord with teachers or classmates
4. Inadequate school environment
5. School problems
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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
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Problems with Access to Health Care Services
1. Inadequate health care services
2. Transportation to health care facilities unavailable
3. Inadequate health insurance
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Problems Related to Interaction with the Legal System/Crime
1. Arrest
2. Incarceration
3. Litigation (lawsuit/trial)
4. Victim of crime
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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.
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