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Multiaxial Diagnosis and the Psychosomatic Model of Disease

From the Department of Psychiatry, Pennsylvania Hospital, and University of Pennsylvania, Philadelphia, PA.

Address reprint requests to: Donald Oken, MD, Department of Psychiatry, Pennsylvania Hospital, 800 Spruce St., Philadelphia PA 19107-6192.

ABSTRACT

Current medical diagnosis reflects the prevailing biomedical model of disease. A need exists for a new system of diagnosis that, instead, is based on the psychosomatic model. This article presents an analysis of the underlying framework of the multiaxial system developed in recent years for diagnosis in Psychiatry that indicates its relevance to the psychosomatic model. It goes on to describe a new multiaxial system of diagnosis derived from that analysis that allows diagnosis to be stated as a process of adaptation in the environment, which includes biological, psychological, and social factors. The practical application of this system to the broad range of medical illnesses is explained and illustrated. This multiaxial approach represents a first step toward, and a stimulus for, the development of a better diagnostic system that can provide one basis for the crucial transformation of medical care to reflect the psychosomatic model of disease.

Key Words: diagnosis • psychosomatic • disease model • multiaxial.

Abbreviations: Consultation/liaison = C/L; DSM-III = Diagnostic andStatistical Manual of Mental Disorders, third edition; DSM-III-R = Diagnostic and Statistical Manual of MentalDisorders, third edition, revised; DSM-IV =Diagnostic and Statistical Manual of Mental Disorders,fourth edition; ICD = International Classification of Diseases; MAS = multiaxial assessment system.

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