DIAGNOSIS MULTIAKSIAL

Psikologi abnormal
DIAGNOSIS MULTIAKSIAL
 DSM (Diagnostic and Statistical Manual of Mental
Disorder) published by American Psychiatric
Association (APA)
 In Indonesia, mental disorder diagnosis classify in
PPDGJ (Pedoman Penggolongan dan Diagnostik
Gangguan Jiwa)  based on DSM and ICD
(International Classification of Diseases) published by
WHO
Diagnosis Multiaxial
 DSM pertama kali diperkenalkan di tahun 1952.
 DSM diterbitkan oleh APA (American Psychiatric
Association)
 Classification in DSM - IV (1994) are description,
atheoretical, and multiaxial  more comprehensif
(Millon & Davis, 2000)  DSM IV - TR
 DSM-IV-TR includes five axes = multiaxial
classification system, by requiring judgements on
each of the five axes, forces the diagnostician to
consider a broad range of information
 Pada tahun 1939, WHO (World Health
Organization) memasukkan gangguan jiwa ke
dalam ICD (International List of Causes of Death)
5 Axes in DSM-IV-TR
 Axes I:
 Clinical Disorder
 Other conditions that may be a focus of clinical attention
 Axes II:
 Personality Disorder
 Mental Retardation
 Axes III: General Medical Condition
 Axes IV: Psychosocial and environmental problems
 Axes V: Global Assesment of Functioning (GAF) Scale
5 Axes in DSM-IV-TR
 Axes I:
 Clinical Disorder
 Other conditions that may be a focus of clinical attention
 Axes II:
 Personality Disorder
 Mental Retardation
 Axes III: General Medical Condition
 Axes IV: Psychosocial and environmental problems
 Axes V: Global Assesment of Functioning (GAF) Scale
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 Tujuan Pembedaan Aksis I, II, III:

1. encourage thoroughness in evaluation
2. enhance communication among health
professionals
 Tidak mengimplikasikan bahwa ada perbedaan
fundamental dalam konseptualisasinya  tidak
ingin mengatakan bhw. Ggn mental tidak
berhubungan dengan proses atau faktor fisik,
biologis atau psikososial
 Aksis I dan II:
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 Isi mata kuliah Psikologi Abnormal

(kecuali mental retardation)
 Aksis III:
General Medical Condition (GMC)
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 Current general medical conditions that are

potentially relevant to the understanding or
management of the individual’s mental disorder.
 GMC can be related to mental disorders in
several ways:
10

 Bila GMC merupakan etiologi perkembangan atau

memburuknya simtom mental  efek fisiologis, mis.
Hypothyroidism penyebab simtom depresi
Aksis I: mood disorder due to hypothyroidism
with depressive features
Aksis III: hypothyroidism
 Hub antara GMC mgkn ada, tp tdk jelas
Aksis I: dituliskan simtom mentalnya apa
Aksis III: GMC nya apa
11

 GMC dicatat pada Aksis III, meskipun tak

berhubungan langsung dengan ggn mental, krn
penting untuk memahami keseluruhan treatment
individu. Mis. Individu yang depresi karena
diagnosis kanker payudara
Aksis I: Adjustment disorder with depressed
mood
Aksis III: kanker payudara
 GMC dicatat untuk tujuan pharmacotherapy
(supaya tidak overlap dalam pemberian obat)
 Aksis IV: Psychosocial and Environmental
Problems
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 Psychosocial and environmental problems that may affect

the diagnosis, treatment, and prognosis of mental disorders:
- negative life events
- environmental difficulties or deficiencies
- familial or other interpersonal stress
- inadequacy of social support or personal
resources
- positive stressors (mis. Promosi, pernikahan) yang
menyebabkan stress.
 Cara menulis pada Aksis IV:
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 Problems with primary support group (e.g. death of

a family, remarriage of parent)
 Problems related to the social environment (e.g.
inadequate social support, living alone, retirement)
 Educational problems (e.g. academic, discord with
teachers)
 Occupational problems (unemployment, job
dissatisfaction)
14

 Housing problems (e.g. homelessness, inadequate

housing)
 Economic problems (e.g. extreme poverty)
 Problems with access to health care service
(e.g.transport unavailable)
 Problems related to interaction with the legal
system/crime (e.g. arrest)
 Other psychosocial and environmental problems
(e.g. exposure to disasters, wars)
15

 Catatan:
- note only those psychosocial and environmental
problems that have been present during the year
preceeding the current evaluation

- bila masalah terjadi lebih dari 1 tahun  catat

bila jelas memberi kontribusi, atau telah menjadi
fokus treatment
 Aksis 5: Global Assessment of Functioning
(GAF) Scale
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 Berdasarkan pertimbangan berfungsinya secara

psikologis, sosial & okupasional, pada suatu
kontinum hipotesis dari kesehatan-gangguan
mental.
 Jangan memasukkan hendaya dalam berfungsi
yang berhubungan dengan keterbatasan fisik atau
lingkungan.
GAF Scale

Consider psychological, social, and occupational functioning on a

hypothetical continuum of mental heal/illness. Do not include
impairment in functioning due to physical (or environment)
limitations.
0 : Inadequate information
1-10 : Persistent danger of severely hurting self or others/
persistent inability to maintain minimal personal hygiene
51-60 : moderate symptoms/moderate difficulty in social,
occupational, or school functioning
91-100: No symptoms, superior functioning in a wide range of
activities
 Contoh Penulisan Diagnosis
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Multiaksial
Aksis I : (296.23) Gangguan depresi berat, tanpa
ciri psikotik
Aksis II : (301.6) Gangguan kepribadian dependen,
sering menggunakan mekanisme
defense denial
Aksis III : tidak ada
Aksis IV : ancaman kehilangan pekerjaan
Aksis V : GAF=35 (current)
Diagnosis Multiaxial

Axes I : (296.23) Severe major depression,

without psychotic feature
Axes II : (301.6) Personality disorder, defence
mechanism denial
Axes III : none
Axess IV : Occupational Problem
Axes V : GAF=35 (current)
Current issues related to
DSM-V
 Disorder that might be included in DSM-V
 Behavioral Addiction
 Definition:
excessive use sex, shopping, or computers may
signal addiction. These behavior can be taken to such
extremes that they easily mimic the behaviors of drug
addicts.
 Binge Eating Disorder
 Definition:individuals who binge are unable to control
periods of overeating and feel guilty or disgusted with
themselves. They often become obese. Some eat alone to
avoid feelings of shame.
Current issues related to
DSM-V
 Complicated Grief
 Definition:
after the death of someone close, grief and
sadness normally begin to dissipate within six months.
But some people continue to mourn for much longer.
Current issues related to
DSM-V
 Disorder that might be excluded in DSM-V
 The Paraphilia: Intense sexual urges involving animals,
children, nonconsensual sex, suffering, or humiliation are
classified as paraphilias – a term that was thought to
be relatively non judgmental when it replaced
“perversions” in 1980.
 Gender Identity Disorder: Since the DSM-III appeared
in 1980, individual who wish to be of the opposite sex-
and who are uncomfortable with their own-have been
diagnosed with Gender Identity Disorder.