To illustrate this point we’ll use the following case.
Chad is a twenty-one-year-old college junior who was brought to the emergency room by the police after his mother called 911. According to Chad’s mother, her son, who was hospitalized last year for two weeks following a serious suicide attempt by hanging, has been phoning home multiple times a day for the past week and a half and speaking in a loud voice at a very rapid rate. He becomes easily angered, and his speech and thought processes are rambling and disorganized.
In the emergency room, Chad is found to be disheveled and unshaven. He talks without stopping and any attempt to interrupt him is met with angry outbursts. His roommate reports that Chad stopped attending all of his classes two weeks ago, has not been sleeping, and for the past week has been spreading copies of the stock market report on the floor of his room stating that he has discovered a secret conspiracy involving the president and CEOs of several Fortune 500 corporations. He refuses to answer most questions, but angrily shouts that he has no thoughts of harming himself or anyone else.
His past history is significant for two episodes of depression, and he has a paternal grandmother who had bipolar disorder.
Blood tests and urine tests obtained in the emergency room show no presence of drugs or alcohol and no acute medical processes are occurring. He has no allergies and is currently taking no medication.
Using Chad’s presentation, his five axes diagnosis would be as follows.
Axis 1: Bipolar I Disorder, most recent episode manic, severe with psychotic features
Axis 2: No diagnosis
Axis 3: No medical problems
Axis 4: Educational problems (stopped attending classes)
Axis 5: Global assessment of functioning: 21 (this out of a possible 100)