3.2 Mental health disorders

A Family Guide to Concurrent Disorders - Part I: What are concurrent disorders?

As with substance use problems, there is no clear line that indicates when problems become severe enough to warrant treatment. As we explained in Chapter 1, many clinicians use the DSM-IV diagnostic criteria to help screen and assess people for mental health disorders. Most people with mental health problems will receive a specific diagnosis at some point during treatment. However, because the symptoms of many disorders are similar, the diagnosis may change several times during the course of treatment.

You may hear mental health and substance use service providers use the terms Axis I disorder and Axis II disorder. The DSM-IV uses five axes to help organize information about mental disorders:

• Axis I: all mental health disorders (e.g. schizophrenia, bipolar disorder, substance dependence disorder) except personality disorders and mental retardation (also called intellectual disability)
• Axis II: personality disorders and mental retardation
• Axis III: medical conditions that may be contributing to psychological problems (e.g., infectious diseases)
• Axis IV: psychosocial and environmental problems (e.g., housing problems)
• Axis V: global assessment of functioning (how well a person is coping with daily life).

Axis II disorders are much less straightforward and even harder to diagnose than Axis I disorders.

Dimensional approaches

Another way to understand mental health problems is to divide mental health problems into broad groups based on the behaviours that we see. We did this in Chapter 2 with substance use problems by suggesting that drugs that have psychoactive effects could be divided into three groups: depressants, stimulants, opiates and hallucinogens.

We suggest that mental health problems can be divided into four groups:

• Anxiety
• Mood
• Psychosis
• Impulsivity (Skinner, 2005).

Mental health problems are described in terms of the severity of behaviours in each of these groups. This dimensional approach is a useful way to begin to organize the observations that indicate that a person has a mental health problem.

Table 3-1: The dimensional approach.
Click here to view the PDF of Table 3-1.

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