Most health care professionals who diagnose and treat mental disorders use the diagnostic criteria outlined in the Diagnostic and Statistical Manual for Mental Disorders, Fourth Edition–Text Revised (DSM-IV-TR), which uses a multiaxial system to ensure a comprehensive assessment and evaluation of the patient's presenting symptoms, general medical condition, psychosocial and environmental problems, and level of function. The five axes are mental disorders; personality and mental disorders; general medical conditions; psychosocial and environmental problems, and global assessment of functioning (GAF) scale. Psychosocial and environmental problems may affect diagnosis, treatment, and prognosis of mental disorders; the problems or stressors can contribute to the development of a mental disorder or can be the result of a mental disorder. The multiaxial assessment process should result in the following; documentation of the primary and any secondary mental and behavioral disorders; definition of physical disorders that may be present and indication if they are related to or influence the mental and behavioral disorders; identification of environmental stressors that may affect, contribute to, complicate, or exacerbate the mental and behavioral disorder; and a rating of the person's psychological, social, and occupational functioning. A table shows the GAF scale (ratings by deciles from 1 to 100; higher numbers indicate fewer problems) and does not include impairments that result from physical or environmental limitations.

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