The diagnostic formulation summarizes and integrates relevant issues from the biopsychosocial, developmental, and temporal axes. The biopsychosocial axis refers to multiple systems, from molecular to sociocultural, that interact constantly and are manifest in current objective behavior and subjective experience. The developmental axis is applied to different levels of the biopsychosocial axis in order to determine whether each level is developmentally normal, delayed, advanced, or deviant. The temporal axis refers to the ontogenesis of the individual from his or her origins to the present and beyond.
Current functioning is the expression of multiple biopsychosocial levels within the patient, as he or she interacts with the physical, family, sociocultural, occupational, and economic environment. In order to evaluate present functioning, the clinician examines the levels and systems described in Table 12–1.
Table 12–1. The Biopsychosocial Axis |Favorite Table|Download (.pdf)
Table 12–1. The Biopsychosocial Axis
Peripheral organ systems
Internal working models of the self and others
Unconscious conflicts, ego defenses, and coping style
Patterns of psychopathology
Family system (nuclear and extended)
Sociocultural systems (peers, adults, school)
Each level of the biopsychosocial axis can be assessed with regard to what would be expected for that age. Some of these assessments (e.g., height, weight, head circumference) are very accurate. For others (e.g., intelligence), although a number of assessment instruments are available, existing measures represent a composite of skills potentially affected by extraneous factors (e.g., social class, motivation). For still others (e.g., ego defenses, working models of attachment), measurement techniques are relatively crude and the norms subjective.
Nevertheless, during interviewing and mental status examination, the clinician will scan the levels shown in Table 12–2 for delay, precocity, or deviation from the normal and, when appropriate, order formal special investigations.
Table 12–2. The Developmental Axis |Favorite Table|Download (.pdf)
Table 12–2. The Developmental Axis
Peripheral organ systems (e.g., height, weight, head circumference)
Developmental assessment, neuropsychological testing
Intelligence testing, special testing for memory and other cognitive functions, educational attainment testing, neuropsychological testing
Speech and language assessment, neuropsychological testing
Behavioral observation, psychological testing
Internal working models
Interviewing, personality testing
Conflicts, defenses, coping style
Interviewing, behavioral observation, personality testing
Interviewing, checklists, structured interviews
Family system, peer relations, school functioning
Family interviews, observations, checklists
All individuals have come from somewhere, exist where they are now, and are headed somewhere. Using the temporal axis, the clinician explores the unfolding of a problem up to the present time and ...