DSM-III-R Axis IV: clinician reliability and comparability to patients' reports of stressor severity

Stress has long been considered an important precipitant to the development or exacerbation of psychopathology (Selye 1980). However, it has been difficult to reach agreement on how to measure stressors reliably, and whether stressors should be assessed using an objective clinical rating or a subjective appraisal (Mazure and Druss 1995). When the DSM-III multiaxial diagnostic system was derived, Axis IV was designed to provide a mechanism for objectively rating the severity of psychosocial stressors that contributed to the development or exacerbation of psychiatric disorders (Williams 1985). With the continued use of this nosological system, DSM-III-R Axis IV has become the most commonly used assessment of stressors in clinical settings today. The current work focuses on whether DSM-III-R Axis IV can be used reliably by clinicians generating objective ratings, and on whether these objective ratings reflect patients' appraisals of the severity of their psychosocial stressors. Based on this work, options for future use of Axis IV are discussed.