The psychodiagnsos of these disorders are specified in such a way as to reflect:
- recent vs chronic,
- developmental vs environmental stressors, and
- severity of the presenting problem.
Clinical disorders are the reasons for which we seek care. Examples with which you may be familiar is the psychodiagnosis of major depressive disorder, posttraumatic stress disorder, and pain disorder.
Underlying a clinical disorder may be a developmental or personality disorder. Examples are learning disabilities and dependent or compulsive personality disorder. These disorders will influence how the clinical disorder presents differently in each person. These disorders are not typically the reason why a person seeks care (but may be ample reason why a family member wishes they would).
Personality disorders vary in their presentation, but what they have in common is that all of them interfere with adaptive responses to the world.
Concurrently, many people have a physical condition, disease or disorder. These problems may be a herniated disc, a torn rotator cuff, diabetes, high blood pressure, cancer history and a host of other physical problems which impact the clinical disorder.
Additionally, quite often people have stressors in their lives such as finances, education, legal and support system problems in relationships. These stressors may give rise to the clinical disorder, make the clinical disorder worse or be worsened by the clinical disorder.
Finally, there is the true degree of impairment that exists as a result of all of this. There are people with major depressive disorder, for example, who may be only minimally impaired. There may be a patient with posttraumatic stress disorder who is severely disabled.
The point is that the existence of one or more disorder does not immediately tell us the degree of impairment. It requires looking at all (axes) factors. For the purposes of pure disability, this determination is not difficult for the skilled clinician to make. The challenge is identifying those problems that have arisen solely or primarily from a physical injury.