physical or biological factors or processes, or  that general medical conditions are unrelated
to behavioral or psychosocial factors or processes.” The approa ch of separately noting di-
agnosis from psychosocial and contextual fact ors is also consistent with established WHO
and ICD guidance to consider the individual’s functional status separately from his or her
diagnoses or symptom status. In DSM-5, Axis  III has been combined with Axes I and II.
Clinicians should continue to list medical cond itions that are import ant to the understand-
ing or management of an individual’s mental disorder(s).
DSM-IV Axis IV covered psychosocial and en vironmental problems that may affect the
diagnosis, treatment, and prognosis of ment al disorders. Although this axis provided
helpful information, even if it was not us ed as frequently as intended, the DSM-5 Task
Force recommended that DSM-5 should not deve lop its own classification of psychosocial
and environmental problems, bu t rather use a selected set of the ICD-9-CM V codes and
the new Z codes contained in ICD-10-CM. Th e ICD-10 Z codes were examined to deter-
mine which are most relevant to mental  disorders and also to identify gaps. 
DSM-IV Axis V consisted of the Global Assessment of Functionin g (GAF) scale, repre-
senting the clinician's judgment of the individu al’s overall level of “functioning on a hy-
pothetical continuum of ment al health–illness.” It was recommended that the GAF be
dropped from DSM-5 for several reasons, including its conceptual lack of clarity (i.e., in-
cluding symptoms, suicide risk, and disabilities in its descriptors) and questionable psy-