LCSW EXAM STUDY GUIDE
The DSM-IV organizes each psychiatric diagnosis into five levels (axes) relating to different
aspects of disorder or disability:
Axis I: Clinical disorders, including major mental disorders, and learning disorders
Axis II: Personality disorders and mental retardation (although developmental disorders,
such as Autism, were coded on Axis II in the previous edition, these disorders are now
included on Axis I)
Axis III: Acute medical conditions and physical disorders
Axis IV: Psychosocial and environmental factors contributing to the disorder
Axis V: Global Assessment of Functioning or Children's Global Assessment Scale
for children and teens under the age of 18
Common Axis I disorders include depression, anxiety disorders, bipolar disorder, ADHD,
autism spectrum disorders, and schizophrenia.
Common Axis II disorders include personality disorders: paranoid personality disorder, schizoid
personality disorder, schizotypal personality disorder, borderline personality disorder, antisocial
personality disorder, narcissistic personality disorder, histrionic personality disorder, avoidant
personality disorder, dependent personality disorder, obsessive-compulsive personality disorder,
and mental retardation.
Common Axis III disorders include brain injuries and other medical/physical disorders which
may aggravate existing diseases or present symptoms similar to other disorders.
Personality Disorders (criteria)
An enduring pattern of inner experience and behavior that deviates markedly from the
expectation of the individual's culture, is pervasive and inflexible, has an onset in
adolescence or early adulthood, is stable over time, and leads to distress or impairment.
A personality disorder is a pattern of deviant or abnormal behavior that the person doesn't
change even though it causes emotional upsets and trouble with other people at work and in
personal relationships. It is not limited to episodes of mental illness, and it is not caused by drug
or alcohol use, head injury, or illness. There are about a dozen different behavior patterns
,classified as personality disorders by DSM-IV. All the personality disorders show up as
deviations from normal in one or more of the following:
(1) Cognition -- i.e., perception, thinking, and interpretation of oneself, other people, and
events;
(2) Affectivity -- i.e., emotional responses (range, intensity, lability, appropriateness);
(3) Interpersonal functions;
(4) Impulsivity.
Formerly referred to as character disorders, defined as "an enduring pattern of inner experience
and behavior that deviates markedly from the expectations of the culture of the individual who
exhibits it.
Personality disorders are noted on Axis II These behavioral patterns in personality disorders are
typically associated with severe disturbances in the behavioral tendencies of an individual,
usually involving several areas of the personality, and are nearly always associated with
considerable personal and social disruption. Additionally, personality disorders are inflexible
and pervasive across many situations, due in large part to the fact that such behavior is ego-
syntonic (i.e. the patterns are consistent with the ego integrity of the individual) and are,
therefore, perceived to be appropriate by that individual.
The onset of these patterns of behavior can typically be traced back to late adolescence and the
beginning of adulthood and, in rarer instances, childhood. It is therefore unlikely that a
diagnosis of personality disorder will be appropriate before the age of 16 or 17 years.
Criteria for Borderline-
A pervasive pattern of instability of interpersonal relationships, self- image, and affects,
and marked impulsivity beginning by early adulthood and present in a variety of contexts,
as indicated by five (or more) of the following:
1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or
self-mutilating behavior covered in Criterion 5.
2. A pattern of unstable and intense interpersonal relationships characterized by
alternating between extremes of idealization and devaluation.
, 3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex,
substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-
mutilating behavior covered in Criterion 5.
5. recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria,
irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
7. chronic feelings of emptiness
8. inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of
temper, constant anger, recurrent physical fights)
9. transient, stress-related paranoid ideation or severe dissociative symptoms
The essential feature of Borderline Personality Disorder is a pervasive pattern of
instability of interpersonal relationships, self-image, and affects, and marked impulsivity
that begins by early adulthood and is present in a variety of contexts.
Individuals with Borderline Personality Disorder make frantic efforts to avoid real or imagined
abandonment (Criterion 1). The perception of impending separation or rejection, or the loss of
external structure, can lead to profound changes in self-image, affect, cognition, and behavior.
These individuals are very sensitive to environmental circumstances.
They experience intense abandonment fears and inappropriate anger even when faced with a
realistic time-limited separation or when there are unavoidable changes in plans (e.g. sudden
despair in reaction to a clinician’s announcing the end of the hour; panic of fury when someone
important to them is just a few minutes late or must cancel an appointment). They may believe
that this "abandonment" implies they are "bad." These abandonment fears are related to an
intolerance of being alone and a need to have other people with them. Their frantic efforts to
avoid abandonment may include impulsive actions such as self-mutilating or suicidal behaviors,
The DSM-IV organizes each psychiatric diagnosis into five levels (axes) relating to different
aspects of disorder or disability:
Axis I: Clinical disorders, including major mental disorders, and learning disorders
Axis II: Personality disorders and mental retardation (although developmental disorders,
such as Autism, were coded on Axis II in the previous edition, these disorders are now
included on Axis I)
Axis III: Acute medical conditions and physical disorders
Axis IV: Psychosocial and environmental factors contributing to the disorder
Axis V: Global Assessment of Functioning or Children's Global Assessment Scale
for children and teens under the age of 18
Common Axis I disorders include depression, anxiety disorders, bipolar disorder, ADHD,
autism spectrum disorders, and schizophrenia.
Common Axis II disorders include personality disorders: paranoid personality disorder, schizoid
personality disorder, schizotypal personality disorder, borderline personality disorder, antisocial
personality disorder, narcissistic personality disorder, histrionic personality disorder, avoidant
personality disorder, dependent personality disorder, obsessive-compulsive personality disorder,
and mental retardation.
Common Axis III disorders include brain injuries and other medical/physical disorders which
may aggravate existing diseases or present symptoms similar to other disorders.
Personality Disorders (criteria)
An enduring pattern of inner experience and behavior that deviates markedly from the
expectation of the individual's culture, is pervasive and inflexible, has an onset in
adolescence or early adulthood, is stable over time, and leads to distress or impairment.
A personality disorder is a pattern of deviant or abnormal behavior that the person doesn't
change even though it causes emotional upsets and trouble with other people at work and in
personal relationships. It is not limited to episodes of mental illness, and it is not caused by drug
or alcohol use, head injury, or illness. There are about a dozen different behavior patterns
,classified as personality disorders by DSM-IV. All the personality disorders show up as
deviations from normal in one or more of the following:
(1) Cognition -- i.e., perception, thinking, and interpretation of oneself, other people, and
events;
(2) Affectivity -- i.e., emotional responses (range, intensity, lability, appropriateness);
(3) Interpersonal functions;
(4) Impulsivity.
Formerly referred to as character disorders, defined as "an enduring pattern of inner experience
and behavior that deviates markedly from the expectations of the culture of the individual who
exhibits it.
Personality disorders are noted on Axis II These behavioral patterns in personality disorders are
typically associated with severe disturbances in the behavioral tendencies of an individual,
usually involving several areas of the personality, and are nearly always associated with
considerable personal and social disruption. Additionally, personality disorders are inflexible
and pervasive across many situations, due in large part to the fact that such behavior is ego-
syntonic (i.e. the patterns are consistent with the ego integrity of the individual) and are,
therefore, perceived to be appropriate by that individual.
The onset of these patterns of behavior can typically be traced back to late adolescence and the
beginning of adulthood and, in rarer instances, childhood. It is therefore unlikely that a
diagnosis of personality disorder will be appropriate before the age of 16 or 17 years.
Criteria for Borderline-
A pervasive pattern of instability of interpersonal relationships, self- image, and affects,
and marked impulsivity beginning by early adulthood and present in a variety of contexts,
as indicated by five (or more) of the following:
1. Frantic efforts to avoid real or imagined abandonment. Note: Do not include suicidal or
self-mutilating behavior covered in Criterion 5.
2. A pattern of unstable and intense interpersonal relationships characterized by
alternating between extremes of idealization and devaluation.
, 3. Identity disturbance: markedly and persistently unstable self-image or sense of self.
4. Impulsivity in at least two areas that are potentially self-damaging (e.g., spending, sex,
substance abuse, reckless driving, binge eating). Note: Do not include suicidal or self-
mutilating behavior covered in Criterion 5.
5. recurrent suicidal behavior, gestures, or threats, or self-mutilating behavior
6. Affective instability due to a marked reactivity of mood (e.g., intense episodic dysphoria,
irritability, or anxiety usually lasting a few hours and only rarely more than a few days).
7. chronic feelings of emptiness
8. inappropriate, intense anger or difficulty controlling anger (e.g., frequent displays of
temper, constant anger, recurrent physical fights)
9. transient, stress-related paranoid ideation or severe dissociative symptoms
The essential feature of Borderline Personality Disorder is a pervasive pattern of
instability of interpersonal relationships, self-image, and affects, and marked impulsivity
that begins by early adulthood and is present in a variety of contexts.
Individuals with Borderline Personality Disorder make frantic efforts to avoid real or imagined
abandonment (Criterion 1). The perception of impending separation or rejection, or the loss of
external structure, can lead to profound changes in self-image, affect, cognition, and behavior.
These individuals are very sensitive to environmental circumstances.
They experience intense abandonment fears and inappropriate anger even when faced with a
realistic time-limited separation or when there are unavoidable changes in plans (e.g. sudden
despair in reaction to a clinician’s announcing the end of the hour; panic of fury when someone
important to them is just a few minutes late or must cancel an appointment). They may believe
that this "abandonment" implies they are "bad." These abandonment fears are related to an
intolerance of being alone and a need to have other people with them. Their frantic efforts to
avoid abandonment may include impulsive actions such as self-mutilating or suicidal behaviors,
