Multiaxial diagnosis schemas in psychiatry were first devised, half a century ago, as alternatives to avoid the inconsistencies of psychiatric classification caused by the lack of discrimination between descriptive and etiological terms. Three decades after the initial proposals appeared, multiaxial diagnosis emerged as major topic in diagnostic formulation in psychiatry. The third edition of the Diagnostic and Statistical Manual of Mental Diseases (DSM-III, 1980) was the first official classification to adopt a multiaxial format and its successors, the third edition revised and the fourth edition (DSM-III-R and DSM-IV), stick to such a system. Another multiaxial schema, but this one truly international both in origin and scope, was recently developed within the framework of the International and Statistical Classification of Diseases and Related Health Problems, tenth revision (ICD-10). This study aimed at identifying and discussing the conceptual and empirical issues on multiaxial diagnosis in psychiatric literature, with particular emphasis on the empirical validation of the schemas currently used (DSM-IV and ICD-10).5312737Alarcon, R.D., Culture and psychiatric diagnosis: Impact on DSM-IV and ICD-10 (1995) The Psychiatric Clinics ot North America, 18 (3), pp. 449-465Angst, J., European long-term follow-up studies of schizophrenia (1988) Schizophrenia Bulletin, 14 (8), pp. 501-513Bassett, A.S., Beiser, M., DSM-III: Use of the multiaxial diagnostic system in clinical practice (1991) Canadian Journal ot Psychiatry, 36, pp. 270-274Bech, P., Hjortso, A., Lund, K., Vimar, T., Kastrup, M., An integration of the DSM-III and ICD-8 by global severity assessments for measuring multidimensional outcomes in general hospital psychiatry (1987) Acta Psychiatrica Scandinavica, 75, pp. 297-306Berganza, C.E., Mezzich, J.E., Otero-Ojeda, A.A., Jorge, M.R., Villaseñor- Bayardo, S.J., Rosas-Malpica, C., The Latin-American guide tor psychiatric diagnosis (2001) The Psychiatric Clinics of North America, 24 (3), pp. 433-446Berner, P., Gabriel, E., Kieffer, W., Schanda, H., Paranoid psychoses: New aspects of classification and prognosis coming from the Vienna Research Group (1986) Psychopathology, 19, pp. 16-29Cleghorn, J.M., Formulation: A pedagogic antidote to DSM-III (1985) Comprehensive Psychiatry, 26 (6), pp. 504-512D'Ercole, A., Skodol, A.E., Struening, E., Curtis, J., Millman, J., Diagnosis of physical illness in psychiatric patients using axis III and a standardized medical history (1991) Hospital and Community Psychiatry, 42, pp. 395-400Essen-Möeller E, Wohlfahrt S. Suggestions for the amendment of the official Swedish classification of mental disorders. Acta Psychiatrica Scandinavica 1947Supple 47: 551 -5Essen-Möeller, E., On classification of mental disorders (1961) Acta Psychiatrica Scandinavica, 37, pp. 119-126Essen-Möeller, E., Suggestions for further improvement of the international classification of mental disorders (1971) Psychological Medicine, 1, pp. 308-311Fabrega, H., Ahn, C., Mezzich, J.E., Can multiaxial diagnosis predict future use of psychiatric hospitalization? (1991) Hospital and Community Psychiatry, 42 (9), pp. 920-924Feinstein, A.I., POR, and DRG: Unsolved scientific problems in the nosology of clinical medicine (1988) Archives of Internal Medicine, 148, pp. 2269-2274Fernando, T., Mellsop, G., Nelson, K., Peace, K., Wilson, J., The reliability of axis V of DSM-III (1986) American Journal of Psychiatry, 143 (6), pp. 752-755Goldman, H.H., Skodol, A.E., Lave, T.R., Revising axis V for DSM-IV: A review of measures of social functioning (1992) American Journal of Psychiatry, 149, pp. 1148-1156Goor-Lambo, G., The reliability of axis V of the multiaxial classification scheme (1987) Journal of Clinical Psychology and Psychiatry, 28 (4), pp. 597-612Goor-Lambo, G., Orley, J., Poustka, F., Rutter, M., Classification of abnormal psychosocial situations: Preliminary report of a revision of a WHO Scheme (1990) Journal of Child Psychology and Psychiatry, 31 (2), pp. 229-241Gordon, R.E., Eisler, R.L., Gutman, E.M., Gordon, K.K., Predicting prognosis by means of the DSM-III multiaxial diagnosis (1991) Canadian Journal of Psychiatry, 36, pp. 218-221Helmchen, H., Multiaxial systems of classification (1980) Acta Psychiatrica Scandinavica, 61, pp. 33-55Helmchen, H., Multiaxial classification in psychiatry (1983) Comprehensive Psychiatry, 24 (1), pp. 20-24Jampala, V.C., Sierles, F.S., Taylor, M.A., Consumers' views of DSM-III: Attitudes and practices of U.S. psychiatrists and 1984 graduating psychiatric residents (1986) American Journal of Psychiatry, 143 (2), pp. 148-153Janca, A., Kastrup, M., Katschnig, H., López-Ibor, J.J., Mezzich, J.E., Sartorius, N., The ICD-10 multiaxial system for use in adult psychiatry: Structure and applications (1996) The Journal of Nervous and Mental Diseases, 184 (3), pp. 191-192Janca, A., Kastrup, M., Katschnig, H., López-Ibor, J.J., Mezzich, J.E., Sartorius, N., Contextual aspects of mental disorders: A proposal for axis III of the ICD-10 multiaxial system (1996) Acta Psychiatrica Scandinavica, 94, pp. 31-36Karasu, T.B., Skodol, A.E., Vlth axis for DSM-III psychodynamic evaluation (1980) American Journal of Psychiatry, 137 (5), pp. 607-610Kastrup, M., Mezzich, J.E., Quality of life: A dimension in multiaxial classification (2001) European Archives of Psychiatry and Clinical Neuroscience, 251 (SUPPL. 2). , II-32-II/37Kastrup, M., Experience with current multiaxial diagnostic systems: A critical review (2002) Psychopathology, 35, pp. 122-126Katschnig, H., Simhandl, C., New developments in the classification and diagnosis of functional disorders (1986) Psychopathology, 19, pp. 219-235Knorring, L., Perris, C., Jacobson, L., A multi-aspect classification of mental disorders (1978) Acta Psychiatrica Scandinavica, 58, pp. 401-412Leigh, H., Price, L., Ciarcia, J., Mirassou, M.M., DSM-III and consultation-liaison psychiatry: Toward a comprehensive medical model of the patient (1982) General Hospital Psychiatry, 4, pp. 283-289Lobo, A., On multiaxial psychiatric diagnosis for general medical patients (1989) British Journal of Psychiatry, 154 (SUPPL. 4), pp. 38-41Lobo, A., Campos, R., Echevererria, M.J.P., Izuzquiza, J., Campayo, J.G., Saz, P., Marcos, G., A new interview for the multiaxial assessment of psychiatric morbidity in medical settings (1993) Psychological Medicine, 23, pp. 505-510Lolas, F., Communication of emotional meaning, alexithimia, and somatoform disorders: A proposal for a diagnostic axis (1989) Psychotherapy and Psychosomatics, 52, pp. 214-219Loranger, A.W., The impact of DSM-III on diagnostic practice in a university hospital (1990) Archives of General Psychiatry, 47, pp. 672-675Malt, U., Five years of experience with the DSM-III system in clinical work and research: Some concluding remarks (1986) Acta Psychiatrica Scandinavica, 328 (SUPPL.), pp. 76-84Maricle, R., Leung, P., Bloom, J.D., The use of DSM-III axis III in recording physical illness in psychiatric patients (1987) American Journal of Psychiatry, 144 (11), pp. 1484-1486Maser, J.D., Kaelber, C., Weise, R.E., International use and attitudes toward DSM-III and DSM-III-R: Growing consensus in psychiatric classification (1991) Journal of Abnormal Psychology, 100 (3), pp. 271-279Mazure, C.M., Kincare, P., Schaffer, C.E., DSM-III-R axis IV: Clinician reliability and comparability to patients' reports of stressor severity (1995) Psychiatry, 58, pp. 56-64McKegney, F.P., McMahon, T., King, J., The use of DSM-III in a general hospital consultation-liaison service (1983) General Hospital Psychiatry, 5, pp. 115-121Mellsop, G., Varghese, F., Joshua, S., Hicks, A., The reliability of axis II of DSM-III (1982) American Journal of Psychiatry, 139, pp. 1360-1361Mezzich, J.E., Patterns and issues in multiaxial psychiatric diagnosis (1979) Psychological Medicine, 9, pp. 125-137Mezzich, J.E., Evanczuk, K.J., Mathias, R.J., Coffman, G.A., Admission decisions and multiaxial diagnosis (1984) Archives of General Psychiatry, 41, pp. 1001-1004Mezzich, J.E., Fabrega, H., Mezzich, A.C., Coffman, G.A., International experience with DSM-III (1985) The Journal of Nervous and Mental Disease, 173 (12), pp. 738-741Mezzich, J.E., Fabrega, H., Coffman, G.A., Multiaxial characterization of depressive patients (1987) The Journal of Nervous and Mental Disease, 175 (6), pp. 339-346Mezzich, J.E., On developing a psychiatric multiaxial schema for ICD-10 (1988) British Journal of Psychiatry, 152 (SUPPL.), pp. 38-43Mezzich, J.E., Architecture of clinical information and prediction of service utilization and cost (1991) Schizophrenia Bulletin, 17 (3), pp. 469-474Mezzich, J.E., Schmolke, M.M., Multiaxial diagnosis and psychotherapy planning: On the relevance of ICD-10, DSM-IV and complementary schemas (1995) Psychotherapy and Psychosomatics, 63, pp. 71-80Mezzich, J.E., Cultural formulation and comprehensive diagnosis (1995) The Psychiatric Clinics of North America, 18 (3), pp. 649-657Mezzich, J.E., Good, B.J., On culturally enhancing the DSM-IV multiaxial formulation (1997) DSM-IV Sourcebook, 3, pp. 983-989. , Washington, DC: American Psychiatric Press;Mezzich, J.E., Janca, A., Kastrup, M.C., Multiaxial diagnosis in psychiatry (2002) Psychiatric diagnosis and classification, pp. 163-176. , Maj M, Gaebel W, López-Ibor JJ, Sartorius N, editors, West Sussex: Wiley;Mezzich, J.E., International surveys on the use of ICD-10 and related diagnostic systems (2002) Psychopathology, 35, pp. 72-75Michels, R., Siebel, U., Freyberger, H.J., Stieglitz, R.D., Schaub, R.T., Dilling, H., The multiaxial system of ICD-10: Evaluation of a preliminary draft in a multicentric field trial (1996) Psychopathology, 29, pp. 347-356Michels, R., Siebel, U., Freyberger, H.J., Schönell, H., Dilling, H., Evaluation of the multiaxial system of ICD-10 (preliminary draft): Correlations between multiaxial assessment and clinical judgements of aetiology, treatment indication and prognosis (2001) Psychopathology, 34, pp. 69-74Nakdimen KA. DSM-III's multiaxial system: political finesse. American Journal of Psychiatry 1981138: 259Oken, D., Multiaxial diagnosis and the psychosomatic model of disease (2000) Psychosomatic Medicine, 62, pp. 171-175Ottosson, J.O., Perris, C., Multidimensional classification of mental disorders (1973) Psychological Medicine, 3, pp. 238-243Paul, H.A., Diagnosis: Psychiatric and psychoanalytic perspectives (1983) The American Journal of Psychoanalysis, 43 (2), pp. 99-113Puri, B.K., Baxter, R., Cordess, C.C., Characteristics of fire-setters: A study and proposed multiaxial psychiatric classification (1995) British Journal of Psychiatry, 166, pp. 393-396Rey, J.M., Plapp, J.M., Stewart, G.W., Richards, I., Bashir, M., Reliability of the psychosocial axes of DSM-III in an adolescent population (1987) British Journal of Psychiatry, 150, pp. 228-234Rey, J.M., Plapp, J.M., Stewart, G.W., Richards, I., Bashir, M., Reliability of DSM-III axis IV (1987) Archives General Psychiatry, 44, pp. 96-97Rey, J.M., Stewart, G.W., Plapp, J.M., Bashir, M., Richards, I., Validity of axis V of DSM-III and other measures of adaptative functioning (1988) Acta Psychiatrica Scandinavica, 77, pp. 535-542Rey, J.M., Stewart, G.W., Plapp, J.M., Bashir, M., Richards, I., DSM-III axis IV revisited (1988) American Journal of Psychiatry, 145 (3), pp. 286-292Russell, A.T., Cantwell, D.P., Mattinson, R., Will, L., A comparison of DSM-II and DSM-III in the diagnosis of childhood psychiatric disorders (1979) Archives of General Psychiatry, 36, pp. 1223-1226Rutter, M., Lebovici, S., Eisenberg, L., Sneznevsky, A.V., Sadoun, R., Brooke, E., Lin, T.S., A triaxial classification of mental disorders in childhood (1969) Journal of Child Psychology and Psychiatry, 10, pp. 41-61Rutter, M., Shaffer, D., Sheperd, M., An evaluation of the proposal for a multiaxial classification of child psychiatric disorders (1973) Psychological Medicine, 3, pp. 244-250Saavedra, J.E., Mezzich, J.E., Salloun, I.M., Kirisci, L., Impact of DSM-III on the diagnosis of physical disorders in ambulatory psychiatric patients (1995) The Journal of Nervous and Mental Diseases, 183 (11), pp. 711-714Saavedra, J.E., Mezzich, J.E., Salloun, I.M., Kirisci, L., Predictive validity of the physical disorders axis of the DSM multiaxial diagnostic system (1997) The Journal of Nervous and Mental Diseases, 189 (7), pp. 435-441Salloum, I.M., Mezzich, J.E., Saavedra, J.E., Kirisci, L., Usefulness of DSM-III axis III in psychiatric inpatients: An actuarial comparison with the DSM II period (1994) American Journal of Psychiatry, 151 (5), pp. 768-769Schneider, W., Heuft, G., Freyberger, H.J., Janssen, P.L., Diagnostic concepts, multimodal and multiaxial approach in psychotherapy and psychosomatics (1995) Psychotherapy and Psychosomatics, 63, pp. 63-70Schneider, W., Freyberger, H.J., Muhs, A., Schüssler, G., Results of the ICD-10 Research Criteria Study in German-speaking countries in the field of psychosomatics and psychotherapy (1996) Psychopathology, 5, pp. 306-314Schrader, G., Gordon, M., Harcourt, R., The usefulness of axis IV and V assessments (1986) American Journal of Psychiatry, 143, pp. 904-907Shaffer, D., Gould, M.S., Rutter, M., Sturge, C., Reliability and validity of a psychosocial axis in patients with child psychiatric disorder (1991) Journal of American Academy of Child Adolescent Psychiatry, 30 (1), pp. 109-115Skodol, A.E., Spitzer, R.L., Williams, J.B.W., Teaching and learning DSM-III (1981) American Journal of Psychiatry, 138 (12), pp. 1581-1586Skodol, A.E., Spitzer, R.L., DSM-III: Rationale, basic concepts, and some differences from ICD-9 (1982) Acta Psychiatrica Scandinavica, 66, pp. 271-281Skodol, A.E., Williams, J.B.W., Spitzer, R.L., Gibbon, M., Kass, F., Identifying common errors in the use of DSM-III through diagnostic supervision (1984) Hospital and Community Psychiatry, 35 (3), pp. 251-255Skodol, A.E., Link, B.G., Shrout, P.E., Horwath, E., Toward construct validity for DSM-III axis V (1988) Psychiatry Research, 24, pp. 13-23Skodol, A.E., Link, B.G., Shrout, P.E., Horwarth, E., The revision of axis V in DSM-III-R: Should symptoms have been included? (1988) American Journal of Psychiatry, 145 (7), pp. 825-829Skodol, A.E., Shrout, P.E., Use of DSM-III axis IVm clinical practice: Rating etiologically significant stressors (1989) American Journal of Psychiatry, 146 (1), pp. 61-66Skodol, A.E., Shrout, P.E., Use of DSM-III axis IV in clinical practice: Rating the severity of psychosocial stressors (1989) Psychiatry Research, 30, pp. 201-211Skodol, A.E., Axis IV: A reliable and valid measure of psychosocial stressors? (1991) Comprehensive Psychiatry, 32 (6), pp. 503-515Skodol, A.E., Axis IV (1997) DSM-IV Sourcebook, 3, pp. 409-422. , Washington, DC: American Psychiatric Press;Spitzer, R.L., Forman, J., Nee, J., DSM-III field trials: I. Initial interrater diagnostic reliability (1979) American Journal of Psychiatry, 136 (6), pp. 815-817Spitzer, R.L., Forman, J.B.W., DSM-III field trials: II. Initial experience with the multiaxial system (1979) American Journal of Psychiatry, 136 (6), pp. 818-820Spitzer, R.L., Williams, J.B.W., Skodol, A.E., DSM-III: The major achievements and an overview (1980) American Journal of Psychiatry, 137 (2), pp. 151-164Strauss, J., A comprehensive approach to psychiatric diagnosis (1975) American Journal of Psychiatry, 132 (11), pp. 1193-1197Takada, K., Nakane, Y., Progress of ICD-10 (F) family in Japan: Research, field trials and publications (1998) Psychiatry and Clinical Neurosciences, 52 (SUPPL.), pp. S341-S343Treece, C., DSM-III as a research tool (1982) American Journal of Psychiatry, 139 (5), pp. 577-583Velamoor, V.R., Waring, E.M., Fisman, S., Cernovsky, Z., Brownstone, D., DSM-III in residency training: Results of a Canadian survey (1989) Canadian Journal of Psychiatry, 34, pp. 103-106Webb, L.J., Gold, R.S., Johnstone, E.E., Diclemente, C.C., Accuracy of DSM-III diagnoses following a training program (1981) American Journal of Psychiatry, 138 (3), pp. 376-378Williams, J.B.W., Spitzer, R.L., Focusing on DSM-III's multiaxial system (1982) Hospital and Community Psychiatry, 33 (11), pp. 891-892Williams, J.B.W., The multiaxial system of DSM-III: Where did it come from and where should it go? (1985) Archives of General Psychiatry, 42, pp. 175-180Williams, J.B.W., The multiaxial system of DSM-III: Where did it come from andwhere should it go? (1985) Archives of General Psychiatry, 42, pp. 181-186Williams, J.B.W., Spitzer, R.L., Skodol, A.E., DSM-III in residency training: Results of a national survey (1985) American Journal of Psychiatry, 142 (6), pp. 755-758Williams, J.B.W., Goldman, H.H., Gruenberg, A., Mezzich, J.E., Skodol, A.E., The multiaxial system (1990) Hospital and Community Psychiatry, 41 (11), pp. 1181-1182Williams, J.B.W., (1998) DSM-IV multiaxial system: Final overview, 4, pp. 939-946. , DSM-IV Sourcebook-Washington, DC: American Psychiatric Press;(1997) Multiaxial presentation of the ICD-10 for use in adult psychiatry, , World Health Organization, Cambridge: Cambridge University Press;Zimmerman, M., Pfohl, B., Stangl, D., Coryell, W., The validity of DSM-III axis IV (severity of psychosocial stressors) (1985) American Journal of Psychiatry, 142 (12), pp. 1437-1441Zimmerman, M., Pfohl, B., Coryell, W., Stangl, D., The prognostic validity of DSM-III axis IV in depressed inpatients (1987) American Journal of Psychiatry, 144 (1), pp. 102-106Zung WWK, Mahorney SL, Davidson J. Classification of depressive disorders: a multiaxial approach. Journal of Clinical Psychiatry 198445[7, Sec. 2]: 5-13