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。 Other Interpersonal： problems with one’s friends； neighbors； associates； nonconjugal
family members； illness of best friend； discordant relationship with one’s boss
。 Occupational： work； school； homemaking； unemployment； retirement
。 Living Circumstances： change in residence； threat to personal safety； immigration
。 Financial： inadequate finances； change in financial status
。 Legal： arrest； imprisonment； lawsuit； trial
。 Developmental： phases of the life cycle； puberty； transition to adult status； menopause；
“being 30/40/50”
。 Physical Illness/Injury： illness； accident； surgery； abortion
NOTE： A physical disorder is listed on Axis III whenever it is related to the development
or management of an Axis I or II disorder。 A physical disorder can also be a psychosocial
stressor if its impact is due to its meaning （importance） to the individual。 In that case； it
will be listed on both Axis III and IV。
。 Other Psychosocial Stressors： natural or manmade disaster； persecution； unwanted
pregnancy； out…of…wedlock birth of a child； rape
。 Family Factors （children and adolescents）： in addition to the above； for children and
adolescents； the following stressors may be considered： cold； hostile； intrusive； abusive；
conflictual； or confusingly inconsistent relationships between parents or toward child；
physical or mental illness of a family member； lack of parental guidance or excessively
harsh or inconsistent parental control； insufficient； excessive； or confusing social
cognitive stimulation； anomalous family situation； plex or inconsistent parental
custody and visitation arrangements； foster family； institutional rearing； loss of nuclear
family members。
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CHAPTER 15： PSYCHOLOGICAL DISORDERS
AXIS V： GLOBAL ASSESSMENT OF FUNCTIONING
This axis allows the clinician to indicate his/her overall judgment of the individual’s
psychological； social； and occupational functioning on a scale （the Global Assessment of
Functioning Scale （GAF） that assesses mental health or illness。 Ratings on the GAF are made for
two periods：
· Current： level of functioning at time of evaluation
· Past Year： highest level of functioning for a least at few months during the past year
For children and adolescents； this should include at least one month during the school year。 The
ratings of current level of functioning generally reflect the current need for treatment or care。
Ratings of highest level of functioning within the past year are frequently prognostic； because the
individual may be able to return to his or her prior level of functioning； following recovery from
an illness episode。
Eve White and Eve Black
The most extreme form of dissociation is dissociative identity disorder （DID）； formerly known as
multiple personality disorder。 Until fairly recently； this disorder was thought to be rare。
However； within the past few years； we have reason to believe this disorder to be more pervasive
than originally thought。 Ralph Allison； a therapist with extensive experience in treating this DID；
has long believed the actual incidence of this disorder to be much higher； with many cases going
undiagnosed （1977）。
DID is frequently confused with schizophrenia。 The term； schizophrenia； literally means； “splitting
in the mind” （Reber； 1985）。 DID is actually a severe form of neurosis； the personality “in
mand” at any given moment remains in contact with reality。 Schizophrenia is a psychotic
disorder； in which the individual’s functioning is “split off” from external reality。 Dissociative
identity disorder is one of the major dissociative disorders in which the individual develops two
or more distinct personalities that alternate in consciousness； each taking over conscious control
of the person for varying periods of time。 Both dissociative identity disorder and the
schizophrenias are Axis I clinical syndromes。
Classic cases of dissociative identity disorder manifest at least two fully developed personalities；
and more than two are mon。 Of cases reported in recent years； about 50％ had 10 or fewer
personalities and approximately 50 percent had more than 10。 Each personality has its own
unique memories； behavioral patterns； and social relationships。 Change from one personality to
another is usually sudden； with the change being acplished in a matter of seconds to
minutes。 The change is usually sudden； often triggered by psychosocial stress。
The original personality； the one from which all the others diverge； is usually unaware of the
existence of the others。 However； the first personality to “split” from the original usually knows
about the original； and any additional personalities that may surface subsequently。 This first
personality to split from the original is the active controller of which personality is “out；” when it
is out； why it is out； and for how long。 This personality is referred to as the dominant personality；
and is often diametrically opposed to the original personality （e。g。； Eve White and Eve Black）。 It
is not unusual for one or more of the “new” personalities to have a different gender than the
original personality； as well as a different sexual orientation。
At any given moment； there is only one personality interacting with the environment。
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PSYCHOLOGY AND LIFE
Interestingly； the personality that presents for treatment often has little…if any…knowledge of the
multiples…they just are aware that something is a little unusual。
Onset of dissociative identity disorder is usually during childhood； but may not be diagnosed
until adulthood。 The disorder is chronic； and the degree of impairment varies from mild to
severe。 In nearly all cases； the disorder is preceded by abuse； often sexual in nature； or from some
other form of severe emotional trauma during the childhood years。 The disorder is seen three to
nine times more frequently in females than in males。
There is some indication that the incidence in first…degree biological relatives of dissociative
identity disorder is higher than that in the general population。 Interestingly； a child is often the
first to notice the presence of multiples （e。g。； “I have 2 mommies； but it’s okay because they both
love me。”）
This dramatic form of reaction is well illustrated by the widely publicized case of Eve White。 Eve；
25 years old and separated from her husband； had sought therapy because of severe； blinding
headaches； frequently followed by “blackouts。” During one of her early therapy sessions； Eve
was greatly agitated。 She reported that she had recently been hearing voices。 Suddenly she put
both hands to her temples； then looked up at the doctor with a provocative smile and introduced
herself as “Eve Black。”
It was obvious from the voice； gestures； and mannerisms of this second Eve that she was a
separate personality。 She was fully aware of Eve White’s doings； but Eve White was unaware of
Eve Black’s existence。 Eve White’s “blackouts” were actually the periods when Eve Black was in
control； and the “voices” marked unsuccessful attempts of Eve Black to “e out。” With
extended therapy； it became evident that Eve Black had existed since Eve White’s early
childhood； when she occasionally took over and indulged in forbidden pleasures； leaving the
other Eve to face the consequences。 This habit had persisted； and Eve White frequently suffered
Eve Black’s hangovers。 After about eight months of therapy； a third personality appeared。 This
one； Jane； was more mature； capable； and forceful than the retiring Eve White。 She gradually
came to be in control most of the time。
As the therapist probed the memories of the two Eves； he felt sure that some shocking event must
have hastened the development of these distinct alternate personalities in the disturbed child。 In
a dramatic moment； the climax of therapy； the missing incident became known。 Jane suddenly
stiffened and in a terrified voice began to scream； “Mother … Don’t make me … I can’t do it！ I
can’t！” When the screams subsided； a new personality took over。 She was able to recall the
shocking event t