The multiaxial system (MAS) of ICD-10, chapter V (F) consists of three axes: axis I, clinical syndromes (psychiatric disorders including personality disorders and somatic diseases); axis II, disabilities; axis III, environmental/circumstantial and personal life-style/life management factors. Results of a multicentric field trial evaluating a preliminary draft of the MAS are presented. 45 raters in seven German centers made 488 ratings on 12 written case histories. With a mean kappa of 0.50 for 3-character diagnoses interrater reliability for axis I was moderate although lower than expected from previous field trials. On axis II the WHO Disability Diagnostic Scale (WHO-DDS) was compared to the Global Assessment of Functioning (GAF) used in DSM-III-R and DSM-IV. For both scales the intraclass correlation coefficient showed a moderate interrater reliability (WHO-DDS = 0.62; GAF = 0.65). On axis III the number of relevant psychosocial circumstances coded by the different raters varied greatly. Interrater reliability was very poor with kappa values ranging from 0.03 to 0.55 for the different categories and an overall kappa of 0.16.

High-magnitude stressors and posttraumatic stress disorder (PTSD) are frequently in psychiatric patients. In contrast, the role of low-magnitude stressors has rarely been studied. We assessed a consecutive series of 78 psychiatric inpatients taking part in our psychotherapy programme for potentially traumatic events and PTSD with a structured interview. All participants completed self-report questionnaires on PTSD-symptomatology, dissociative and general psychopathology (DES, SCL-90). A distressing event was reported by 48 patients (61.5%) and 27 (34.6%) met the diagnostic criteria for PTSD. Of these, 16 reported a lowmagnitude stressor, while 11 had experienced a high-magnitude stressor. There were no significant differences in PTSD symptoms, dissociative and general psychopathology between patients with PTSD due to a minor trauma and those with a major trauma. Our preliminary findings suggest that low-magnitude stressors can also lead to PTSD. We discuss the possible implications with regard to psychotherapy.

Forty-five raters in 7 German centres took part in a multicentric field trial of the multiaxial system of ICD-10, delivering a total of 488 multiaxial assessments of 12 written case summaries. In addition to the multi-axial ratings (including main and subsidiary psychiatry diagnoses, level of social dysfunctioning and psychosocial stressors), assessments were made by the raters of the aetiology, treatment indications and prognosis of the main psychiatric disorder. There were significant correlations between these judgements and the measures of the multiaxial ratings: 62% of the cases diagnosed as endogenous were assessed as having a high level of social dysfunctioning (the proportion for all cases being 50.4%) and 63.4% as having a low number of stressors (vs. 52.8% in all cases). In contrast, cases diagnosed as reactive were assessed as having a lower level of social dysfunctioning and more social stressors. Cases whose prognosis was poor showed a higher rate of comorbidity and a high level of social dysfunctioning. The results demonstrate that the multiaxial approach reflects factors important to the process of clinical treatment and decision making and delivers preliminary evidence of this system’s treatment and prognostic validity.

To assess the relationship between the axis IV (structure) of the Operationalized Psychodynamic Diagnostics (OPD) and sociodemographic, clinical and psychopathological features, we rated the structural level of 156 psychiatric inpatients, which was related to sociodemographic variables, to clinical diagnoses (particularly to personality and substance use disorders), to suicidal ideation and self-injurious behavior (SIB) as well as to the psychopathological impairment at admission (measured by the SCL-90). We found significant associations among the structural level on the one hand and the marital status, the professional group, a comorbid personality disorder, suicidal ideation and SIB on the other hand. There were no associations with the sex, the age, the school education, the occupational situation or the SCL-90 findings. Our results replicate and extend previous findings. For every-day routine, it is possible to derive a preliminary judgement of the structural level by means of the marital status, the professional group, a comorbid personality disorder, suicidal ideation and SIB.

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