Axis V associated abnormal psychosocial conditions

These include a range of pyschosocial hazards, from abnormal intrafamilial relationships such as physical or sexual abuse, to mental disorders in other family members, distorted intrafamilial communication patterns, abnormal upbringing, for example in an institution, acute life events, and chronic interpersonal stress arising from difficulties at school. Each is coded dimensionally on a three-point scale. As the number of psychosocial adversities goes up, so the rate of psychiatric disorders increases/23ยป Rutter(24) found that no one psychosocial adversity was associated with particular disorders, rather the total number was important. Those with only one adversity had no increase in disorders over those without, whereas those with two had a fourfold increase in disorders. There were further exponential rises in disorder rates as the number of adversities increased. Conduct disorder is particularly associated with poor immediate psychosocial environments, (25> whereas emotional disorders are more associated with acute life events and school-related chronic stressors. (26> As with other axes, abnormalities are coded irrespective of apparent cause. This is particularly relevant since while perhaps 20 years ago the mechanism was thought to be directly environmental, in the last 10 years good evidence has been collected to show that some environmental characteristics of the home are genetically mediated. ^ For example, the association between lack of books in the home and poor child reading is partly mediated through parents with lower IQ buying fewer books.

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