Which of the following would fall under Axis 4 of the DSM IV multi-axial assessment system?

• A. Alcohol dependence
• B. Physical abuse by parents
• C. Diabetes
• D. Schizophrenia

Answer: (B)

Axis IV captures psychosocial and environmental problems that can affect functioning and treatment. This includes stressors like abuse, family conflict, poverty, housing issues, unemployment, and limited access to resources. Physical abuse by parents is a clear psychosocial stressor in the person's environment and can influence mental health and overall functioning, which is why it fits under Axis IV. The other options represent a clinical disorder (alcohol dependence, schizophrenia) or a medical condition (diabetes), which fall on other axes. Understanding Axis IV helps clinicians consider how these environmental factors might worsen symptoms or hinder treatment and prognosis.