Diagnostic and Statistical Manual of Mental Disorders

DIAGNOSTIC AND STATISTICAL MANUAL OF MENTAL DISORDERS

The Diagnostic and Statistical Manual of Mental Disorders, 4th edition, Text Revision (DSM-IV-TR) is a taxonomy published by the APA. The DSM-IV-TR describes all mental disorders, outlining specific diagnostic criteria for each based on clinical experience and research. All mental health clinicians who diagnose psychiatric disorders use the DSM-IV-TR.

The DSM-IV-TR has three purposes:

·    To provide a standardized nomenclature and language for all mental health professionals

·    To present defining characteristics or symptoms that differentiate specific diagnoses

·    To assist in identifying the underlying causes of disorders.

A multiaxial classification system that involves assessment on several axes, or domains of information, allows the practitioner to identify all the factors that relate to a per-son’s condition:

·    Axis I is for identifying all major psychiatric disorders except mental retardation and personality disorders. Examples include depression, schizophrenia, anxiety, and substance-related disorders.

·    Axis II is for reporting mental retardation and personality disorders as well as prominent maladaptive personality features and defense mechanisms.

·    Axis III is for reporting current medical conditions that are potentially relevant to understanding or managing the person’s mental disorder as well as medical conditions that might contribute to understanding the person.

·    Axis IV is for reporting psychosocial and environmen-tal problems that may affect the diagnosis, treatment, and prognosis of mental disorders. Included are prob-lems with the primary support group, the social envi-ronment, education, occupation, housing, economics, access to health care, and the legal system.

·        Axis V presents a Global Assessment of Functioning, which rates the person’s overall psychological function-ing on a scale of 0 to 100. This represents the clinician’s assessment of the person’s current level of functioning; the clinician also may give a score for prior functioning (e.g., highest Global Assessment of Functioning in the past year or 6 months ago).

All clients admitted to a hospital for psychiatric treat-ment will have a multiaxial diagnosis using the DSM-IV-TR. Although student nurses do not use the DSM-IV-TR to diag-nose clients, they will find it a helpful resource to under-stand the reason for the admission and to begin building knowledge about the nature of psychiatric illnesses.