The Diagnostic and Statistical Manual of Mental Disorders-Text Revision (DSM-IV-TR), now in its fourth edition, 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 multi-axial classification system that involves
assessment on several axes, or domains of information, allows the practitioner to identify all the factors that relate to a person’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 environmental problems that may affect the diagnosis, treatment, and prognosis of mental disorders. Included are problems with primary support group, social environment,
education, occupation, housing, economics, access to health care, and legal system.
• Axis V presents a Global Assessment of Functioning (GAF), which rates the person’s overall psychological functioning 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 (for instance, highest
GAF in past year or GAF 6 months ago).
All clients admitted to a hospital for psychiatric treatment will have a multi-axis diagnosis from the DSM-IV-TR. Although student nurses do not use the DSM-IV-TR to diagnose clients, they will find it a helpful resource to understand the reason for the admission and to begin building knowledge
about the nature of psychiatric illnesses.
