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Graduate Nursing Programs: DSM IV

A guide for nursing students on how to find tools/instruments.

Diagnostic and Statistical Manual of Mental Disorders – 4th Ed. (DSM-IV-

Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV)


DSM IV Text Revision - Current Edition


Psychiatric Diagnoses are categorized by the Diagnostic and Statistical Manual of Mental Disorders, 4th. Edition.  Better known as the DSM-IV, the manual is published by the American Psychiatric Association and covers all mental health disorders for both children and adults. It also lists known causes of these disorders, statistics in terms of gender, age at onset, and prognosis as well as some research concerning the optimal treatment approaches.


Mental Health Professionals use this manual when working with patients in order to better understand their illness and potential treatment and to help 3rd party payers (e.g., insurance) understand the needs of the patient.  The book is typically considered the ‘bible’ for any professional who makes psychiatric diagnoses in the United States and many other countries. Much of the diagnostic information on these pages is gathered from the DSM IV.


The DSM IV is published by the American Psychiatric Association.  Much of the information from the Psychiatric Disorders pages is summarized from the pages of this text.  Should any questions arise concerning incongruences or inaccurate information, you should always default to the DSM as the ultimate guide to mental disorders.


The DSM uses a multiaxial or multidimensional approach to diagnosing because rarely do other factors in a person's life not impact their mental health.  It assesses five dimensions as described below:


Axis I: Clinical Syndromes

·         This is what we typically think of as the diagnosis (e.g., depression, schizophrenia, social phobia)

Axis II: Developmental Disorders and Personality Disorders

·         Developmental disorders include autism and mental retardation, disorders which are typically first evident in childhood 

·         Personality disorders are clinical syndromes which have a more long lasting symptoms and encompass the individual's way of interacting with the world.  They include Paranoid, Antisocial, and Borderline Personality Disorders.

Axis III: Physical Conditions which play a role in the development, continuance, or exacerbation of Axis I and II Disorders

·         Physical conditions such as brain injury or HIV/AIDS that can result in symptoms of mental illness are included here. 

Axis IV: Severity of Psychosocial Stressors

·         Events in a person's life, such as death of a loved one, starting a new job, college, unemployment, and even marriage can impact the disorders listed in Axis I and II.  These events are both listed and rated for this axis.

Axis V: Highest Level of Functioning

·         On the final axis, the clinician rates the person's level of functioning both at the present time and the highest level within the previous year.  This helps the clinician understand how the above four axes are affecting the person and what type of changes could be expected.