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01.10 Psychological Disorders

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Overview

  1. Diagnostic and Statistical Manual of Mental Disorders (DSM)
    1. Section 1
      1. Basics/ Introduction
    2. Section 2
      1. Diagnostic Criteria and Codes
    3. Section 3
      1. Emerging Measures and Models

Nursing Points

General

Diagnostic and Statistical Manual of Mental Disorders (DSM)

  1. Section 1
    1. Basics/ Introduction
  2. Section 2
    1. Diagnostic Criteria and Codes
      1. Neurodevelopmental Disorders
      2. Schizophrenia Spectrum and Other Psychotic Disorders
      3. Bipolar and Related Disorders
      4. Depressive Disorders
        1. Major Depressive Disorder
          1. Five or more symptoms present during a 2 week period, change in functioning, one symptom being either 1) depressed mood or 2) loss of interest or pleasure
          2. Nine symptoms listed
          3. Cannot include symptoms attributed to another medical condition
      5. Anxiety Disorders
      6. Obsessive-Compulsive and Related Disorders
      7. Trauma-and Stressor-Related Disorders
      8. Dissociative Disorders
      9. Somatic Symptom and Related Disorders
      10. Feeding and Eating Disorders
      11. Elimination Disorders
      12. Sleep-Wake Disorders
      13. Sexual Dysfunctions
      14. Gender Dysphoria
      15. Disruptive, Impulse-Control, and Conduct Disorders
      16. Substance-Related and Addictive Disorders
      17. Neurocognitive Disorders
      18. Personality Disorders
      19. Paraphilic Disorders
      20. Other Mental Disorders
      21. Medication-Induced Movement Disorders and Other Adverse Effects of Medications
      22. Other Conditions That May Be a Focus of Clinical Attention (V codes)
  3. Section 3
    1. Emerging Measures and Models
      1. Assessment measures
      2. Guidance on the cultural formulation
      3. An alternative model for diagnosing personality disorders
      4. Conditions for further study

Video Transcript

Today we’re going to be talking about psychological disorders.

The Diagnostic and Statistical Manual of Mental Disorders, DSM for short, is used for diagnosing mental health conditions. It is in it’s fifth edition and includes over 260 different conditions. It is seen as the bible for mental health. It is split into three sections. The first covers basic information, which includes some of the history and review process. The second section covers actual criteria and code, while the third section includes techniques to help the clinical decision-making process.


I want to note that only those that are trained professionals that have received training on the DSM should diagnose and treat. All the disorders in the DSM require that the person have an impairment in the functioning- it could be school, work, relationships, legal issues. Every person’s situation is different and the DSM is not meant to just label based off surface level evaluation. A person’s culture, context, and functioning must also be assessed. Finally, a person must meet criteria in order for a diagnosis to be given. Finally, most diagnoses have specifiers that can be added- such as mild, moderate or severe. Another kid of specifier is when being more specific about the disorder like bipolar 1 disorder with psychotic features for example. Specifying ‘with psychotic features’ is a more precise.

Section two of the DSM starts listing disorders based on their overall category. The DSM is made up of 22 categories that disorders fall under. I’m going to go through each and name a few disorders in each category. The first is neurodevelopmental disorders. This includes intellectual disabilities, autism, ADHD, and motor disorders. The second is schizophrenia spectrum and other psychotic disorders. This includes delusional disorder, schizoaffective disorder, and brief psychotic disorders. The third category is bipolar and related disorders, including bipolar 1 and bipolar 2, and cyclothymic disorder. The fourth category is depressive disorder, like major depressive disorder or Dysthymia. Anxiety disorder include generalized anxiety disorder, selective mutism, social anxiety disorder, and agoraphobia.


Another category is obsessive compulsive and related disorders. this includes disorders like OCD, Body Dysmorphic Disorder, Hoarding, Trichotillomania (hair-pulling disorder). Trauma-and stressor related disorders include reactive attachment disorder, PTSD, and adjustment disorder. Dissociative disorders include dissociative identity disorder and dissociative amnesia. Somatic symptom and related disorders includes disorders like conversion disorder and illness anxiety disorder. Feeding and eating disorders includes Pica, Binge-eating disorder, anorexia nervosa, and bulimia nervosa. 


Elimination disorders include Enuresis and Encopresis. Sleep-wake disorders include insomnia, narcolepsy, and restless leg syndrome. Sexual dysfunctions include erectile disorder and female orgasmic disorder. Gender dysphoria includes gender dysphoria and other specified gender dysphoria. Disruptive, impulse-control and conduct disorder includes oppositional defiant disorder, conduct disorder, pyromania, kleptomania, and antisocial personality disorder. 


Substance-related and addictive disorder includes alcohol use disorder, hallucinogen-related disorders, opioid-related disorders, and stimulant-related disorders. Neurocognitive disorders include delirium, major or mild neurocognitive disorder with lewy bodies or due to alzheimer’s. Personality disorders are broken down into 3 clusters- A, B, and C. Cluster A includes paranoid personality disorder, schizoid personality disorder. Cluster B includes borderline personality disorder, narcissistic personality disorder. Cluster C includes dependent personality disorder and obsessive compulsive personality disorder. Paraphilic disorders includes voyeuristic disorder, exhibitionistic disorder, and sexual sadism disorder. The category for other mental disorders includes codes where a mental health condition is present but may be due to another medical condition. 


I personally have not used the second to last category so I’m not going to touch on it much. These disorders include adverse effects from medications. The last category does not use typical code but instead uses V codes, examples in this category include problems related to family upbringing, abuse and neglect, and educational and occupational problems.


Let’s walk through the criteria for Major Depressive Disorder. First let’s go over the actual criteria and then we’ll break it down. In order to meet criteria for Major Depressive Disorder, a person must present with at least five of the nine following symptoms during a consecutive two week period and represent a change from a previous functioning level and at least one of the symptoms must be depressed mood or loss of interest or pleasure. A special note for MDD is that a clinician should not include symptoms that are clearly attributed to another medical condition. 

The symptoms that may be present are:

    • Depressed mood most of the day, nearly every day, as indicated by either subjective report or observation made by others.

    • Markedly diminished interest or pleasure in all, or almost all, activities most of the day, nearly every day.

    • Significant weight loss when not dieting or weight gain (change of more than 5% body weight in a month) or decrease in appetite nearly every day.

    • Insomnia or hypersomnia nearly every day.

        • Psychomotor agitation or retardation nearly every day (observable by others)

        • Fatigue or loss of energy nearly every day.

        • Feelings of worthlessness or excessive or inappropriate guilt nearly every day.

        • Diminished ability to think or concentrate, or indecisiveness, nearly every day.

        • Recurrent thoughts of death (not just fear of dying), recurrent suicidal ideation without a specific plan, or a suicide attempt or a specific plan for committing suicide.

If the person experiences five or more of those symptoms for at least a two week period of time, with one being either depressed mood or loss of interest, and the symptoms cause clinically significant distress or impairment in social, occupational, or other important area of functioning, and the episode is not attributed to physiological effects of a substance or other medical condition, then they may be diagnosed as having Major Depressive Disorder. I want to point out number three. All mental health conditions need to cause clinically significant distress or impairment to an important area of functioning in order to be diagnosed. Our culture sometimes throws around labels and self-diagnosing; however, it is not diagnosable unless it is impairing functioning. For example, let’s look at a parent that experiences the death of a child and turns that child’s room into a place of remembrance where nothing is every changed and nothing is done to that room. If the parent is an empty nester and doesn’t need to use that room, this may not be diagnosable; however, if the parent has other minor children who are sleeping in the living room because the parent is unable to move on, then we need to start considering a diagnosis related to prolonged grief.

The main thing to remember is that the DSM is the big book of criteria for all the mental health disorders. It clearly lists the criteria for each diagnosis. Each diagnosis must cause clinically significant distress or impairment in functioning. Remember, only trained clinicians should diagnose.

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