Redefining Mental Illness: Teaching Nurse Practitioner Students During the Transition from DSM-IV to DSM-5

The accurate diagnosis of persons with mental illness is essential to psychiatric nurse practitioners and is the foundation for treatment planning, management of psychotropic medications, and often psychotherapy. The precursor for modern classification of mental illness began in the 1800s with the United States Census records. Other classification systems evolved worldwide that paralleled current social, cultural, or political thought. The Diagnostic and Statistical Manual (DSM), was first published by the American Psychiatric Association in 1952 and has become the mainstay for psychiatric providers in the formulation of diagnosis and treatment. The DSM is undergoing its fourth major revision to the categorization and classification of mental illness. DSM-5 will be released in May 2013, a full 18 years since the current DSM-IV was published, and with it come major changes and controversial aspects and implications. It is unclear how smoothly the transition will be from using DSM-IV criteria to DSM-5 criteria as insurers and facilities adopt the latter. Changes in the new edition include expansion of diagnostic coverage and crosscutting dimensional diagnostic stances. It is essential that psychiatric nurse practitioner students in current educational programs understand both the DSM-IV and the DSM-5. Primary care nurse practitioners as interdisciplinary collaborators will also be impacted by these unprecedented changes in diagnoses, the redefinition of mental illness. In this presentation, we will briefly review the evolution of diagnostic structures for defining mental illness, as well as introduce newly devised dimensional and disability assessment measures. Curriculum development strategies will be discussed for teaching NP students to both practice with current and prepare for use of future diagnostic DSM categories, and major DSM changes which impact psychiatric nursing will be highlighted. Potential controversial social implications of DSM-5 will be previewed, including issues of diagnostic expansion, insurability and stigma.