→ Common disorders and red flags for nurse practitioner students

In NRNP-6635-11: Psychopathology & Diagnostic Reasoning, one of your most important skills is learning how to accurately identify psychiatric conditions using the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders, 5th Edition). Understanding the criteria—and recognizing key red flags—helps ensure accurate diagnosis, treatment planning, and documentation.

Whether you're a PMHNP student or an FNP gaining diagnostic insight, this guide offers practical ways to use the DSM-5 effectively.

? What Is the DSM-5?

The DSM-5 is the authoritative guide for diagnosing mental disorders. Each disorder includes:

  • Diagnostic criteria
  • Specifiers and subtypes
  • Differential diagnoses
  • Severity ratings
  • Timeframes and functional impairment requirements

Knowing how to navigate this structure is key for writing accurate diagnoses in your SOAP notes and clinical documentation.

? General Tips for Using the DSM-5

✅ Start with symptom clusters, not labels
✅ Assess duration and impact – many disorders require a minimum timeframe and evidence of functional impairment
✅ Rule out medical causes and substance use
✅ Use structured interviews or screening tools (e.g., PHQ-9, GAD-7, MDQ) to support findings
✅ Consider cultural and developmental context

? Common Disorders and Their DSM-5 Highlights

? Major Depressive Disorder (MDD)

  • At least 5 symptoms during the same 2-week period, including either depressed mood or anhedonia
  • Sleep/appetite changes, guilt, fatigue, psychomotor changes
  • Must cause clinically significant distress or impairment
  • Rule out substance/medical condition and bereavement

? Red Flags: Suicidal ideation, psychosis, marked functional decline

? Generalized Anxiety Disorder (GAD)

  • Excessive worry more days than not for 6+ months
  • 3+ symptoms: restlessness, fatigue, irritability, muscle tension, sleep issues
  • Causes distress or dysfunction

? Red Flags: Somatic symptoms misinterpreted as medical illness, overlap with panic disorder

? Bipolar I Disorder

  • At least one manic episode (≥1 week) with 3+ symptoms: grandiosity, decreased sleep, pressured speech, distractibility, risk-taking
  • May have hypomanic or depressive episodes

? Red Flags: Misdiagnosed as unipolar depression; check for elevated mood or irritability

? Schizophrenia Spectrum Disorders

  • 2+ core symptoms (delusions, hallucinations, disorganized speech, catatonia, negative symptoms) for ≥1 month, with disturbance ≥6 months
  • Functional decline is required

? Red Flags: Onset in late adolescence/early adulthood; family history; gradual withdrawal from functioning

? PTSD (Post-Traumatic Stress Disorder)

  • Exposure to trauma, plus:
    • Intrusion symptoms (e.g., flashbacks)
    • Avoidance
    • Negative cognition/mood
    • Arousal/reactivity (e.g., hypervigilance)
  • Duration >1 month; functional impairment

? Red Flags: Sleep disturbance, substance misuse, dissociation

? ADHD (Adult)

  • Symptoms must have started before age 12
  • Inattention and/or hyperactivity-impulsivity present in 2+ settings
  • Functional impairment required

? Red Flags: Poor work performance, chronic lateness, misdiagnosed as anxiety

? Helpful Tools and Frameworks

  • DSM-5 Cross-Cutting Symptom Measures – Great for initial assessments
  • Mental Status Exam (MSE) – Use to support DSM findings
  • Differential Diagnosis by Tree Diagram – Helps separate overlapping conditions (e.g., depression vs. bipolar)

? Final Tips for NP Students

  • When documenting, always include DSM-5 codes and criteria justification
  • Consider rule-out diagnoses and comorbidities
  • Practice case formulation (Biopsychosocial + DSM-5 criteria)
  • Use SOAP templates that include DSM checklists