<?xml version="1.0"?>
<ownershipDocument>

    <schemaVersion>X0202</schemaVersion>

    <documentType>4</documentType>

    <periodOfReport>2004-05-04</periodOfReport>

    <issuer>
        <issuerCik>0000829608</issuerCik>
        <issuerName>PSYCHIATRIC SOLUTIONS INC</issuerName>
        <issuerTradingSymbol>PSYS</issuerTradingSymbol>
    </issuer>

    <reportingOwner>
        <reportingOwnerId>
            <rptOwnerCik>0001199270</rptOwnerCik>
            <rptOwnerName>LAMONT ANN H</rptOwnerName>
        </reportingOwnerId>
        <reportingOwnerAddress>
            <rptOwnerStreet1>C/O OAK INVESTMENT PARTNERS</rptOwnerStreet1>
            <rptOwnerStreet2>ONE GORHAM ISLAND</rptOwnerStreet2>
            <rptOwnerCity>WESTPORT</rptOwnerCity>
            <rptOwnerState>CT</rptOwnerState>
            <rptOwnerZipCode>06880</rptOwnerZipCode>
            <rptOwnerStateDescription></rptOwnerStateDescription>
        </reportingOwnerAddress>
        <reportingOwnerRelationship>
            <isDirector>1</isDirector>
            <isOfficer>0</isOfficer>
            <isTenPercentOwner>1</isTenPercentOwner>
            <isOther>0</isOther>
        </reportingOwnerRelationship>
    </reportingOwner>

    <reportingOwner>
        <reportingOwnerId>
            <rptOwnerCik>0000933938</rptOwnerCik>
            <rptOwnerName>OAK INVESTMENT PARTNERS VI LP</rptOwnerName>
        </reportingOwnerId>
        <reportingOwnerAddress>
            <rptOwnerStreet1>ONE GORHAM ISLAND</rptOwnerStreet1>
            <rptOwnerStreet2></rptOwnerStreet2>
            <rptOwnerCity>WESTPORT</rptOwnerCity>
            <rptOwnerState>CT</rptOwnerState>
            <rptOwnerZipCode>06880</rptOwnerZipCode>
            <rptOwnerStateDescription></rptOwnerStateDescription>
        </reportingOwnerAddress>
        <reportingOwnerRelationship>
            <isDirector>0</isDirector>
            <isOfficer>0</isOfficer>
            <isTenPercentOwner>1</isTenPercentOwner>
            <isOther>0</isOther>
        </reportingOwnerRelationship>
    </reportingOwner>

    <reportingOwner>
        <reportingOwnerId>
            <rptOwnerCik>0001131676</rptOwnerCik>
            <rptOwnerName>OAK INVESTMENT PARTNERS X LTD PARTNERSHIP</rptOwnerName>
        </reportingOwnerId>
        <reportingOwnerAddress>
            <rptOwnerStreet1>ONE GORHAM ISLAND</rptOwnerStreet1>
            <rptOwnerStreet2></rptOwnerStreet2>
            <rptOwnerCity>WESTPORT</rptOwnerCity>
            <rptOwnerState>CT</rptOwnerState>
            <rptOwnerZipCode>06880</rptOwnerZipCode>
            <rptOwnerStateDescription></rptOwnerStateDescription>
        </reportingOwnerAddress>
        <reportingOwnerRelationship>
            <isDirector>0</isDirector>
            <isOfficer>0</isOfficer>
            <isTenPercentOwner>1</isTenPercentOwner>
            <isOther>0</isOther>
        </reportingOwnerRelationship>
    </reportingOwner>

    <reportingOwner>
        <reportingOwnerId>
            <rptOwnerCik>0001143824</rptOwnerCik>
            <rptOwnerName>OAK X AFFILIATES FUND LP</rptOwnerName>
        </reportingOwnerId>
        <reportingOwnerAddress>
            <rptOwnerStreet1>ONE GORHAM ISLAND</rptOwnerStreet1>
            <rptOwnerStreet2></rptOwnerStreet2>
            <rptOwnerCity>WESTPORT</rptOwnerCity>
            <rptOwnerState>CT</rptOwnerState>
            <rptOwnerZipCode>06880</rptOwnerZipCode>
            <rptOwnerStateDescription></rptOwnerStateDescription>
        </reportingOwnerAddress>
        <reportingOwnerRelationship>
            <isDirector>0</isDirector>
            <isOfficer>0</isOfficer>
            <isTenPercentOwner>1</isTenPercentOwner>
            <isOther>0</isOther>
        </reportingOwnerRelationship>
    </reportingOwner>

    <derivativeTable>
        <derivativeTransaction>
            <securityTitle>
                <value>Option (Right to Buy)</value>
            </securityTitle>
            <conversionOrExercisePrice>
                <value>22.36</value>
            </conversionOrExercisePrice>
            <transactionDate>
                <value>2004-05-04</value>
            </transactionDate>
            <transactionCoding>
                <transactionFormType>4</transactionFormType>
                <transactionCode>A</transactionCode>
                <equitySwapInvolved>0</equitySwapInvolved>
            </transactionCoding>
            <transactionAmounts>
                <transactionShares>
                    <value>4000</value>
                </transactionShares>
                <transactionPricePerShare>
                    <footnoteId id="F3"/>
                </transactionPricePerShare>
                <transactionAcquiredDisposedCode>
                    <value>A</value>
                </transactionAcquiredDisposedCode>
            </transactionAmounts>
            <exerciseDate>
                <footnoteId id="F1"/>
            </exerciseDate>
            <expirationDate>
                <value>2009-05-04</value>
            </expirationDate>
            <underlyingSecurity>
                <underlyingSecurityTitle>
                    <value>Common Stock</value>
                </underlyingSecurityTitle>
                <underlyingSecurityShares>
                    <value>4000</value>
                </underlyingSecurityShares>
            </underlyingSecurity>
            <postTransactionAmounts>
                <sharesOwnedFollowingTransaction>
                    <value>4000</value>
                </sharesOwnedFollowingTransaction>
            </postTransactionAmounts>
            <ownershipNature>
                <directOrIndirectOwnership>
                    <value>D</value>
                    <footnoteId id="F2"/>
                </directOrIndirectOwnership>
                <natureOfOwnership>
                    <value></value>
                </natureOfOwnership>
            </ownershipNature>
        </derivativeTransaction>
    </derivativeTable>

    <footnotes>
        <footnote id="F1">The Director Options became exercisable as to 1,000 shares on May 4, 2004, with the remainder becoming exercisable for an additional 1,000 shares on each of the first, second and third anniversaries of May 4, 2004.</footnote>
        <footnote id="F2">Includes Director Options to purchase 3,937 shares of Common Stock, which are held by Ann H. Lamont on behalf of Oak Investment Partners X, Limited Partnership (&quot;Oak X, L.P.&quot;) and Director Options to purchase 63 shares of Common Stock, which are held by Ms. Lamont on behalf of Oak X Affiliates Fund, Limited Partnership (&quot;Oak X Affiliates, L.P.&quot;).</footnote>
        <footnote id="F3">Not applicable</footnote>
    </footnotes>

    <remarks>Remarks

Ann H. Lamont is a Director of Psychiatric Solutions, Inc.  Ms. Lamont is a Managing Member of Oak Associates VI, L.L.C., the General Partner of Oak Investment Partners VI, L.P.; a Managing Member of Oak Associates X, L.L.C., the General Partner of Oak X, L.P.; and a Managing Member of Oak X Affiliates, L.L.C., the General Partner of Oak X Affiliates, L.P.

Each Reporting Person disclaims the existence of a &quot;group&quot; and disclaims beneficial ownership of any securities (except to the extent of such Reporting Person's pecuniary interest in such securities) other than any securities reported herein as being directly owned by such Reporting Person, and this report shall not be deemed an admission that such Reporting Person is the beneficial owner of any such securities for purposes of Section 16 or for any other purpose.</remarks>

    <ownerSignature>
        <signatureName>Ann H. Lamont</signatureName>
        <signatureDate>2004-05-05</signatureDate>
    </ownerSignature>

    <ownerSignature>
        <signatureName>Ann H. Lamont, Managing Member of Oak Associates VI, L.L.C., the General Partner of Oak Investment Partners VI, Limited Partnership</signatureName>
        <signatureDate>2004-05-05</signatureDate>
    </ownerSignature>

    <ownerSignature>
        <signatureName>Ann H. Lamont, Managing Member of Oak Associates X, L.L.C., the General Partner of Oak Investment Partners X, Limited Partnership</signatureName>
        <signatureDate>2004-05-05</signatureDate>
    </ownerSignature>

    <ownerSignature>
        <signatureName>Ann H. Lamont,  Managing Member of Oak X Affiliates, L.L.C., the General Partner of Oak X Affiliates Fund, Limited Partnership</signatureName>
        <signatureDate>2004-05-05</signatureDate>
    </ownerSignature>
</ownershipDocument>

