DSM 4, what does 4th criteria really mean

[AmandaM]

I found this and was wondering. I qualify under 1,2,3, but 4 is different. I've suffered from anxiety and depression all my life. Most of the time, I've felt impaired socially, occupationally, etc. cause I just feel different or spend a lot of time obsessed with my gender or crossdressing or serious obsession/jealously of women. I often wonder if I wasn't "blessed" with this condition if I would be more successful in life. I have considered asking my doctor for a low dose of female hormones to see if it improves my anxiety and depression. How do we define #4 below?

(DSM-IV-TR). These criteria are:
1. Strong and persistent cross-gender identification
2. Persistent discomfort about one's assigned sex or a sense of inappropriateness in the gender-role of that sex
3. The diagnosis is not made if the individual has a concurrent physical intersex condition.
4. Clinically significant distress or impairment in social, occupational, or other important areas of functioning.

[Hope]

"Clinically significant" is a term used to avoid trying to define what "normal" is and to avoid providing treatment to those who do not want / need treatment based on some external standard. It is difficult to define when a person requires treatment for any number of conditions (outside of court ordered treatment), because everyone is different and everyone is able to tolerate a variety of conditions differently; and so generally treatment is provided when it is requested.

It is a check on imposing care on those who don't need or want it. Imagine the case of schizophrenia. Schizophrenia, (generally defined as having auditory or visual hallucinations or as the inability to distinguish one's inner thought processes from the outside world) is one of the most common mental illnesses, and is easy to diagnose. It would be easy to suggest that schizophrenia is not "normal" (though given how common schizophrenia is, even that is debatable) and that those who experience the hallucinations should be treated. But here is the rub: some people like it. Some folks think they are receiving angelic communications. Some folks enjoy being unique. Some folks simply don't mind it that much. Some folks are troubled by schizophrenia, but feel that the side effects of the medications used to treat it are even worse. These folks do not have a condition that should be treated, and indeed, treating them would be ethically abhorrent (though the folks in the latter group are in a grey area - it is generally believed that patients should be allowed to choose to receive treatment or not.) These are folks who do not suffer with a condition that is "clinically significant." They have a diagnosable (and treatable) condition, but it is not "clinically significant."

If a person presents with a condition complaining that it impairs their social interactions - that is "clinically significant." If a person presents with a condition and can show that the condition has impacted their occupation, ("I wore a skirt to work and lost a promotion because of it") that is "clinically significant." If a person never shows up at a clinicians office, or if a person shows up only because a spouse or a parent has found a stash of clothing and has insisted that they go to see the "head shrinker" but the person in question is not bothered by their condition or behavior - that is NOT "clinically significant."

From the content of your post, it sounds to me like you will have no problem meeting the criteria. Congratulations?

[Katesback]

In my case specifically I found what was really important in the DSM was the statment that said that some people do not need therapy. I took that to heart LOL.

Therapist? Never went to one.

[AmandaM]

Yeah it's tough. Do I meet the criteria cause I'm anxious and depressed, or am I just anxious and depressed.

[Myojine]

In my case specifically I found what was really important in the DSM was the statment that said that some people do not need therapy. I took that to heart LOL.

Therapist? Never went to one.

i thought you had to see a therapist to get approval for SRS?

[Alexei]

4. Clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Defining that is actually fairly easy, although that's not to say it's easy to apply.

It's just asking whether whatever condition is being looked at interferes with day to day life.

I'll use depression as an easy example. To an outside observer, someone with depression could just be in a bad mood, but someone who is feeling blue can still function. With a very serious case of depression, some people can have a blunt affect seriously hindering their interactions with anything.

Also keep in mind that psychology is one of the least exact sciences, and labeling any mental disorder or other condition often involves a patient that is missing some symptoms or even has extra symptoms.

[AmandaM]

I talked to my shrink. I asked how come when my stress level goes up, my gender issues go up? Then, when I get really stressed, my gender issues as well as everything else come to a grinding halt. The answer was that when you are a little stressed you're looking for solutions, then when you get really stressed, you just focus on the problem at hand. I take this to mean that my gender issues are stress-induced. That I'm not transsexual. That I only have transsexual feelings as my stress goes up. Is that what you think it means?

[Kaitlyn Michele]

amanda

be careful about bias --i'm transitioning so i'm biased, you may or may not be ashamed or guilty about your situation which can bias you..your doctor may be biased as well..

i think your doctors idea is valid but i also think it seems lacking regarding your gender issues...you could make his statement about anything..

i've lived my whole life avoiding things until i had to deal with them...if it's not on fire, then i'll deal with it later...it has nothing at all to do with my gender identity...

In fact, i didnt deal with my own gender issue until it was on fire...:heehee:

[SuzanneBender]

i think your doctors idea is valid but i also think it seems lacking regarding your gender issues...you could make his statement about anything..

Amanda your Therapist's postulate concerning your condition may be right or it could be oversimplification.

The challenge any therapist, and patient, has in our situation is to determine if the adjustment issues (depression, anxiety, etc) are stand alone issues, related to your gender congruency (I hate the word dysphoria when related to us), or some other underlying issue. I don't feel comfortable when clinicians simple leap to a one size fits all solution based off anecdotal observations.

#4 simply means that if you are not well adjusted in your life (who really is) and the clinician determines it is because of the criteria listed in #1 or #2 and #3 is ruled out this diagnosis can be applied and further action taken.