Desire Disorders and Diagnostic Structure · Clinical Exercise

Does It Meet Criteria?

Three presentations taken criterion by criterion, then the two specifiers that redirect the entire clinical search. Two of the three cases do not meet criteria, and they fail for completely different reasons.

What this exercise practises

Applying diagnostic criteria one at a time rather than recognising a pattern and working backwards, committing to a verdict, and assigning both specifiers to a presentation before calling the assessment done.

The last part asks what you do when the structure you have just been applying was built around a binary that does not fit the client in front of you.

Estimated time to complete this exercise: 25 minutes

1Case 1
2Case 2
3Case 3
4Specifiers
5The binary
6Close

Before you begin

How this one works

Three presentations, taken criterion by criterion. For each one you mark which criteria are satisfied and then commit to a verdict, and the verdict is the part that counts.
Two of the three do not meet criteria, and they fail for completely different reasons. One fails at the core criterion and the distress criterion together. One satisfies four criteria and fails at the fifth.
Part 4 is the two specifiers. Lifelong or acquired, generalised or situational. Four combinations, six presentations, and each combination redirects the clinical search somewhere different.
Part 5 is the gender-diverse application, because the structure you have just been applying was built around a binary that does not fit every client.
Nothing is graded and nothing is recorded. Reloading starts it again.

Applying strict criteria including the distress threshold and the six-month duration produces substantially lower rates than screening questions about desire alone. That gap between the two numbers is what criteria are for, and this exercise is about working inside it.

References

  1. American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787
  2. Brotto, L. A. (2010). The DSM diagnostic criteria for hypoactive sexual desire disorder in women. Archives of Sexual Behavior, 39(2), 221–239. https://doi.org/10.1007/s10508-009-9543-1
  3. Clayton, A. H., & Montejo, A. L. (2006). Major depressive disorder, antidepressants, and sexual dysfunction. Journal of Clinical Psychiatry, 67(Suppl. 6), 33–37.
  4. Shifren, J. L., Monz, B. U., Russo, P. A., Segreti, A., & Johannes, C. B. (2008). Sexual problems and distress in United States women: Prevalence and correlates. Obstetrics & Gynecology, 112(5), 970–978. https://doi.org/10.1097/AOG.0b013e3181898cdb
  5. World Health Organization. (2022). International classification of diseases for mortality and morbidity statistics (11th rev.). https://icd.who.int