Removal of clinical significance criterion from the criteria sets for Tic Disorders
A "clinical significance criterion" (i.e., “the disturbance causes clinically significant distress or impairment”) was added to the criteria sets of a majority of disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) (Tic Disorders among them) in order to emphasize that a mental disorder should not be diagnosed in trivial cases (i.e., when the disturbance is so mild that it has little impact on the patient), an addition that has been the focus of some criticism. Thus, according to the criteria in DSM-IV, a diagnosis of Tic Disorder can be made only after it is established that the tic causes clinically significant distress or impairment in the child.
After the publication of DSM-IV, concerns were raised about the appropriateness of this criterion for tic disorders by clinicians, researchers, and patient advocacy groups (i.e., Tourette Syndrome Association [TSA]). For example, clinicians have expressed concerns about what to do in relation to children who come for evaluation, whose presentations clearly meet the tic symptomatology criteria for Tourette's Disorder, but who do not have significant impairment or distress from their tics, a situation quite common in clinical experience. Furthermore, in June 1999, the TSA with the support of NIH held the third international symposium on Tourette Syndrome and Associated Disorders. At the symposium, there was general agreement that the impairment criterion was confusing and a burden to research, and as a result was largely ignored. Thus, this criterion has been eliminated from the criteria sets for Tourette's Disorder, Chronic Vocal or Motor Tic Disorder, and Transient Tic Disorder.