John is a 19-year-old male who is self-referred for care after being prematurely discharged from the military
John is a 19-year-old male who is self-referred for care after being prematurely discharged from the military. He was in the US Army for one year and see was injured during basic training when his truck went off a bridge into a river. He was pulled out of the water by a bystander and he sustained a GCS of 15 (E1, V1, M4). He had no headache. CT scan of the head found that he had bilateral frontal contusions, right eye subconjunctival hemorrhage, and mild cerebral edema. A lumbar puncture with normal opening pressure and CSF glucose yielded a white blood cell count of 3 cells/uL, platelet count 200,000/uL (in addition to having 16 red blood cells/uL), protein 96 mg/dL, and glucose 80 mg/dL.
John is a friendly, outgoing young man who serves in the Army. He recently completed basic training, but was unable to attend advanced training because of his level of anxiety. He explains that he feels calmer when he is near to others and does not like the feeling of being alone. John lives with his family: his mother and father, one brother and two sisters. His relationships with his father and brother are strained, and he avoids contact with them whenever possible. He feels very dependent on his mother, who has high levels of anxiety as well.
John is a 19-year-old male who is self-referred for care after being prematurely discharged from the military. He is vague as to the details of his discharge, but it appears he had difficulty with performance evaluations and was apparently arrested for several incidences of illegal substance abuse. Comprehensive evaluation of John reveals that he thinks he “is really a woman,” but he cannot accept this and joined the Army to try and “be a real man.” John indicates that he has always felt like he was really a girl, and he says that he “hates that he has a penis.” When considering a diagnosis of gender dysphoria, the PMHNP knows that which of the following would be most consistent with John’s history?