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Sex bias, diagnosis, and DSM-III
Abstract
Sixty-five licensed clinical psychologists independently diagnosed 18 written case histories on the basis of 10 DSM-III categories. The results showed that females were rated significantly more histrionic than males exhibiting identical histrionic symptoms. There was no comparable sex bias to diagnose males showing antisocial pathology as more antisocial than females. The explanation proposed is that the antisocial category is behaviorally anchored whereas the histrionic category is trait dominated. Thus, the findings suggest that vague diagnostic descriptions promoted sex stereotyping and sex bias in diagnosis.
... 23 DSM-III-R was criticized for being gender-biased, especially for personality disorders. 24,25 DSM-IV built on the previous criteria, and added "clinically significant distress or impairment" across diagnostic criteria to improvise on the term "dysfunction" used in its previous version, the concept of which was unclear. 26 DSM-IV-TR further detailed the associated features of disorders. ...
... Gender-biased, especially for personality disorders. 24,25 Lack of conceptual clarity of the term "dysfunction." 26 ...
This article examines the limitations of existing classification systems from the historical, cultural, political, and legal perspectives. It covers the evolution of classification systems with particular emphasis on the DSM and ICD systems. While pointing out the inherent Western bias in these systems, it highlights the potential of misuse of these systems to subserve other agendas. It raises concerns about the reliability, validity, comorbidity, and heterogeneity within diagnostic categories of contemporary classification systems. Finally, it postulates future directions in alternative methods of diagnosis and classification factoring in advances in artificial intelligence, machine learning, genetic testing, and brain imaging. In conclusion, it emphasizes the need to go beyond the limitations inherent in classifications systems to provide more relevant diagnoses and effective treatments.
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... Although in recent years there has been an increasing research focus on sex bias in psychiatric diagnosis, studies examining the possible influence of gender of patient on diagnoses made according to the revised third edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-HI-R;American Psychiatric Association, 1987) are few in number. Data from several analogue studies seem to support the conclusions that antisocial personality disorder is a diagnosis more frequently applied to men than to women when symptomatology is identical (Fernbach, Winstead, & Derlega, 1989;Ford & Widiger, 1989;Warner, 1978) and that a diagnosis of histrionic (hysterical) personality disorder is more often applied to women (Ford & Widiger, 1989;Hamilton, Rothbart, & Dawes, 1986;Warner, 1978) regardless of whether the case study used presents ambiguous criteria for diagnosis or clear-cut criteria prototypical of the disorders. Unreplicated analogue studies have shown a lack of sex bias in the DSM-III diagnoses of masochistic personality disorder (Fuller & Blashfield, 1989), somatization disorder (Fernbach et al., 1989), and primary orgasmic dysfunction (Wakefield, 1987). ...
... One methodological issue that influences the generalizability of sex bias studies is that of subject selection. In a number of current studies on sex bias in diagnosis (Ford & Widiger, 1989;Hamilton et al., 1986;Teri, 1982;Warner, 1978), sex of clinician was not linked to significant or reliable results, whereas in this study, sex of clinician figured prominently. The inclusion of the social work group combined to increase the number of female participants in the study and perhaps to contribute to the obtaining of both significant and reliable results where they had not previously been found. ...
Questioned the existence of sex bias in the clinical diagnosis of both borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD). Social workers, psychologists, and psychiatrists (
N = 1,080) were asked in a mail survey to assess the applicability of a number of diagnoses to a case tailored to include equal numbers of criteria for both BPD and PTSD. Half of the Ss received a "male" case; the other half received an identical "female" case. Results from the final sample of 311 Ss revealed sex bias in diagnosis, particularly with respect to sex of client, sex of clinician, and profession of clinician. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... sociation, 1987) personality disorders (e.g., Hamilton, Rothbart, & Dawes, 1986). Yet as Widiger and Spitzer (1991) maintained, from past research it is difficult to distinguish between various types and sources of gender bias, such as etiologic, sampling, diagnostic, assessment, and criterion bias. ...
The authors examined the construct of psychopathy as applied to 103 female offenders, using the multitrait–multimethod matrix proposed by D. T. Campbell and D. W. Fiske (1959). Instruments used in the study included the following: (a) Antisocial Scale of the Personality Assessment Inventory (L. C. Morey, 1991); (b) Psychopathy Checklist—Revised (R. D. Hare, 1990); and (c) Antisocial scale of the Personality Disorder Examination (A. W. Loranger, 1988). Criterion-related validity was also evaluated to determine the relationship between psychopathy and staff ratings of aggressive and disruptive behavior within the institution. Results revealed significant convergence and divergence across the instruments supporting the construct of psychopathy in a female offender sample. The measures of psychopathy demonstrated moderate convergence with staff ratings of violence, verbal aggression, manipulativeness, lack of remorse, and noncompliance. It is interesting to note that an exploratory factor analysis of the PCL–R identified a substantially different factor structure for women than has been previously found for male psychopathy.
... One particular area of gender bias in treatment is in diagnosis. Women with SMI tend to be overdiagnosed with affective and personality disorders and underdiagnosed with substance abuse problems (Becker & Lamb, 1994;Cook, Warnke, & Dupuy, 1993;Eriksen & Kress, 2008;Hamilton, Rothbart, & Dawes, 1986;Seeman, 2015). They are more commonly assigned histrionic, borderline, or dependent personality disorders than their male counterparts (Eriksen & Kress, 2008;Reich, Nduaguba, & Yates, 1988;Ussher, 2011). ...
The unique experiences of women with serious mental illness (SMI) are often overlooked in the literature in mental health and rehabilitation services. This population faces increased risk of violence, sexual abuse, treatment bias, and a number of health problems when compared with their male counterparts. Further research is needed to identify these differences and suggest clinical implications for working with women with SMI. The present qualitative research includes data from a grounded theory study analyzing interviews with 20 women with SMI to explore their treatment experiences with mental health providers. The following themes pertaining to treatment experiences of women with SMI were generated from qualitative analysis: diminishing dismissals (questions as to the legitimacy of the symptoms and concerns of women with SMI in their mental health treatment), symptom misattribution (erroneous ascriptions of their mental health symptoms), male mistrust (wariness toward, and avoidance of, male providers), psychiatric insults (perceptions that mental health providers tend to make stigmatizing diagnoses), doomsday predictions (experience of providers' negative prognoses of their future), and diagnostic reordering (tendency of mental health providers to revise prior diagnoses of women with SMI in ways that reduce stigma and build trust). Clinical implications of these findings will be discussed, including the need for enhanced awareness of providers as to the perceptions and expectations of gender bias in treatment among women with SMI. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
... In several studies, the sex of the clinicians did not influence their diagnosis on axis II (Hamilton et al., 1986;Teri, 1982;Warner, 1978). ...
This study investigated sex bias in the classification of borderline and narcissistic personality disorders. A sample of psychologists in training for a post-master degree (N = 180) read brief case histories (male or female version) and made DSM classification. To differentiate sex bias due to sex stereotyping or to base rate variation, we used different case histories, respectively: (1) non-ambiguous case histories with enough criteria of either borderline or narcissistic personality disorder to meet the threshold for classification, and (2) an ambiguous case with subthreshold features of both borderline and narcissistic personality disorder. Results showed significant differences due to sex of the patient in the ambiguous condition. Thus, when the diagnosis is not straightforward, as in the case of mixed subthreshold features, sex bias is present and is influenced by base-rate variation. These findings emphasize the need for caution in classifying personality disorders, especially borderline or narcissistic traits.
... The National Comorbidity Study (Kessler et al., 1994) also found higher rates of ASPD in males than in females (5.8% vs. 1.2%). It has been proposed that men are over-diagnosed with ASPD (Warner, 1978;Hamilton et al., 1986;Ford and Widiger, 1989;Becker and Lamb, 1994). Men with borderline personality disorder (BPD) may be diagnosed with ASPD because of the frequent presence of antisocial features in men with BPD (Sansone and Sansone, 2011;Banzhaf et al., 2012). ...
... A reasonably large literature on gender bias followed. This literature often focused on the PDs (Adler et al. 1990, Becker & Lamb 1994, Fernbach et al. 1989, Ford & Widiger 1989, Hamilton et al. 1986, Henry & Cohen 1983. Many of the findings were inconsistent across researchers, cases, and changes in methodology. ...
The Diagnostic and Statistical Manual of Mental Disorders (DSM) was created in 1952 by the American Psychiatric Association so that mental health professionals in the United States would have a common language to use when diagnosing individuals with mental disorders. Since the initial publication of the DSM, there have been five subsequent editions of this manual published (including the DSM-III-R). This review discusses the structural changes in the six editions and the research that influenced those changes. Research is classified into three domains: (a) issues related to the DSMs as measurement systems, (b) studies of clinicians and how clinicians form diagnoses, and (c) taxonomic issues involving the philosophy of science and metatheoretical ideas about how classification systems function. The review ends with recommendations about future efforts to revise the DSMs.
... In an investigation of clinical judgment, Phillips (1985) found evidence that mental health therapists were influenced by sex role stereotypes when assessing clients. In a study of gender bias in personality diagnoses involving 65 licensed clinical psychologists, Hamilton, Rothbart, and Dawes (1986) found that female clients were rated significantly more histrionic than male clients who were exhibiting identical symptoms and that there was no comparable gender bias in diagnoses of male clients. ...
Examined how training and experience, family roles, and gender of observed family leadership affect ratings of both family and individual parent functioning. Seventy experienced therapists and 70 clinically naive individuals rated 2 videotaped family interviews. One interview demonstrated a matriarchal style of family interaction and the other demonstrated a patriarchal style. Ratings from the 2 groups of observers were compared to determine the effects of training and experience. The effects of leader gender were determined by comparing ratings of the 2 family interviews. Ratings of the mother and the father from the 2 interviews were compared to determine the effects of family roles. Results suggest that experienced observers in assessments of family functioning are vulnerable to biased views of mother-led families. In assessments of parent functioning, results suggest that although training and experience may promote more critical ratings, vulnerability to biased views of women as family leaders is not significantly affected. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
... However, when a semistructured interview was used, the proportion varied &om 47% to 100% (with a mean of68.7%). There are also data to indicate that clinicians do overdiagnose HPD in women (e.g., Adler, Drake, & Teague, 1990;Ford & Widiger, 1989;Hamilton et al., 1986;Thompson & Goldberg, 1987;Warner, 1978), and may be more likely to do so in the absence of a semistructured interview format. ...
Diagnosis of the personality disorders (PDs) across men and women has been the focus of considerable controversy in the psychological and psychiatric literature, most of which has concerned the possibility of a sex bias. However, the interpretation of the differential sex prevalence rates reported within the literature is complicated and problematic even if one assumes an absence of sex bias. The most recent revision of the American Psychiatric Association's (APA) Diagnostic and Statistical Manual of Mental Disorders, 4th ed. (DSM-IV) contains substantial revisions in the conclusions presented in an earlier edition of the manual (DSM-III-R) regarding the existence of sex differences in the PDs. This article reviews the empirical support for the conclusions provided in DSM-IV, discusses the complicated nature of interpreting sex prevalence rates across different samples, and offers a conceptual model for understanding sex differences among the PDs.
... Several researchers (e.g., Hamilton et al., 1986) contend that differing conceptualizations of psychopathy may result in differing prevalence rates for female psychopathy with some authors suggesting that the conceptualizations currently utilized are less applicable to girls. In essence, these authors (e.g., Hamilton et al., 1987) argue that female psychopathy may be as prevalent as male psychopathy, but because we do not have sensitive measures of female psychopathy, similar prevalence rates cannot be detected. ...
Psychopathy in youth has received increased recognition as a critical clinical construct for the evaluation and management of troubled adolescents (e.g., Frick, P. J. (1998). In Cooke, D. J., Forth, A. E., and Hare, R. D. (eds.), Psychopathy: Theory, Research and Implications for Society. Kluwer Academic Publishers, Boston, MA, pp. 161–187; Lynam, D. R. (1998). J. Abnorm. Psychol., 107: 566–575). To date, clinical research has examined psychopathy simply as a global construct rather than focusing on its specific criteria. In addition, researchers have tended to utilize downward extensions of adult conceptualizations of psychopathy to understand this syndrome in youth. This study was designed to assist in clarifying the construct of psychopathy in youth from a fresh perspective via prototypical analysis. Psychologists from the Clinical Child Psychology Section of the American Psychological Association (i.e., Division 53; N = 511) rated the prototypicality of the psychopathy construct for both male and female youth. Factor analyses for both genders resulted in 2 dimensions that reflected both personality and behavioral components of the disorder. Prototypicality ratings revealed important adult-to-child and male-to-female differences. In addition, child psychologists' views of their effectiveness at treating psychopathy in youth was surveyed. Contrary to the prevailing pessimism, clinical child psychologists reported that children and adolescents made moderate gains in psychotherapy. These results provide a framework for clinical child psychologists in their evaluations and treatment of psychopathic youth.
... With large numbers of women reporting the problem, the condition is subject to all of the gender biases in definition, perception, treatment, and policymaking that have plagued the history of women's health (Geller & Harris, 1994;Laurence & Weinhouse, 1994;Nechas & Foley, 1994;Showalter, 1985;Tavris, 1992). One particular way that women are misperceived is that they are seen as being overemotional and wanting of attention, resulting in the overdiagnosis of histrionic personality, a new name for Freud's old hysteria (Hamilton, Rothbart, & Dawes, 1985;Loring & Powell, 1988). Consequently, their physical complaints are not taken as seriously as men's, as Freud saw women as manifesting their neuroses in their bodies through "somatic compliance" (Freud, 1963). ...
In this article I explore community access-primarily the lack thereof-for persons with disabling environmental sensitivities (ESs). Respondents with chemical and electrical sensitivities described their level of access to common community resources that most persons take for granted, including communities of worship, grocery stores, health food stores, community meetings, public libraries, the homes of extended family members and friends, offices of dentists and medical doctors, public parks, and classes at their local universities. Most had tentative access at best. In addition, participants listed the disability barriers that most restricted them from public participation. Results are described using both quantitative and qualitative data and the problem is analyzed within the context of industrial capitalism's influence upon institutions.
The differential prevalence of the histrionic and antisocial personality disorders among men and women has been attributed both to sex biases and to actual variation in disorder base rates. The present study assessed the bias and base rate explanations and examined whether sex biases are minimized by the relatively explicit diagnostic criteria in the DSM–III. Psychologists (N = 354) either diagnosed 9 DSM–III disorders from case histories that varied in the ambiguity of the antisocial and histrionic personality disorder diagnoses or rated the degree to which specific features extracted from the case histories met 10 histrionic and antisocial diagnostic criteria. The sex of the patient was either male, female, or unspecified. Sex biases were evident for the diagnoses but not for the diagnostic criteria. The results are discussed with respect to base rate effects, sex biases, and the construction of diagnostic criteria.
This study examined the interdiagnostician reliability and potential gender bias of the DSM-IV/DSM-5 Section II and DSM-5 Alternative Model definitions of borderline personality disorder. A national sample of 123 mental health professionals provided diagnostic judgments on 12 case vignettes selected to represent a range of personality pathology. Two versions of each case were included, one identified as male and the other as female, but which were otherwise identical. Analyses examined the intraclass correlation between clinicians and also examined rates of diagnostic assignments as a function of case gender. Reliability of diagnosis of borderline personality did not differ across the two diagnostic approaches, and concordance of diagnoses across the two systems was significant. The dimensional components of the DSM-5 Alternative Model demonstrated significantly more diagnostic reliability than the DSM-IV categorical diagnoses. The DSM-5 Alternative Model conceptualization of borderline personality can be diagnosed with comparable or greater reliability than the extant DSM-IV definition.
When asked whether psychopathology in children and youths is changing, a large number of mental health experts, parents and teachers would answer positively, but with different explanations. According to numerous studies, the most common reasons are: changes in family dynamics, the growing influence of mass media and our surroundings, increased pressure and expectations from young people without the adequate support, better quality of diagnostic methods which allows a better insight into the aetiology of a problem for professionals, etc. Studies on the prevalence of certain types of behaviour are indicative of the increase of both anxious and depressive disorders, but different aetiological factors are stressed in accordance to the basic education of the interviewer. Numerous studies aimed at the aetiology of psychotic disorders point towards differences when taking interviewers into account The analysis of current classifications is indicative of changes in approach. A large number of researchers believe that DSM did not focus on aetiology previously, while DSM 5 made changes in diagnostic criteria, which, in turn, reflect on assessment of certain diagnostic groups and therapeutic approaches. Deficit in cognitive abilities beginning early in the developmental period are highlighted in particular, which is thought to be of great influence on mental disorder development. Change in the clinical picture due to numerous studies brings new revelations in aetiology to the forefront, especially connected to the functioning of the central nervous system and interconnectivity of biological and psychological factors, as well as the changes in the dynamics of family relations and models of education. All of this creates a need for an interdisciplinary approach in the diagnostic processes, as well as a need for further research and further collaboration between clinicians and researchers.
Examined how training and experience, family roles, and gender of observed family leadership affect ratings of both family and individual parent functioning. Seventy experienced therapists and 70 clinically naive individuals rated 2 videotaped family interviews. One interview demonstrated a matriarchal style of family interaction and the other demonstrated a patriarchal style. Ratings from the 2 groups of observers were compared to determine the effects of training and experience. The effects of leader gender were determined by comparing ratings of the 2 family interviews. Ratings of the mother and the father from the 2 interviews were compared to determine the effects of family roles. Results suggest that experienced observers in assessments of family functioning are vulnerable to biased views of mother-led families. In assessments of parent functioning, results suggest that although training and experience may promote more critical ratings, vulnerability to biased views of women as family leaders is not significantly affected.
In this paper, we summarize the results of an online survey of persons in the United States with chemical intolerance/multiple chemical sensitivity who sought help from mental health providers, including counselors, psychologists, psychiatrists, and others. Respondents reported on their most recent contact with a provider, describing reasons for the contact, accommodations requested and received, and suggestions for how the experience could be more helpful. Overall, though clients were accommodated in small ways, some received no accommodation, and many felt that the providers needed to be more knowledgeable regarding chemical intolerance. Results are discussed in terms of the importance of providers becoming more aware of multiple chemical sensitivity and more willing to make their services accessible to these clients.
The categories of histrionic and dependent personality disorders have two major themes in common. First, both have their origins in early psychoanalytic writings on character structure. Second, both concepts have been associated with women. This chapter provides a historical review of the psychoanalytic ideas associated with these personality disorder categories, discusses the recent empirical studies relevant to the DSM-III/ DSM-III-R definitions of the categories, and concludes with comments on the possible sex bias in the diagnosis of the categories.
In the last several years, there has been a growing interest in the study and understanding of personality disorders. Patients with personality disorders have been part of the clinician’s case load since the beginning of the recorded history of psychotherapy; the general psychotherapeutic literature on the treatment of personality disorders, however, has emerged more recently and is growing quickly. The main theoretical orientation in the present literature is psychoanalytic (Abend, Porder, & Willick, 1983; Chatham, 1985; Goldstein, 1985; Gunderson, 1984; Horowitz, 1977; Kernberg, 1975, 1984; Lion, 1981; Masterson, 1978, 1980, 1985; Reid, 1981; Saul & Warner, 1982). Millon (1981) is one of the few volumes in the area of personality disorders that offers a behavioral focus, and the volume by Beck, Freeman and associates (1989) will be the first to offer a specific cognitive-behavioral focus. This is of interest, in that leading cognitive therapists have been, and remain, interested in “personality disorder” and “personality change” (Hartman & Blankenstein, 1986). When Beck (1963a,b) and Ellis (1957a, 1958) first introduced cognitive approaches, they drew upon the ideas of “ego analysts,” derived from Adler’s critiques of early Freudian psychoanalysis. Though their therapeutic innovations were seen as radical, their earliest cognitive therapies were, in many ways, “insight therapies” in that the therapy was assumed to change a patient’s overt “personality,” whether or not the therapy changed some hypothesized underlying personality. Although Beck and Ellis were among the first to use a wide array of behavioral treatment techniques, including structured in vivo homework, they have consistently emphasized the therapeutic impact of these techniques on cognitive schemata and have argued in favor of the integration of behavioral techniques into therapy within a broad framework that has some roots in prior analytic practice (Beck, 1976; Ellis & Bernard, 1985); they and their associates have emphasized the impact of treatment for particular types, or styles, of cognitive errors on dysfunctional self-concepts, as well as on presenting focal problems (Beck & Freeman, 1989; Ellis, 1985; Freeman, 1987).
Severe personality disorders develop symptoms due to psychological stress which bring to fore a psychotic disorder. Considering the borderline personality disorder which occurs in women with particular frequency, this is regarded as one of the personality-specific criteria. To date there have been almost no systematic investigations into the occurrence of psychotic disorder traits with other severe personality disorders. Taking this as her background, the author intends to initially investigate the gender-specific differences between the personality disorders detailed in DSM-IV [1], so as to subsequently concentrate on the two personality disorders which manifest the greatest gender differences; these are the borderline personality disorder, a typically female one and the antisocial personality disorder, a typical male type of personality disorder. They noticeably differ in respect to their treatment of anxiety and aggression. In threatening situations, men turn the aggression outwards, while women turn it onto themselves out of fear of losing an object which is for them important in their life. The more frequent occurrence of psychotic or close-to-psychotic episodes with the (female implicated) borderline personality disorder which can be explained against a background of a gender theory perspective. At the same time, the cultural gender stereotypes which flow unnoticed into these diagnoses experience repeated reconfirmation. It is only in a situation where these gender-specific dichotomies are scrutinised that an insightful approach to both forms of anxiety repression is possible.
BACKGROUND: The introduction of the DSM-III in 1980 has resulted in ideological controversy about possible gender biases that might threaten the validity of psychiatric diagnoses, particularly personality disorders. AIM: To critically review the scientific evidence for prevalence differences associated with gender and gender bias in the diagnosis of personality disorders. METHOD: Critical literature review. RESULTS: Research shows that: (1) prevalence differences associated with gender are plausible; (2) the nature and size of these differences are to date unknown; (3) gender bias is evident at the level of the clinical evaluation but not at the level of the classification system; and (4) the observed gender bias primarily occurs at the diagnostic but not at the criterion level. CONCLUSION: Empirical studies of gender bias in the diagnosis of personality disorders point to the importance of a thorough examination of personality pathology at the level of the specific diagnostic criteria for example by using a semistructured interview schedule.
The costs of occupational stress in terms of sickness absence, ill-health-related retirement, litigation and lost productivity are increasing, putting strain on economies across the world. The fact that health care work is inherently more stressful than many other occupations makes it vital that the problem of occupational stress among health professionals is addressed. CBT for Occupational Stress in Health Professionals goes beyond simply defining the problem and fills a gap in the current literature by providing clear and concise individual treatment interventions. In three parts, the book covers: an overview of stress in the occupational context; the standard CBT approach to assessment, formulation and treatment; a new schema-focused approach to treating occupational stress. The schema-focused approach presented here provides powerful tools for treating a range of work-related problems for which standard CBT approaches are ineffective. Case studies are presented throughout the book to illustrate the therapeutic approaches described. This book will be of huge benefit to clinical and organizational psychologists, psychiatrists, mental health workers, counsellors and anyone else involved in treating occupational stress. It will also have much to offer those who manage people suffering from stress, human resource workers and those who are experiencing work-related stress. © 2006 selection and editorial matter, Martin R. Bamber; individual chapters, the contributors. All rights reserved.
This article provides a framework for integrating gender-relevant issues with practical procedures for the psychological assessment of women in clinical practice. It reviews some historical and current approaches to gender in the clinical-assessment process, and offers suggestions for information-collection strategies that acknowledge the influence of gender-related variables on women's psychological health and well-being. The article discusses some of the concerns and research associated with gender bias in assessment, evidence for the influence of bias in the diagnostic process, and the important role of gender in selected clinically relevant topics. Finally, it describes assessment strategies with women clients based on five themes, one of which is that women in all groups are at risk for repeated experiences of interpersonal violence and sexual abuse, which have significant and specific effects on their psychological health. The article deals primarily with assessment for the purposes of intervention and treatment, but many of the concepts presented are of importance in the consideration of gender variables in forensic and other types of evaluations.
This course was created to examine institutionalized prejudice in the field of psychology. Psychology, as a discipline, has been an arena for examining the structure and etiology of prejudice (Duckitt; Myers). Coetaneously, psychology has been rife with institutionalized prejudice in terms of theories, especially Freud's theory (see Kittay; Westerlund; the investigation of intelligence (e.g., Gould; Zuckerman and Brody) sex differences (e.g., Baumeister; Gould), and racial differences (e.g., Fairchild; Gould), and in diagnostic criteria and categorization (e.g., Franks; Tavris; Wright et al.). This course was designed to examine these issues and to look for ways in which we might contribute to more objective research, teaching, and service in psychology and allied disciplines. This overview focuses primarily on prejudice in the areas of psychometry and diagnostics. Prejudice and intelligence testing Duckitt reports that prejudice did not emerge as an area of study until the 1920s, because until then the scientific community viewed blacks as inferior to whites. Thus, in the early 1900s, rather than examining prejudice, notions of white superiority were used by psychologists and others to rationalize slavery and other discrimination against blacks. However, by the late 1920s and early 1930s, most psychologists had stopped viewing race differences as inevitable or as an adequate reason for prejudice and discrimination. Psychologists then started to view prejudice as irrational and unjustified and began to study its etiology and expression (Duckitt). Nonetheless, racism and sexism had already become firmly entrenched in some facets of Western psychology (Gould). Early psychometry, which consisted primarily of methods like craniometry (measuring skulls), was rife with racist and sexist assumptions. Both Agassiz and Morton, early "psychometricians," viewed those of African descent, Caucasians, and Native Americans as different species. They assumed that Caucasians were superior to those of African and Native American descent in several respects, including intelligence (Gould). Many craniometrists also assumed that males were of superior intellect, which was not difficult to "prove," as males almost invariably have larger skulls than females. Galton and Broca, two of the last craniometrists, both thought that men were innately more intelligent than women. Gould found that several early "psychometricians," including Morton and Broca, either finagled data or used it selectively to support their sexist and/or racist assumptions.
Various types of gender bias in the criteria and use of the Diagnostic and Statistical Manual of Mental Disorders (3rd edition, revised; DSM-III-R; American Psychiatric Association, 1987) by counselors are discussed. Recommendations for addressing such bias in counselor training are provided.
Concerns have been raised related to the intersection of gender and diagnosis, particularly with respect to biases in diagnoses made according to the Diagnostic and Statistical Manual of Mental Disorders (4th ed., text rev.; American Psychiatric Association, 2000). The authors review the literature on the prevalence of diagnoses by gender, sex bias in diagnosis, the problematic impact of particular diagnoses on women, and the relationship of diagnosis to socialization and social conditions. Alternative diagnoses, diagnostic procedures, and diagnostic foci that can help counselors to most effectively avoid gender bias are offered.
This study compared an immigrant sample of Caribbean-Canadian women (n = 20) and a sample of women living in the Caribbean (n = 20) on the following variables: dominant domain of meaning (defined as that aspect of the participant's life from which she derives primary meaning for her sense of self); self-silencing (defined as the tendency to silence one's thoughts and feelings; Jack, 1991); and symptoms of depression. Results revealed that the Caribbean women were more likely to report relational domains of meaning as primary (e.g., family, friendships, intimate relationships), while the Caribbean-Canadian women were more likely to report domains of self-nurturance as primary (e.g., career goals, spirituality). Furthermore, univariate analysis revealed that the Caribbean-Canadian women reported higher levels of self-silencing and depressive symptoms, and derived less meaningfulness from their primary domains of meaning compared to the Caribbean women. These findings suggest that the immigrant experience may be a factor in women's emotional well-being.
This article explores the ways in which the DSM-IV Casebook constructs gender and race/ethnicity in depictions of individuals with mental illness. Analyses indicated that the case studies were gendered in accordance with socially sanctioned descriptions of women and men, with women more likely to be described negatively and in terms of physical attractiveness, and that women of color in particular were more likely to be sexualized. We argue that the studies in the Casebook contribute to a gendered and raced conceptualization of mental illness, and that these explicit definitions of pathology reflect implicit definitions of normalcy.
This article describes the development and psychometric evaluation of the Counseling Women Competencies Scale (CWCS). The CWCS is designed to assess clinicians' self-perceived competencies with regard to therapeutic practice with diverse female clients. Through an extensive review of the literature on counseling women and expert review by 32 members of the Section for the Advancement of Women (Division 17, APA), content validity was supported. Exploratory factor analysis, conducted on a sample of 321 male and female counseling and psychology graduate students and professionals, supported a two-factor model consisting of knowledge/skills and self-awareness factors. Findings also provided support for the internal consistency reliability and construct (convergent, divergent, and incremental) validity of the scale.
This article describes a course that introduces undergraduates to important information about women. This course prepares students to articulate controversies related to culture and women's mental health and provides a background for a more gender-balanced view of psychology. Cultural factors that influence mental health and treatment for women are explored in relation to specific mental health topics, such as eating disorders, self-esteem, sexual assault, depression, sex bias in diagnosis, and feminist therapy. Pretest and posttest scores collected on a 25-item true-false measure of relevant information showed a significant gain in knowledge.
Attempts to predict adult psychopathy generally focus on aggressive and antisocial behavior exhibited in childhood and adolescence. Yet, children with conduct problems constitute a heterogeneous group, and many of the unique interpersonal and affective features associated with the construct of psychopathy only apply to a small subset of children displaying antisocial behavior. The current review seeks to derive an understanding of the specific precursors of the apparently amoral, affectionless, and self-centered orientation that psychopathic youngsters display towards other people. The focus is on the notions of temperament and attachment in early childhood, and their links to the emergence of moral emotions later in life. Based on a developmental perspective, the data currently available are examined, highlighting the insights gained from this body of work and outlining the conceptual and methodological challenges that still need to be addressed.
This article explores therapists' responses to clients' suspicions that they have repressed memories of childhood sexual abuse (CSA). Each participant was randomly assigned one of two vignettes, varied for gender, each concerning a client who suspects that he/she is a victim of CSA. Following the vignette, a series of questions regarding the client assesses the participants' ratings of diagnoses, treatment goals, treatment plans, appropriate responses, and validity of suspicions. Participants were significantly more likely to endorse a diagnosis of borderline personality disorder and endorse treatments focusing on present symptoms over treatments focusing on the client's past. Participants were unlikely to endorse controversial treatments, suggestive statements, or strong opinions regarding the client's suspicions of CSA. The client's gender had a significant effect on diagnoses only. These results do not support reports that many therapists neglect clients' current symptoms and instead focus on memories, use controversial techniques, make suggestive statements regarding abuse, or immediately assume that their clients have repressed memories.
This article describes a poetry-writing assignment designed to encourage students to explore the experience of mental illness. No restrictions o n format, length, or topic are given. This assignment promotes creative thinking and empathy for the mentally ill.
Presents a gender and culturally sensitive diagnostic and training model as an alternative to traditional etic models. The diagnostic model needs to use an emic approach which considers what a client is saying, and places this content in the cultural and gender-related context. Four categories by which counselors can explore difficulties from a cultural perspective are cultural systems and structures, values, gender socialization, and the effect of trauma. In addition, biocultural struggles taking place within the client must also be considered. A training model is described, consisting of 5 steps: (1) critiquing general theories and the specifics of the DSM system, (2) examining the 4 categories, (3) identifying a personal biocultural struggle, (4) analyzing cultural and gender socialization in a number of cultures, and (5) integrating theoretical and cultural components of the course. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
several investigators . . . have argued that the cognitive heuristics and biases formulated by Kahneman, Tversky, and others (Kahneman, Slovic & Tversky, 1982; Nisbett & Ross, 1980) are descriptive of how psychologists and psychiatrists make judgments and decisions / research on whether these heuristics and biases are descriptive of clinicians will be reviewed, comments will be made about how clinicians learn from experience, and implications for training and clinical practice will be discussed (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The potential of gender bias within the DSM personality disorders has long been a concern of scholars and clinicians. Over the past three decades, research findings utilizing the case vignette methodology have repeatedly indicated a gender bias within the histrionic diagnosis. The current study replicates these findings using a novel case vignette, but extends them to investigate the potential for gender biases within an alternative dimensional model of personality—the Five-Factor Model (FFM). One hundred and forty-one practicing clinicians rated either a male or a female version of a case vignette in terms of either the FFM or the personality disorders from the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). The results supported the concern of gender bias, with the female case less likely to be diagnosed as antisocial and the male case less likely to be diagnosed as histrionic. However, when the FFM conceptualizations of these two disorders were compared, no significant differences were noted. The results indicate that the FFM may be less prone to gender bias than the current DSM nomenclature. Copyright © 2009 John Wiley & Sons, Ltd.
Studies on race bias, social class bias, and gender bias are reviewed. Topics include psychodiagnosis and rating level of adjustment, the description of personality traits and psychiatric symptoms, the prediction of behavior, and treatment planning. Replicated findings include race bias in the differential diagnosis of schizophrenia and psychotic affective disorders, gender bias in the differential diagnosis of histrionic and antisocial personality disorders, race bias and gender bias in the prediction of violence, and social class bias in the referral of clients to psychotherapy. Recommendations for decreasing bias include (a) being aware of when biases are likely to occur, (b) adhering to diagnostic criteria, and (c) using statistical prediction rules to predict behavior.
Stereotypic categorization schemas pertaining to the male gender role are examined in two related studies. Study I provides preliminary evidence for four stereotypic categories and their attributes: Businessman, Athlete, Family Man, and Loser. When compared to a similar study on female stereotypes, male stereotypes appear more weakly held. Study II expanded the populations sampled, employing a hierarchical cluster analysis to analyze responses to a card sorting task using attributes from Study I. Differences were found between the three, primarily Caucasian, subject groups. Results support a social cognitive orientation to understanding stereotypes, which suggests that broad categories, such as men or women, do not capture the commonly made distinctions within these groups, which are more accurately conceptualized as subtypes.
Gender differences in children's play activities, preferred school subjects, and occupational goals were examined in relation to such parental variables as toy-giving and chore assignment. Subjects were 245 children in grades K, 3, 6, and 8. Subjects completed questionnaires before and after Christmas asking what gifts they wanted, asked for, received, and liked best. They also were asked to name their friends and play activities, favorite and least-liked school subjects, occupational aspirations, and chores at home. Children generally wanted, asked for, received, and most-liked gender-typical toys. They were less likely to receive requested gender-atypical toys. Children's preferred activities, job aspirations and assigned chores were along gender-typical lines. Girls preferred masculine toys and jobs more than boys preferred feminine ones. With increasing age, both girls and boys increasingly preferred masculine toys and male friends. No gender differences in favorite or least-liked school subjects were found. School subject preference was related to gender-typing of occupational choice for girls but not boys.
The introduction and development of feminist psychotherapy was one of the many accomplishments of second wave feminism in
the West and very much a product of the social and cultural context of the late 1960s and early 1970s, during which time feminism
enjoyed an unparalleled resurgence in Western societies. Within a brief time, it also appeared in various cultural incarnations
in many non-Western and developing countries as local and indigenous groups began to realize that women’s rights are human
rights.
The purposes of this chapter are to dispel the myth that psychiatric diagnosis is value free and based on sound scientific
evidence and to show how the client’s sex and the therapist’s biases about gender often fill parts of the vacuum left by the
absence of science when therapists attempt to identify, categorize, and label people’s emotional suffering.
Findings that clinicians diagnose Histrionic Personality Disorder more frequently in women may be due to the feminine gender weighting of the criteria or because the diagnostic label elicits a feminine stereotype. Using a method derived from the act-frequency approach, undergraduates generated behavioral examples of the DSM-IIIR and DSM-IV Histrionic criteria without regard to sex or according to sex role instructions that elicited masculine or feminine sex roles. A national sample of psychologists and psychiatrists rated the representativeness of the symptoms for the Histrionic criteria or for Histrionic Personality Disorder. Feminine behaviors were rated more representative of Histrionic Personality Disorder and somewhat more representative of the Histrionic criteria than masculine behaviors suggesting that the feminine sex role is more strongly associated with the label than the criteria. Masculine behaviors were also rated less representative than sex-unspecified examples. Results provide a possible explanation for the higher rates of diagnosis of Histrionic Personality Disorder in women.
The main purpose of this research was to determine whether clinicians discern the intent of an analogue study of gender bias in clinical judgment and, if so, whether they respond in a socially desirable manner. A total of 147 psychologists responded to a national mail survey in which they were instructed to make clinical ratings of a case summary describing either a female or male client. In one condition (the Social Desirability condition), clinicians were informed of the study's intent and instructed to respond in a socially desirable fashion. In another condition (the No Social Desirability condition), the study's intent was not revealed and clinicians were asked to guess the study's hypothesis following their ratings. Results indicate that only 10 of 100 clinicians reported having deduced the purpose of the study. The small number of guessers prohibited examination of whether guessing the intent leads to socially desirable responses. Results provide no evidence that either therapist or client gender influenced clinical judgment. Implications for evaluating experimental findings which fail to support gender bias in clinical judgment are discussed.
There has been considerable controversy regarding a possible sex bias in the diagnosis of personality disorders (PDs). However, prior research has at times confused a bias within clinicians who fail to adhere to the diagnostic criteria with a bias within the diagnostic criteria. Rather than assess whether females are more likely than males to be diagnosed with a respective disorder, the current study assesses whether the thresholds for the diagnosis of female-typed PDs are lower than the thresholds for male-typed PDs. Subjects completed two self-report inventories for the DSM-III-R personality disorders, and three inventories that assessed 30 aspects of personality dysfunction organized with respect to social dysfunction, occupational dysfunction, and personal distress. There was no indication that the diagnostic thresholds for personality disorders that occur more often in females is lower than the thresholds for the personality disorders that occur more often in males. The implications of these findings for the issue of sex biased diagnoses are discussed.
When treating a client or testifying in court, clinicians should be aware of how they make judgments and when their judgments are likely to be correct and when they are likely to be wrong. Research on the validity of judgments is reviewed along with research on the cognitive processes of clinicians. Some of the results are surprising. For example, recent research indicates that clinicians might be able to make moderately valid long-term predictions of violence. Finally, recommendations are made for improving clinical judgment, and comments are made about the appropriate use of statistical prediction rules and automated assessment test reports.
The hypothesis that the DSM-III-R personality disorders are sex biased is a co ntroversial issue of considerable importance. The effort to resolve this issue empirically, however, has been flawed by conceptual and methodological problems that have contributed to a misinterpretation of research findings and to a perpetuation of inadequate research methodologies. This review emphasizes in particular the failure to distinguish between various types and sources of sex bias, including etiologic, sampling, diagnostic, assessment, and criterion bias. The importance of these distinctions is illustrated in a review of studies concerned with the relationship of patient sex to the diagnosis of personality disorders and to the assessment of personality disorder criteria. The optimal methodology to identify criterion sex bias is discussed. It is suggested that in order for the sex bias controversy to be resolved, future research needs to delineate the nature of personality disorder pathology and the boundaries between abnormal and normal personality functioning.
Participants (N = 141) rated videotaped dyadic adult-child interactions on dimensions of quality. Participants who were informed that they were viewing mother-child dyads rated the quality of interactions differently than participants who believed they were watching unrelated care provider-child dyads. “Mothers” were judged more harshly than “providers” in the bad and mixed quality segments but not in the good quality segments. Questionnaires completed by the participants revealed that participants' sex and own child care experiences influenced attitudes toward child care and maternal employment but did not influence quality ratings. Potential explanations for the biases in quality attribution to maternal and non-maternal care providers and the possible invalidity of attitude questionnaires in the detection of these biases are discussed.
Argues that one reason women's treatment rates for mental illness are higher than men's is that masculine-biased assumptions about what behaviors are healthy and what behaviors are "crazy" are codified in diagnostic criteria and thus influence diagnosis and treatment patterns. Several theories accounting for women's higher treatment rates are reviewed. P. Chesler's (1972) theory of women's overconforming and underconforming to sex-role stereotypes is evaluated in the light of the I. D. Broverman et al findings that therapists' criteria for healthiness in men and healthiness in adults were the same, but their criteria for healthiness in women were different. The implications of DSM-III's definition of mental disorder, the diagnoses of Histrionic Personality Disorder and Dependent Personality Disorder, and 2 fictitious diagnostic categories (Independent Personality Disorder and Restricted Personality Disorder) are discussed to illustrate assumptions implicit in DSM-III diagnoses. It is shown that behaving in a feminine stereotyped manner alone will earn a DSM-III diagnosis but behaving in a masculine stereotyped manner alone will not. A past diagnosis regarding women's sexuality is reviewed to specifically illustrate past assumptions resulting in the labeling of healthy women as sick. (33 ref)
Tested the assumption that sexual stereotypic beliefs affect the judgments of individuals in an experiment with 98 male and 97 female undergraduates. No evidence was found for effects of stereotypes on Ss' judgments about a target individual. Instead, Ss judgments were strongly influenced by behavioral information about the target. To explain these results, it is noted that the predicted effects of social stereotypes on judgments conform to Bayes' theorem for the normative use of prior probabilities in judgment tasks, inasmuch as stereotypic beliefs may be regarded as intuitive estimates for the probabilities of traits in social groups. Research in the psychology of prediction has demonstrated that people often neglect prior probabilities when making predictions about people, especially when they have individuating information about the person that is subjectively diagnostic of the criterion. An implication of this research is that a minimal amount of subjectively diagnostic target case information should be sufficient to eradicate effects of stereotypes on judgments. Results of a 2nd experiment with 75 female and 55 male undergraduates support this argument. (24 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Social stereotypes may be defined as beliefs that various traits or acts are characteristic of particular social groups. As such, stereotypic beliefs represent subjective estimates of the frequencies of attributes within social groups, and so should be expected to “behave like” base-rate information within the context of judgments of individuals: specifically, individuating target case information should induce subjects to disregard their own stereotypic beliefs. Although the results of previous research are consisten with this prediction, no studies have permitted normative evaluation of stereotypic judgments. Because the hypothesis equates base rates and stereotypes, normative evaluation is essential for demonstrating equivalence between the base-rate fallacy and neglect of stereotypes in the presence of individuating case information. Two experiments were conducted, allowing for normative evaluation of effects of stereotypes on judgments of individuals. The results confirmed the hypothesis and established the generalizability of the effect across controversial and uncontroversial, socially desirable and socially underirable stereotypic beliefs. More generally, an examination of the differences between intuitive and normative statistical models of the judgment task suggest that the base-rate fallacy is but one instance of a general characteristic of intuitive judgment processes: namely, the failure to appropriately adjust evaluations of any one cue in the light of concurrent evaluations of other cues.
Criticizes M. Kaplan's (see PA, 71:6606) theory that 1 explanation for certain mental disorders being diagnosed more frequently in women is because of masculine-biased assumptions about what behaviors are healthy that are codified in DSM-III. Kaplan makes the faulty assumption that recognizing a societal problem (e.g., sexism) excludes the utility of clinical diagnosis of the individual. Examination of the sex ratios for the DSM-III Axis I clinical syndromes in the DSM-III field trials reveals many categories that are more commonly diagnosed in men, providing no support to Kaplan's thesis. (9 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
Argues that one reason women's treatment rates for mental illness are higher than men's is that masculine-biased assumptions about what behaviors are healthy and what behaviors are "crazy" are codified in diagnostic criteria and thus influence diagnosis and treatment patterns. Several theories accounting for women's higher treatment rates are reviewed. P. Chesler's (1972) theory of women's overconforming and underconforming to sex-role stereotypes is evaluated in the light of the I. D. Broverman et al (see record 1970-06951-001) findings that therapists' criteria for healthiness in men and healthiness in adults were the same, but their criteria for healthiness in women were different. The implications of DSM-III's definition of mental disorder, the diagnoses of Histrionic Personality Disorder and Dependent Personality Disorder, and 2 fictitious diagnostic categories (Independent Personality Disorder and Restricted Personality Disorder) are discussed to illustrate assumptions implicit in DSM-III diagnoses. It is shown that behaving in a feminine stereotyped manner alone will earn a DSM-III diagnosis but behaving in a masculine stereotyped manner alone will not. A past diagnosis regarding women's sexuality is reviewed to specifically illustrate past assumptions resulting in the labeling of healthy women as sick. (33 ref) (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The issue of sex-bias in DSM-III
- J B W Williams
- R L Spitzer
- J. B. W. Williams
Williams, J. B. W., & Spitzer, R. L. The issue of sex-bias in DSM-III. American Psychologist, 1983, 38, 793-798.