GENDER AND PSYCHOPATHOLOGY:The Diagnostic Criteria

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Gender Issues In Psychology (PSY - 512)

Lesson 42

GENDER AND PSYCHOPATHOLOGY

Gender and Psychopathology

Psychopathology refers to mental disorders, or mental illness. Stereotypically speaking, certain mental disorders

are specific to, or more common in, women and certain others are found only in men.

Some of such traditionally held beliefs are:

_ Hysteria, dissociative disorders, is specific to women, especially young girls

_ Mostly women are anxiety ridden and suffer from anxiety disorders, and very few men

have anxiety

_ Women are scared of insects, animals, or people and usually are phobic

_ Men are brave, scared of nothing and do not develop phobias

_ Depression in women is not something to be taken too seriously, since women have a natural disposition

for feeling sad, and they recover with the passage of time

_ Habit disorders, smoking, drug abuse, or alcoholism are men's problems

These and many other wrong perceptions are not only held by the members of most societies, but are also

promoted, strengthened, and passed on to the younger generation. Most modern research suggests that there

are no significant differences in mental illness, except a few. There are only two or three categories of mental

illness where women are in higher proportions, and vice versa. The differences that have been found in

clinically diagnosed cases are not consistent. The rates of only two illnesses have been found higher in women:

a) Mood disorders

b) Anxiety disorders (Cockerham, 1996; Kessler et al., 1994).

Men have higher rates of personality disorders (Cockerham, 1996; Kessler et al., 1994). Research has further

shown that females are also higher in case of tendencies toward such depression and anxiety that, although not

clinically diagnosable, make people feel psychologically distressed; This fact stands true for the U.S as well as

other countries of the globe (Cockerham, 1996; Desjarlais et al., 1993; Lai, 1995).

In our discussion on the present topic, we will be focusing upon two things:

1. The gender bias in the diagnostic criteria, and

2. The facts about existing gender differences in psychological disorders

The Diagnostic Criteria

Diagnostic criteria refer to the standards laid down and used by psychiatrists and psychologists for categorizing

and labeling people as mental patients, or as suffering from a mental illness. These criteria not only decide

whether or not a person is mentally ill, but also specify the type of disorder. A number of psychologists are of

the opinion that there are inherent biases in the diagnosing and identifying procedures. These have been

designed in a manner that the likelihood of women being diagnosed as mentally ill is higher. The most

commonly used criteria, worldwide, is the Diagnostic and Statistical Manual of Mental Disorders or DSM. The

DSM, developed by the American Psychiatric Association, is the most widely used criteria. The first version

came in 1952, the second edition in 1968, followed by the third edition in 1980, and the slightly revised edition

of the same in 1987. In 1994, DSM-IV was developed, that was not much different from the previous version.

A text revision of the DSM-IV appeared in year 2000. In the 2000 revision, the diagnostic categories remained

unchanged; however the text descriptions were enlarged. The DSM covers more than 240 different diagnoses.

It also includes descriptions of symptoms characteristics of the disorders. It has a multi-axial system, and

contains five axes or dimensions for diagnosis. The first three axes cover the diagnosis, whereas the remaining

two provide criteria for the evaluation of stressors and overall functioning. Information regarding the age of

onset, the course of disorders, and the gender ratio of the disorder

The Issue of Gender Bias in Diagnosis of Clinical Disorders

A number of researchers and mental health professionals have criticized the multiaxial system of the DSM for

an inherent gender bias (Kaplan, 1983a, 1983b; Lerman, 1996; Marecek, 2001). The main criticism posed

against the prevalent diagnostic system of the DSM is that women are more likely to be diagnosed with

problem behavior, whereas actually the problem may be due to some other cause than pathology. In the

diagnosis of mental illness, man are used as the norm, and this increases that likelihood of females being

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diagnosed as disorder-positive when the behavior under consideration is occurring more frequently in women

and not in men. "Professionals have used male-based norms to define healthy versus pathological

behavior"(Cook, Warnke, and Dupuy, 1993, Pp. 312-313). As a consequence of this tendency, behavior and

personality characteristics of men are treated as normal, and behaviors typical of women are considered

abnormal or pathological. Therefore, characteristic male behaviors like competitiveness, assertiveness,

independence and an aggressive attitude are thought to be a part of a healthy mental functioning. On the other

hand characteristic female behaviors like emotional experiences are taken to be indicative of underlying

psychopathology.

Some critics have raised the criticism that the cultural background and life circumstances of the person under

consideration for diagnosis are ignored in the DSM criteria (Lerman, 1996; Marecek, 2001). Some critics believe

that although the DSM-IV and DSM-IV-TR have given consideration to the significance of cultural factors, it

does not give due importance to these factors (Dana, 2001). The assumption that the DSM follows is that

although a person's circumstances may be relevant, the problem primarily resides within the person. Therefore,

the source of the problem is the person, and not the circumstances.

Consequently, if a raped or acid burnt women is depressed, isolated, phobic or severely anxiety-ridden, she will

be labeled as having one of the relevant disorders. Hence `what' she is will be important and not `why' she is

like that.

In some cases even the American Psychiatric Association itself has also warned against over diagnosis or under

diagnosis. Referring to the diagnosis of Personality Disorders, it has been said that the clinicians "must be

cautious not to over-diagnose or under-diagnose certain Personality Disorders in females or in males because

of social stereotypes about typical gender roles and behaviors" (American Psychiatric Association, 2000, P.

688).

Typical Gender behaviors likely to be Diagnosed as Disorders:

In case of Personality Disorders, certain behaviors or symptoms that may be put into a category of these

disorders are actually exaggerated forms and extensions of typical male behavior. These male behaviors are the

prevailing gender stereotypes. For example: "a pervasive pattern of social and interpersonal deficits marked by

acute discomfort with, and reduced capacity for, close relationships as well as cognitive or perceptual

distortions and eccentricities of behavior" is the way in which the Schizotypical Personality disorder is

characterized (American Psychiatric Association, 2000, P. 697).

The Antisocial Personality Disorder is described as: "pervasive pattern of disregard for, and violation of the

rights of others" (American Psychiatric Association, 2000, P. 701). This includes physical cruelty, telling lies,

stealing or fighting.

An exaggerated picture of the traditional male gender role can be seen in the description of the above

mentioned Personality Disorders (Brannon, 1976).

On the other hand, some descriptions are exaggerations of the stereotypical female gender role. "A pervasive

and excessive need to be taken care of that leads to submissive and clinging behavior and fear of separation"

(American Psychiatric Association, 2000, P. 701).

This is how Dependent Personality Disorder is described. This is a blow-up of the conventional, stereotypical

feminine role.

Culturally Promoted Behaviors that can be labeled as Mental Disorders

There are a number of behaviors and tendencies that are promoted by our culture in men and women. Many of

these genders specific behaviors, if adopted intensely and expressed frequently, may appear to be symptoms of

certain disorders included in the diagnostic criteria. In this section we will discuss some of those, with

reference to the labels that they may acquire.

Anxiety in Women

Most women are trained to be dependent upon men. They are taught, directly or indirectly, that men are their

protectors and saviors, and they can not face the world outside home without a man. Major decisions are

usually taken by men, about the house hold, girls' education, occupation, mobility and marriage. As a result

women find it hard to take independent decisions. Therefore, whenever they are caught in a problem situation,

they feel anxiety. Consequently one finds more women expressing anxiety and helplessness. Besides, in a male

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dominated society, girls are brought up with a belief that they have to always please others, especially men. A

consistent attempt for perfection and a fear of failure also nurture anxiety generated attitudes, and tendencies

including obsessive tendencies.

Women and Phobias

From very early childhood, girls learn to be scared of insects, animals, strangers, and strange situations. Besides,

a feeling of dependence on the `perceived protectors', mothers as role models are possible contributory factor.

Young boys do not have fathers as role models for phobias and fears. Since girls are kept protected, much

more than boys, they turn into over-cautious mothers with phobic tendencies.

Women and Depression

Men are discouraged from expressing pain, hurt, and grief. Women and young girls are not discouraged, if not

encouraged, from an open expression of such feelings. For women, crying, weeping, sighing, and lamenting are

socially acceptable behavior. At the same time anger and aggression are discouraged in woman, and considered

acceptable for men. Consequently women may cry, and lament uninhibitedly, but may not be expected and

allowed to express anger over matters involving their relationship with men, no matter who they are; fathers,

brothers, or husbands. Such circumstances and situations may promote behaviors similar to clinically

diagnosable depression.

Some facts about Gender Differences in Psychopathology

Although, as said earlier, no significant gender differences exist in the incidence of specific categories of mental

disorders, some gender differences in some disorders have been found.

We present here some facts pertaining to specific disorders in males and females. Gender differences are found

in the onset of schizophrenia; males tend to have an earlier onset than women, more hospitalization, and higher

relapse rates (Szymanski et al., 1995). Major depression is more common in women with a 2:1 ratio. There are

no known differences in bipolar disorder (American Psychiatric Association, 2000). Dysthymia is more

prevalent in women with a ratio of 2-3:1. The prevalence of depression in women is almost double as

compared to the prevalence in men (Culbertson, 1997). This gap widens during mid to late adolescence

(Hankin et al., 1998). The rate of personality disorders is higher among men.

In case of Substance Related Disorders, men are higher in Alcohol dependence (ratio 5:1), Amphetamine

dependence (ratio 3:1-4:1), Cannabis, cocaine (ratio 1.5-2:1), Hallucinogens (ratio 3:1), and Opiates (ratio 1.5-

3:1).

Women are at a higher risk in sedatives, hypnotics, or anxiolytics (American Psychiatric Association, 2000).

Women are at a higher risk of panic attacks with and without agoraphobia (ratio 2-3:1), and social phobias in

women in general population (men higher in clinical settings).

There are no gender differences in Obsessive Compulsive Disorder or Posttraumatic Stress Disorder

(American Psychiatric Association, 2000).

Conversion Disorder is substantially more common in women than in men (ratio 2-10:1) (American Psychiatric

Association, 2000).

Women account for 95% of somatization disorder patients (Tomasson, Kent, and Coryell, 1991). In the U.S,

this diagnosis is rare in men, but not so in other cultures (American Psychiatric Association, 2000).

There are no gender differences in Body Dysmorphic Disorder. Dissociative Identity Disorder is more

common in women with a ration of 3-9:1. Sexual dysfunction, Paraphilias is rarely diagnosed in women, and

the men to women ratio are 20:1.

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