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GENDER AND PSYCHOPATHOLOGY:The Diagnostic Criteria

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Gender Issues In Psychology (PSY - 512)
VU
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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Gender Issues In Psychology (PSY - 512)
VU
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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Table of Contents:
  1. INTRODUCTION:Common misconception, Some questions to ponder
  2. FEMINIST MOVEMENT:Forms or Varieties of Feminism, First wave feminists
  3. HISTORICAL BACKGROUND:Functionalism, Psychoanalytic Psychology:
  4. Gender- related Research:Andocentricity, Overgeneralizing, Gender Blindness
  5. RESEARCH METHODS FOR GENDER ISSUES:The Procedure of Content Analysis
  6. QUALITATIVE RESEARCH:Limitations Of Quantitative Research
  7. BIOLOGICAL DIFFERENCES BETWEEN GENDERSHormones and Chromosomes
  8. BIOLOGICAL DIFFERENCES BETWEEN GENDERS: HORMONES AND NERVOUS SYSTEM
  9. THEORIES OF GENDER DEVELOPMENT:The Biological Approach,
  10. THEORIES OF GENDER DEVELOPMENT (2):The Behavioral Approach
  11. THEORIES OF GENDER DEVELOPMENT (3):The Cognitive Approach
  12. THEORIES OF GENDER DEVELOPMENT (3):Psychoanalytic Feminism
  13. OTHER APPROACHES:The Humanistic Approach, Cultural Influences
  14. GENDER TYPING AND STEREOTYPING:Development of sex-typing
  15. GENDER STEREOTYPES:Some commonly held Gender Stereotypes
  16. Developmental Stages of Gender Stereotypes:Psychoanalytic Approach, Hostile sexism
  17. CULTURAL INFLUENCE & GENDER ROLES:Arapesh, Mundugumor
  18. DEVELOPMENT OF GENDER ROLE IDENTIFICATION:Gender Role Preference
  19. GENDER DIFFERENCES IN PERSONALITY:GENDER DIFFERENCES IN BULLYING
  20. GENDER DIFFERENCES IN PERSONALITY:GENDER, AFFILIATION AND FRIENDSHIP
  21. COGNITIVE DIFFERENCES:Gender Differences in I.Q, Gender and Verbal Ability
  22. GENDER AND MEDIA:Print Media and Portrayal of Genders
  23. GENDER AND EMOTION:The components of Emotions
  24. GENDER, EMOTION, & MOTIVATION:Affiliation, Love, Jealousy
  25. GENDER AND EDUCATION:Impact of Educational Deprivation
  26. GENDER, WORK AND WOMEN'S EMPOWERMENT:Informal Work
  27. GENDER, WORK AND WOMEN'S EMPOWERMENT (2):Glass-Ceiling Effect
  28. GENDER, WORK & RELATED ISSUES:Sexual Harassment at Workplace
  29. GENDER AND VIOLENCE:Domestic Violence, Patriarchal terrorism
  30. GENDER AND HEALTH:The Significance of Women’s Health
  31. GENDER, HEALTH, AND AGING:Genetic Protection, Behavioral Factors
  32. GENDER, HEALTH, AND AGING:Physiological /Biological Effects, Changes in Appearance
  33. GENDER DIFFERENCES IN AGING:Marriage and Loneliness, Empty Nest Syndrome
  34. GENDER AND HEALTH PROMOTING BEHAVIORS:Fitness and Exercise
  35. GENDER AND HEALTH PROMOTING BEHAVIOR:The Classic Alameda County Study
  36. GENDER AND HEART DISEASE:Angina Pectoris, The Risk factors in CHD
  37. GENDER AND CANCER:The Trend of Mortality Rates from Cancer
  38. GENDER AND HIV/AIDS:Symptoms of AIDS, Mode of Transmission
  39. PROBLEMS ASSOCIATED WITH FEMALES’ REPRODUCTIVE HEALTH
  40. OBESITY AND WEIGHT CONTROL:Consequences of Obesity, Eating Disorders
  41. GENDER AND PSYCHOPATHOLOGY:Gender, Stress and Coping
  42. GENDER AND PSYCHOPATHOLOGY:The Diagnostic Criteria
  43. GENDER AND PSYCHOTHERAPY:Traditional Versus Feminist Theory
  44. FEMINIST THERAPY:Changes targeted at societal level
  45. COURSE REVIEW AND DISCUSSION OF NEW AVENUES FOR RESEARCH IN GENDER ISSUES