Operational criteria application does not change clinicians’ opinion on the diagnosis of mental disorder: a pre- and post-intervention validity study (original) (raw)
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Gender differences in the diagnosis of mental disorders: Conclusions and controversies of the DSM-IV
Psychological Bulletin - PSYCHOL BULL, 1998
One of the more controversial issues in terms of mental disorder diagnoses has been their differential sex prevalence. The conclusions provided in the 4th edition of the American Psychiatric Association's {1994) Diagnostic and Statistical Manual of Mental Disorders were derived from systematic reviews of the research literature. However, this research is perhaps complicated by common sources of error. Two sources, in particular, are emphasized here: biases in sampling and biases within the diagnostic criteria themselves. The potential for such biases is illustrated for a wide variety of mental disorder diagnoses, and suggestions for research to address them are provided. One of the more controversial issues for mental disorder diagnoses has been their differential sex prevalence. The diagnoses that generated the most controversy in the development of the recent editions of the American Psychiatric Association's (APA's) influential Diagnostic and Statistical Manual of Mental Disorders (DSM; APA, 1980, 1987, 1994) were controversial largely because of their questionable application to one sex relative to the other (Ross, Frances, & Widiger, 1995). The critiques of decisions made for the third (DSM-III), revised third (DSM-III-R), and fourth (DSM-IV) editions of the DSM have often focused on issues concerning a purported sex
Sex and gender in psychopathology: DSM–5 and beyond
Psychological Bulletin, 2019
Sex and gender differences in psychopathology have been understudied, yet identifying and understanding variability by sex and gender is important for the development of comprehensive etiological models as well as effective assessment and treatment of psychopathology in all persons. In the current article, we discuss the importance of sex and gender in psychopathology research, review terminology used when examining these constructs, and present multiple explanations for differential prevalence rates. Next, we review articles from psychopathology journals and conclude that researchers more often include both males and females than they did two decades ago, but still do not consistently analyze by sex or gender. We also provide an update of male-to-female ratios as presented in the DSM-5 and conduct a systematic review of the literature for selected disorders. We conclude that the DSM-5 presentation of sex or gender ratios is not systematic. Finally, we provide suggestions for the next DSM task force, researchers, journal editors, and funding agencies. These recommendations focus on more consistently and systematically considering sex and gender in all aspects of psychopathology research. Public Significance Statement The authors reviewed existing theories for interpreting sex differences in psychopathology. Next, they reviewed data from major journals and concluded that researchers often include both sexes but do not consistently analyze data by sex, which limits practical applications. Rates of mental health problems for males and females as presented in the diagnostic manual were also reviewed, and the authors systematically compared this information to the literature for selected disorders. They conclude that the presentation of sex/gender ratios is not systematic.
The effects of gender on diagnosis of psychological disturbance
Journal of behavioral …, 1991
This research examines the effect of patient gender on the detection of psychological disturbance. In Study 1, primary-care patients were requested to complete the General Health Questionnaire (GHQ), a measure of nonpsychiatric psychological disturbance, prior to their consultation. The patient's GHQ score was compared with physician judgments about the level of disturbance in that patient (N = 1913). Although there were a similar number of GHQ high scorers among males and females, the physicians classified significantly more females than males as disturbed. The doctors classified as disturbed a larger proportion of nondisturbed women than nondisturbed men. In order to explore the behavior of recent medical graduates, Study 2 examined the detection behavior of interns in an outpatient department with 384 of their patients. The interns behaved in a similar manner to the primary-care physicians.
Sex bias in the diagnosis of borderline personality disorder and posttraumatic stress disorder
Professional Psychology: Research and Practice, 1994
This study 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 subjects received a "male" case; the other half received an identical "female" case. Results from the final sample of 311 revealed sex bias in diagnosis, particularly with respect to sex of client, sex of clinician, and profession of clinician. 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). It is not surprising that the DSM-III (American Psychiatric Association, 1980) and DSM-IH-R (American Psychiatric Association, 1987) personality disorders have been so well represented among diagnoses that have been examined for possible sex bias, because, of all categories, they "seem to represent medical diseases least of all and to be dependent on social conventions most of all" (Kroll, 1988, p. 9). Numerous challenges
Stability of sex differences by diagnosis in psychiatric hospitalizations
Psychiatry Research, 2012
We examined sex differences in the distribution of psychiatric diagnoses among hospitalized patients, controlling for socio-demographic variables. The sample included 1865 psychiatric inpatients consecutively admitted during a 9-year period. The finding of a higher proportion of men among patients hospitalized for schizophrenia or substance use disorder and a higher proportion of women among those admitted for affective disorders, including bipolar disorder, was stable over time. A better understanding of these differences may help to establish more effective treatment strategies.
Sex differences in DSM-III-R, Axis II�Personality disorders
Personality and Individual Differences, 1996
In the present study, an attempt has been made to elucidate sex differences present in the Axis II, personality disorders, in the DSM-III-R. Five-hundred and thirty-one subjects, 176 healthy volunteers and 355 psychiatric patients, 231 males and 300 females, were investigated by means of the SCID screen questionnaire. There were significant sex differences as concerns 31 out of total 103 Axis II criteria. The most pronounced sex differences were seen in narcissistic, borderline and antisocial personality disorders. As a previous study demonstrated that personality disorders are in fact dimensional traits where the cut off points are placed within a normal rather than a bimodal distribution, it was of interest to elucidate the number of criteria fulfilled for each separate personality disorder. Significant sex differences in this dimensional perspective were seen in self-defeating and borderline personality disorders (females predominating). Antisocial personality traits were more common among males. It has also been demonstrated in an earlier study that if an adjusted cutoff is used, the presence or absence of personality disorders can be determined by means of the SCID screen questionnaire with an accuracy of a kappa coefficient = 0.78. If such a method is used, males had a higher prevalence of obsessivecompulsive and schizoid personality disorder. The opposite was true for borderline personality disorder.
ABSTRACT: Psychiatry is one of the oldest specialty professions in medicine, arising after 1800 in small communities of European, British, and American physicians who were physically, socially, and professionally isolated in asylums for the care and management of persons suffering from severe disturbances of thought, emotion, and behavior (“insanity”). In the twentieth century psychiatry turned its attention to milder psychiatric conditions (e.g.,“neurosis” or “neurasthenia”) in the general population, changing its mission and treatment methods. Competing views of mental disorder as biologically specifiable categories of disease (promoted by Emil Kraepelin), as dimensional psychosocial “reactions” (Adolf Meyer), or as mental mechanisms of personality (Sigmund Freud) have not been resolved by biomedical, psychological, or statistical methods.
Psychiatric Diagnosis: Lessons from the DSM-IV Past and Cautions for the DSM-5 Future
Annual Review of Clinical Psychology, 2012
The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders provides the authoritative list of what are considered to be mental disorders. This list has a tremendous impact on research, funding, and treatment, as well as a variety of civil and forensic decisions. The development of this diagnostic manual is an enormous responsibility. Provided herein are lessons learned during the course of the development of the fourth edition. Noted in particular is the importance of obtaining and publishing critical reviews, restraining the unbridled creativity of experts, conducting field trials that address key issues and concerns, and conducting forthright risk-benefit analyses. It is suggested that future editions of the diagnostic manual be developed under the auspices of the Institute of Medicine. The goal would be broad representation, an evidence-based approach, disinterested recommendations, and a careful attention to the risks and benefits of each su...