Sex bias in the diagnosis of borderline personality disorder and posttraumatic stress disorder (original) (raw)

1994, Professional Psychology: Research and Practice

Abstract

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

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  52. Received March 26,1993 Revision received July 21,1993 Accepted July 27, 1993 • P&C Board Appoints Editor for New Journal: Journal of Experimental Psychology: Applied In 1995, APA will begin publishing a new journal, the Journal of Experimental Psychology: Applied.
  53. Raymond S. Nickerson, PhD, has been appointed as editor. Starting immediately, manuscripts should be submitted to Raymond S. Nickerson, PhD Editor, JEP: Applied Department of Psychology Tufts University Medford, MA 02155
  54. The Journal of Experimental Psychology: Applied will publish original empirical investiga- tions in experimental psychology that bridge practically oriented problems and psychologi- cal theory. The journal also will publish research aimed at developing and testing of models of cognitive processing or behavior in applied situations, including laboratory and field settings. Review articles will be considered for publication if they contribute significantly to important topics within applied experimental psychology. Areas of interest include applications of perception, attention, decision making, reasoning, information processing, learning, and performance. Settings may be industrial (such as human-computer interface design), academic (such as intelligent computer-aided instruc- tion), or consumer oriented (such as applications of text comprehension theory to the development or evaluation of product instructions).