Author: Sana Rehman
Diagnostic
criteria allude to the norms and standards organised and used by psychiatrist
and psychologists for ordering and labelling the individuals with mental health
issues, or as experiencing psychological maladjustment. These criteria not just
determined whether or not an individual is mentally unstable, yet also indicate
the type and nature of the disorder. Numerous psychologists, psychotherapist
and psychiatrist anticipated that there are inborn predispositions for biases
in the diagnosing and distinguishing mental disorders for both genders. These
have been structured in a way that the probability of females being analysed as
mentally unhealthy is at higher risk as compared to males. The most normally
utilised criteria, around the world, is the Diagnostic and Statistical Manual
of Mental Disorders or DSM. The DSM, created by the American Psychological Association
and many revisions has been made with time according to the needs and
requirement of time.
The Issue of Gender Bias in the Diagnosis of Clinical Disorders
Various
psychologists and researchers and mental health experts have scrutinised the
multiaxial system of the DSM for intrinsic gender bias (Kaplan, 1983a, 1983b;
Lerman, 1996; Marecek, 2001). The primary analysis presented against the
pervasive diagnostic system of the DSM is that women are more likely to
diagnosed for having a mental health issue, despite ignoring the evidence that
the issue might be because of some other reason than pathology. In the
conclusion of psychological maladjustment, man is considered as the standard,
and this improves the probability of females being analysed as mentally sick.
Also, the behaviour under consideration is often labialized as more frequently
occurring in males than females. "Mental health practitioners have raised
male-based standards to characterise pathological vs healthy behaviours (Cook,
Warnke, and Dupuy, 1993, Pp. 312-313). As a result of this propensity,
behaviour and personality of men are treated as normal, and practices, emotions
and behaviour of a ladies are viewed as abnormal or obsessive. In this manner,
the personality characteristics of male-like aggressiveness, assertiveness,
competitiveness, confidence, and independence are believed to be a piece of
solid mental working. Then again, the personality attributes of female-like
passionate emotional are taken to be demonstrative of basic psychopathology.
A few
commentators have raised the criticism that the social backgrounds and living
conditions of the individual under consideration for diagnosis are disregarded
in the DSM criteria (Lerman, 1996; Marecek, 2001). A few experts accept that
even though the DSM-IV and DSM-IV-TR have offered thought to the noteworthiness
of social components, it doesn't give due significance to these variables
(Dana, 2001). The suspicion that the DSM pursues is that even though an
individual's conditions might be significant, the issue fundamentally dwells
inside the individual. Hence, the rising of the issue is the individual and not
the conditions. Like this, if an assaulted or acidic burnt lady is isolated,
anxious, disengaged, and phobic, she will be labelled as having one of the
pertinent issue or disorder. Subsequently 'what she is’ will be significant and
not 'why she is’ that way. In particular, cases, even American Psychiatric
Association itself has warned against over and under a diagnosis of disorders.
Alluding to the finding of Personality Disorders, it has been said that the
clinicians "must be careful not to over or under-diagnosed certain
Personality Disorders in females or males in light of social stereotypes about
gender roles and behaviour" (American Psychiatric Association, 2000, P.
688).
Typical Gender behaviours likely to be Diagnosed as Disorders
A few
Personality characteristics have been categorised into the category of
personality disorder because of an exaggerated form of typical behaviours. The
male behaviour considers prevailing gender stereotypes. For example,
schizotypal personality disorder marked by social and interpersonal deficits
with distorted close relationships and antisocial personality disorder
highlights the characteristics of violation of the rights of others. Stealing,
telling lies, cruelty and fighting is also a part of the antisocial personality
(American Psychiatric Association, 2000, P. 697). The exaggerated form of the
typical male gender role can be seen in the personality mentioned above
disorder (Brannon, 1976).
In contrast,
dependent personality disorder considered to be an exaggerated form of the
traditional female gender role. Dependent personality disorder refers to the
clinging and submissive behaviour and fear of separation (American Psychiatric
Association, 2000, P. 701).
The definition
of dependent personality disorder shows the blow-up stereotypical and
conventional feminine role.
Culturally Promoted Behaviors that can be labeled as Mental Disorders
Many tendencies
and behaviours are culturally specific, i.e. promoted by cultural standards and
norms. Therefore many multicultural genders specific behaviours, if expressed
frequently and adopted intensively considered symptoms or disorder according to
the diagnostic criteria. The below section elaborates the behaviors about
labels they may acquire.
Anxiety in Women
Women are
trained to be dependent on males, regardless of their tendencies to grow
independently. By birth, they are directly or indirectly trained to admit that
men tare their saviour and protector. The decision making power of men consider
superior, and they were given the right to take any decision regarding female
education, marriage, mobility, and occupation. Consequently, women feel low self-esteem and inferiority
complex and feel severe anxiety to take any decision independently. Therefore, it can conclude that female
anxiousness is culture originated, and they have to strive for making peace in
the society to eradicate stereotype labelling.
Women and Phobias
Phobias and
fears are learned behaviours; females learn to fear from insects, darkness, and
animals, strange situations. Apart from being dependent on the perceived
protector, mothers are followed as a role model as a contributory factor for
developing fears and phobias. Boys do not take mothers as a role model for
developing fears rather follow the brave and strong personalities or father to
define their personality or strive to develop such attributes. In contrast,
females are kept protected as compared to boys. As a result, they turned into
over-cautious mother with high phobic tendencies.
Women and Depression
Males
experience severe criticism if they express pain, grief or stress. In contrast,
females receive support and sympathies in response to hurtful emotions. For
women, weeping, crying, sighing, crying, and lamenting are socially acceptable
behaviours. On the other hand, aggression and anger are unacceptable for women
but acceptable for men. Particularly women are not allowed to express anger to
men, no matter who they are, brother, father and husbands. Such cultural
discrepancies and circumstances may promote clinically diagnosed
depression.
Some Facts about Gender Differences in Psychopathology
The gender
differences in the incidence of mental disorder have not been found
significant, but the gender difference in mental disorders are mentioned below.
According to DSM V, some difference occurs among males and females as male
early-onset, more hospitalisation and relapse rate of schizophrenia compared to
women (Szymanski et al., 1995). A major depressive disorder is more prevent
among women with a ratio of 2:1, but no significant evidence has been found
regarding the gender discrepancies over bipolar disorder. (American Psychiatric
Association, 2000). Dysthymia and depression are more common among women, and
the gap expends from mid to late adolescents. The ratio of dysthymia is 2-3:1
and depression is double among females as compared to males (Culbertson, 1997).
The ratio of personality is more among men than females. As far as substances
related disorders, men are higher in Amphetamine (ratio 3:1-4:1),
hallucinogenic (ratio 3:1), opiates (1:5-3:1), alcohol (ratio, 5:1), and
cocaine (ratio 1.5-2:1).
Women found to
be at higher risk of hypnotic, anxiolytics and sedatives (American Psychiatric
Association, 2000). Similarly, women encounter more panic attacks associated
with and without agoraphobia with the ration of 2-3:1. As far as social phobias
are concerned, it is more common among females of the general population, while
in clinical population men at higher risk for panic attacks.
Posttraumatic
Stress Disorder and Obsessive-Compulsive Disorder found to be similar in both
genders (American Psychiatric Association, 2000). In contrast, Conversion
disorder is more prevalent among females than males — conversion (ratio 2-10:1)
(American Psychiatric Association, 2000). The ratio of Somatization is 95%
among women (Tomasson, Kent, and Coryell, 1991). In the U.S, the diagnosis of
somatisation is rare, but the prevalence is different in diverse culture
(American Psychiatric Association, 2000). Gender dysmorphic disorder is common
among both gender, and the ratio of Dissociative Identity Disorder is more
common in women 3-9:1. The paraphilia (sexual dysfunctions) are more frequent
among males than the female with a ratio of 20:1.