Gender-bias in medical diagnosis

Gender-biased diagnosing is a controversial[1] sociological observation which asserts that medical and psychological diagnosis may be influenced by the gender of the patient. Several studies have found evidence of differential diagnosis for patients with similar ailments but of different sexes.

Medical diagnosis

The phenomenon may affect physical diagnosis. Women are more likely to be given a diagnosis of psychosomatic nature for a physical ailment than men, despite presenting with similar symptoms. Women sometimes have trouble being taken seriously by physicians when suffering from medically unexplained illness, and report difficulty receiving appropriate medical care for their illnesses because doctors repeatedly diagnose their physical complaints as related to psychiatric problems. Clinical offices that rely on healthcare routines become less distinct due to biased medical knowledge of gender. There is a distinct differentiation between gender and sex in the medical sense. Gender is the societal construction of what femininity and masculinity is, whereas, sex is the biological aspect that defines the dichotomy of female and male. The way of lifestyle and the place in society are often considered when diagnosing patients.[2]

According to traditional medical studies, most of these medical studies were done on men thus overlooking many issues that were related to women’s health. This topic alone sparked controversy and brought about question to the medical standard of our time. Research that was done on diseases that affected women more were less funded than those diseases that affected men and women equally.[3]

There was an example of gender bias in the psychiatric field as well, Hamburg notes that, "psychiatrists would diagnose women with depression and then, eventually psychiatrists would begin to assume that women were more depressed than men due to the fact that the patients that were examined by the psychiatrists were women and they had similar symptoms. As for the men, they were diagnosed with drug or alcohol problems and they were thrown out of the study.”[4]

As for the Women’s Health Equity Act that was passed in 1993, this Act gave women the chance to participate in medical studies and examine the gender differences.[5] Before the Women’s Health Equity Act was introduced there was no research done on infertility, breast cancer, and ovarian cancer which were essential to women’s health.[6]

Psychological diagnosis

There is a suggestion that assumptions regarding gender specific behavioural characteristics can lead to a diagnostic system which is biased.[7] The issue of gender bias with regard to Diagnostic and Statistical Manual of Mental Disorders (DSM) personality disorder criteria has been controversial and widely debated. The fourth DSM (4th ed., text revision; DSM–IV–TR; American Psychiatric Association, 2000) makes no explicit statement regarding gender bias among the ten personality disorders (PDs), but it does state that six PDs (antisocial, narcissistic, obsessive-compulsive, paranoid, schizotypal, schizoid) are more frequently found in men. Three others (borderline, histrionic, dependent) are more frequent in women. Avoidant is equally common in men and women.

There are many ways to interpret differential prevalence rates as a function of gender. Some critics have argued that they are an artifact of gender bias. In other words, the PD criteria assume unfairly that stereotypical female characteristics are pathological. The results of this study conclude with no indication of gender-biased criteria in the borderline, histrionic, and dependent PDs. This is in contrast with what is predicted by critics of these disorders, who suggest they are biased against women. It is possible, however, that other sources of bias, including assessment and clinical bias, are still at work in relation to these disorders. The results do show that the group means are higher in women than in men, an expected result considering the higher prevalence rate of these disorders for women.[8]

The original purpose of the DSM–IV was to provide an accurate classification of psychopathology, not to develop a diagnostic system that will, democratically, diagnose as many men with a personality disorder as women”. However, if the criteria are to serve equally as indicators of disorder for both men and women, it will be important to establish that the implications of these criteria for functional impairment are comparable for both sexes. Whereas it is plausible that there are gender-specific expressions of these disorders, DSM–IV criteria that function differentially for men and women can systematically over-pathologize or under-represent mental illness in a particular gender. The present study is limited by the investigation of only four personality disorders and the lack of inclusion of additional diagnoses that have also been controversial in the gender bias debate (such as dependent and histrionic personality disorders), although it offers a clearly articulated methodology for studying this possibility. In addition, it provides an examination of a clinical sample of substantial size and uses functional assessments that cut across multiple functional domains and multiple assessment methods. Our results indicate that BPD criteria showed some evidence of differential functioning between genders on global functioning, although there is little evidence of sex bias within the diagnostic criteria for avoidant, schizotypal, or obsessive– compulsive personality disorders. Further investigation and validation across sexes for those disorders would be an important direction of future research. [9]

Considerable evidence indicates a prominent role for trauma-related cognitions in the development and maintenance of posttraumatic stress disorder (PTSD) symptoms. The present study utilized regression analysis to examine the unique relationships between various trauma-related cognitions and PTSD symptoms after controlling for gender and measures of general affective distress in a large sample of trauma-exposed college students. In terms of trauma-related cognitions, only negative cognitions about the self were related to PTSD symptom severity. Gender and anxiety symptoms were also related to PTSD symptom severity. Theoretical implications of the results are consistent with previous studies on the relationship between PTSD and negative cognitions, the self, world, and blame subscales of the PTCI were significantly related to PTSD symptoms. The study correlations indicated that increased negative trauma-related cognitions were related to more severe PTSD symptoms. Also consistent with previous reports, correlations also indicated that gender was related to PTSD symptom severity, such that women had more severe PTSD symptoms. PTSD symptom severity was also positively related to depression, anxiety, and stress reactivity. [10]

Distinguishing between borderline personality disorder (BPD) and posttraumatic stress disorder (PTSD) is often challenging, especially when the client has experienced a trauma such as childhood sexual abuse (CSA), which is strongly linked to both disorders. Although the individual diagnostic criteria for these two disorders do not overlap substantially, patients with either of these disorders can display similar clinical pictures. Both patients with BPD and PTSD may present as aggressive toward self or others, irritable, unable to tolerate emotional extremes, dysphoric, feeling empty or dead, and highly reactive to mild stressors. Despite having similar clinical pictures, PTSD and BPD are regarded differently by many clinicians. Results from a 2009 study concluded that patient gender does not affect diagnosis. This finding is consistent with research suggesting that women are not more likely to be given the BPD diagnosis, all else being equal, though it contradicts other findings from studies that have used similar case vignettes. Nor did the data support an effect of clinician gender or age on diagnosis.[11]

A 2012 study examined gender-specific associations between trauma cognitions, alcohol cravings and alcohol-related consequences in individuals with dually diagnosed PTSD and alcohol dependence (AD). Participants had entered a treatment study for concurrent PTSD and AD; baseline information was collected from participants about PTSD-related cognitions in three areas: (a) Negative Cognitions About Self, (b) Negative Cognitions About the World, and (c) Self-Blame. Information was also collected on two aspects of AD: alcohol cravings and consequences of AD. Gender differences were examined while controlling for PTSD severity. The results indicate that Negative Cognitions About Self are significantly related to alcohol cravings in men but not women, and that interpersonal consequences of AD are significantly related to Self-Blame in women but not in men. These findings suggest that for individuals with comorbid PTSD and AD, psychotherapeutic interventions that focus on reducing trauma-related cognitions are likely to reduce alcohol cravings in men and relational problems in women. [12]

References

  1. ↑ Authors V. Mark Durand, M.V. & Barlow, D.H. (2009) Essentials of Abnormal Psychology p.436. Cengage Learning. ISBN 0-495-59982-4. Retrieved November 2011
  2. ↑ Hamberg, K. (2008). Gender bias in medicine. Women's Health (London, England), 4(3), 237-243.
  3. ↑ Trechak A (1999). "On cultural and gender bias in medical diagnosis". Multicultural Education. 7 (2): 41.
  4. ↑ Hamberg, Katarina. "Gender Bias in Medicine." Women's Health (London, England), 4.3 (2008): 237-243.
  5. ↑ WOMEN'S HEALTH EQUITY ACT of 1993. Congressional Record Daily Edition. n.p.: 1993.
  6. ↑ THE WOMEN'S HEALTH EQUITY ACT of 1991. Congressional Record Daily Edition. n.p.: 1991.
  7. ↑ Maddux, J.E. & Winstead, B.A. (2005) Psychopathology: foundations for a contemporary understanding p.77. Routledge. ISBN 0-8058-4077-X Retrieved November 2011
  8. ↑ Jane, J. S., Oltmanns, T. F., South, S. C., & Turkheimer, E. (2007) "Gender bias in diagnostic criteria for personality disorders: An item response theory analysis" Journal of Abnormal Psychology, 116(1), 166-175
  9. ↑ Boggs, C. D., Morey, L. C., Skodol, A. E., Shea, M. T., Sanislow, C. A., Grilo, C. M., et al. (2009) "Differential impairment as an indicator of sex bias in DSM-IV criteria for four personality disorders" Personality Disorders: Theory, Research, and Treatment, S(1), 61-68.
  10. ↑ Moser J. S.; Hajcak G.; Simons R. F.; Foa E. B. (2007). "Posttraumatic stress disorder symptoms in trauma-exposed college students: The role of trauma-related cognitions, gender, and negative affect". Journal of Anxiety Disorders. 21 (8): 1039–1049. doi:10.1016/j.janxdis.2006.10.009.
  11. ↑ Woodward, H. E., Taft, C. T., Gordon, R. A., & Meis, L. A. (2009) "Clinician bias in the diagnosis of posttraumatic stress disorder and borderline personality disorder" Psychological Trauma: Theory, Research, Practice, and Policy, 1(4), 282-290.
  12. ↑ Jayawickreme N.; Yasinski C.; Williams M.; Foa E. B. (2012). "Gender-specific associations between trauma cognitions, alcohol cravings, and alcohol-related consequences in individuals with comorbid PTSD and alcohol dependence" (PDF). Psychology of Addictive Behaviors. 26 (1): 13–19. doi:10.1037/a0023363.

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