This study examines gender differences in the clinical profiles and long-term outcomes of chronic DSM-III Axis I psychotic inpatients from the Chestnut Lodge followup study. Diagnostic groups include schizophrenia, schizoaffective psychosis, and unipolar affective disorder. Sex differences were frequent, especially in schizophrenia. Females with schizophrenia, for example, had superior premorbid social, sexual, and marital adjustments. They presented at index hospitalization with more depression, self-destructive behaviors, and troubled interpersonal relationships. Their long-term outcomes were better than males in terms of social activity, work competence, time symptomatic, substance abuse, and marital and parental status. Baseline gender differences were comparatively sparse for the schizoaffective and unipolar cohorts. Outcome differences were virtually nonexistent among the schizoaffective patients but unipolar females received better ratings than males in work competence and substance abuse. Females had a later onset of illness and males presented with more antisocial behaviors across all three diagnostic groups. Results highlight the importance of analyzing data by gender in studies of the psychotic disorders.

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<P>The notion of character disorder in children remains highly controversial given unanswered questions regarding personality formation. According to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, personality is defined as “enduring patterns of perceiving, relating to and thinking about the environment and oneself … when they are maladaptive and inflexible, they constitute Personality Disorders.” Currently, such disorders are “generally recognized by adolescence or earlier.” DSM-IV continues, however, by emphasizing corresponding diagnoses given to children and adolescents, such as Conduct Disorder, as an earlier equivalent to Antisocial Personality Disorder. Narcissistic Personality Disorder (NPD) has no such equivalent despite the acknowledgment that it develops earlier than 18 years. The ambivalence and ambiguity regarding personality disorder in children are further highlighted by the suggestion that one can apply the diagnosis of personality disorder to children if the traits are stable for at least 1 year and are not limited to a particular developmental stage. </P><H4>ABOUT THE AUTHOR </H4><P>Karen Kernberg Bardenstein, PhD, is with Case Western Reserve University, Cleveland, OH. </P><P>Address correspondence to: Karen Kernberg Bardenstein, PhD, 12429 Cedar Road, Suite 18, Cleveland Heights, OH 44106; or e-mail <A HREF="MAILTO:kkbard@earthlink.net">kkbard@earthlink.net</a>. </P><P>Dr. Bardenstein has disclosed no relevant financial relationships. </P>

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