Gender bias in diagnostic criteria for personality disorders: An item response theory analysis.

Abstract

The authors examined gender bias in the diagnostic criteria for Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision; American Psychiatric Association, 2000) personality disorders. Participants (N=599) were selected from 2 large, nonclinical samples on the basis of information from self-report questionnaires and peer nominations that suggested the presence of personality pathology. All were interviewed with the Structured Interview for DSM-IV Personality (B. Pfohl, N. Blum, & M. Zimmerman, 1997). Using item response theory methods, the authors compared data from 315 men and 284 women, searching for evidence of differential item functioning in the diagnostic features of 10 personality disorder categories. Results indicated significant but moderate measurement bias pertaining to gender for 6 specific criteria. In other words, men and women with equivalent levels of pathology endorsed the items at different rates. For 1 paranoid personality disorder criterion and 3 antisocial criteria, men were more likely to endorse the biased items. For 2 schizoid personality disorder criteria, women were more likely to endorse the biased items.

Health Measurement in Population Surveys: Combining Information from Self-reported and Observer-Measured Health Indicators

“…This suggests that women tend to perceive their health as better than it actually is: that is, having an optimistic view of their health status. This finding is in contradiction to previous research that found that women were prone to overreporting of mental health symptoms (Jane et al 2007;Sigmon et al 2005), and suggests a possible reversal of response bias functioning between self-reported health indicators and mental health items. On the contrary, men appear to perceive their health status as worse than it actually is and, hence, overreporting health symptoms.…”

Genetic and Environmental Structure of DSM-IV Criteria for Antisocial Personality Disorder: A Twin Study

“…Differential Item Functioning (DIF) has been previously reported for 3 of the ASPD criteria (Jane et al 2007). DIF with respect to sex means that one sex endorses a specific criterion differently from the other sex despite adjusting for possible differences in the overall (or ‘latent’) ASPD between the sexes (Penfield and Camilli 2007).…”

Sex Bias in Classifying Borderline and Narcissistic Personality Disorder

“…Dependent, histrionic, and borderline PDs occur more often in female patients whereas antisocial, narcissistic, and obsessive-compulsive PDs occur more often in male patients (Anderson et al, 2001). The DSM IV-TR makes no statement regarding sex bias among the PDs, but it does suggest that six disorders (antisocial, narcissistic, obsessive-compulsive, paranoid, schizotypal, schizoid) are more prevalent in men, and three others (borderline, histrionic, dependent) occur more in women (Jane et al, 2007). The diagnosis schizoid PD (SPD) is more common in men (Fulton and Winokur, 1993), whereas borderline PD (BPD) is more often diagnosed in women than in men (De Moor et al, 2009).…”