Gender and Diagnosis of Mental Disorders: Implications for Mental Health Counseling

Article excerpt

The DSM-IV-TR and epidemiological studies have documented disproportionate gender-related prevalence rates for various mental disorders. However, mental health counselors have largely been omitted from the research base. This study investigated whether gender-specific prevalence rates differ in terms of counselor diagnoses of certain mood, psychotic, adjustment, childhood, and substance-related disorders, and whether these diagnoses exhibit the same gender-related differences as those reported in the DSM-IV-TR and by researchers who are not counselors = 1,583). Chi square analyses revealed that all disorders studied were disproportionately diagnosed at rates consistent with previously published gender-specific statistics. Clinical and research implications are discussed as they relate to mental health counseling.

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Gender differences are apparent in a myriad of biological and psychosocial domains, and increasingly so in the field of mental health. Recent epidemiological studies have consistently reported gender differences in mental illness (Klose & Jacobi, 2004). They suggest that several mental disorders exhibit markedly different prevalence rates by gender, with some disorders (e.g., schizophrenia; Usall, Barcelo, & Marquez, 2006) manifesting different symptoms or frequencies depending on gender. This finding is robust and supported across age (Veysey & Hamilton, 2007) and geographic location (Klose & Jacobi, 2004). The current Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision; DSM-IV-TR; American Psychiatric Association [APA], 2000) further elucidates the prevalence rates of mental disorders and provides corroboration for gender discrepancies in mental illness diagnoses. Although the Publication Manual of the American Psychological Association (2010) explains that "gender refers to role, not biological sex, and is cultural" (p. 73), because DSM-IV-TR and studies cited here refer to gender rather than sex when discussing diagnoses, this article does the same, in congruence with the goal of comparisons with DSM-related published information.

Because the DSM-IV-TR is the preeminent reference for the diagnosis of mental health disorders, it has become integral to the work of mental health counselors and researchers (Cermele, Daniels, & Anderson, 2001; Eriksen & Kress, 2006). Its multi-axial assessment system is currently the primary language for identifying and categorizing client symptoms (Seligman, 2004). Counselors therefore use DSM-IV-TR diagnoses in communication, training, and research. How useful the DSM-IV-TR is with regard to gender is debated, however, given the vast differences in the prevalence of mental disorders by gender. Of particular interest to the current investigation are the prevalence rates and gender ratios of certain diagnoses in the DSM-IV-TR categories of mood, psychotic, adjustment, childhood, and substance-related disorders. We review and evaluate the prevalence by gender of these mental disorder categories because of their reported high prevalence in general and because of the vast differential in their rates by gender reported in the literature. Table 1 shows gender-specific prevalence rates of these disorders as reported by DSM-IV-TR.

Despite the robust evidence suggested by the DSM-IV-TR and other researchers, there is still considerable controversy about gender differences in mental illness. Several explanations have been suggested for gender differences apparent in specific mental disorders, among them systemic explanations, such as gender differences in help-seeking behavior or symptomatology; biological explanations, such as differential brain functioning; and social explanations, such as differential socioeconomic status and inequitable social networks by gender (Klose & Jacobi, 2004). Other researchers attribute gender-related prevalence differences to alleged gender bias in the DSM-IV-TR diagnostic criteria (Flanagan & Blashfield, 2005; Jane, Oltmanns, South, & Turkheimer, 2007). …