Gender issues and DSM-V

Abstract

With each edition of the DSM, there has been greater attention paid to gender issues. The DSM-I, published in 1952, contained essentially no mention of sex differences in psychiatric illness. The DSM-II (1958) only rarely noted sex differences in disorders but did include the sex-specific disorder “Psychosis with Childbirth” as well as “Involutional Melancholia”, which was commonly associated with menopause. The DSM-III (1980) added a text section on “Sex Ratios” for each disorder but provided only minimal information such as “more common in women” or stated the information was not available; there were also sporadic comments about gender differences in course and treatment-seeking behavior. Several diagnoses in the DSM-III were sex-specific or had different diagnostic criteria for men and women, most of which were in the section on Psychosexual Disorders. The other disorder with sex-specific diagnostic criteria in DSM-III was Somatization Disorder, which had a threshold of 14 symptoms for women and 12 symptoms for men from among the 37 possible symptoms, 4 of which were categorized as ”female reproductive symptoms” (painful menstruation, menstrual irregularity, excessive bleeding, and severe vomiting during pregnancy). The DSM-III-R (1987) added proposed criteria for another sex-specific diagnosis, Late Luteal Phase Dysphoric Disorder (LLPDD). Because of the tremendous controversy generated by this diagnosis and concerns voiced by women’s groups that its inclusion in the DSM may stigmatize women, it was placed in the Appendix as a diagnosis for further study, to be coded as an Unspecified Mental Disorder. In DSM-IV (1994), a text section on “Specific Culture, Age, and Gender Features” was added for each disorder, which included any known information about gender differences in prevalence, symptoms and course. LLPDD remained in the Appendix of DSM-IV, with the name changed to Premenstrual Dysphoric Disorder (PMDD) and the coding changed to Depressive Disorder Not Otherwise Specified; in the body of the DSM, PMDD was listed as an example of Depressive Disorder NOS. The criteria for Somatization Disorder were changed so that the number of categories and required symptoms were equal for men and women, although some sex-specific symptoms were still included as examples. Another important addition in DSM-IV was the modifier “With Postpartum Onset” to describe episodes of Major Depressive Disorder, Bipolar I or II Disorder, or Brief Psychotic Disorder with onset within 4 weeks after childbirth. In DSM-IV-TR (2000), the information in the text about gender differences in the prevalence, symptoms, and course of disorders was greatly expanded. “With Postpartum Onset” was retained as a specifier with the same 4-week time frame. The only disorders that are unique to men or women or have sex-specific diagnostic criteria are among the Sexual and Gender Identity Disorders (and PMDD in the Appendix). What changes with regard to gender issues should be incorporated into DSM-V? The following options should be considered: