Sexual Symmetry in Psychiatric Diagnosis

Abstract

While proponents of the psychiatric perspective submit that diagnosis using DSM is sex symmetrical, i.e., males and females with similar mental illness symptoms receive the same diagnosis, followers of the labeling perspective argue that diagnosis is not sex symmetrical, i.e., males and females with similar symptoms receive diagnosis that is concomitant with sex role expectations. Research provides conflicting evidence on the effects of sex on diagnosis, but it has been suggested that the effects of sex found in previous research have been eradicated with the introduction of DSM, an ostensibly objective diagnostic system based solely on symptomatology. We offer a convergence thesis arguing that the effects of sex depend on whether one is using Axis-l clinical or Axis-II personality mental health categories for diagnosis. To test the accuracy of this claim, we asked 152 psychiatrists to use both Axis-l clinical and Axis-II personality categories to diagnose a case. Each psychiatrist received either a male, female, or sex-unspecified client with identical symptoms. Results support the convergence thesis since diagnosis using DSM-III-R is sex symmetrical when Axis-I clinical disorders are applied and sex asymmetrical when Axis-II personality disorders are utilized. We conclude that labeling in psychiatric diagnosis based on sex varies across mental health categories.