Sex bias in the diagnosis of personality disorders: an evaluation of the DSM-IV criteria.

This study considered whether the Diagnostic and Statistical Manual of Mental Disorders (4th ed.; American Psychiatric Association, 1994) is biased against women by requiring less dysfunction for the personality disorders that are more commonly diagnosed in women (e.g., histrionic). Clinicians estimated the extent of social dysfunction, occupational dysfunction, and personal distress suggested by each of the diagnostic criteria for 6 personality disorders. The results failed to suggest a bias against women, as there was no difference in the overall level of dysfunction associated with the female-typed personality disorder diagnostic criteria (fewer criteria are also required for the male-typed diagnoses). However, the considerable variation in dysfunction across disorders and criteria, and the minimal degree of impairment implied by some of the diagnostic criteria, also raise more general issues that should perhaps be addressed in future editions of the diagnostic manual.     

Judgments of impairment and distress associated with symptoms of internalizing and externalizing disorders

The pattern of dysfunction (i.e. impairment vs. distress) judged to be associated with disorders empirically identified by Krueger, Caspi, Moffitt and Silva (1998) as internalizing (e.g. major depressive episode; agoraphobia) was compared to the pattern characterizing disorders classified as externalizing (e.g. antisocial personality disorder; alcohol dependence). In Study 1, lay raters (N=270) judged the social impairment, occupational impairment, and personal distress associated with symptoms of seven internalizing and four externalizing disorders. As predicted, symptoms composing internalizing disorders were perceived as involving a greater degree of distress, and a lesser degree of impairment, relative to symptoms composing externalizing disorders. In Study 2, conducted with a small sample of clinician judges (N=21), symptoms composing internalizing disorders were again judged as involving a greater degree of distress (but, in this case, not a lesser degree of impairment) relative to symptoms composing externalizing disorders. This research provides a novel means of validating the distinction between internalizing and externalizing groups of disorders.     

Sex bias in the diagnosis of personality disorders: A different approach

There has been considerable controversy regarding a possible sex bias in the diagnosis of personality disorders (PDs). However, prior research has at times confused a bias within clinicians who fail to adhere to the diagnostic criteria with a bias within the diagnostic criteria. Rather than assess whether females are more likely than males to be diagnosed with a respective disorder, the current study assesses whether the thresholds for the diagnosis of female-typed PDs are lower than the thresholds for male-typed PDs. Subjects completed two self-report inventories for the DSM-III-R personality disorders, and three inventories that assessed 30 aspects of personality dysfunction organized with respect to social dysfunction, occupational dysfunction, and personal distress. There was no indication that the diagnostic thresholds for personality disorders that occur more often in females is lower than the thresholds for the personality disorders that occur more often in males. The implications of these findings for the issue of sex biased diagnoses are discussed.     

Impairment and Distress Judgments of Symptoms Composing Childhood Externalizing and Internalizing Syndromes

The pattern of perceived dysfunction associated with symptoms composing the externalizing childhood disorder syndrome was compared to the pattern characterizing the internalizing syndrome. In Study 1, undergraduate students (N = 205) judged the social impairment, academic/occupational impairment and personal distress associated with symptoms from the child and adolescent psychopathology scale (Lahey et al. 2004) related to externalizing and internalizing syndromes. As predicted, symptoms composing the externalizing syndrome were judged as involving less personal distress and more impairment than those composing the internalizing syndrome. Converging findings emerged in Study 2 when undergraduates (N = 183) judged DSM-IV symptoms composing externalizing and internalizing disorders. This research reveals systematic differences in perceptions of impairment and distress related to the symptoms that compose the externalizing and internalizing syndromes.     

Longitudinal associations between gender-typed skills and interests and their links to occupational outcomes

Although gender-based occupational segregation has declined in past decades, the world of work remains segregated by gender. Grounded in research showing that individuals tend to choose jobs that match their interests and skills, this study examined the longitudinal associations between gendered activity interests and skills from middle childhood through adolescence and tested gendered interests and skills, measured in adolescence, as predictors of occupational outcomes in young adulthood. Data were collected from 402 participants at four time points—when they averaged 10, 12, 16, and 25 years old. Results revealed that the longitudinal linkages between male-typed interests and skills were bidirectional, that both male-typed interests and skills in adolescence predicted working in male-typed occupations in young adulthood, and that skills, but not interests, predicted income. In contrast, female-typed interests predicted female-typed skills, but not the reverse, adolescent female-typed skills (but not interests) predicted working in female-typed occupations in young adulthood, and there were no links between female-typed interests or skills and income. Discussion focuses on the differential meanings and developmental implications of male- versus female-typed interests and skills.     

Histrionic personality disorder and antisocial personality disorder: sex-differentiated manifestations of psychopathy?

Little is known about the etiology of histrionic personality disorder (HPD) or its relation to other personality disorders. In this study, we examined whether HPD is etiologically related to psychopathy and more specifically whether HPD and antisocial personality disorder (ASPD) are sex-typed alternative manifestations of psychopathy. In addition, based on Newman's (1987) response modulation hypothesis of psychopathy, we examined the associations between psychopathic, HPD, and ASPD features and performance on laboratory measures of passive avoidance errors and interference effects. Seventy-five live theater actors completed self-report questionnaires and two laboratory measures of response modulation, and peers completed questionnaires concerning the participants' personality disorder features. The results provided weak and inconsistent support for the hypotheses that HPD is a female-typed variant of psychopathy and that ASPD is a male-typed variant of psychopathy. Contrary to previous findings, scores on response modulation tasks were not significantly related to psychopathy, or to either HPD or ASPD. The limitations of this study and possibilities for future research in this area are outlined.     

Group-serving attributions across intergroup contexts: Cultural differences in the explanation of sex-typed behaviours

This research attempted to integrate Tajfel's (1978) social identity theory with self-presentational concerns by exploring attributions about perceived group differences in behaviour. As such, it dealt with group-level rather than individual-level attributions, exploring whether bias in making such verbal attributions varied as a function of the interviewer's group identity and the presence of an ingroup audience. Undergraduate men and women at The Chinese University of Hong Kong rated the appropriateness of ingroup-favouring and outgroup-favouring explanations for male-typed and female-typed behaviors in a face-to-face interview. A group-serving bias was found for female-typed behaviours, but only when the same-sex audience was absent. A conceptual replication of the experiment was run in the United States to examine the possible cultural basis for the Chinese moderation of favouritism in the audience condition. The group-serving bias was more robust for the American undergraduates, extending across male- and female-typed behaviours and also across audience conditions, It was argued that these cultural differences in attributional bias appear to reflect the strength of the movement for women's liberation and norms surrounding the avoidance of conflict in the United States and Hong Kong.     

Clinical Correlates of Co-occurring Psychiatric and Autism Spectrum Disorder (ASD) Symptom-Induced Impairment in Children with ASD

Although psychiatric symptom severity and impairment are overlapping but nevertheless distinct illness parameters, little research has examined whether variables found to be associated with the severity are also correlated with symptom-induced impairment. Parents and teachers completed ratings of symptom-induced impairment for DSM-IV-referenced syndromes, and parents completed a background questionnaire for a consecutively referred sample of primarily male (81 %) 6-to-12 year olds with autism spectrum disorder (ASD) (N?=?221). Some clinical correlates (e.g., IQ?<?70, maternal level of education, pregnancy complications, current use of psychotropic medication, season of birth) were associated with impairment for several disorders, whereas others were correlated with only a few syndromes (e.g., gender, co-morbid medical conditions) or were not related to impairment in any disorder (e.g., family psychopathology). There was little convergence in findings for parents’ versus teachers’ ratings. Some clinical correlates (e.g., season of birth, current psychotropic medication, maternal education) were unique predictors of three or more disorders. Pregnancy complications were uniquely associated with social anxiety and schizoid personality symptom-induced impairment. IQ was a unique predictor of schizophrenia, ASD, oppositional defiant disorder symptom-induced impairment. Children whose mothers had relatively fewer years of education had greater odds for symptom-induced impairment in social anxiety, depression, aggression, and mania and greater number of impairing conditions. Season of birth was the most robust correlate of symptom-induced impairment as rated by teachers but not by parents. Children born in fall evidenced higher rates of co-occurring psychiatric and ASD symptom-induced impairment and total number of impairing conditions. Many variables previously linked with symptom severity are also correlated with impairment.     

Assessment and DSM-IV Diagnosis of Personality Disorders: A Primer for Counselors

The DSM-IV categorizes 10 personality disorders, long-term patterns of personality traits that result in impairment of social and occupational functioning. The author details steps in the recognition and diagnosis of personality disorders, with emphasis on using the DSM-IV diagnostic framework.     

On the accuracy of ratings of personality by strangers

Past studies in person perception have shown unexpectedly high correlations between targets' self-ratings of personality traits and ratings of those targets made by stranger judges. Possible reasons for the apparent accuracy of strangers' ratings are examined, including personality judgments that are based on (a) the perceived social desirability of targets, (b) known sex-linked base rates of behavior, and (c) the inevitable presence of valid personality cues in the typical stranger rating study. A computer simulation study is then described that illustrates that a relatively small number of nonrandom accurate judgments among many random judgments can produce substantial overall correlations between self-ratings and stranger ratings. The data of the study provide some clarification of past empirical results of both stranger and acquaintance ratings of personality.     

Role conflict and perceptions of gender roles (the case of Israel)

The present study focuses on work—family role conflict among Jewish women employed in a female-typed occupation (secondary school teachers) and a male-typed occupation (university professors). The major hypotheses of the study are that women who work in different occupation types employ different strategies to reduce role conflict and that family roles contribute more to role conflict than work roles. The findings support the hypotheses and show that women in a male-typed occupation spend less time on family and domestic roles, and increase their hours of work. Consequently, their burden at home decreases while their burden at work increases. Because the burden at home contributes more to role conflict than the burden at work, women in male-typed occupations report less role conflict than women in a typically female occupation.An earlier version of this paper was presented at the Society for the Advancement of Socio-Economics Conference, Paris, 1994. We wish to acknowledge our gratitude to Dafna Izraeli for her insightful critique. We also thank the anonymous reviewers for their helpful comments. This research was funded jointly by Schein Institute and The Eshkol Foundation.     

Do they know how hard I work? Investigating how implicit/explicit achievement orientation,reputation, and political skill affect occupational status

Researchers have yet to precisely test the Socioanalytic proposition that social skill moderates the personality identity–personality reputation relationship. Further, although research has found personality to have both explicit and implicit aspects, scholars have not examined these differences with respect to the Socioanalytic perspective on personality. The present study investigates how explicit and implicit achievement orientation identities relate to one’s reputation for that trait in the workplace and to career success, as measured by occupational status. We propose that explicit and implicit achievement orientation, political skill and their interplay positively relate to reputation of achievement orientation at work, which, in turn, is positively related to occupational status. We found that (1) both explicit and implicit achievement orientation were positively associated with its reputation, as rated by co-workers; (2) reputation mediated both relations between implicit/explicit achievement orientation and occupational status and (3) heightened political skill strengthened the relationship between explicit achievement orientation and its reputation, as well as its indirect effect on occupational status via reputation (first stage moderated mediation). Our research provides a potential explanation for why observer ratings of personality are more strongly associated with outcomes than self-ratings: Observers perceive both implicit and explicit personality behaviours.     

Person perception through facial photographs: Effects of glasses,hair, and beard on judgments of occupation and personal qualities

Thirty-two photographs of male faces, four for each combination of the presence and absence of glasses, hair, and beard, were rated by 75 judges on 23 scales, assessing the typicality for 15 occupations as well as eight personal qualities. The effects of facial attributes on ratings formed characteristic profiles for the different scales. The pattern of correlations between facial attributes and factor scores from a factor analysis of the ratings indicates that the judges associated wearing glasses with intellectualism and goodness, being bald with idealism, and wearing a beard with unconventionality and goodness. In two further experiments, judges were to identify each of three faces with one of three or four occupations; the results confirmed the operativeness of the profiles from the rating experiment.     

Personality disorders and response to outpatient treatment of chronic pain

As part of a comprehensive interdisciplinary evaluation conducted prior to participation in an outpatient chronic pain treatment program, the psychological status of 101 persons was assessed. The majority of participants was found to have a form of personality disorder, determined by conservative cutoff scores applied to their Millon Clinical Multiaxial Inventory (MCMI) profiles. DSM-III-R Cluster C disorders (i.e., Avoidant, Dependent, Obsessive-Compulsive, and Passive-Aggressive) were overrepresented in this sample. Subsequent analyses revealed that personality disorders were related to higher levels of self-reported distress and pain at both the beginning and the end of outpatient treatment. Differential responses to treatment were observed on self-report measures; however, few relations were found between personality disorder and physical therapist ratings of impairment and improvement. Implications for the assessment of personality disorders in outpatient pain treatment programs are discussed and appropriate intervention strategies are considered.     

Conceptualizations of Personality Disorders with the Five Factor Model-count and Empathy Traits

Previous research has long advocated that emotional and behavioral disorders are related to general personality traits, such as the Five Factor Model (FFM). The addition of section III in the latest Diagnostic and Statistical Manual of Mental Disorders (DSM) recommends that extremity in personality traits together with maladaptive interpersonal functioning, such as lack of empathy, are used for identifying psychopathology and particularly personality disorders (PD). The objective of the present study was to measure dispositions for DSM categories based on normal personality continuums, and to conceptualize these with empathy traits. We used a validated FFM-count method based on the five personality factors (neuroticism, extraversion, openness, agreeableness, and conscientiousness), and related these to 4 empathy traits (emphatic concern, perspective-taking, fantasy, and personal distress). The results showed that FFM-based PD scores overall could be conceptualized using only two of the empathy traits, low emphatic concern and high personal distress. Further, specific dispositions for personality disorders were characterized with distinct empathy traits (e.g., histrionic with high fantasy, and paranoid with low perspective-taking). These findings may have both theoretical and practical implications in capturing potential for personality disorders with ease and efficiency.     

Important questions remain to be addressed before adopting a dimensional classification of mental disorders

Comments on the original article "Plate tectonics in the classification of personality disorder: Shifting to a dimensional model," by T. A. Widiger and T. J. Trull. Widiger and Trull raised important nosological issues that warrant serious consideration not only for the personality disorders but for all mental disorders as the Diagnostic and Statistical Manual of Mental Disorders (DSM) is revised during the next few years. As argued compellingly by these authors, dimensional classification may indeed offer substantial improvement over the present categorical system. Several questions remain to be addressed in evaluating whether this is the case and, if so, how dimensional classification can be implemented to best serve the disparate users of the DSM.     

Reciprocal Influences of Personality and Job Characteristics Across Middle Adulthood

ABSTRACT The present research uses an economically diverse, middle-aged sample to examine the concurrent and longitudinal interplay between personality and occupational experiences. Using the Five-Factor Model of personality and the Demand-Control Model of the occupational environment as guiding frameworks, participants ( N =722) reported on their personality, job characteristics, and occupational history; a subset ( n =297) made the same ratings approximately 10 years later. Measured concurrently, emotionally stable, extraverted, open, and conscientious participants reported jobs with greater decision-making latitude, whereas disagreeable participants had more physically demanding and dangerous jobs. Longitudinal cross-lagged analyses revealed that personality was associated with changes in decision latitude, hazardous working conditions, and physical demands. None of the job characteristics predicted change in personality at the factor level. Thus, personality shaped occupational experiences, but occupational experiences had minimal impact on personality. Support for the Five-Factor Theory perspective and implications for environmental approaches to personality development are discussed.     

Borderline personality disorder,complex trauma,and problems with self and identity: A social-communicative approach

Borderline personality disorder (BPD) is a relatively highly prevalent psychiatric disorder that is associated with very high personal and socioeconomic costs. This paper provides a state-of-the-art review of the relationship between complex trauma and key features of BPD, with a focus on problems with self-coherence and self-continuity. We first review evidence for the high prevalence of complex trauma in BPD patients. This is followed by a discussion of emerging knowledge concerning the biobehavioral mechanisms involved in problems related to self and identity in BPD. We emphasize three biobehavioral systems that are affected by complex trauma and are centrally implicated in identify diffusion in BPD: the attachment system, mentalizing or social cognition, and the capacity for epistemic trust—that is, an openness to the reception of social communication that is personally relevant and of generalizable significance. We formulate a new approach to personality and severe personality disorders, and to problems with self and identity in these disorders, rooted in a social-communicative understanding of the foundations of selfhood. We also discuss how extant evidence-based treatments address the above-mentioned biobehavioral systems involved in identity diffusion in BPD and related disorders, and the supporting evidence. We close the paper with recommendations for future research.