Date of Award

Fall 12-1-2001

Document Type

Dissertation

Degree Name

Doctor of Psychology (PsyD)

Department

Psychology

First Advisor

Michael J. Murphy

Second Advisor

Veanne Anderson

Abstract

Clinicians have been found to assign differing personality disorder diagnoses based on the patient's sex, raising concerns of sex bias. However, studies assessing symptom ratings have yielded different results than studies assessing the assignment of diagnoses. The present study utilized both approaches to address sex bias. A national sample (N = 167) of psychologists provided both symptom ratings and diagnoses for two case vignettes meeting minimum DSM-IV criteria for Antisocial and Histrionic personality disorders, and the sex of the patients in the cases was manipulated. A sexunspecified condition was used as a baseline measure to assess for over- and underpathologizing bias. Clinicians' sex roles were assessed using the Bern Sex Role Inventory - Short Form. Participants responded via the researcher's Internet web page or by returning a paper-and-pencil version of the study. Most participants chose the paper-and-pencil method of responding, reportedly due to convenience. Results were unclear for the Histrionic case due to its level of ambiguity. However, for the Antisocial case, bias was most likely to occur when the patient's sex was inconsistent with the gender weighting of the symptoms, but the direction of the bias was consistent with sex roles (underdiagnosis of sex-roleinconsistent diagnoses, overdiagnosis of sex-role-consistent diagnoses). Models of accurate and inaccurate diagnosis were developed (for this case) in which patient sex had a direct effect on diagnosis while clinician sex role had an indirect effect through symptom ratings which then affected diagnosis. Implications and directions for future research are discussed.

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