Date of Award

2001

Document Type

Dissertation

Degree Name

Doctor of Philosophy (PhD)

Department

Psychology

Abstract

This study investigated the relative influence of gender and sex on psychologists' diagnoses of histrionic (HPD) and narcissistic (NPD) personality disorders. Gender was defined according to conventional behavioral norms, and included the categories of masculine, feminine, and androgynous. Sex was defined by biological features, and included the categories of male, female, and sex-unspecified. Psychologists were mailed a survey and asked to assign a single diagnosis to a clinical case vignette that was equally representative of DSM-IV (APA, 1994) HPD and NPD criteria, but which varied regarding the nine possible pairings of a gender and a sex. A total of 184 doctoral-level licensed psychologists provided usable diagnoses. Log-linear modeling resulted in a best fitting model that included significant two-way associations between both diagnosis and gender, and diagnosis and sex, with gender having a primary influence on diagnosis and sex having a secondary influence on diagnosis. Observation of frequency percentages revealed that feminine and masculine genders were substantially associated with HPD and NPD diagnoses respectively; a female and male sex were moderately associated with HPD and NPD diagnoses respectively; and an androgynous gender was equally associated with both HPD and NPD diagnoses. An inconsistent pattern emerged for sex-unspecified vignettes. Overall, sex had a compounding or moderating effect on the influence of gender---depending on the unique pairing. It was concluded that gender should be consistently operationalized and measured in future studies that explore the influence of sex on psychologists' diagnoses of personality disorders; that past research findings regarding sex bias in diagnosing particular personality disorders should be re-examined for the potential confounding effects of gender; that clinicians should be aware of the possibility that gender presentation may be inconsistent with conventional expectations regarding sex-congruent behavior; and that gender may have a greater impact than sex on personality disorder diagnosis.

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