Differential impairment as an indicator of sex bias in DSM-IV criteria for four personality disorders.

Abstract

The aim of the present study was to investigate the possibility of sex bias in the diagnostic criteria for borderline, schizotypal, avoidant, and obsessive-compulsive personality disorders. A clinical sample of 668 individuals was evaluated for personality disorder criteria using a semistructured interview, and areas of functional impairment were assessed with both self-report and semistructured interview. The authors used a regression model of bias to identify bias as differences in slopes or intercepts between men and women in the relationship between each diagnostic criterion and level of impairment. The results suggest that most of the diagnostic criteria examined do not seem to display sex bias. However, those criteria that displayed evidence of bias came largely from the borderline diagnosis.

An investigation of differential item functioning across gender of BPD criteria.

“…Specifically, Jane et al reported gender invariance for all BPD criteria, whereas we report gender invariance for seven of nine criteria. Our findings do, however, diverge from a recent study by Boggs et al (2009), which used a regression model of bias to identify bias as differences in slopes or intercepts between men and women in the relationship between each diagnostic criterion and level of impairment. While Boggs et al utilized a method distinct from the current study in that they examined intercepts and slopes in relation to functional impairment, it is worth noting that bias for all BPD criteria except impulsivity was demonstrated.…”

“…These considerations also point to the fact that a variety of quantitative methods can and should be used across a variety of samples to clarify mixed findings. Boggs et al (2009) provocatively quoted Widiger (1998), who noted that the purpose of the DSM system is to provide an accurate classification of psychopathology and not a system that would democratically diagnose as many women as men. The DSM 5 helpfully also adds that "Although these differences in prevalence probably reflect real gender differences in the presence of such patterns, clinicians must be cautious not to overdiagnose or underdiagnose certain personality disorders in females or in males because of social stereotypes about typical gender roles and behaviors."…”

“…The rationale for this study lies in the dearth of studies that investigate whether noted gender differences in BPD refiect true group differences or gender bias, and recent calls for further study in this area (Boggs et al, 2009). Widiger and Spitzer (1991) suggested that bias can function at two levels: assessment bias (a biased application of diagnostic criteria), and criterion bias (bias within the defining criteria for the disorder).…”

“…Despite this potential, DIF analyses using IRT have been applied in only one study of BPD in adults, and there has been a call for more studies examining criterion-level gender differences (Boggs et al, 2009;see, however, Aggen, Neale, Roysamb, Reichbom-Kjennemd, &Kendler, 2009 andBoggs et al, 2009 for confirmatory non-IRT factor analytic studies on this topic). In the only IRT study thus far conducted to examine gender DIF in adult BPD, Jane, Oltmanns, South, and Turkheimer (2007) evaluated gender-based DIF in a nonchnical sample.…”