Gender issue in DSM-5

Transcription

1 Gender issue in DSM-5 Wen-Chen Ouyang Chair, IRB, Jianan Mental Hospital, Taiwan 2.Director, Geriatric Psychiatry Dep., Jianan Mental Hospital, Taiwan 3.Standing Director, Taiwanese Society of Geriatric Association 4.Editor-in-chief, Taiwanese DSM-5 Newsletter Nov 04,

2 Outline Historical context for gender issue Epidemiology: gender difference Possibilities for the gap in gender-specific prevalence Gender issues in DSM-5 2

3 Classification of mental disorders & diagnostic criteria 1952 DSM-I 1968 DSM-II & ICD (79) ICD-9(ICD-9-CM) 1980 DSM-III 1987 DSM-IIIR 1992 ICD DSM-IV 2000 DSM-IV-TR 2013 DSM-5 3

4 Historical context for gender issue DSM-I: there are did not discuss sex ratios and gender-specific prevalence among different psychiatric disorders. DSM-II: gender-specific category of psychosis with childbirth had been mentioned, but did not retain the category in the future iteration of DSM. 4

5 Historical context for gender issue in DSM-III & DSM-III-R gender-specific prevalence and sex ratio however, much information were imprecise. gender identity disorder of childhood & psychosexual disorder was included. late luteal phase dysphoric disorder was included in the appendix of DSM-III-R. 5

6 Historical context for gender issue in DSM-IV & DSM-IV-TR, separate diagnostic criteria for gender identity criteria some sexual disorder such as female sexual arousal disorder and male erectile disorder. late luteal phase dysphoric disorder was renamed as premenstrual dysphoric disorder and retained in appendix. A specifier to indicate post-partum onset of major depressive disorder was added in DSM-IV. There were more gender-specific information provided in DSM-IV. 6

7 Term: gender Biological sex: gene and organ and hormone Psychosocial: Gender identity Sexual partner or preference Sexual function 7

8 Gender difference in prevalence Female > male (F/M) Very late onset schizophrenia (8) Major depressive disorder (2) Anxiety disorders: PTSD (2), GAD (2) Hysteria (high) Female < male Substance & alcohol dependence Fetishism: one of paraphilia (almost always in men) Antisocial personality disorder (1/3) Attention-deficit/hyperactivity disorder(1/2-5) 8

9 Possibilities for gender difference Biological determinants: Hormone effect in developmental stage Not assume gender neutrality Dyspareunia (sexual pain disorder) in female(less in men) Vaginismus in female Erectile disorder in male Assume gender neutrality 9

10 Diagnostic structured interview 1978: Schedule for Affective Disorders & Schizophrenia (SADS), Spitzer RL 1980: Diagnostic Interview Schedule (DIS), Bland RC DSM-IIIR 1990: Composite International Diagnostic Interview (CIDI), WHO ICD : Schedules for Clinical Assessment in Neuropsychiatry (SCAN), WHO 1992: Structure Clinical Interview for DSMIII (SCID-P), Spitzer RL 10

11 Possibilities for gender difference selection bias: no evidence Information bias Socially acceptable answer: tearful in male (Salokangas et al, 2002 ), report substance in female (Greenfield et al, 2007) Lower threshold for diagnosis in female (Zoccolillo et al 1996) Different symptom components of illness in different gender (Doyle et al, 2003; Lahey etal, 2006), then different criteria was considered. 11

12 Different symptom components of illness in different gender Men in depressive disorder have less libido problem such a sleep and appetite (Silverstein 1999) Hysteria & PTSD for female (Williams and Morris 1996): easily tearful expression or different s/s Besides, this gender neutral issue have arisen and been discussed in somatization disorder and hysteria in DSM and some disorders may still have different criteria for men and female in DSM-5. 12

13 The DSM-5 diagnostic criteria for Hypoactive Sexual Desire Disorder The dilemma of whether desire and arousal can be reliably differentiated in men is discussed, and parallels to the literature in women are drawn. Finally, options for DSM-5. Option 1 proposes that the DSM-IV-TR name and criteria are preserved for men in DSM-5. Option 2 proposes that the recently proposed criteria for Sexual Interest/Arousal Disorder in women are also adopted for men, which would result in one genderneutral category. Option 3 proposes that the criteria for Sexual Interest/Arousal Disorder also be applied to men, with a minor modification to one criterion (i.e., that absent or reduced genital and/or nongenital physical changes not be included as a criterion); this diagnosis would then be applied only to men. (Brotto LA 2010) 13

14 Different criteria for men and female in DSM-5 Hyperseulity not in DSM-5 Sexual aversion disorder (not proposed in DSM-5) Sexual disorder (not proposed in DSM-5), now cll sexual dysfunction in DSM-5 Substance induced sexual disorder (no change) Gender identity disorder (changed in DSM-5) paraphillia 14

15 Different criteria for men and female in DSM-5 P00 gender dysphora in child P01 gender dysphoria in adolescent or adult P03 unspecified gender dysphoria Gender identity in DSM-III-R was renamed adding different criteria such as B The Sexual and Gender Identity Disorders Work Group is chaired by Kenneth J. Zucker, Ph.D. 15

16 Further issue Difference threshold and number ofsymptoms in diagnostic criteria Different natural course and different biological intervention in one disorder Relapse of unipolar depression before mense in women 16

17 Thank you for your attetion! 17

18 Need for diagnostic structured interview Validity of diagnosis in psychiatric disorder For Intuitive diagnosis on chief problem Fail to check all of diagnostic criteria Free of define symptoms depending on subjective experience Weakness of Incomplete questioning statement 18

19 History and outlook of the SCID 1972 Feighner criteria 1978 research diagnostic criteria 1980 publication of DSMIII 1990 SCID for DSM-IIIR 1996 SCID for DSM-IV 2001 SCID for DSM-IV-TR 19