The Politics of Personality Disorder

Development and Psychometric Evaluation of the Counseling Women Competencies Scale (CWCS)

This article describes the development and psychometric evaluation of the Counseling Women Competencies Scale (CWCS). The CWCS is designed to assess clinicians' self-perceived competencies with regard to therapeutic practice with diverse female clients. Through an extensive review of the literature on counseling women and expert review by 32 members of the Section for the Advancement of Women (Division 17, APA), content validity was supported. Exploratory factor analysis, conducted on a sample of 321 male and female counseling and psychology graduate students and professionals, supported a two-factor model consisting of knowledge/skills and self-awareness factors. Findings also provided support for the internal consistency reliability and construct (convergent, divergent, and incremental) validity of the scale.

Twenty Years of Feminist Counseling and Therapy

This article summarizes the history and current status of feminist counseling and psychotherapy. It describes the formation and development of feminist therapy during the 1970s, compares early commitments with aspects of change and maturation during the second decade, and reviews areas of agreement and disagreement during the 1980s and early 1990s. Initial feminist efforts resulted in the creation of an overarching philosophical framework for feminist psychotherapy. The second decade was marked by rapid expansion and the application of feminist therapy to diverse populations and problems as well as the integration of feminist philosophy with mainstream psychotherapeutic systems. Feminist therapists developed more complex models of personality, diagnosis, and ethical behavior and engaged in the examination and revision of early commitments. This review draws on the literatures of both social work and psychology and discusses the contribution of counseling psychologists to feminist therapy. It also addresses theoretical issues, research, training needs, and the role of advocacy and activism in feminist therapy.

Feminist Interventions: Accountability Beyond Symptom Reduction

Feminist interventions to facilitate women's psychological well-being are forging new pathways to achieving the goals of the Decade of Behavior. In emphasizing the complex interplay between internal and external factors in women's lives, feminist interventions are designed to promote women's safety health, positive life styles, personal strength, competence, and resilience. In contrast, prevailing medical models locate the problem within the woman by concentrating on diagnosis and treatment of pathology and internal disorders. I offer a model here for implementing and assessing intervention strategies that targets both the effects of unsupportive or negative environments and the imperative to strengthen and empower girls and women, their families, and their communities. The obligation to be accountable for the outcomes of feminist interventions encompasses a major focus of this article. Evolving developments in research on accountability are reviewed in relation to conceptualization, goal setting, and assessment of feminist interventions. I encourage continuing collaboration between the feminist-informed research and practitioner communities to promote women's health, safety, and well-being in the Decade of Behavior and beyond.

Gender Roles, Externalizing Behaviors, and Substance Use Among Mexican-American Adolescents

A sample of 60 male and 91 female Mexican-American adolescents (age 13-18) were administered measures of positive (i.e., assertive masculinity, affective femininity) and negative (i.e., aggressive masculinity, submissive femininity) gender roles, internalizing and externalizing problem behaviors, peer substance use, and own substance use (alcohol, cigarettes, marijuana). Negative gender roles were significantly correlated with internalizing and externalizing problems for both boys and girls, with aggressive masculinity also predicting peer substance use for both genders. Assertive masculinity significantly predicted lower alcohol use in boys, and this effect was not mediated by internalizing problems, externalizing problems, or peer substance use. Negative gender roles significantly predicted higher alcohol use in girls, but this effect was almost completely mediated by internalizing problems, externalizing problems, and peer substance use. Results are discussed in terms of gender role socialization among Mexican Americans.

Effect of patient sex, clinician sex, and sex role on the diagnosis of Antisocial Personality Disorder: Models of underpathologizing and overpathologizing biases

This study examined the influence of patient sex and clinician sex and sex role for a case, meeting minimum diagnostic criteria for Antisocial Personality Disorder, in which patient sex was varied. The purpose was to provide an in-depth evaluation of the process by which patient sex and characteristics of clinicians may contribute to bias in personality disorder diagnoses. Psychologists (N = 167) read two cases, including the target case, and provided symptom ratings and diagnoses. A sex-unspecified condition served as a baseline to assess for over- and underpathologizing bias, and diagnoses based on the symptom ratings were compared to assigned diagnoses. Clinician sex role was assessed using the Bem Sex Role Inventory-Short Form. Results revealed that bias occurred when the patient's sex (female) was inconsistent with the gender weighting of the symptoms in the case (masculine), but the direction of the bias was consistent with sex roles (underdiagnosis of sex-role-inconsistent diagnoses, overdiagnosis of sex-role-consistent diagnoses). Path models of over- and underdiagnostic bias were developed using structural equation modeling. Patient sex had a direct effect on diagnostic ratings whereas clinician sex role had an indirect effect through symptom ratings.

Gender bias in the diagnosis of personality disorders: the roles of base rates and social stereotypes

In all three studies described in this article, novices were trained to associate traits from the DSM-IV Cluster B personality disorder categories with four letters of the alphabet. Novices were also taught various gender associations (i.e., "base rate" information) with the categories (none, stereotype-consistent, or stereotype-inconsistent). Results showed that when no gender associations were taught (Study I), case gender did not affect ratings of case vignettes. When associations were consistent with social stereotypes (Study II), case gender influenced ratings in the expected direction. When associations were the opposite of social stereotypes (Study III), only the ratings for narcissistic and histrionic were affected. Across the three studies, these results suggested that subjects rated cases in accordance with known "base rates," but that the correspondence between base rates and stereotypic associations affected the consistency and magnitude of this base rate effect.

Gender role and personality disorders

Many researchers have hypothesized relationships between personality disorders and gender role (i.e., masculinity and femininity). However, research has not addressed if people who are masculine or feminine more often meet the criteria for personality disorders. The present study examined whether college students (N = 665, 60% women) higher in masculinity or femininity more often exhibited features of the 10 DSM-IV personality disorders. Feminine men exhibited more features of all the personality disorders except antisocial. Dependent traits were associated with higher femininity and lower masculinity. Antisocial traits were associated with masculinity. Both men and women who typically behaved consistent with their gender had more narcissistic and histrionic features, whereas participants who typically behaved unlike their gender had more features of the Cluster A personality disorders.

Effects of sex and sex roles on the perceived maladaptiveness of DSM-IV personality disorder symptoms

This study investigated the influence of sex on the perceived maladaptiveness of DSM-IV personality disorder criteria based on previous findings that inconsistency of symptoms with sex roles affects the perception of personality disorder symptoms. The effects of rater characteristics (i.e., sex, sex role) were also examined. A total of 161 undergraduates (65 men, 96 women) rated the diagnostic criteria according to how maladaptive they were for males (male condition), females (female condition), or without regard to sex (neutral condition that served as a baseline) using a 7-point scale. Participants' sex role was determined using the Bem Sex Role (1981a) Inventory. Dependent and depressive personality disorder criteria (trend for borderline) were rated more maladaptive for females than males, whereas obsessive-compulsive personality disorder criteria were rated more maladaptive for males than females. Participant sex and sex role had little or no significant effects on the ratings. Results are compared with those of previous research. Methodological issues and implications for the diagnosis of personality disorders are discussed.

Are personality disorder criteria ethnically biased? A card-sort analysis

On the basis of methodology used in previous research on sex criterion bias, this study examined ethnicity criterion bias of personality disorders (PDs) defined in the Diagnostic and Statistical Manual of Mental Disorders (3rd ed., Rev.) and included examination of sex as well as ethnicity. A card-sort analysis using undergraduate college students as sorters indicated that criteria for all of the PDs were applied disproportionately by ethnicity, resulting in particular ethnic groups receiving diagnoses for specific PDs. Criteria were sorted systematically such that diagnoses of antisocial and paranoid PDs were assigned to African Americans, schizoid PD was assigned to Asian Americans, and schizotypal PD was assigned to Native Americans. All other PDs were assigned to European Americans, whereas none of the criteria were sorted resulting in any PD diagnosis being applied to Latinos. Implications for clinicians, methodological considerations, and recommendations for future research are discussed.

A content analysis of obstetrics and gynecology scholarship: implications for women's health

In the context of studying the medicalization of women, we sought insight into the reflexive and mutually influential relationships between the prevailing social agenda and the formal knowledge base by analyzing the content, purpose and funding source of the scholarly work published in the three major, English-language obstetrics and gynecology journals. Our analysis of the 6103 articles published in 1975, 1980, 1985, 1990, and 1993 led us to the conclusion that, rather than responding to changing social needs and life-styles, the obstetrics and gynecology specialty has continued to emphasize the reproductive nature of women rather than the health and well-being requirements of non-pregnant and non-fertile women. The social values and attitudes toward women inferred from the priorities evident in these data are ideologically consistent with the view that women's primary role is that of reproduction. The implied importance of certain themes and the consequent allocation of resources may serve to perpetuate the politically oppressive view of women as biologically motivated and determined.

Gender stereotypes for paranoid, antisocial, compulsive, dependent, and histrionic personality disorders

To assess similarity between gender-role stereotypes and the personality disorder prototypes, university students (31 women and 13 men) were asked to assign gender to six descriptions of DSM-III--R personality disorders. Significant agreement was found in gender assignment for five of the six descriptions. Descriptions of the paranoid, antisocial, and compulsive personality disorders were viewed as male, and descriptions of the dependent and histrionic personality disorders were viewed as female. The description of schizoid personality disorder was not significantly gender-typed.