Fabrega H, Mezzich J, Ulrich R, Benjamin L
University of Pittsburgh, Western Psychiatric Institute and Clinic, PA 15213.
Psychiatry. 1990 Feb;53(1):1-16. doi: 10.1080/00332747.1990.11024476.
It is generally acknowledged that some psychiatric disorders are more commonly found among members of one sex rather than the other (e.g., Dohrenwend and Dohrenwend 1976; Gove and Tudor 1973; Kass et al. 1983; Robins et al. 1984; Rosenfield 1980; Weissman and Klerman 1977). Females, moreover, are consistently overrepresented in treatment populations of different sorts, and various reasons involving responses to illness and inclination to seek treatment have been offered to account for this (Finkler 1984; Kessler et al. 1981; Nathanson 1975; Verbrugge and Wingard 1987). In contrast to accepted gender differences in prevalence, incidence and inclination to use services, a prevailing view about psychopathology is that the actual content or manifestations of a disorder should be "culture free" or universal. In the theory of psychopathology (e.g., implicit in DSM-III), general descriptors of the person (i.e., demographic and cultural) play a comparatively minor role in the stipulation of the manifestations of psychiatric illness. Among socially and culturally oriented psychiatrists, on the other hand, such descriptors are considered important clues to origins of psychopathology. However, in such analyces, sociocultural is usually equated with altogether different symbolic/language traditions (e.g., Finkler 1985; Lieban 1978), although reports exist of sex differences in symptom expression in Western societies (Brown and Harris 1976; Hinkle et al. 1960; Nathanson 1979). Feminist critics assert that even within the sociocultural tradition linked to Anglo-American society, a bias exists with respect to how psychopathology is shaped, defined and handled (Kaplan 1983; Showalter 1985). The topic of gender differences in psychiatric morbidity is thus of considerable general interest and one that can be approached from a number of different perspectives. In this study we compare psychopathology in males and females who were referred to an intake setting. The DSM-III formulations and level and type of symptoms were the focus of analysis. The results are interpreted in light of findings in psychiatric epidemiology and social psychiatry.
人们普遍认为，某些精神疾病在某一性别成员中比另一性别更为常见（例如，多赫伦温德和多赫伦温德，1976年；戈夫和图多尔，1973年；卡斯等人，1983年；罗宾斯等人，1984年；罗森菲尔德，1980年；魏斯曼和克莱曼，1977年）。此外，在各类治疗人群中，女性的比例始终过高，人们提出了各种原因来解释这一现象，包括对疾病的反应和寻求治疗的倾向（芬克勒，1984年；凯斯勒等人，1981年；内桑森，1975年；韦尔布鲁格和温加德，1987年）。与普遍存在的患病率、发病率和使用服务倾向方面的性别差异形成对比的是，关于精神病理学的一种主流观点是，一种疾病的实际内容或表现应该是“无文化差异的”或普遍的。在精神病理学理论中（例如，隐含在《精神疾病诊断与统计手册》第三版中），对人的一般描述（即人口统计学和文化方面）在规定精神疾病的表现方面作用相对较小。另一方面，在以社会和文化为导向的精神病学家中，这些描述被视为精神病理学起源的重要线索。然而，在这类分析中，社会文化通常被等同于完全不同的符号/语言传统（例如，芬克勒，1985年；利班，1978年），尽管有报道称西方社会在症状表现上存在性别差异（布朗和哈里斯，1976年；欣克尔等人，1960年；内桑森，1979年）。女权主义批评家断言，即使在与英美社会相关的社会文化传统中，在精神病理学的形成、定义和处理方式上也存在偏见（卡普兰，1983年；肖沃尔特，1985年）。因此，精神疾病发病率中的性别差异这一话题引起了广泛的普遍关注，并且可以从多个不同角度进行探讨。在本研究中，我们比较了被转介到一个接待机构的男性和女性的精神病理学情况。分析的重点是《精神疾病诊断与统计手册》第三版的表述以及症状的程度和类型。研究结果将根据精神疾病流行病学和社会精神病学的研究结果进行解读。
