13.1 Demographic Differences in Diagnosis Rates

Mental health disorders are diagnosed by examining several dimensions, including whether there is distress, dysfunction, deviance, or danger. Distress refers to the suffering or emotional pain experienced, dysfunction refers to the negative impact on daily functioning, deviance refers to the extent to which the individual’s behavior deviates or departs from sociocultural norms, and danger refers to posing a threat to oneself or others.

Psychological disorders are characterized by maladaptive patterns of significant disturbance in emotion, cognition, or behavior that result in distress or dysfunction in important areas of daily living. Embedded within this definition is the importance of understanding culturally expected or acceptable patterns of behavior, cognition, and emotion, as these would not constitute mental disorders, despite the clinician’s perspective of the deviance. Posing a threat to oneself or others can also be a criterion to consider

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Figure 13.1. Sex-dependent prevalence of mental disorders as related to age. [Image Description]

Sex and gender differences have been found in the prevalence and diagnosis of many mental disorders. For example, women have a higher lifetime risk of mood disorders, such as major depression; anxiety disorders, such as generalized anxiety disorder and panic disorder; and eating disorders, such as anorexia nervosa. Men have a higher lifetime risk of substance use disorders, such as alcohol use disorder, and externalizing disorders, such as ADHD. These differences are likely a combination of small true sex differences reflecting underlying biology and large gender differences reflecting biases in diagnosis and socialization. For example, biological sex differences exist in the amounts of testosterone present in the body, with males typically having more testosterone than females. A higher amount of testosterone that is present postnatally is associated with more male-typical play behavior in toddlerhood (Lamminmaki et al., 2012), which includes more motor activity than female-typical play behavior. An increased desire for motor movement may make it more difficult for boys to sit still and follow directions in early education classrooms, thereby increasing the chances of being identified by teachers as having signs of ADHD (such as hyperactivity or impulsivity) and leading to more evaluations and diagnoses. However, what likely accounts for a greater proportion of the differences between genders is the subsequent biases observed in diagnosing. For example, the more frequently ADHD is viewed as a male disorder, the more likely healthcare providers may be to rely on stereotypes about the disorder and diagnosis boys with ADHD.

Similarly, socialization, or the influence of societal norms and expectations, can also result in the increased diagnosis of certain disorders in a particular gender. For example, girls and women are “allowed” to cry and feel sad more often than boys and men are in Western society. As a result, girls and women may be more likely than boys and men to cry and express sadness over time and to report them as symptoms, facilitating a depression diagnosis. Indeed, the prevalence data show that women are diagnosed with depression at twice the rate of men.

Another example of the influence of socialization on disorder diagnosis is the relatively greater emphasis that society places on the bodies and appearances of girls and women than on the bodies and appearances of boys and men. Girls and women’s bodies are remarked upon more frequently, and there is a narrower “body ideal” of thinness, which the media continuously reinforces and emphasizes. As a result, it is not hard to imagine that girls and women of all shapes and sizes spend more time trying to fit into a body ideal, regardless of whether that is possible or healthy for their actual bodies. These attempts to fit into the thin ideal can become preoccupations that utilize significant time and energy and may result in an eating disorder. Therefore, socialization is likely a major factor in why women, when compared to men, are diagnosed with anorexia and bulimia at a rate of 9:1. In contrast, men, when compared to women, are diagnosed with substance use disorders and autism spectrum disorders at a rate of 4:1.

Image Descriptions

Figure 13.1 Image Description. The image is a bar graph illustrating the ratio percentages of males and females with various conditions along different stages of human life. The x-axis categorizes the conditions: TS, ADHD, ASD, SCZ, BD, MDD, AXD, and AD. The y-axis represents the ratio percentage ranging from 0 to 100. The graph uses two colors: blue for males and light purple for females. The conditions TS, ADHD, ASD have significantly higher male ratios compared to females, while SCZ, BD, MDD, AXD, and AD show varied ratios with no consistent dominance by one gender. Below the graph, a timeline labeled “Human Life” is divided into “Early Life,” “Adolescence,” “Adult and Midlife,” and “Older Age,” with corresponding silhouettes representing each life stage. [Return to Figure 6]