Sex bias in the diagnosis of personality disorders: Conceptual and methodological issues

The hypothesis that the DSM-III-R personality disorders are sex biased is a co ntroversial issue of considerable importance. The effort to resolve this issue empirically, however, has been flawed by conceptual and methodological problems that have contributed to a misinterpretation of research findings and to a perpetuation of inadequate research methodologies. This review emphasizes in particular the failure to distinguish between various types and sources of sex bias, including etiologic, sampling, diagnostic, assessment, and criterion bias. The importance of these distinctions is illustrated in a review of studies concerned with the relationship of patient sex to the diagnosis of personality disorders and to the assessment of personality disorder criteria. The optimal methodology to identify criterion sex bias is discussed. It is suggested that in order for the sex bias controversy to be resolved, future research needs to delineate the nature of personality disorder pathology and the boundaries between abnormal and normal personality functioning.