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Psychosis and Gender: Everything You Always Wanted to Know About Sex (and Gender) in Psychosis but Were Afraid to Ask

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Psychopathology in Women

Abstract

In Chap. 5 in “General Aspects,” I argue for sex- and gender-based analysis (SGBA) to improve the science of psychosis research, describing how to conduct SGBA. I extend that argument in this chapter by reviewing what we currently know about sex and gender in psychosis, highlighting gaps in our knowledge and illustrating how SGBA might fill those gaps by clarifying research findings and/or enhancing methodology, ultimately increasing our understanding of the development, maintenance, and recovery of psychotic experiences, strengthening my argument from Chap. 5.

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References

  1. Mendrek A. Sex and gender differences in mental health research. In: Cohen S, Banister E, editors. What a difference sex and gender make: a gender, sex and health research casebook. Ottawa: Institute of Gender and Health of the Canadian Institutes of Health Research; 2012.

    Google Scholar 

  2. Abel KM, Drake R, Goldstein JM. Sex differences in schizophrenia. Int Rev Psychiatry. 2010;22(5):417–28.

    Article  PubMed  Google Scholar 

  3. Falkenburg J, Tracy DK. Sex and schizophrenia: a review of gender differences. Psychos Psychol Soc Integr Approaches 2012;6(1):1–9.

    Google Scholar 

  4. Kulkarni J, Gavrilidis E. Psychosis in women: gender differences in presentation, onset, course and outcome of schizophrenia. In: Women and health (pp. 1283–1291). 2nd ed.; 2013.

    Google Scholar 

  5. Leung A, Chue P. Sex differences in schizophrenia, a review of the literature. Acta Psychiatr Scand. 2000;101:3–38.

    Article  Google Scholar 

  6. McGrath J, Saha S, Chant D, Welham J. Schizophrenia: a concise overview of incidence, prevalence, and mortality. Epidemiol Rev. 2008;30:67–76.

    Article  PubMed  Google Scholar 

  7. Riecher-Rössler A, Hafner H. Gender aspects in schizophrenia: bridging the border between social and biological psychiatry. Acta Psychiatr Scand. 2000;102:58–62.

    Article  Google Scholar 

  8. Seeman MV. Gender. In: Mueser KT, Jeste DV, editors. Clinical handbook of schizophrenia. New York: Guilford; 2008.

    Google Scholar 

  9. Iacono WG, Beiser M. Are males more likely than females to develop schizophrenia? Am J Psychiatry. 1992;I49:1070–4.

    Google Scholar 

  10. Iacono WG, Beiser M. Where are the women in first-episode studies of schizophrenia? Schizophr Bull. 1992;18:471–80.

    Article  PubMed  CAS  Google Scholar 

  11. McGrath JJ, Susser ES. New directions in the epidemiology of schizophrenia. Med J Aust. 2009;190(4):S7–9.

    PubMed  Google Scholar 

  12. Thorup A, Waltoft BL, Pedersen CB, Mortense PB, Nordentoft M. Young males have a higher risk of developing schizophrenia: a Danish register study. Psychol Med. 2007;37:479–84.

    Article  PubMed  Google Scholar 

  13. Wahl OF, Hunter J. Are gender effects being neglected in schizophrenia research? Schizophr Bull. 1992;18(2):313–7.

    Article  PubMed  CAS  Google Scholar 

  14. Lewine RR. Sex: an imperfect marker of gender. Schizophr Bull. 1994;20(4):777–9.

    Article  PubMed  CAS  Google Scholar 

  15. Castle DJ, Wessley S, Murray RM. Sex and schizophrenia: effects of diagnostic stringency, and associations with premorbid variables. Br J Psychiatry. 1993;162:658–64.

    Article  PubMed  CAS  Google Scholar 

  16. Thorup A, Petersen L, Jeppesen P, Ohlenschlæger J, Christensen T, Krarup G, Jorgensen P, Nordentoft M. Gender differences in young adults with first-episode schizophrenia spectrum disorders at baseline in the Danish OPUS study. J Nerv Ment Dis. 1997;195:396–405.

    Google Scholar 

  17. Aleman A, Kahn RS, Selten JP. Sex differences in the risk of schizophrenia: evidence from meta-analysis. Arch Gen Psychiatry. 2003;60:565–71.

    Article  PubMed  Google Scholar 

  18. Saha S, Chant D, Welham J, McGrath J. A systematic review of the prevalence of schizophrenia. PLoS Med. 2005;2:e141.

    Article  PubMed  PubMed Central  Google Scholar 

  19. Perala J, Suvisaari J, Saarni SI, Kuoppasalmi K, et al. Lifetime prevalence of psychotic and bipolar I disorders in a general population. Arch Gen Psychiatry. 2007;64(1):19–28.

    Article  PubMed  Google Scholar 

  20. Ezra Susser E, Wanderling J. Epidemiology of nonaffective acute remitting psychosis vs schizophrenia: sex and sociocultural setting. Arch Gen Psychiatry. 1994;51(4):294–301.

    Article  Google Scholar 

  21. Chang WC, Tang JY, Hui CL, Chiu CP, Lam MM, Wong GH, Chung DW, Law CW, Tso S, Chan KP, Hung SF, Chen EY. Gender differences in patients presenting with first-episode psychosis in Hong Kong: a three-year follow up study. Aust N Z J Psychiatry. 2011;45:199–205.

    Article  PubMed  Google Scholar 

  22. Nasser EH, Walders N, Jenkins JH. The experience of schizophrenia: what’s gender got to do with it? A critical review of the current status ofresearch on schizophrenia. Schizophr Bull. 2002;28(2):351–62.

    Article  PubMed  Google Scholar 

  23. Riecher-Rössler A, Pflüger M, Borgwardt S. Schizophrenia in women. In: Kohen D, editor. Oxford textbook of women and mental health. Oxford: Oxford University Press; 2010. p. 102–14.

    Google Scholar 

  24. Schön U. Recovery from severe mental illness, a gender perspective. Scand J Caring Sci. 2010;24:575–80.

    Article  Google Scholar 

  25. Kirkbride JB, Errazuriz A, Croudace TJ, et al. Incidence of schizophrenia and other psychoses in England, 1950–2009: a systematic review and meta-analyses. PLoS ONE. 2012;7:e31660.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  26. Andia AM, Zisook S, Heaton RK, Hesselink J, Jernigan T, Kuck J, et al. Gender differences in schizophrenia. J Nerv Ment Dis. 1995;183:522–8.

    Article  PubMed  CAS  Google Scholar 

  27. Maric N, Krabbendam L, Vollebergh W, de Graaf R, van Os J. Sex differences in symptoms of psychosis in a non-selected, general population sample. Schizophr Res. 2003;63(1–2):89–95.

    Article  PubMed  Google Scholar 

  28. Morgan V, Castle DJ, Jablensky AV. Do women express and experience psychosis differently from men? Aust N Z J Psychiatry. 2008;42:74–82.

    Article  PubMed  Google Scholar 

  29. McGlashan TH, Bardenstein KK. Gender differences in affective, schizoaffective, and schizophrenic disorders. A review. Schizophr Res 1990;3(3):159–72.

    Google Scholar 

  30. Verdoux H, van Os J, Maurice-Tison S, Gay B, Salamon R, Bourgeois M. Increased occurrence of depression in psychosis-prone subjects: a follow-up study in primary care settings. Compr Psychiatry. 1999;40:462–8.

    Article  PubMed  CAS  Google Scholar 

  31. Garety P, Kuipers E, Fowler D, et al. A cognitive model of the positive symptoms of psychosis. Psychol Med. 2001:31:189–95.

    Google Scholar 

  32. Van Os J, Verdoux H, Maurice Tison S, Gay B, Liraud F, Salamon R, Bourgeois M. Self-reported psychosis-like symptoms and the continuum of psychosis. Soc Psychiatry Psychiatr Epidemiol. 1999;34(9):459–63.

    Article  PubMed  Google Scholar 

  33. Al-Issa I. Gender and schizophrenia. In: Al-Issa I, editor. Gender and psychopathology. New York: Academic; 1982. p. 153–77.

    Chapter  Google Scholar 

  34. Cotton S, Lambert M, Schimmelmann BG, Foley DL, Morley KI, McGorry PD, Conus P. Gender differences in premorbid, entry, treatment, and outcome characteristics in a treated epidemiological sample of 661 patients with first episode psychosis. Schizophr Res. 2009;114:17–24.

    Article  PubMed  CAS  Google Scholar 

  35. Lucas CJ, Sainsbury P, Collins JG. A social and clinical study of delusions in schizophrenia. J Ment Soc. 1962;108:747–58.

    CAS  Google Scholar 

  36. Mirowsky J, Ross CE. Paranoia and the structure of powerlessness. Am Sociol Rev. 1983;48:228–39.

    Article  PubMed  CAS  Google Scholar 

  37. Ochoa S, Usall J, Cobo J, Labad X, Kulkarni J. Gender differences in schizophrenia and first-episode psychosis: a comprehensive literature review. Schizophr Res Treatment. 2012;2012:1–9.

    Google Scholar 

  38. Grossman LS, Harrow M, Rosen C, Faull R, Strauss GP. Sex differences in schizophrenia and other psychotic disorders: a 20-year longitudinal study of psychosis and recovery. Compr Psychiatry. 2008;49(6):523–9.

    Article  PubMed  PubMed Central  Google Scholar 

  39. Allan JA, Hafner JR. Sex differences in the phenomenology of schizophrenic disorder. Can J Psychiatr. 1989;34:46–8.

    CAS  Google Scholar 

  40. Hollander MH, Callahan AS. Erotomania and De Clerambault’s Syndrome. Arch Gen Psychiatry. 1975;32:1574–6.

    Article  Google Scholar 

  41. Modlin H. Psychodynamics and management of paranoid states in women. Arch Gen Psychiatry. 1963;8:262–8.

    Article  Google Scholar 

  42. Raskin DE, Sullivan KE. Erotomania. Am J Psychiatry. 1974;131:1033–5.

    PubMed  CAS  Google Scholar 

  43. Rudden M, Sweeney J, Frances A, Gilmore M. A comparison of delusional disorders in women and men. Am J Psychiatry. 1983;140(12):1575–8.

    PubMed  CAS  Google Scholar 

  44. Benedict PK, Jacks I. Mental illness in primitive societies. Psychiatry. 1954;17:377–89.

    PubMed  CAS  Google Scholar 

  45. Seeman MV. Schizophrenic men and women require different treatment programs. J Psychiatr Treat Eval. 1983;5:143–8.

    Google Scholar 

  46. Sherman M, Sherman IC. Psychotic symptoms and social backgrounds. In: Bentley M, Cowdry EV, editors. The problem of mental disorder: a study undertaken by the Committee on psychiatric investigations National research council. New York: McGraw-Hill; 1934. p. 339–45.

    Google Scholar 

  47. LaTorre RA. The psychological assessment of gender identity and gender role in schizophrenia. Schizophr Bull. 1976;2(2):266–85.

    Article  PubMed  CAS  Google Scholar 

  48. Yap PM. Mental diseases peculiar to certain cultures: a survey of comparative psychiatry. Br J Psychiatry. 1951;97:313–27.

    Article  CAS  Google Scholar 

  49. Reed MR. The masculinity-femininity dimension in normal and psychotic subjects. J Abnorm Psychol. 1957;55(3):289–94.

    Article  PubMed  CAS  Google Scholar 

  50. Levant RF. Research in the psychology of men and masculinity using the gender role strain paradigm as a framework. Am Psychol. 2011;66(8):765–76.

    Article  PubMed  Google Scholar 

  51. O’Neil JM. Summarizing 25 years of research on men’s gender role conflict using the gender role conflict scale—new research paradigms and clinical implications. [Review]. Couns Psychol. 2008;36(3):358–445.

    Article  Google Scholar 

  52. Pleck JH. The myth of masculinity. Cambridge: MIT Press; 1981.

    Google Scholar 

  53. Pleck JH. The gender role strain paradigm: an update. In: Levant RF, Pollack WS, editors. A new psychology of men. New York: Basic Books; 1995.

    Google Scholar 

  54. Root MPP. Rethinking racial identity development: an ecological framework. In: Spickard P, Burroughs J, editors. We are a people: narrative in the construction and deconstruction of ethnic identity. Philadelphia, PA: Temple University Press; 2000.

    Google Scholar 

  55. Weinstein EA. Cultural aspects of delusion: a psychiatric study of the Virgin Islands. New York: The Free Press of Glencoe, Inc.; 1962.

    Google Scholar 

  56. Tolman DL, Impett EA, Tracy AJ, Michael A. Looking good, sounding good: femininity ideology and adolescent girls’ mental health. Psychol Women Q. 2006;30(1):85–95.

    Article  Google Scholar 

  57. Sajatovic M, Jenkins J, Strauss M, Butt Z, Carpenter E. Gender identity among men and women with schizophrenia. Psychiatr Serv. 2005;56(1):96–8.

    Article  PubMed  Google Scholar 

  58. Barrett AE, White HR. Trajectories of gender role orientations in adolescence and early adulthood: a prospective study of the mental health effects of masculinity and femininity. J Health Soc Behav. 2002;43:451–68.

    Article  PubMed  Google Scholar 

  59. Johnson JL, Greaves L, Repta R. Better science with sex and gender: a primer for health research. Vancouver: Women’s Health Research Network; 2007. p. 557–64.

    Google Scholar 

  60. Whitely BE. Sex-role orientation and psychological wellbeing: two meta-analyses. Sex Roles. 1984;12:207–25.

    Article  Google Scholar 

  61. Arieti S. An overview of schizophrenia from a predominately psychological approach. Am J Psychiatr. 1974;131:241–9.

    PubMed  CAS  Google Scholar 

  62. Klaf FS. Female homosexuality and paranoid schizophrenia. Arch Gen Psychiatry. 1961;1:84–6.

    Article  Google Scholar 

  63. Menon SM, Cornelio N, Saraswathy K. Delusions—a study in sex differences. Int J Soc Psychiatry. 1980;26:93–8.

    Article  PubMed  CAS  Google Scholar 

  64. Kinderman P, Read J, Moncrieff J, Bentall RP. Drop the language of disorder. Evid Based Ment Health. 2013;16:2–3.

    Article  PubMed  Google Scholar 

  65. Walston F, David AS, Charlton BG. Sex differences in the content of persecutory delusions: a reflection of hostile threats in the ancestral environment? Evol Human Behav. 1998;19:257–60.

    Article  Google Scholar 

  66. Segal JH. Erotomania revisited: from Kraepelin to DSM-III-R. Am J Psychiatry. 1989;146(10):1261–6.

    PubMed  CAS  Google Scholar 

  67. Galdos P, van Os J. Gender, psychopathology, and development: From puberty to early adulthood. Schizophr Res. 1995;14:105–12.

    Article  PubMed  CAS  Google Scholar 

  68. Gecici O, et al. Phenomenology of delusions and hallucinations in patients with schizophrenia. Bull Clin Psychopharmacol. 2010;20:204–12.

    Google Scholar 

  69. Klaf FS, Davis CA. Homosexuality and paranoid schizophrenia: a survey of 150 cases and controls. Am J Psychiatr. 1960;116:1070–5.

    PubMed  CAS  Google Scholar 

  70. Legg L, Gilbert P. A pilot study of gender of voice and gender of voice hearer in psychotic voice hearers. Psychol Psychother. 2006;79:517–27.

    Article  PubMed  Google Scholar 

  71. Musalek M, Berner P, Katschnig H. Delusional theme, sex and age. Psychopathology. 1989;22(5):260–7.

    Article  PubMed  CAS  Google Scholar 

  72. Kala AK, Wig NN. Delusion across cultures. Int J Soc Psychiatry. 1982;28(3):185–93.

    Article  PubMed  CAS  Google Scholar 

  73. Suhail K. Phenomenology of delusions in Pakistani patients: effect of gender and social class. Psychopathology. 2003;36(4):195–9.

    Article  PubMed  Google Scholar 

  74. Azhar MZ, Verma SL, Hakim HR. Phenomenological differences of delusions between schizophrenic patients of two cultures of Malaysia. Singapore Med J. 1995;36:273–5.

    PubMed  CAS  Google Scholar 

  75. El-Assra A. Erotomania in a Saudi woman. Br J Psychiatry. 1989;155:553–5.

    Article  PubMed  CAS  Google Scholar 

  76. Kazamias NG. Sex difference in the incidence of grandiose delusions in paranoid patients in Greece. Int J Soc Psychiatry. 1970;16(3):228–31.

    Article  PubMed  CAS  Google Scholar 

  77. Gutiérrez-Lobos B, Schmid-Siegel B, Bankier B, Walter H. Delusions in first-admitted patients: gender, themes and diagnoses. Psychopathology. 2001;34:1–7.

    Article  PubMed  Google Scholar 

  78. Goldstein JM. The impact of gender on understanding the epidemiology of schizophrenia. In: Seeman MV, editor. Gender and Psychopathology. Washington, DC: American Psychiatric Press, Inc.; 1995.

    Google Scholar 

  79. Kelly BD. Erotomania: epidemiology and management. CNS Drugs. 2005;19(8):657–69.

    Article  PubMed  Google Scholar 

  80. Yamada N, Nakajima S, Noguchi T. Age at onset of delusional disorder is dependent on the delusional theme. Acta Psychiatr Scand. 1998;97:122–4.

    Article  PubMed  CAS  Google Scholar 

  81. Reiff M, Castille DM, Muenzenmaier K, Link B. Childhood Abuse and the content of adult psychotic symptoms. Psychol Trauma. 2012;4:356–69.

    Article  Google Scholar 

  82. Rhodes JE, Jakes S. Correspondence between delusions and personal goals: A qualitative analysis. Br J Med Psychol. 2000;73:211–25.

    Article  PubMed  Google Scholar 

  83. Nayani TH, David AS. The auditory hallucination: a phenomenological survey. Psychol Med. 1996;26(01):177–89.

    Article  PubMed  CAS  Google Scholar 

  84. Birchwood M, Gilbert P, Gilbert J, Trower P, Meaden A, Hay J, Miles JNV. Interpersonal and role-related schema influence the relationship with the dominant ‘voice’ in schizophrenia: a comparison of three models. Psychol Med. 2004;34(08):1571–80.

    Article  PubMed  Google Scholar 

  85. Birchwood M, Meaden A, Trower P, Gilbert J, Plainstow J. The power and omnipotence of voices and significant others. Psychol Med. 2000;30(2):337–44.

    Article  PubMed  CAS  Google Scholar 

  86. Hayward M, Berry K, Ashton A. Applying interpersonal theories to the understanding of and therapy for auditory hallucinations: a review of the literature and directions for further research. Clin Psychol Rev. 2011;31(8):1313–23.

    Article  PubMed  Google Scholar 

  87. Birrell PJ, Freyd JJ. Betrayal trauma: relational models of harm and healing. J Trauma Pract. 2006;5(1):49–63.

    Article  Google Scholar 

  88. Brown LS. Feminist therapy. Washington, DC: American Psychological Association; 2009.

    Google Scholar 

  89. World Health Organization. Gender in mental health research report. 2004. Geneva: Author. Available at: http://whqlibdoc.who.int/publications/2004/9241592532.pdf?ua=1. Accessed 29/03/2011.

  90. Boyle M. Schizophrenia: a scientific delusion? 2nd ed. London: Routledge; 2002.

    Google Scholar 

  91. Kaschak E. Engendered lives. New York: Basic Books; 1992.

    Google Scholar 

  92. Jenkins JH. Schizophrenia as a paradigm case for understanding fundamental human processes. Cambr Stud Med Anthropol. 2004;11:29–61.

    Google Scholar 

  93. Sells DJ, Staynor DL, Davidson L. Recovering the self in schizophrenia: an integrative review of qualitative studies. Psychiatry Q. 2004;75(1):87–97.

    Article  Google Scholar 

  94. Leaper C. The social construction and socialization of gender during development. In: Miller PH, Kofsky-Scholmick E, editors. Toward a feminist developmental psychology. Florence, KY: Taylor & Francis/Routledge; 2000. p. 127–52.

    Google Scholar 

  95. Bebbington PE, Jonas S, Kuipers E, King M, Cooper C, Brugha T, Meltzer H, McManus S, Jenkins R. Sexual abuse and psychosis: data from an English National survey. Br J Psychiatry. 2011;199:29–37.

    Article  PubMed  Google Scholar 

  96. Fisher H, Morgan C, Dazzan P, Craig T, Morgan K, Hutchinson G, Jones PB, Doody GA, Pariente C, McGuffin P, Murray RM, Leff J, Fearon P. Gender differences in the association between childhood abuse and psychosis. Br J Psychiatry. 2009;194:319–25.

    Article  PubMed  Google Scholar 

  97. Beck JC, van der Kolk B. Reports of childhood incest and current behavior of chronically hospitalized psychotic women. Am J Psychiatr. 1987;144:1474–6.

    PubMed  CAS  Google Scholar 

  98. Hardy A, Fowler D, Freeman D, Smith B, Steel C, Evans J, et al. Trauma and hallucinatory experience in psychosis. J Nerv Ment Dis. 2005;193:501–7.

    Article  PubMed  Google Scholar 

  99. Rudman LA, Glick P. The social psychology of gender: how power and intimacy shape gender relations. New York: The Guilford Press; 2008.

    Google Scholar 

  100. Williams JE, Satterwhite RC, Best DL. Pancultural gender stereotypes revisited: the five factor, Health Organization. (Undated) Gender and women’s mental health; 1999

    Google Scholar 

  101. Eagly AH, Wood W. The origins of sex differences in human behaviour: evolved dispositions versus social roles. American Psychologist. 1999;54(6):408–23.

    Article  Google Scholar 

  102. Ratner PA, Sawatzky RG. Approaches to the measurement of gender. In: Oliffe JL, Greaves L, editors. Designing and conducting gender, sex, and health research. Los Angeles: Sage; 2012. p. 65–84.

    Chapter  Google Scholar 

  103. Read J, Bentall RP, Fosse R. Time to abandon the bio-bio-bio model of psychosis: exploring the epigenetic and psychological mechanisms by which adverse life events lead to psychotic symptoms. Epidemiol Psychiatr Soc. 2009;18(4):299–310.

    Google Scholar 

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  1. Clinical Psychology, Institute of Psychology, Health and Society, University of Liverpool, Liverpool, UK

    Maria Haarmans

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  1. Dept. of Psychiatry, Hospital Universitario de Alava, Victoria, Spain

    Margarita Sáenz-Herrero

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Haarmans, M. (2015). Psychosis and Gender: Everything You Always Wanted to Know About Sex (and Gender) in Psychosis but Were Afraid to Ask. In: Sáenz-Herrero, M. (eds) Psychopathology in Women. Springer, Cham. https://doi.org/10.1007/978-3-319-05870-2_15

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