494 Chapter 13the actual feature of the disorder. If a feature
of a disorder is linked to gender roles, should
it be altered so it is equally endorsed by both
sexes? We certainly would not change the
features of medical illnesses such as prostate
cancer or breast cancer so they are equally
represented among both men and women.
You may recall from Chapter 10 that heart
disease is manifested differently among
women and men. Men are more likely
than women to experience classic chest pain,
and women are more likely than men to expe-
rience shortness of breath. However, as Win-
stead and Sanchez (2005) point out, in this
case, the underlying disease—heart disease—is
the same among men and women. With psy-
chiatric disorders there is no underlying dis-
ease (to date!) that can be objectively measured
independently of symptom reports.
With respect to depression, some peo-
ple argue that women and men are equally
“distressed” but manifest it in different ways.
A study of male and female twins showed dif-
ferences in symptoms of depression (Khan
et al., 2002). Females reported more fatigue,
excessive sleepiness, and slowed speech and
body movements, and males reported more
insomnia and agitation. A study of depressed
adolescents showed that females reported
more guilt, body dissatisfaction, self-blame,
feelings of failure, and difficulties concentrat-
ing compared to males (Bennett et al., 2005).
The latter items could be linked to rumina-
tion (discussed later in the chapter), whereas
the other items seem to reflect greater links
to self-esteem difficulties in females. Find out
if your peers perceive depression differently
among women and men in Do Gender 13.2.
The idea that some items are more
likely to be associated with a trait, such as
depression, among men versus women is
referred to asdifferential item function-
ing. For example, crying is a depression itembe unlikely to associate ambiguous symptoms
with depression. I once interviewed a man
following coronary bypass surgery who com-
plained of a lack of energy, a loss of interest in
leisure activities, and a desire to stay in bed all
day. He was perplexed by these symptoms but
completely denied any feelings of depression
on a questionnaire I administered. Thus men
may underreport their depression because
they do not recognize depressive symptoms.Different Manifestations of Depression
One difficulty in examining sex differences
in depression, or any other disorder, is that
symptoms of depression may differ for
women and men. This is a general problem
associated with the classification of many
mental illnesses (Winstead & Sanchez, 2005).
Most mental health problems seem to be
more prevalent in one sex than the other,
raising concerns about whether there is an
actual sex difference in prevalence or if the
disorder is described in ways that make it
seem one sex is more likely to experience it
than the other. If one eliminated disorders
from theDSM-IV-TRfor which there are
sex differences in prevalence, the major-
ity of the disorders would be removed. For
example, histrionic personality disorder is
more common among women than men. In
an earlier version of the manual used to di-
agnosis this disorder (theDSM-III-R), a fea-
ture of the disorder was “overconcern with
physical attractiveness.” There was some
concern that this feature biased the disorder
in favor of women. In the most recent ver-
sion of the manual (DSM-IV-TR), this fea-
ture was changed to “physical appearance
draws attention to the self.” Undoubtedly,
this change in wording reduced the extent
to which the disorder was linked to women.
However, the change in wording also alteredM13_HELG0185_04_SE_C13.indd 494 6/21/11 12:55 PM