The Psychology of Gender 4th Edition

Mental Health 519

are encouraged to express their emotions more than men. When an experimental procedure was

applied to induce symptoms of panic (i.e., inhalation of carbon dioxide), females and males had

similar physiological responses but females reported less control, greater panic, and more fear dur-

ing the task and shortly after the task than males (Kelly, Forsyth, & Karekla, 2006).

One concern with the sex differences in some of these disorders is that features of a particular

disorder are perceived as more maladaptive in one sex than another. Borderline personality disorder

is a good example. Being overly dependent, demanding, and having high rates of sexual activity may

be viewed as more pathological among females than males (Nehls, 1998). To determine the validity

of this concern, one study surveyed clinicians from the American Psychological Association (Ander-

son, Sankis, & Widiger, 2001). Clinicians were provided with a list of features of antisocial personality,

borderline personality, histrionic personality, and narcissistic personality disorders and asked to rate

either how rare each feature was in a particular person or how maladaptive the feature was in a partic-

ular person. Clinicians were randomly assigned to rate a male, a female, or a person whose sex was not

specified. Although there were differences in the frequency with which clinicians ascribed features of

personality disorders to females and males, there was no difference in the pathology of a given feature

for females and males for any of the disorders. A similar study was performed with college students

and showed that students rated dependent, depressive, and borderline symptoms as more maladap-

tive in females than males (Sprock, Crosby, & Nielsen, 2001). However, of 105 symptoms, only 8 were

rated as differentially maladaptive in females versus males. Furthermore, it is probably more impor-

tant that clinicians rather than college students do not perceive symptoms differently.

SIDEBAR 13.3:Attention Deficit Hyperactivity Disorder—A Problem for Males Only?

Males have higher rates of attention deficit hyperactivity disorder (ADHD) than females. The

size of the difference depends on how it is measured (Cassidy, 2007). Among clinic samples, the

male to female ratio ranges from 9:1 to 6:1. Among community samples, the difference is smaller

but still sizable, on the order of 3:1. There are some sex similarities and differences in ADHD.

ADHD is equally likely to be associated with mood disorders and family difficulties in girls and

boys (Bauermeister et al., 2007). However, ADHD is more likely to be associated with school

suspensions in boys than girls. This may be due to the fact that ADHD manifests itself differently

in males and females. A meta-analytic review of the literature showed that females with ADHD

have more intellectual impairment than males, but males with ADHD have more hyperactiv-

ity, externalizing behavior, and aggression (Gaub & Carlson, 1997). Boys with ADHD are more

likely than girls to have problems at school and to have conduct disorders (Biederman et al.,

2002). Three types of ADHD have been delineated: (1) inattentive, (2) hyperactive, and (3) com-

bined—inattentive plus hyperactive. Some studies have shown that females are more likely than

males to have the inattentive type (Cassidy, 2007), but other studies showed no sex differences

(Ghanizadeh, 2009). If true, this would explain why boys are more likely than girls to be referred

to clinics for ADHD—their behavior is more disruptive and attracts attention. Among adults,

there does not seem to be a sex difference in subtypes (Rasmussen & Levander, 2009). ADHD

in young children (ages 4–6) predicts subsequent mental health problems, such as anxiety and

depression, in adolescence—more so for females than males (Lahey et al., 2007).

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