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Many mental disorders show marked gender differences as regards prevalence, symptomatology, risk factors or course. Other disorders do per definition only occur in women – e.g. PMDD – or are markedly influenced by female specific factors such as hormonal changes over the life cycle or reproductive processes.
Current classification systems have tried to take into account these gender aspects, but some problems will certainly have to be discussed again with the next revisions of the ICD and DSM.
As regards gender differences in prevalence and symptomatology questions of gender bias in diagnostic instruments and diagnostic criteria will have to be readdressed. New findings from unselected epidemiological samples, which were analysed by gender will have to be taken into account as well as new findings from research into gender specific personality traits, which can influence the symptomatology of mental disorders. Decisions will have to be taken whether to revise existing diagnostic criteria and provide alternative diagnostic thresholds for men and women or even develop alternative criteria sets in certain disorders, or rather to enhance the gender neutrality of criteria.
A further question to be addressed will be that of gender specific diagnoses versus diagnostic specifiers – e.g. regarding peripartum disorders. In the whole discussion the general aim of identifying “true” entities with a common aetiology should always be kept in mind – i.e. we should be able to identify specific diagnostic entities with descriptive, construct and predictive validity quite independently of the influences of gender.
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