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Neuropsychiatric Disorders - Gender Bias Cheat Sheet by

health     gender     mental     bias

Introd­uction

Some neurop­syc­hiatric disorders are thought to originate during fetal develo­pment, even if patients are not typically diagnosed until adoles­cence or young adulthood. Of these, most are much more common in males. Other disorders begin to manifest at puberty or later in life, and these occur more frequently in females. The biological reasons for these sex biases in disease prevalence are currently under invest­iga­tion.

Major depressive disorder (female)

One of the most common neurop­syc­hiatric disorders, MDD is considered strongly gender biased, with women twice as likely as men to be diagnosed. This bias is seen worldwide, suggesting a biological as opposed to cultural origin. Dysreg­ulation of the stress axis and its conver­gence with the dynamic nature of reprod­uctive hormones in women are implicated as root causes of greater risk in women, although more recent evidence suggests this dysreg­ulation may have its origins in very early childhood. However, the importance of other variables contri­buting to the gender bias, such as the willin­gness of women to seek help while men tend to self-m­edicate with drugs and alcohol, cannot be discou­nted.

Female: Anorexia nervosa

Strictly postpu­bertal in onset, anorexia nervosa is predom­inantly a young woman’s disease, with a gender bias greater than 10:1 that is almost assuredly driven by perceived societal pressures. Intere­sti­ngly, bulimia nervosa, a disorder of binge eating but in which normal body weight is mainta­ined, is much less gender biased, with women only three times as likely as men to suffer the disorder.

Female: Schizo­phrenia

When considered for the population overall, there is no clear gender bias in the frequency of schizo­phr­enia. However, diagnosis is much more common in boys and young men than in girls, whereas diagnosis in middle age or older is substa­ntially more frequent in women. Differ­ential responses to stress, with distinct brain regions being over- or undera­cti­vated in men versus women, further contribute to divergence in the disease.
 

Gender Bias

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Female: Biplolar disorder

Rates of bipolar disorder do not vary between men and women, yet a genetic polymo­rphism strongly associated with the disorder is relevant to risk in women but not men. This highlights how much we have to learn about the nature of sex differ­ences in neurop­syc­hiatric disorders and the multiple ways in which some differ­ences can manifest.

Male: Autism spectrum disorder

While ASD was originally considered only twice as prevalent in boys, recent estimates put the ratio closer to 5:1. A currently popular but unproven theory postulates that elevated testos­terone in utero leads to ASD-like behaviors by placing boys on the extreme end of the male spectrum. A counte­r-t­heory is that girls are underd­iag­nosed for ASD due to physician bias and a different presen­tation, with fewer social and cognitive defects. Others argue that girls are more resilient and require a greater load of genetic insult before the disorder manifests, and empirical evidence supports this view for those limited instances in which a genetic origin of ASD is clear.

Male: Attention deficit hypera­ctivity disorder:

Reports of the degree to which ADHD occurs more frequently in boys than girls vary widely and are likely influenced as much by cultural factors as biological ones. Additi­onally, males tend to show greater impair­ments, making them at least four times more likely to be diagnosed.

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