Introduction: Gender-Specific Issues Relative to Mental Illness

Researchers and clinicians have recently become more interested in sex and gender differences in mental disorders.¹ The reasons for this are manifold. On the one hand, sex and gender differences belong to the most stable findings in psychiatry and it is hoped that explaining them would provide interesting clues regarding the etiology of certain disorders. On the other hand, psychiatrists and psychotherapists increasingly understand that we can only deliver optimal psychiatric therapy and care if we take these differences into account.

This Special Report offers articles on gender-specific issues relevant to mental disorders. Mary Seeman, MD, focuses on clinical implications of gender differences in schizophrenia. In fact, many sex and gender differences in schizophrenic psychoses have been reported, but few have been soundly replicated. A stable finding is the later age of onset in women compared with men.

A better understanding of the different etiologies and pathogenetic pathways of schizophrenic psychoses in women and men on sex (biological) and gender (psychosocial) factors is needed to better tailor treatments and improve outcomes.¹

Michelle Mielke, PhD, provides a very informative review on sex and gender differences in Alzheimer dementia. She concludes that the study of these differences is still in its infancy compared with other areas of medicine such as cardiology. She explains that in cardiology a better understanding of sex and gender differences has led to improved treatment and care for both women and men, and the same should happen regarding dementia.

Bronwyn Graham, PhD, offers insight into gender vulnerabilities for anxiety disorders and the influence of sex hormones. She states that our understanding of the role of sex hormones in anxiety in women, while increasing, is still in its infancy, and if sex bias in anxiety research is not addressed, our understanding and treatment of anxiety will remain less rigorous for women. She also suggests ways that clinicians can already integrate existing knowledge into their daily practice.

In her article, Florence Thibaut, MD, PhD, discusses gender differences in addiction and their clinical implications. Findings from recent epidemiological studies indicate an alarming increase in the prevalence of dependence in adult women. Women’s consumption of psychoactive substances during pregnancy can be associated with serious consequences for the child. However, female outpatients are still underrepresented in specialized treatment settings. Providing services adapted to the needs of women, especially for those of childbearing age, is of emergent importance.

All the authors stress that mental health research often ignores sex and gender differences as well as the different risk factors and protective factors for both women and men. This is unfortunate, because not to investigate potentially different causal pathways and treatment responses of both genders not only undermines scientific validity of research, but also results in a failure to deliver gender sensitive treatments.

It is therefore high time for a shift in practice and research. Sex and gender aspects must be addressed more rigorously in research, psychiatric training, and clinical practice. This includes more research on gender differences in illness behavior, coping, help-seeking, and compliance as well as psychopharmacology, hormonal therapies, or gender-sensitive psychotherapy.

In This Special Report:

Introduction: Gender-Specific Issues Relative to Mental Illness
Anita Riecher-Rössler, MD

Clinical Implications of Gender Differences in Schizophrenia
Mary V. Seeman, MDCM, DSc

Sex Hormones and Gender Vulnerabilities to Anxiety Disorders
Bronwyn M. Graham, MPsychol (Clinical), PhD

Sex and Gender Differences in Alzheimer Disease Dementia
Michelle M. Mielke, MD

Gender Differences in Addiction: Clinical Implications
Florence Thibaut, MD, PhD

Disclosures:

Dr Riecher-Rössler is Professor of Psychiatry and Head of the Center for Gender Research and Early Detection, University of Basel, Psychiatric University Clinics, Basel, Switzerland.

Dr Riecher-Rössler reports no conflicts of interest concerning the subject matter of this Special Report.

References:

1. Riecher-Rössler A. Comment: sex and gender differences in mental disorders. Lancet Psychiatry. 2017;4:63-72.

2. Riecher-Rössler A, Butler S, Kulkarni J. Sex and gender differences in schizophrenic psychoses: a critical review. Arch Women’s Mental Health. May 16, 2018; E-pub ahead of print.