The effect of increasingly stringent diagnostic criteria on sex differences in schizophrenia

Abstract

Sex differences in premorbid function and symptomatology were examined as increasingly stringent criteria for schizophrenia were applied to 182 male and 139 female psychotic patients. The male/female ratio rose from 1.6 among those meeting the CATEGO 'broad' criteria for schizophrenia to 3.7 among those satisfying DSM-III criteria. Of 76 women meeting the former criteria, 53 were excluded by the latter, the majority rediagnosed as affective or schizo-affective psychosis. Consequently, although women meeting CATEGO 'broad' criteria showed more affective and fewer typical schizophrenic symptoms than their male counterparts, these differences were abolished by DSM-III criteria. Among CATEGO 'broad' schizophrenics, men were more likely than women to have received special education, and had shown worse childhood social adjustment and worse adult social achievement than women. These differences disappeared among DSM-III schizophrenics, but women continued to have fewer premorbid schizoid and schizotypal traits, a greater likelihood of marriage, and a later age of onset.