Gender bias in clinicians’ pathologization of atypical sexuality: a randomized controlled trial with mental health professionals

The psychiatric classification of "normal" versus disordered sexual behavior has been a subject of some dispute. Although atypical sexual interests have been viewed traditionally as typically male, epidemiological data indicate its presence in both genders. We examined how gender and sexual orientation influence whether or not atypical sexual behavior is classified as a mental disorder. Mental health professionals (N = 546) were presented with five case vignettes where subjects exhibit paraphilic behaviors; one case with psychotic symptoms served as the control condition. For each vignette we randomly changed the described subject's gender (male/female), sexual orientation (homosexual/heterosexual), and presented diagnostic criteria (fulfilled/ambiguous). Female subjects were significantly less pathologized and overall more stigmatized in terms of exhibitionistic, frotteuristic, sexual sadistic and pedophilic behavior. On the other hand, female sexual behavior that fulfilled diagnostic criteria for masochistic disorder was more pathologized. Our results demonstrate that nosologically irrelevant factors, which may be related to different sexual norms for men and women, affect clinicians' decisions regarding atypical sexuality.