Marrie H. J. Bekker

Anxiety Disorders: Sex Differences in Prevalence, Degree, and Background, But Gender-Neutral Treatment

BACKGROUND Anxiety disorders are more prevalent among women than among men. OBJECTIVE The aim of this paper was to investigate to what degree current psychological theories and treatment of anxiety disorders incorporate sex and gender considerations. METHODS Relevant English, Dutch, German, or French empirical articles published until November 2006 were identified using the PsycINFO and PubMed databases as well as manual searches. The following search terms were used: anxiety disorders and sex differences, anxiety disorders and gender, anxiety disorders and women, anxiety disorders and men; combinations of these terms were used with prevalence, phenotypes, treatment, and therapy. In addition to all the aforementioned combinations, we replaced anxiety disorders with agoraphobia, panic disorder, social phobia, specific phobia, obsessive-compulsive disorder, posttraumatic stress disorder, acute stress disorder, and generalized anxiety disorder. RESULTS Whereas widespread attention has been paid to sex differences in the prevalence of anxiety disorders and their possible origins, scant attention has been given to these differences in terms of treatment. CONCLUSIONS Prevention and treatment of anxiety disorders might be more effective if the available knowledge about sex and gender specificity was implemented. Concomitantly, treatment effect studies could be improved by greater consideration of sex and gender throughout the research process. More fundamental research is needed regarding the relationship between sex, gender, and anxiety disorders, particularly in association with other mental disorders that have an unequal prevalence between the sexes.

Relations between negative affect, coping and emotional eating

The study was designed to examine the relations between negative affect, coping, and emotional eating. It was tested whether emotion-oriented coping and avoidance distraction, alone or in interaction with negative affect, were related to increased levels of emotional eating. Participants were 125 eating-disordered women and 132 women representing a community population. Measures included the Positive and Negative Affectivity Schedule (PANAS), the Coping Inventory for Stressful Situations (CISS), and the Dutch Eating Behavior Questionnaire (DEBQ). Both emotion-oriented coping and avoidance distraction were related to emotional eating, while controlling for levels of negative affect. Negative affect did not have a unique contribution to emotional eating over and above emotion-oriented coping or avoidance distraction. The findings suggest that emotional eating is related to reliance on emotion-oriented coping and avoidance distraction in eating-disordered women as well as in relatively healthy women.

Women's work roles and their impact on health, well-being, and career: comparisons between the United States, Sweden, and The Netherlands.

ABSTRACT As women have become more assimilated into the workforce over recent decades, they have realized considerable changes in their work roles which may contribute to health problems and other negative outcomes such as marital strain and diminished job status. The purpose of this review was threefold: (1) to synthesize data on the distribution of womens work efforts in the areas of paid employment, household chores, and childcare; (2) to outline research which addresses the impact of womens workload on their well-being and careers; and (3) to make international and gender comparisons regarding womens work responsibilities. Our findings showed that women from each of the three countries examined–the United States, Sweden, and The Netherlands–contribute more effort to household chores and childcare and less to the workplace than men do. As a result, their total workloads appear to be somewhat greater and more diffusely distributed than those of men. Heavy workloads may adversely affect womens health, especially in the presence of certain role characteristics (e.g., having a clerical, managerial, professional, or executive position, or caring for young children). Heavy work responsibilities may also undermine marital happiness, particularly if there is perceived inequity in the way partners share household work. Finally, womens total work responsibilities often impact their careers due to compensatory reductions in work commitment and job status. These observations point to the need for further research on womens workload and work roles, on the relationship of work to well-being, and on methods of preventing or alleviating adverse effects on overburdened workers.

Childcare involvement, job characteristics, gender and work attitudes as predictors of emotional exhaustion and sickness absence

Abstract Reports in the literature vary regarding the existence of gender differences in relation to burnout and sickness absence. To investigate this, the present study was aimed at investigating the role of several gender-relevant variables, particularly childcare obligations, job characteristics, and work attitudes in emotional exhaustion and sickness absence in 404 male and female nurses in an institution for people with learning difficulties. Questionnaires were administered reflecting demographic and job characteristics, work and non-work attitudes, and emotional exhaustion (as measured by the Emotional Exhaustion Scale of the Maslach Burnout Inventory). Female nurses were expected to report higher levels of emotional exhaustion and to be absent through sickness more often than men. Also, childcare investment, job characteristics, and (non) work attitudes were expected—via emotional exhaustion—to predict gender differences in sickness absence. It was found that women did not have higher sickness absence rates, and although a gender difference appeared in emotional exhaustion it was in the opposite direction from that predicted. For both genders, emotional exhaustion had a significant positive effect on sickness absence, and especially childcare investment and number of work hours appeared to contribute to both outcomes. These results are of interest because, despite current stereotypes, sickness absence was not higher in women, and neither were women more at risk for emotional exhaustion. In particular, load—workload as well as care load—appeared to predict emotional exhaustion and thus sickness absence.

The relationships among part-time work, work-family interference, and well-being

The authors investigated the effect of part-time work on work-family interference and well-being among 160 part-time and 29 full-time employed mothers (with a partner) working at 2 insurance companies in the Netherlands. The authors controlled for working part time as a strategy for reducing work-family imbalance and found that part-time work was associated with a lower level of work-to-family interference. Also, high levels of work-family interference were associated with diminished well-being. Work-to-family interference played a mediating role in the relationship between part-time work and well-being. Results indicate that part-time jobs can enhance the work-family balance not only for those explicitly choosing part-time employment as a means to reduce work-family imbalance but also for other employees.

Schema therapy for borderline personality disorder: A comprehensive review of its empirical foundations, effectiveness and implementation possibilities

Borderline personality disorder is a serious psychiatric disorder for which the effectiveness of the current pharmacotherapeutical and psychotherapeutic approaches has shown to be limited. In the last decades, schema therapy has increased in popularity as a treatment of borderline personality disorder; however, systematic evaluation of both effectiveness and empirical evidence for the theoretical background of the therapy is limited. This literature review comprehensively evaluates the current empirical status of schema therapy for borderline personality disorder. We first described the theoretical framework and reviewed its empirical foundations. Next, we examined the evidence regarding effectiveness and implementability. We found evidence for a considerable number of elements of Youngs schema model; however, the strength of the results varies and there are also mixed results and some empirical blanks in the theory. The number of studies on effectiveness is small, but reviewed findings suggest that schema therapy is a promising treatment. In Western-European societies, the therapy could be readily implemented as a cost-effective strategy with positive economic consequences.

Sickness absence: A gender-focused review

Women compared with men are generally considered to have higher sickness absence rates. Also determinants of sickness absent may differ between the sexes, a relevant area of knowledge for organizations that want to fine-tune particular measures to particular determinants. The present article offers a review of the literature regarding the relationships between sickness absence and gender. Various explanations mentioned in the literature are discussed using a classification derived from the Multi-Facet Gender and Health Model. Women compared to men seem indeed more frequently absent at work but this depends on countries, age – and professional groups, and seems restricted to short-term absence. Main conclusions with respect to future research concern the desirability of context-sensitive research and the usefulness of short-term versus long-term absenteeism as an outcome variable. Additionally, we recommend to further investigate the effects of organizational and psychosocial gender-related work characteristics, gender-bias in diagnostics and treatment, as well as gender differences in specific person-related factors interacting with gender differences in work-related daily life factors.

A short form of the Autonomy Scale: properties of the Autonomy-Connectedness Scale (ACS-30).

The Autonomy Scale (Bekker, 1993) measures individual differences in gender-linked autonomy, a psychological condition resulting from the process of individuation and separation. The theoretical background of the concept is found in a combination of feminist, neoanalytical object relations theory and attachment theory. The 3 subscales are Self-Awareness, Sensitivity to Others, and Capacity for Managing New Situations. We report the development and properties of the Autonomy–Connectedness Scale (ACS–30), a shortened 30-item version of the Autonomy Scale. We present 2 studies. In the first study, we examined the structure of the scale as well as its validity and reliability. The second study was aimed at further validation by relating the ACS–30 to various indexes of psychopathology. Exploratory as well as confirmatory factor analyses provided support for a 3-factor structure that was identical to that of the original scale. The ACS–30 showed good internal consistency reliability and an expected pattern of convergent validity with personality and mental health variables. The psychometric properties of the ACS–30 suggest it can be used to assess gender-linked autonomy. It also has the advantage of being more economical and simple as compared with the original 50-item version.

Agoraphobia and gender: A review

Abstract Agoraphobia is approximately four times more likely to be diagnosed in women than in men in clinical or community samples. In this article, the literature on the relationship between agoraphobia, biological sex, and gender is reviewed. First, the numerical distribution of agoraphobia is discussed. Second, theories and results of studies are pointed out that contribute to an explanation of the high prevalence of agoraphobia in women. Special attention is paid to the relationship between agoraphobia, dependence, and gender. It is concluded that dependence, or low autonomy, is relevant in agoraphobia but cannot explain the specificity of the disorder. Third, the agoraphobia literature about gendered meanings of solitary and public anonymous situations and publications on bodily sensations are discussed. It is concluded that the current sex role approach to agoraphobia is too narrowly focussed. A broad-spectrum sex role approach is proposed. Finally, several research questions are raised for the future.

The development of an Autonomy scale based on recent insights into gender identity

The concept of autonomy has a long history, not only in psychology, but also in philosophy. In this article, the concept is discussed in relation to gender and mental health. The criticisms of several authors with regard to the classical psychological concept of autonomy are reviewed. Also, some recent theoretical developments which start from a psychoanalytical perspective are discussed. Then the reader is introduced to the construction of a new Autonomy scale that takes the criticism mentioned into account and connects with new insights into gender identity. Two studies are presented in which the structure of the scale, as well as it validity and reliability, is investigated. The Autonomy scale appears to measure consistently three aspects: Self‐awareness, Sensitivity to Others, and Capacity for Managing New Situations. Reliability and validity are satisfactory. Furthermore, in a third study the factor structure found in Studies 1 and 2 was cross‐validated in a more heterogeneous, adult sample. This cross‐validation was also done across the sexes. It is concluded that the Autonomy scale is a valid and reliable instrument for measuring the new autonomy concept in various populations. Secondly, the scale seems to fill the gap that is left open by more classically oriented autonomy (and dependence) scales by measuring Sensitivity to Others, an important aspect of femininity and thus for female identity.