health treatment. studies show that physicians often perceive women's complaints as emotional responses rather than physiological pain. women are less likely to be prescribed painkillers after surgeries, according to several studies conducted in the 1980s. for example, after undergoing coronary artery bypass surgery, women received more sedatives rather than pain treatment. studies from the 2000s showed that physicians dismissed women's pain as inexplicable because they refused to believe the complaints; some physicians even blamed the female patients for their pain. western cultural recognition of pain bias as the issue of pain bias becomes more popular, media coverage of the topic has also increased. in 2014, the national pain report conducted an online national survey of almost 2,600 women with a variety of chronic pain conditions. 65% felt that their pain was being given inadequate attention because they were female, and 91% believed that the health-care system discriminated against women. nearly half of the women were told that their pain was psychological, and 75% were told they must learn to deal with the pain. in 2015, the atlantic published an article about a woman's experience with acute abdominal pain. she had to wait almost two hours at the emergency room before receiving treatment, but she endured the pain longer than necessary due to a misdiagnosis. in the united states, women wait an average of 65 minutes before receiving an analgesic for acute abdominal pain, while men only wait 49 minutes. a 2019 article published by the washington post references a 2008 study that supports the statements made in 2015 the atlantic article. psychological diagnosis there was an example of gender bias in the psychiatric field as well, hamberg notes that, "psychiatrists would diagnose women with depression and then, eventually psychiatrists would begin to assume that women were more depressed than men due to the fact that the patients that were examined by the psychiatrists were women and they had similar symptoms. as for the men, they were diagnosed with drug or alcohol problems and they were thrown out of the study." there is a suggestion that assumptions regarding gender specific behavioral characteristics can lead to a diagnostic system which is biased. the issue of gender bias with regard to diagnostic and statistical manual of mental disorders (dsm) personality disorder criteria has been controversial and widely debated. the fourth dsm (4th ed., text revision; dsm–iv–tr; american psychiatric association, 2000) makes no explicit statement regarding gender bias among the ten personality disorders (pds), but it does state that six pds (antisocial, narcissistic, obsessive-compulsive, paranoid, schizotypal, schizoid) are more frequently found in men. three others (borderline, histrionic, dependent) are more frequent in women. avoidant is equally common in men and women. there are many ways to interpret differential prevalence rates as a function of gender. some critics have argued that they are an artifact of gender bias. in other words, the pd criteria assume unfairly that stereotypical female characteristics are pathological. the results of this study conclude with no indication of gender-biased criteria in the borderline, histrionic, and dependent pds. this is in contrast with what is predicted by critics of these disorders, who suggest they are biased against women. it is possible, however, that other sources of bias, including assessment and clinical bias, are still at work in relation to these disorders. the results do show that the group means are higher in women than in men, an expected result considering the higher prevalence rate of these disorders for women. the original purpose of the dsm–iv was to provide an accurate classification of psychopathology, not to develop a diagnostic system that will, democratically, diagnose as many men with a personality disorder as women. however, if the criteria are to serve equally as indicators of disorder for both men and women, it will be important to establish that the implications of these criteria for functional impairment are comparable for both sexes. whereas it is plausible that there are gender-specific expressions of these disorders, dsm–iv criteria that function differently for men and women can systematically over-pathologize or under-represent mental illness in a particular gender. the present study is limited by the investigation of only four personality disorders and the lack of inclusion of additional diagnoses that have also been controversial in the gender bias debate (such as dependent and histrionic personality disorders), although it offers a clearly articulated methodology for studying this possibility. in addition, it provides an examination of a clinical sample of substantial size and uses functional assessments that cut across multiple functional domains and multiple assessment methods. our results indicate that bpd criteria showed some evidence of differential functioning between genders on global functioning, although there is little evidence of sex bias within the diagnostic criteria for avoidant, schizotypal, or obsessive–compulsive personality disorders. further investigation and validation across sexes for those disorders would be an important direction of future research. the signs and symptoms of ptsd considerable evidence indicates a prominent role for trauma-related cognitions in the development and maintenance of posttraumatic stress disorder (ptsd) symptoms. the present study utilized regression analysis to examine the unique relationships between various trauma-related cognitions and ptsd symptoms after controlling for gender and measures of general affective distress in a large sample of trauma-exposed college students. in terms of trauma-related cognitions, only negative cognitions about the self were related to ptsd symptom severity. gender and anxiety symptoms were also related to ptsd symptom severity. theoretical implications of the results are consistent with previous studies on the relationship between ptsd and negative cognitions, the self, world, and blame subscales of the ptci were significantly related to ptsd symptoms. the study correlations indicated that increased negative trauma-related cognitions were related to more severe ptsd symptoms. also consistent with previous reports, correlations also indicated that gender was related to ptsd symptom severity, such that women had more severe ptsd symptoms. ptsd symptom severity was also positively related to depression, anxiety, and stress reactivity. distinguishing between borderline personality disorder (bpd) and post traumatic stress disorder (ptsd) is often challenging, especially when the client has experienced a trauma such as childhood sexual abuse (csa), which is strongly linked to both disorders. although the individual diagnostic criteria for these two disorders do not overlap substantially, patients with either of these disorders can display similar clinical pictures. both patients with bpd and ptsd may present as aggressive toward self or others, irritable, unable to tolerate emotional extremes, dysphoric, feeling empty or dead, and highly reactive to mild stressors. despite having similar clinical pictures, ptsd and bpd are regarded differently by many clinicians. results from a 2009 study concluded that patient gender does not affect diagnosis. this finding is consistent with research suggesting that women are not more likely to be given the bpd diagnosis, all else being equal, though it contradicts other findings from studies that have used similar case vignettes. nor did the data support an effect of clinician gender or age on diagnosis. a 2012 study examined gender-specific associations between trauma cognition, alcohol cravings and alcohol-related consequences in individuals with dually diagnosed ptsd and alcohol dependence (ad). participants had entered a treatment study for concurrent ptsd and ad; baseline information was collected from participants about ptsd-related cognition in three areas: (a) negative cognition about self, (b) negative cognition about the world, and (c) self-blame. information was also collected on two aspects of ad: alcohol cravings and consequences of ad. gender differences were examined while controlling for ptsd severity. the results indicate that negative cognition about self are significantly related to alcohol cravings in men but not women, and that interpersonal consequences of ad are significantly related to self-blame in women but not in men. these findings suggest that for individuals with co-morbid ptsd and ad, psycho-therapeutic interventions that focus on reducing trauma-related cognition are likely to reduce alcohol cravings in men and relational problems in women. female patients women have been described in studies and in narratives as hysterical and neurotic, and many feel that physicians take their pain less seriously. historically, women's health was only associated with reproductive health, and thus has often been called "bikini medicine" because the field largely focused on the anatomy covered by a bathing suit. until recently, clinical research mainly used male subjects, male cells, and male mice, and many women were excluded from research because they were considered too weak, too variable, and in need of protection from the harms associated with medical research studies. results from these all-male studies, including studies important in understanding how certain drugs behave in the body, were applied to female patients as well, despite biological differences in the way disease presents in females and males and that women are more likely to have adverse reactions to medication. modern research on human subjects are made up of approximately an equal distribution of female and male subjects, but female subjects in research are largely still underrepresented in specific areas of medical research, like cardiovascular research and drug studies. narrative from physicians include reporting that women's complaints are considered exaggerated and may be assumed to be invalid. women have been historically considered less stable than men, and their physical ailments are often considered by physicians to be a result of emotions. women's symptoms are often not taken seriously, and women experience high rates of misdiagnosis, unrecognized symptoms, or are assumed to be experiencing a psychosomatic disorder. there has also been a reported difference between treatment of physically attractive patients versus physically unattractive patients, a bias that exists in both male and female patients, but is more pronounced in female patients. female patients who are considered conventionally attractive are thought to be experiencing less pain than unattractive female patients. female patients have also been considered more demanding patients, and are considered to be a greater burden than male patients. one observer has stated that, "different forms of female suffering are minimized, mocked, coaxed into silence." in the medical community, women are perceived as having to "prove they are as sick as male patients," what the medical community has deemed "yentyl syndrome." there are those that disagree with this characterization, stating that chronic pain specifically is hard to treat in all people, and that there is a greater bias against young people than against genders. generally, women are treated less aggressively than men for pain, and over 90% of women with chronic pain believe that they are treated differently by healthcare professionals because of their gender. women are often referred to psychiatrists for treatment, and are more likely to be prescribed sedatives than pain medicine. this can cause complications if a psychiatric condition is diagnosed, often incorrectly, and can be especially detrimental if drugs are prescribed because antidepressants and psychiatric drugs "are absorbed differently in women and vary in effectiveness" and can have unwanted side effects. research has indicated that women metabolize drugs differently than men. however, drug dosage is rarely broken down by sex, and this can lead to highly detrimental effects. a specific example of how misdiagnosis effects women is the care of female heart-attacks. women who are experiencing a heart attack are seven times more likely to be misdiagnosed and released from the hospital during the heart attack. this is often due to the fact that women generally experience different heart-attack symptoms than men, including flu-like symptoms. aging women a common health concern associated with aging women is that of menopause. characterized simply, menopause refers to a gradual hormonal change, typically onset between the ages of 48-52 wherein menstrual periods cease, and women are no longer able to conceive and bear children. a 2001 research interview study examined personal experiences, where age of patients within patient-doctor interactions correlated with negative experiences relating to validity and treatment of health concerns, for menopause specifically. this study, consisting of 61 women; with varying backgrounds concerning age, race, level of education, relationship status and income, found that often patients expressed experiencing symptoms of menopause in their early thirties and late forties; yet were dismissed due to their age not aligning with the estimated averages. intersection of gender and racial bias specifically, black women and women of color are at an even greater disadvantage. black women are twice as likely to have strokes, and their chances for survival are even lower than white women. black women are also more likely to have adverse