Introduction 15
These three concepts (for whic h discussion and examples are provided in Section III
and the Appendix) suggest cultural ways of understanding and describing illness experi-
ences that can be elicited in the clinical encounter. They influence symptomatology, help
seeking, clinical presentations, expectations  of treatment, illness adaptation, and treat-
ment response. The same cultur al term often serves more than one of these functions. 
Gender Differences
Sex and gender differences as they relate to th e causes and expression of medical conditions
are established for a number of diseases, including selected mental disorders. Revisions to
DSM-5 included review of potential differenc es between men and women in the expression
of mental illness. In terms of nomenclature, sex differences  are variations attributable to an
individual’s reproductive organs an d XX or XY chromosomal complement. Gender differ-
ences are variations that result from biological sex as well as an individual’s self-represen-
tation that includes the psychological, be havioral, and social consequences of one’s
perceived gender. The term gender differences  is used in DSM-5 because, more commonly,
the differences between men and women are a re sult of both biological sex and individual
self-representation. However, some of the di fferences are based on only biological sex. 
Gender can influence illness in a variety of ways. First, it may exclusively determine
whether an individual is at risk for a disord er (e.g., as in premenstrual dysphoric disor-
der). Second, gender may moderate the overa ll risk for development of a disorder as
shown by marked gender differences in the prevalence and incidence rates for selected
mental disorders. Third, gender may influence the likelihood that particular symptoms of
a disorder are experienced by an individual . Attention-deficit/hype ractivity disorder is