Psychology of Women 401 807
Psychology of Women 401 807
Psychology of Women 401 807
There is also the expectation that heart disease occurs only among
older women and that relatively younger women in their 40s or 50s are
not at risk. However, ischemic heart disease is the leading killer of
women at all ages, with annual mortality rates that affect more women
under the ages of 35, 45, and 55 years than breast cancer (Bell & Nappi,
2000). Among the 500,000 women patients hospitalized in 2000 and
2002 with a first-listed diagnosis of heart attack or acute or chronic is-
chemia (restricted blood flow to the heart), more than 20 percent were
in their 40s or 50s.7 Thus, relatively younger or premenopausal women
may develop heart disease serious enough to require hospitalization.
A related stereotype is that heart disease among men is more serious
and consequently that men are more likely to die from heart disease,
whereas for women heart disease is generally milder and not as seri-
ous. However, data suggest otherwise. For example, women are less
likely than men to survive hospitalization for a heart attack (acute
myocardial infarction). The likelihood of death was higher for women
than men among all individual patient data provided by the National
Hospital Discharge Survey8 for patients over 40 years of age admitted
to hospitalizations having 300 or more beds. Among 237,000 patients
hospitalized with an infarction in 2002, women had a 50 percent
greater likelihood of dying than did men (OR ¼ 1.53, CI: 1.48–1.57).
The single biggest risk factor for heart disease is smoking. Most
other risk factors are also products of lifestyle. For example, eating hab-
its that feature high-fat foods can lead to high cholesterol, and a seden-
tary lifestyle can contribute to hypertension. Having high-density
cholesterol, often referred to as ‘‘good cholesterol,’’ that moves fairly
readily from blood into cells is not a risk factor. Bad cholesterol is low
density, does not readily escape the vascular system, and is more likely
to clump and adhere to the walls of blood vessels. This can occur in
the microvasculature as well as in major arteries of the heart.
Diabetes is a general risk factor for heart disease and for poor out-
comes of treatment. Significantly, diabetes denotes a higher risk factor
among women than it does among men, and women with diabetes are
twice as likely to develop heart disease compared to nondiabetic
women (Centers for Disease Control, 2004).
A seldom-discussed risk factor is the tendency for women as a
group to be more susceptible than men to general inflammatory condi-
tions and autoimmune problems such as arthritis and lupus. The gen-
eralized inflammatory process that contributes to these conditions can
also affect the heart and vascular system. For example, to the extent
that inflammation and irregularity occur in the lining of arterial walls,
cholesterol may adhere and form plaque, which gradually narrows the
artery and reduces blood and oxygen flow to the heart. Such reduced
blood flow and oxygen deficit is termed ischemia, which may be acute
or chronic.9
Women’s Health 381
the course of a lifetime, a little more than a third of all women will
have a diagnosis of some form of cancer (Ries et al., 2006). There is a
great dread of breast cancer, partly because any diagnosis of cancer is
seen as a death sentence, but in fact a high percentage of women live
quite full lives despite having a diagnosis. About 88 percent of women
will survive five or more years, and if the cancer is in situ11 at the time
of diagnosis, 100 percent of the women will survive five or more years
(Ries et al., 2006). Treatments for breast cancer are continually develop-
ing and will not be described here. Instead we concentrate on under-
standing cancer biology and some of the risks.
Cancer Biology
Although one might commonly think of cancer as a single entity,
such as a tumor, it is better understood as a process involving the
actions of many different types of cells and messenger substances, that
is, a constellation of genes, cells, and the communication pathways
between them. The development of cancer (carcinogenesis) typically
requires genetic changes that affect cell function. These errors may
occur at several points in the genes and communication pathways.
Errors early in the process might have the effect of ‘‘initiating’’ a cell,
but these errors must accumulate before a cell becomes transformed to
frankly cancerous. Changes throughout the cancer process might
384 Psychology of Women
Estrogen
The natural history of breast cancer is firmly linked with exposure
to estrogen; this may be endogenous estrogens produced in the body,
exogenous estrogens in pharmaceutical treatments, or estrogen-like
substances associated with environmental toxins. The initial links
between the lifetime dose of estrogen and risk of breast cancer can be
seen most simply in the fact that women with early menarche (prior to
age 11; Pike, Henderson, & Casagrande, 1981) or those with late
Women’s Health 387
menopause (after age 55; Trichopoulos, MacMahon, & Cole, 1972) have
a greater exposure to estrogen over the course of their lifetimes and
also have a higher incidence of breast cancer. Additionally, large-scale
prospective longitudinal studies conducted through the Nurses’ Health
Study14 have found that women with higher levels of estrogen in the
blood are over time more likely to develop breast cancer; this is true
for both postmenopausal (Missmer, Eliassen, Barbieri, & Hankinson,
2004) and premenopausal women (Eliassen et al., 2006). Women with
the highest quartile of circulating sex steroids had two to three times
the risk of breast cancer in comparison to women in the lowest quar-
tile. Cancers among those women with higher levels of circulating
estrogen also were more likely to be invasive rather than in situ.
Exogenous estrogens supplied through hormone replacement ther-
apy among menopausal women have similar increased risks for breast
cancer. This general association was documented a generation ago by
Jick and colleagues (1980) in an epidemiological study. More recent
research has continued to document an increased risk of exogenous
estrogens and breast cancer. A national study known as the Women’s
Health Initiative and developed by the National Institutes of Health
followed 16,000 women over the age of 50 for five years. Those who
received replacement hormones had approximately a 25 percent greater
likelihood of developing breast cancer in comparison to randomly
assigned women who received only placebos (Chlebowski et al., 2003).
Other recent studies have supported the increased risk (Barlow et al.,
2006; McPherson, 2004; Million Women Study Collaborators, 2003;
Writing Group for the Women’s Health Initiative Investigators, 2002).
The biological mechanisms by which extra estrogen might induce
cancer are closely related to the general biology of carcinogenesis dis-
cussed earlier. The natural role of estrogen in the body is to promote
cell division and growth. This necessary component of human repro-
duction is part of the monthly menstrual cycle and affects breast as
well as uterine tissue. Unfortunately, tissues that go through frequent
cell division and growth have a greater baseline risk of incurring a se-
ries of errors in cell genes and gene-to-gene communication pathways.
The risk of uterine cancer due to replacement estrogens can be
reduced to some extent by the inclusion of progestins that induce a
menstrual cycle. The progestins induce menstruation, when flawed
cells of the lining of the endometrium are sloughed off, but there is no
similar sloughing process of flawed cells in breast tissue. Since replace-
ment estrogen increases cell division and proliferation, it technically
falls in the category of a cancer promoter. Estrogen does not necessarily
cause errors or mutations, but it does result in an increased number of
any cells that happen to have mutations, as depicted in figure 12.7.
Despite the historical and contemporary research documenting the
role of estrogen in carcinogenesis, there remains a stunning promotion
388 Psychology of Women
NOTES
1. Medicaid is available to individuals in poverty who are younger than
age 65, while Medicare is available nationally to all individuals over age 65.
2. In 1849, Elizabeth Blackwell was the first woman to receive a doctor of
medicine degree, from Geneva Medical College in New York.
3. Birthweight less than 5 pounds, 8 ounces (2.5 kilograms).
4. Asian American, American Indian, Aleut, Alaska native, and so forth.
5. Hispanic is considered an ethnicity rather than a racial designation,
thus there may be Hispanic whites, non-Hispanic whites, Hispanic blacks, non-
Hispanic blacks, and so on.
6. Prostaglandins occur naturally in the body and are thought to be re-
sponsible for the common experience of menstrual cramps.
7. These data are from my ongoing unpublished work on women and
heart disease.
8. See Travis (2005) for more details on the individualized records of the
National Hospital Discharge Survey.
9. Ischemia refers to any reduction in blood flow and also occurs as tran-
sient ischemia associated with minor strokes.
10. Followed the same patients for several years.
11. Meaning in a localized area without involvement of lymph nodes.
12. Knudson (1971) studied inherited retinoblastoma in children.
13. The acronyms are short for BReast CAncer 1 and 2 and usually pro-
nounced ‘‘brack.’’
14. The Nurses’ Health Study II was established in 1989 and recruited
116,609 female registered nurses, ages 25–42. This group has been followed
biennially by questionnaire and in some cases giving blood samples.
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398 Psychology of Women
about attitudes toward menstruation and how they are influenced by,
and in turn influence, popular culture. You will read about menarche,
the first menstruation, and menopause, the end of menstrual cycles. You
will also learn about disorders that are related to the menstrual cycle.
Latin word for ‘‘month,’’ Maddux, 1975, p. 53), usually lasts four or
five days; three- to seven-day menstrual periods are considered normal,
although women who use oral contraceptives may have even shorter
menses. In our ‘‘typical’’ cycle, menstruation will cease on day 5.
The first half of the menstrual cycle is called the follicular, preovula-
tory, or proliferative phase, and it culminates in ovulation at around day
14. On day 1, levels of both estrogen and progesterone are low, and
the uterine lining begins to shed. Also on day 1, an immature ovum in
one of the two ovaries begins the process of maturation. During the
weeks of the follicular phase, a new uterine lining develops. About day
14, levels of FSH, LH, and estrogen are at their highest, and the now-
mature ovum is released into the fallopian tube. Some women are
aware of the exact moment of ovulation because they experience a
quick, sharp pain known as mittleschmertz (from the German words for
‘‘pain in the middle’’ of the cycle).
The second half of the menstrual cycle is called the luteal, postovula-
tory, or secretory phase. After ovulation, estrogen levels fall somewhat,
then rise again as progesterone levels rise. Progesterone reaches its
highest level, and estrogen is also high, about day 24. They quickly
decline by day 28 if fertilization and implantation have not occurred.
Their decline signals the end of the menstrual cycle. Menstruation
begins, and the body returns to day 1 status.
Although the menses is often called ‘‘bleeding,’’ blood makes up only
50–75 percent of the menstrual fluid (Maddux, 1975). Among the other
elements in the fluid are endometrial tissue and cervical mucus. The
amount of menstrual fluid discharged varies from woman to woman
and usually from day to day in the same woman. The total amount of
discharge averages 50 ml (about 3 tablespoons or less than a quarter of
a cup); a range of 10 ml to 200 ml is considered normal (Gersh & Gersh,
1981). Some women discharge about the same amount of fluid daily
from day 1 to day 5. Others experience a heavier flow during the first
two days, which then tapers off. Still others start off lightly, then flow
more heavily. There is not one correct or healthy way to menstruate;
what’s important for each woman to know is what is normal for her.
The menstrual cycle is a complicated series of events that is con-
trolled by delicately balanced neuroendocrine mechanisms that involve
the cerebral cortex, the hypothalamus, the pituitary gland, and the ova-
ries. The hormones regulate each other’s actions through a complex set
of negative-feedback loops. Contemplation of the system can leave one
amazed at the beauty and intelligence of Nature’s design of a physio-
logical system that we take for granted will be as regular as clockwork
for decades of our lives.
Still, not everyone sees it this way. The menstrual cycle, which was
designed to produce life, is often described in destructive terms. Biolo-
gist Walter Heape (in 1913, as cited in Tavris, 1992, p. 159) considered
The Menstrual Cycle in a Biopsychosocial Context 403
understood, it must have seemed amazing that women who were not
wounded could bleed and that five days of blood loss did not kill or
even seriously weaken them. Therefore, menstruation seemed magical.
Because men did not have magical bleeding themselves, they must
have been afraid of it, perhaps worried that close contact with it might
do them some physical damage or pollute them by association with the
female body. Thus, menstruation seemed poisonous. Do not dismiss
these ideas as na€ive or primitive; remnants of them are present today.
As late as the 1920s and 1930s, scientists (see Delaney, Lupton, & Toth,
1987) were attempting to demonstrate that menstruating women
exuded what were called menotoxins (i.e., poisonous elements) in men-
strual fluid, perspiration, saliva, urine, and tears. Present-day feminists
(e.g., Owen, 1993; Stepanich, 1992; Wind, 1995) who advocate the cele-
bration of menstruation with praise to the Moon Goddess continue the
idea that menses and magic are connected.
Anthropologists have reported that most societies have cultural pre-
scriptions (i.e., rules of conduct) for menstruating women (Buckley &
Gottlieb, 1988). In some societies, menstruating women were considered
taboo, that is, to be avoided while ‘‘unclean.’’ In others, menstruating
women were required to refrain from some activities (e.g., cooking, cul-
tivating crops) or to engage in certain activities to mark the onset or the
end of the menses (e.g., ritual bathing). Beliefs about menstruation have
no doubt been used in the past, as they are in the present, to oppress
women and limit our activities. However, it may be too simple to
assume that all menstrual taboos are the result of misogyny and were
imposed on women by men. Feminist anthropologists (e.g., Leacock,
1978; Martin, 1988) have suggested that women who were experiencing
menstrual cramps or migraines might have been glad to have a break
from cooking, weeding the crops, and walking long distances to collect
water, herbs, or other provisions. Similarly, the menstrual huts in which
some cultures required women to stay during their menses might have
been less like a prison and more like ‘‘Mom’s night out.’’ In the huts or
ritual bathing places, women could relax together, talk and tell stories,
and create a women’s culture they kept secret from men and children.
For example, in his study of the Yurok people of the Pacific Northwest,
Buckley (1982) learned that the Yurok believed that menstruating
women should isolate themselves because they are at the height of their
spiritual power and should not have to waste attention or energy on
mundane tasks. Instead women should spend the time in meditation
and other spiritual pursuits. The Yurok women’s isolation sounds more
like a religious retreat or a spa visit than a banishment.
Nevertheless, superstitious beliefs about menstruation were (and
are) common, and many have led to taboos that circumscribe menstru-
ating women’s behavior. Among the taboos described by Frazer (1951)
are that drops of menstrual blood upon the ground or in a river will
The Menstrual Cycle in a Biopsychosocial Context 405
kill plants and animals; wells will run dry if a menstruating woman
draws water from them; men will sicken or die if they are touched by
or use any objects that have been touched by menstruating women;
beer will turn sour if a menstruating woman enters a brewery; and
beer, wine, vinegar, milk, or jam will go bad if touched by a menstruat-
ing woman. These beliefs have been reported in various places in
Europe, Asia, Africa, Australia, and the Americas, and they are related
to contemporary beliefs that women should not bathe, swim, wash
their hair, do heavy housework, play sports, tend houseplants, or
engage in sexual intercourse during the menses (see, e.g., Tampax
report, 1981; Snow & Johnson, 1978; Williams, 1983).
The rising influence of science and the development of biomedicine
in the 19th and 20th centuries produced new myths about menstruat-
ing women. Physicians of the 19th century believed that women were
ill, weak, and especially dependent during their menstrual periods
(Golub, 1992), and they urged their patients to rest and conserve their
strength during the menses. Only middle- and upper-class women
could afford to seek a doctor’s advice and have household help, whose
efforts made possible their employers’ rest; poor and working-class
women carried on their duties as usual during their menstrual periods,
and no one seemed to think it odd that they were able to do so.
The foremost proponent of menstrual disability was Edward H.
Clarke, a professor at Harvard Medical School. He believed that educa-
tion interferes with women’s health. His thesis was that the menstrual
cycle requires a considerable investment of energy, and therefore any
energy directed at mental activity would necessarily reduce the amount
left to produce ovulation and menstruation. Furthermore, the blood
flow to the brain to support studying, he thought, means less blood
available to supply the ovaries and uterus for their important activities.
Clarke’s 1873 book Sex in Education went through 17 editions and was
very influential with both professional and popular audiences (Bul-
lough & Voght, 1973).
Clarke’s book was published at a time when there was a movement
to promote educational opportunities for women and girls. A number
of women’s colleges were established in the late 19th century, and it’s
sad to think that Clarke’s influence may have caused many parents to
decide against allowing their daughters to attend. Women college grad-
uates were so rare that in 1881 a group of alumnae met to form the
American Association of University Women, a national organization of
women college graduates that continues today to meet in local chapters
for intellectual, social, and political activities. Only 3.8 percent of Amer-
ican women attended college in 1910; 7.6 percent attended in 1920, and
the number increased to only 10.5 percent in 1930 (Levine, 1995).
Despite several studies published around the turn of the 20th cen-
tury that showed no difference in the health of women college students
406 Psychology of Women
and women who did not attend college, ‘‘experts’’ continued to warn
parents not to allow their daughters to engage in intellectual activities
(Bullough & Voght, 1973). John Harvey Kellogg, the diet and exercise
guru, wrote that many young women had permanently damaged their
health by studying too much while menstruating. He also warned of
the danger to menstruating women of exposure to cold, not getting
enough rest, and not dressing or eating ‘‘properly.’’ G. Stanley Hall, a
very influential psychologist of the early 1900s, was a fierce opponent
of coeducation. He thought that women were too frail to stand up to
the rigors that men students could handle, and he urged women’s col-
leges to provide at least four days of rest for students during their
menstrual periods (Golub, 1992). It’s interesting to note that, although
Hall opposed coeducation, he did train several of the early women
psychology graduate students in his lab at Clark University. The
women remained loyal to him for the opportunity he provided them,
although he did not seem to assist them later in their careers (Scarbor-
ough & Furumoto, 1987).
As late as the 1930s, textbooks continued to state that most women
experienced at least some disability during menstruation and that
women should limit their activities and get more rest during their peri-
ods. Today, few professionals would agree with what we might call
‘‘the debilitation hypothesis,’’ but many professionals and the general
public alike are still certain that the menstrual cycle affects women’s
behavior, emotions, and intellectual abilities. In 1970 physician Edgar
Berman was widely quoted in the media for his comments about
women politicians:
feminist scientists have had to spend their time in critiquing and refut-
ing the results of the few studies that have concluded that menstrua-
tion has debilitating effects on women’s abilities. Many of the studies
on this topic are poorly designed, perhaps because they were con-
ducted by people who had no expertise in cyclic biology, yet the
researchers were able to publish their results in respectable journals—
provided, of course, that their findings supported the debilitation hy-
pothesis.
It can be difficult to publish the results of studies that do not con-
firm expectations, a conundrum termed ‘‘the file drawer effect’’
(Sommer, 1987) in reference to the unpublished papers in feminist
scholars’ files—many of which conclude that menstruation does not
affect behavior or that women and men do not differ in some particu-
lar ability under study. The file drawer effect contributes to the waste
of feminists’ time as we conduct the same studies over and over again
because we do not have access to the unpublished data that show the
research to be unnecessary. It is also true that the one study that dem-
onstrates a menstrual cycle effect (or a sex difference) will get much
more scientific and media attention than the six studies that refute it
combined.
Why are there so few good studies of menstrual cycle effects? For
one thing, the menstrual cycle is complex; it represents a constantly
changing biochemical process, and, because we cannot see the changes,
it is not easy to know exactly what the state of the system is when
measurements are taken. The only way to tell what phase of the cycle
a woman is in is to do hormone assays, that is, to take a blood or urine
sample and have it analyzed for hormone concentrations. If, for exam-
ple, progesterone and estrogen are in high concentrations and FSH and
LH are in low concentrations, then we can safely say that the woman
is in the second half of the cycle—the luteal phase.
Many researchers do not use the hormone assay method of partici-
pant assignment because they cannot afford to have the lab tests done
and do not have the training to do the tests themselves, or because
they do not realize its importance. The next best method is the use of
basal body temperature. Participants in the study are asked to take
their temperature each morning when they awake and before they get
out of bed. The temperatures are written in a notebook, and the
researchers later plot them on a graph. Basal body temperature is typi-
cally lower in the follicular phase than in the luteal phase; it drops just
prior to ovulation, then spikes up 0.4 degrees or more after ovulation
occurs and continues at a higher-than-earlier level during the rest of
the cycle. Although hormone levels are not confirmed in this method,
they can be inferred if ovulation occurred. Women do not necessarily
ovulate during every cycle, and it is important to confirm ovulation. If
ovulation did not occur, the woman does not experience a ‘‘true’’ luteal
408 Psychology of Women
phase; that is, her hormone level is not typical. If ovulation cannot be
confirmed, the participant’s data should not be included in the statisti-
cal analysis.
The least reliable way to determine cycle phase is the calendar
method. In this method, the researcher asks the participant for the date
of the start of her last menstrual period. On the assumption that the
woman’s cycle is 28 days long (an assumption that may well not
be true), the researcher then uses a calendar to count the days since the
reported date and estimates the participant’s cycle phase. This method
relies on too many assumptions: that the woman’s recall of the date is
accurate, that ovulation occurred, that her cycle is 28 days long. If
women are using oral contraceptives, the calendar method is even
more unreliable, because the pill alters hormone levels. Although the
calendar method is the least reliable, it is the most popular because it
is the easiest and least expensive and perhaps because the researchers
who use it are ignorant about the method’s defects.
Another methodological problem that makes it difficult to compare
the results of studies to each other is that researchers differ in the way
they divide the menstrual cycle into phases. The simple two-phase
division (follicular, luteal) described earlier is insufficient for those
who wish to study whether menstruation affects behavior. Therefore,
some researchers define a five- or seven-day phase termed ‘‘men-
strual.’’ Others are interested in premenstrual effects on behavior, so
they define a five- or seven-day phase termed ‘‘premenstrual’’ (occa-
sionally the premenstrual phase is defined as 10 or even 14 days
long—but more on that later). Sometimes researchers want to know if
women’s behavior is different around ovulation than at other times of
the cycle, so they define a three- or four-day phase termed ‘‘ovula-
tory.’’ So, we have various studies that define three, four, or even five
different phases. Furthermore, the same phase definition is generally
used for all participants in the study even though their menstrual
cycles probably differ considerably in actual length, and, if the calendar
method is used, we don’t even know that the women were actually in
the phases they were assumed to be in, anyway.
You are probably wondering why we should even discuss a body of
literature that is such a methodological mess, but we must, because the
results of these studies have been highly politicized. What scientists,
journalists, and the general public alike know of the results of these
studies influences stereotypes about women, women’s beliefs and feel-
ings about themselves and their bodies, and even classroom and labor
force discrimination against women and girls.
Following from the debilitation hypothesis, a number of researchers
have looked for evidence that women’s academic or work performance
suffers when they are menstruating. The most frequently cited study of
academic performance was done by Katharina Dalton (1960a). She
The Menstrual Cycle in a Biopsychosocial Context 409
categories. For example, some refer to female visitors (e.g., ‘‘My friend
is here,’’ ‘‘Aunt Flo/Susie/Sylvia/Tilly is visiting me’’), others to cy-
clicity (e.g., ‘‘It’s that time again,’’ ‘‘My time of the month/moon,’’
‘‘my period’’), illness or distress (e.g., ‘‘the curse,’’ ‘‘the misery,’’ ‘‘I’m
under the weather,’’ ‘‘Lady troubles,’’ ‘‘weeping womb,’’ ‘‘falling off
the roof’’), nature (e.g., ‘‘flowers,’’ ‘‘Mother Nature’s gift’’), redness or
blood (e.g., ‘‘I’m wearing red shoes today,’’ ‘‘red plague,’’ ‘‘red moon,’’
‘‘bloody scourge’’), or menstrual products (e.g., ‘‘on the rag,’’ ‘‘riding
the cotton pony,’’ ‘‘using mouse mattresses’’ or ‘‘saddle blankets’’).
References to menstruation that women find particularly offensive
(e.g., ‘‘on the rag’’ or ‘‘OTR,’’ ‘‘her cherry’s in the sherry’’) or that refer
to the sexual taboo (e.g., ‘‘too wet to plow,’’ ‘‘the red flag is up’’) are
more commonly used by men and reflect especially negative attitudes
toward women’s bodies.
Advertisements for menstrual products are cultural artifacts that
play an important role in the social construction of meaning (Merskin,
1999). Ads have contributed to the communication taboo by emphasiz-
ing secrecy, avoidance of embarrassment, freshness, and delicacy
(Coutts & Berg, 1993; Delaney et al., 1987; Houppert, 1999; Merskin,
1999). Allegorical images, such as flowers and hearts, and blue liquid
rather than reddish blood, have been used euphemistically to promote
secrecy and delicacy (Merskin, 1999). Ads play on women’s fear of
being discovered as menstruating; discovery means stigma—being
publicly tainted or ‘‘spoiled’’ (Coutts & Berg, 1993). With the invention
of panty-liners, advertisers began to tell us to use their products every
day so that we can feel ‘‘confident’’ that we can stay ‘‘fresh’’ and
untainted (Berg & Coutts, 1994). When Oxley (1997) questioned 55 Brit-
ish women about their experiences with menstruation, she found that
they echoed many of the themes in the ads. They felt self-conscious
during their menses, preferred tampons because they are ‘‘less noticea-
ble’’ than sanitary napkins, believed that menstrual blood is distasteful
to self and others, and supported the sex taboo.
Advertisements are not the only form of public discourse about
menstruation. Cultural attitudes are also conveyed through books,
magazine and newspaper articles, jokes, and other cultural artifacts,
such as ‘‘humorous’’ products like greeting cards and refrigerator mag-
nets. Most of the attitudes these media convey are negative, and to-
gether they have constructed a stereotype of menstruating women,
especially premenstrual women, as violent, irrational, emotionally
labile, out of control, and physically or mentally ill. Over the past
20 years, my students have brought me bumper stickers (e.g., ‘‘A
woman with PMS and ESP is a bitch who knows everything’’), buttons
(e.g., ‘‘It’s not PMS, I’m always bitchy’’), cartoons (e.g., In a cartoon
titled ‘‘PMS Worst-case Scenario,’’ a woman sits alone on a small desert
island while a man, in the ocean surrounded by sharks, says ‘‘Somehow
414 Psychology of Women
it feels safer out here.’’), greeting cards (e.g., a picture of a cake slashed
to bits and the saying ‘‘Some special advice for the birthday girl—
Never cut your cake during PMS’’), a calendar of cartoons about a
woman with a really bad case of PMS (e.g., ‘‘To take her mind off her
premenstrual syndrome, Melinda decides to rearrange her furniture’’
by hacking it to pieces with an axe), and books (e.g., Raging Hormones:
The Unofficial PMS Survival Guide, the cover of which pictures Joan
Crawford as an axe murderer). When I share my extensive collection
with my classes, students usually laugh at the first few instances, but
by the time they have seen several dozen cartoons, buttons, and so on,
they are usually angry and disheartened. These messages about women
are sent everyday; take a walk through your local shopping mall, and
you’ll see them.
A content analysis (Chrisler & Levy, 1990) of 78 articles about premen-
strual syndrome that were published in American magazines between
1980 and 1987 showed that writers have focused on negative stereotypes
and sensational cases. The menstrual cycle was referred to as the ‘‘cycle
of misery,’’ a ‘‘hormonal roller coaster,’’ ‘‘the inner beast,’’ and the
‘‘menstrual monster’’ (p. 98). The premenstrual and menstrual phases of
the cycle were described as ‘‘weeks of hell’’ during which women are
‘‘hostages to their hormones,’’ and premenstrual women were described
as ‘‘cripples’’ and ‘‘raging beasts’’ (p. 98). The titles of some of the
articles in the analysis were ‘‘Premenstrual Frenzy,’’ ‘‘Dr. Jekyll and Ms.
Hyde,’’ ‘‘Coping with Eve’s Curse,’’ ‘‘Once a Month I’m a Woman Pos-
sessed,’’ and ‘‘The Taming of the Shrew Inside of You’’ (p. 97). The
articles suggest that most (or all) women experience PMS.
The emphasis on violent, out-of-control women in cartoons and
magazine articles could easily make us lose sight of the fact that only a
small percentage of all violent crimes are committed by women. The
articles described above were influenced by the newspaper coverage of
two criminal prosecutions in England of women who were accused of
murder (Sandie Smith) and vehicular homicide (Christine English). Dr.
Katharina Dalton testified in their trials about her belief that the
women had premenstrual syndrome at the time of the crimes. Smith’s
own lawyer described her as a ‘‘Jekyll and Hyde’’ and stated that with-
out medical treatment the ‘‘hidden animal’’ in her would emerge
(Chrisler, 2002). The trials led to an explosion of media interest in
PMS, which has contributed to stereotypes about women and influ-
enced the way that women (and men) think about women’s bodies and
their emotions (Chrisler, 2002).
It is not surprising that people who are exposed to the cultural influ-
ences described above would have negative attitudes toward menstrua-
tion. These attitudes are formed early and are less influenced by
personal experience than one might think. Clarke and Ruble (1978)
asked boys and premenarcheal girls to rate the severity of the
The Menstrual Cycle in a Biopsychosocial Context 415
relatively new and their safety over long-term use is unknown. There
is evidence (Roberts, 2004; Roberts & Waters, 2004) that negative atti-
tudes toward menstruation are among the factors that that produce
self-objectification, the tendency to focus on external aspects of the self
over internal aspects. It is easy to see how cultural messages (e.g., the
text of advertisements for menstrual hygiene products) can lead
women to be ashamed of their bodies and to engage in excessive bod-
ily surveillance, two of the signs of self-objectification. Researchers
(Calogero, Davis, & Thompson, 2005; Szymanski & Henning, in press;
Tylka & Hill, 2004) have shown that self-objectification predicts eating
disorders, depression, and sexual problems in women.
Attitudes toward menstruation can divide women from each other
by pitting those who experience severe symptoms against those who
do not (Stubbs & Costos, 2004), and they affect what people think
about menstruating women. For example, Forbes and his colleagues
(2003) asked a group of college students to rate a set of adjectives in
light of the following instruction: ‘‘Compared with the average woman,
the woman during her period is . . .’’ (p. 59). Both women and men
thought that a menstruating woman is more irritable, sad, and annoy-
ing, and less sexy and energized, than the average woman. In addition,
men thought that a menstruating woman is more annoying and spacey,
and less reasonable and nurturing, than average.
In an earlier study, Golub (1981) found that 75 percent of the male
and 32 percent of the female college students she surveyed believed
that menstruation affects women’s thinking processes. In addition,
59 percent of the men and 51 percent of the women believed that
women are less able to function when they are menstruating.
In a recent experiment by Roberts and her colleagues (Roberts, Gold-
enberg, Power, & Pyszczynski, 2002), their research assistant ‘‘acciden-
tally’’ dropped either a tampon or a hair clip in front of the participants
just before the study began. At the end of the study, the participants
rated the assistant as less competent and less likable when she had
dropped the tampon than they did when she had dropped the hair clip.
They also exhibited a tendency to sit further away from her during the
data collection when they had seen her with the tampon. If employers or
coaches, for example, hold these negative attitudes and inaccurate
beliefs about women, they will be less likely to hire and promote women
or to provide them with opportunities to excel on the playing field.
relatively late in the pubertal process, as much as two years after breast
buds develop (Tanner, 1991), it is menarche that provides the proof of
puberty (Erchull, Chrisler, Gorman, & Johnston-Robledo, 2003). Unlike
the gradual changes that accompany puberty, menarche is sudden and
conspicuous (Golub, 1992), and it thus provides a rather dramatic de-
marcation between girlhood and womanhood. The importance of men-
arche is illustrated by the fact that many women have vivid and
detailed memories of it that are retained over time with surprising
clarity.
Given the cultural images discussed above, it is no surprise that
most girls approach menarche with ambivalence. In studies of North
American girls, participants typically report mixed feelings about men-
arche, such as proud and embarrassed or happy and frightened
(Chrisler & Zittel, 1998; Koff, Rierdan, & Jocobson, 1981; Woods, Dery,
& Most, 1983; Zimmerman & Chrisler, 1996). African American and
Latina girls have reported less positive reactions to menarche than Eu-
ropean American girls, and Latinas also reported the most negative
beliefs about menstruation (Zimmerman & Chrisler, 1996). Interviews
with British early adolescents revealed that they thought of menstrua-
tion primarily as embarrassing, shameful, and something to be hidden;
they also thought of their periods as a time of illness (Burrows & John-
son, 2005).
Many girls are unprepared for menarche and do not understand
what is happening to them when they experience it (Logan, 1980); this
is especially likely to occur in early-maturing girls, for whom menarche
appears to be more traumatic than for those who are ‘‘on time’’ or late
(Petersen, 1983; Scott, Arthur, Panzio, & Owen, 1989). Many mothers
find it difficult to talk to their daughters about menstruation and sex-
uality (Gillooly, 1998), so they put off having the talk as long as possi-
ble—sometimes until it is too late. When they do have ‘‘the talk,’’
mothers often convey to their daughters the negative attitudes and
inaccurate information that their own mothers told them (Britton, 1999;
Costos, Ackerman, & Paradis, 2002). In one study (Scott et al., 1989) of
African American girls, 27 percent of the participants said that they felt
totally unprepared for menarche; this can be compared to the 10–14
percent of European American girls found in other studies (Chrisler &
Zittel, 1998; Koff et al., 1981; Whisnant & Zegens, 1975).
Preparation is not everything, however, as Koff, Rierdan, and Shein-
gold (1982) found that even the 60 percent of their participants who
rated themselves as prepared for menarche had negative feelings about
the event when they actually experienced it. The films and pamphlets
that girls are given to educate them about menstruation tend to use
technical medical vocabularies to describe the physiological aspects of
the menstrual cycle, but are otherwise vague and mysterious (Erchull
et al., 2003; Havens & Swenson, 1989; Whisnant, Brett, & Zegens, 1975).
418 Psychology of Women
Dysmenorrhea
Dysmenorrhea is the technical term used to describe the uterine
cramps, headaches, backaches, and other unpleasant symptoms that
The Menstrual Cycle in a Biopsychosocial Context 419
Premenstrual Syndrome
Premenstrual syndrome, commonly known as PMS, refers to the ex-
perience of psychological and physiological changes in the three to five
days prior to the onset of menstruation. The most frequently reported
symptom of PMS is fluid retention, particularly in the breasts and ab-
domen. Other commonly reported symptoms include headaches, back-
aches, constipation, food cravings, acne, anxiety, tension, lethargy,
sleep changes, irritability, and depression. More than a hundred
changes have been associated with PMS in the professional and popu-
lar literature (Chrisler, 2003; Chrisler & Levy, 1990; Figert, 1996; Laws,
Hey, & Eagen, 1985), including some so gendered that they would
never be considered ‘‘symptoms’’ in men (e.g., craving for sweets,
increased sexual desire). It has been suggested (Dalton, 1960a, 1960b,
1968), although there is little scientific evidence for this, that premen-
strual women have difficulty concentrating, exhibit poor judgment, lack
physical coordination, exhibit decreased efficiency, and perform less
well at school or on the job. Women also report cognitive, behavioral,
and psychological changes that they welcome and view as positive,
such as bursts of energy and activity, increased creativity, increased
sex drive, feelings of affection, increased personal strength or power,
and feelings of connection to nature and other women (Chrisler, John-
ston, Champagne, & Preston, 1994; Lee, 2002; Nichols, 1995). These pre-
menstrual experiences are rarely mentioned in the professional or
popular literature because they do not fit the conceptualization of the
premenstruum as a time of illness and dysphoria.
Sometimes lists of the symptoms of PMS include some surprising
items, such as seizures or convulsions, asthma attacks, and herpes.
Obviously, normal luteal-phase biochemistry does not cause women to
develop epilepsy, asthma, or sexually transmitted infections. However,
Woods and her colleagues (Mitchell et al., 1994; Woods, Mitchell, &
Lentz, 1999) have documented cases in which menstrual cycle fluctua-
tions aggravate or magnify (PMM) existing health conditions, and they
suggested that menstrual cycle–related changes are capable of trigger-
ing flare-ups of chronic conditions. Among the conditions that can flare
up premenstrually are asthma, allergies, sinusitis, depression, anxiety
disorders, herpes, irritable bowel syndrome, migraine headaches, and
multiple sclerosis (Taylor & Colino, 2002). Symptoms of these condi-
tions overlap with those listed above as commonly reported by women
as features of PMS (e.g., fatigue, tension, sadness, anxiety, irritability,
The Menstrual Cycle in a Biopsychosocial Context 421
passive, and self-blaming (e.g., ‘‘It’s not your fault, it’s my PMS’’) strat-
egies for coping with stress (Chrisler & Johnston-Robledo, 2002).
Although there is a large body of literature about PMS in biomedical
and psychosocial journals, there is no definitive cause of PMS
(although speculations include gonadal or adrenal hormone levels,
sleep disturbance, inadequate nutrition, stress, obesity, neuroticism,
and self-fulfilling prophecy), nor is there a cure. Although data do indi-
cate that women experience cyclic changes, it is difficult to know how
common such changes are. Estimates of the number of women who ex-
perience premenstrual ‘‘symptoms,’’ which depend on how the data
were collected, vary from 2 percent (using the strictest criteria of a
30 percent increase in the intensity of selected emotional and physical
experience charted daily over at least two menstrual cycles) to 100 per-
cent (using the loosest criteria, e.g., ‘‘Have you ever experienced cyclic
changes in your physical or emotional state?’’) (Chrisler, 2004). Perhaps
only 5 percent of women experience symptoms severe enough to
require medical attention (Rose & Abplanalp, 1983).
Despite efforts by the Society for Menstrual Cycle Research and the
National Institute of Mental Health to produce a standard definition,
there is little agreement on how many changes must be experienced or
how severe the experience must be in order to be considered a case of
PMS. So many different definitions exist in the literature that the
results of studies cannot easily be compared. Even the timing of the
premenstrual phase is unclear. Some researchers define it as three to
five days or five to seven days prior to menstruation. Others have
defined it as the time between ovulation and menstruation (about two
weeks), and some self-help books suggest that the premenstrual phase
can last almost three weeks (Chrisler, 2003).
The problem of prevalence estimates is made more difficult by the
fact that premenstrual experience is highly variable and personal. All
women do not experience the same changes; moreover, the experience
of any given woman may vary from cycle to cycle. In addition, PMS
has become such a part of popular culture in the past 25 years that the
results of surveys have undoubtedly been affected by a response bias
in the direction of the stereotype of the premenstrual woman (Chrisler,
2004). Thus, many women have diagnosed themselves with PMS.
Feminist scholars (e.g., Chrisler & Caplan, 2002; Figert, 1996; Houp-
pert, 1999; Martin, 1988; Rittenhouse, 1991) have noted ways in which
political expediency has influenced scientific and cultural interest in
the premenstrual phase of the menstrual cycle. The social construction
of PMS is generally agreed to have begun during the Great Depression
with the publication of an article by Robert Frank (1931), an American
gynecologist, who described a condition he called ‘‘premenstrual
tension.’’ He wrote that women became tense and irritable just prior
to menstruation, and he expressed concerns about their tendency to
The Menstrual Cycle in a Biopsychosocial Context 423
changes, but only 3–5 percent experience symptoms that meet the
PMDD criteria. Although it was the stated intent of the psychiatrists
who developed PMDD to move away from the ‘‘kitchen sink’’ diagnos-
tic criteria of PMS and define a subset of women who experienced a
unique psychiatric disorder, the symptoms of PMDD overlap with
those of PMS as defined by Debrovner (1982) and others, and adver-
tisements for pharmacological treatments for PMDD have encouraged
women to confuse PMS and PMDD (Chrisler & Caplan, 2002; Cosgrove
& Riddle, 2003). Furthermore, no definitive evidence has ever been pro-
duced to show that PMDD is a separate entity from PMS or from other
forms of depression (Chrisler & Caplan, 2002). Feminist scholars (e.g.,
Caplan, McCurdy-Myers, & Gans, 1992; Nash & Chrisler, 1997; Offman
& Kleinplatz, 2004) have expressed concerns that the presence of
PMDD in the DSM will result in more, not fewer, erroneous diagnoses
of women’s complaints and will lead to increased bias and discrimina-
tion against women. (For a discussion of the politics of the develop-
ment and implementation of the psychiatric diagnosis, see Caplan,
1995, or Figert, 1996.)
An interesting new line of research consists of qualitative studies
(e.g., focus groups, interviews, discourse analysis) of women’s beliefs
about, attitudes toward, and embrace of or resistance to the PMS label.
Most of the participants in these studies have been white women, as
have most of the women who have sought services at PMS clinics
(Markens, 1996) and most of the women depicted in the cultural prod-
ucts mentioned earlier. Although African American and European
American women have reported similar levels of premenstrual symp-
toms in community studies (Stout, Grady, Steege, Blazer, George, &
Melville, 1986), African American women’s apparent reluctance to seek
medical services and the scarcity of articles about PMS in magazines
that target black women (Markens, 1996) suggest that the resistance to
the PMS label may be greater in some ethnic and socioeconomic
groups than in others. Perhaps women who have experienced discrimi-
nation that is class-, race-, language-, or sexual orientation–based are
less willing to call attention to their female state or less able to believe
that they can expect sympathy for their condition than are women who
have experienced less (or less overt) discrimination in their lives.
In a series of interviews with women patients recruited from a PMS
clinic in England, Swann and Ussher (1995) found that their partici-
pants’ views of PMS were very similar to those presented in popular
culture. They firmly believed that PMS is biologically based, and they
rejected situational attributions for their distress, which the authors
described as ‘‘romantic discourse’’ (e.g., ‘‘everything else in my life is
fine, it’s just my PMS’’) (p. 365). Swann and Ussher’s participants
adopted a ‘‘dualistic discourse’’ (p. 364) that parallels the Jekyll and
Hyde or ‘‘me/not me’’ discourse in self-help books for PMS (Chrisler,
The Menstrual Cycle in a Biopsychosocial Context 425
Menopause
Menopause refers to the cessation of reproductive capacity; it is
defined as 12 months without a menstrual period. Menopause occurs
as a result of age-related changes that lead to the gradual diminishing
of the production of ovarian hormones. The average age of North
American women at menopause is 50 years, but it can occur naturally
at any age between 40 and 60 (Golub, 1992). The process that leads to
menopause (known as perimenopause) takes about seven years to com-
plete. Therefore, a woman who will reach menopause at age 50 will
probably notice the first changes in her menstrual cycle at around age
43. Early changes are likely to include menstrual cycle irregularity,
including shorter or longer cycles and heavier or lighter menstrual
flow. Menopause can also occur artificially, as a result of the surgical
removal of the uterus and ovaries, and women who reach menopause
in this sudden way often report more severe symptoms and distress
than those who approach it gradually (Voda, 1997).
Perhaps because it is associated with aging, menopause is often
viewed in Western societies as a negative event. However, surveys
(e.g., Huffman, Myers, Tingle, & Bond, 2005; Maoz, Dowty, Antonov-
sky, & Wijsenbeck, 1970; Neugarten, Wood, Kraines, & Loomis, 1968)
of midlife women have typically shown that women have mixed feel-
ings. The downside of menopause, women say, is the loss of fertility,
physiological changes that accompany it, feeling less feminine, having
a clear sign of aging, and a belief that it has come too soon. The upside
is the end of dealing with menstrual periods, the end of contraceptive
concerns, and a general sense of liberation. Older women typically
have more positive attitudes toward menopause than younger women
do, and they are more likely than younger women to agree that post-
menopausal women feel freer, calmer, and more confident than ever.
Many women find that the worst part of menopause is not knowing
what to expect.
One reason why women do not know what to expect is that until
recently menopause was not discussed very much; women tended to
keep their experiences private. However, knowing about others’ experi-
ences does not help much in predicting one’s own. Perimenopausal
physiological changes and women’s emotional reactions to them are
highly variable. The most common menopause-related symptom is the
hot flash (or flush), which, surveys show, is experienced by between
43 percent and 93 percent of women (Woods, 1982). One reason women
The Menstrual Cycle in a Biopsychosocial Context 427
complain about the experience of hot flashes is the concern that sweat-
ing or flushing red skin will alert other people to their perimenopausal
status: the secret will be ‘‘out.’’
Other frequent perimenopausal complaints include sweating, vaginal
dryness, headaches, vertigo, fatigue, weight gain, aches and pains,
insomnia, irritability, tingling sensations, and anxiety. Some of these
symptoms are undoubtedly related to each other. For example, hot
flashes that occur during sleep (also known as ‘‘night sweats’’) can
awaken women several times each night. Regular experience of sleep
deprivation leaves women fatigued and irritable and may increase their
anxiety as bedtime draws near. Stress is known to trigger hot flashes,
and so do caffeine, alcohol, hot weather, and spicy foods (Voda, 1982).
The notion that depression is linked to menopause (once known as
‘‘involutional melancholia’’) is not empirically supportable; data from
large epidemiological surveys (e.g., McKinley, McKinley, & Brambila,
1987) indicate that women are no more likely to be depressed at mid-
life than they are at any other developmental stage.
Images of older women and information about menopause in the
media tend to be negative (Chrisler, Torrey, & Matthes, 1999; Gannon
& Stevens, 1998; Mansfield & Voda, 1993; Rostosky & Travis, 2000).
The first widespread public discussion of menopause was occasioned
by the publication in 1966 of Robert Wilson’s book Feminine Forever,
which championed estrogen replacement therapy. Wilson’s (1966) the-
sis was that menopause signals the end not only of women’s reproduc-
tive capacity, but also of their attractiveness, femininity, sexuality,
energy, and, ultimately, health. He defined menopause as a deficiency
disease and pointed to synthetic hormones as its cure. Articles in the
popular press, inspired by Wilson’s book, described menopausal
women as ‘‘crippled castrates’’ and menopause as ‘‘a natural plague,’’
‘‘a horror of living decay,’’ ‘‘progressive defeminization,’’ ‘‘one of
nature’s mistakes,’’ and a ‘‘serious physical and mental syndrome’’ that
only medical treatment can ‘‘prevent’’ (Chrisler et al., 1999, p. 30). It
seems that Tavris (1992, p. 133) was correct when she noted that ‘‘the
only thing worse for women than menstruating is not menstruating.’’
Within 10 years of the publication of Wilson’s book, the medical pro-
fessionals’ and the public’s enthusiasm for unopposed estrogen treat-
ment began to dim, as it became clear that it did not produce all of the
effects claimed for it. Estrogen did help to reduce hot flashes, but it
did not retard aging, make older women supple and graceful, or
improve psychological symptoms. Furthermore, it was shown to lead
to uterine cancer. Feminist theorists (MacPherson, 1981; McCrea, 1983)
and women’s health organizations (e.g., the Boston Women’s Health
Book Collective, the National Women’s Health Network) urged women
to think of menopause not as an illness but as a normal developmental
transition (like menarche) to which one must adjust.
428 Psychology of Women
1997) and Mind over Menopause (Kagan, Kessel, & Benson, 2004) contain
other good advice for midlife women.
CONCLUSION
It is striking that a phenomenon as familiar as the menstrual cycle
can be so misunderstood. College students in my Psychology of
Women classes, who are otherwise well educated and sophisticated, tell
me that they have never heard the word menarche. They do not under-
stand the difference between dysmenorrhea and PMS, and they confuse
‘‘the menstrual cycle’’ with ‘‘the menses,’’ or menstrual phase of the
cycle. How is it possible that cultural images of stereotypical premen-
strual women can be found everywhere, yet menstruation remains a ta-
boo topic of conversation? The answer no doubt is political.
As Sommer (1983) noted, the menstrual cycle is such a clear differ-
entiation between women and men that its very existence has become
politicized and used against women—to keep them out of higher edu-
cation, good jobs, and powerful roles; to keep them in their traditional
places. In ancient times, men found menstruation frightening; it was
mysterious because it could not be understood. Today it is women
who find menstruation (and menopause, and the premenstrual phase
of the cycle) frightening because they have been convinced that any-
thing to do with the menstrual cycle signals illness that requires medi-
cal treatment. Women fear that they will lose control of their emotions
and appetites when they are premenstrual; that they will be discov-
ered, humiliated, and stigmatized when they are menstruating; that
they will not be able to cope with the symptoms of menopause; and
that the decline in gonadal hormone levels will leave them vulnerable
to all manner of disease. Women have been taught to see their own
bodies as the enemy, as shameful, disgraceful, and unmanageable, and
to be preoccupied with their bodies’ deficits—real or imagined. If we
accept this negative and medicalized cultural framing of a benign psy-
chophysiological process once known to earlier generations of women
as ‘‘my friend,’’ there will be no need for the powers-that-be to keep
women in our ‘‘places’’—we will do it ourselves.
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The Menstrual Cycle in a Biopsychosocial Context 439
those structures, and (3) there are unique, non-additive effects of iden-
tifying with more than one social group’’ (pp. 531–532).
At the same time that intersections of difference require more theo-
rizing, the importance of recognizing variation within groups charac-
terized by multiple dimensions of difference (e.g., gender and
ethnicity) cannot be overemphasized. Fortunately, there are now
numerous studies that focus on mental health in subpopulations of
women within difference categories (e.g., African Americans, women
over 65, lesbian mothers, women with fibromyalgia) and various con-
texts (college women, women in prison, women in residential treat-
ment, urban women). It is not possible to consider separately all
dimensions of difference in our discussion here (Greene & Sanchez-
Hucles, 1997). Nonetheless, it should be kept in mind that the rates
and predictors of mental disorder can vary substantially within subpo-
pulations of difference categories. For example, analyses of the
National Latino and Asian American Study (Alegria, Mulvaney-Day,
Torres, Polo, Cao, & Canino, 2007) found that among the four Latina
subethnic groups, women of Mexican heritage were less likely than
Puerto Rican women to have a depressive disorder, and Puerto Rican
women had the highest overall lifetime and past-year prevalence rates
compared to other women.
typically accords women with less power, privilege, and resources than
men (Stewart & McDermott, 2004).
As noted above, gender intersects with other dimensions of social
difference, and the effects of gender may differ depending on one’s
specific mix of social identities (see chapters 2 and 15 in this volume).
In sexist and racist societies, when identities are associated with stigma,
prejudice, and discrimination, they may be associated with increased
risk for psychological distress and psychopathology (Landrine & Klonoff,
1997; Wyche, 2001). For example, the impact of the double burden of gen-
der and ethnic discrimination in mental health and its treatment is well
recognized (American Psychological Association, 2003, 2006; Brown,
Abe-Kim, & Barrio, 2003; Brown & Keith, 2003; Bryant et al., 2005; Sparks,
2002; Sparks & Park, 2000; Wyche, 2001).
Age, ethnicity, race, sexual orientation, class, physical ability, and
size are among the social dimensions associated with stigmatized iden-
tities that may elicit prejudice and discrimination, confer differential
access to power and privilege, and converge with gender to magnify or
diminish risk for experiencing negative life events (e.g., exposure to
violence) and gaining access to psychological and social coping resour-
ces (e.g., collective self-esteem, social support).
Perhaps one of the most important, yet still muddled, conceptual
distinctions that has significant implications for research on mental
health is sex versus gender. In general, sex is recognized across the disci-
plines as a biological category, based on biological characteristics used
to define male and female, while gender is defined as a social category,
based on a social definition of the way males and females should differ
physically, cognitively, emotionally, and behaviorally.
Problems arise, however, in the assumption that the effects of biology
are solely the result of biological processes. Biological, psychological,
and social processes constantly interact, and gender can be a powerful
determinant of that interaction. Krieger (2003) illustrates the usefulness
of distinguishing between sex and gender, while recognizing that gen-
der has biological dimensions in predicting health outcomes, in 12 case
examples that encompass situations from birth defects to mortality and
include occupational and environmental disease, trauma, pregnancy,
menopause, and access to health services, among others. In these, gen-
der and sex-linked biology are singly, neither, or both relevant as inde-
pendent or synergistic determinants of the selected outcomes. Taken as
a whole, these examples articulate how gender relations can influence
expression and interpretation of biological traits. They also show how
the reverse—that is, how sex-linked biological characteristics—may con-
tribute to or magnify gender differences in mental health.
We believe that advancing theoretical perspectives on gender’s rela-
tion to mental health must consider the complex interplay among
446 Psychology of Women
biology, the social context, gender, and social roles. Such advancement
rests on:
women (Russo, 1995). Waisberg and Page (1988) found that female
patients were associated with stronger recommendations for drug treat-
ment in all diagnostic categories except depression, where male
patients were associated with stronger recommendations. A tendency
to misdiagnose other disorders in women as depression may lead to
inappropriate treatment; drugs that are appropriate to treat major
depression are not necessarily effective in treating other disorders (see
Yonkers & Hamilton, 1995).
Childhood physical and sexual abuse are also linked to subsequent
onset of multiple mental health and substance use problems, complicat-
ing the task of diagnosis (Hiday, Swanson, Swartz, Borum, & Wagner,
2001; Horwitz, Widom, McLaughlin, & Raskin White, 2001; Kendler,
Bulik, Silberg, Hettema, Myers, & Prescott, 2000; Molnar, Buka, & Kess-
ler, 2001). Misdiagnosis of PTSD due to rape or battering as clinical
depression has been of particular concern (McGrath, Keita, Strickland,
& Russo, 1990; Russo & Denious, 2001).
This brief picture points to both the complexity and the psychosocial
nature of the relationships among gender, ethnicity, marital status, and
mental health. Gender differences in mental disorder are associated with
age, race/ethnicity, marital roles, parental roles, and economic status
(Alegria et al., 2007; Breslau, Aguilar-Gaxiola, Kendler, Su, Williams, &
Kessler, 2005; Kessler et al., 2005; Kessler, 2006; Mowbray & Benedek,
1988; Whisman, 1999). Narrow intrapsychic or biological approaches are
not sufficient to achieve understanding of the etiology, diagnosis, treat-
ment, and prevention of mental disorders in women. Further, the over-
lapping of symptoms of psychopathology with gender stereotypes
makes misdiagnosis a concern (McGrath et al., 1990; Russo, 1995).
Measurement Issues
Hammen (2005) and Kessler (2006) provide summaries of measure-
ment issues in research that focus on depression but apply to mental
health research in general. We will not repeat them here except to note
that bias in willingness to self-report symptoms does not appear to be
a factor in explaining gender differences in rates of depressive disor-
der. Gender may affect recall bias, however. For example, women
Women and Mental Health 451
report a more chronic course of depression than men, but this has now
been explained as due to differential recall (Kessler, 2006).
Cutoff scores from summary scales that assess depressive symptom-
atology (e.g., CESD) should not be equated with a diagnosis of depres-
sion. Anxiety and mood disorders are heterogeneous diagnostic
categories in the Diagnostic and Statistical Manual of Mental Disorders
(4th ed.; DSM-IV; American Psychiatric Association, 1994) that often
involve overlapping symptomatology. A variety of summary scales are
currently used to assess depressive symptoms such as crying, feelings
of sadness and unhappiness, and eating and sleep difficulties. Inter-
preting results from such scales is problematic because such symptoms
are associated with a variety of psychiatric disorders as well as physi-
cal conditions, including anxiety disorders (Breslau et al., 1995).
A number of researchers have suggested that the largest gender dif-
ferences in such symptomatology are found for less severe symptoms
(Clark, Aneshensel, Frerichs, & Morgan, 1981; Craig & Van Natta,
1979). This suggests that interpretation of gender differences found in
research using summary scales should be interpreted with caution, as
such scales do not separate milder forms of distress, such as sadness,
from more severe psychiatric disorder (Newmann, 1984).
There is also concern that gender differences in milder forms of
symptomatology may reflect gender-role expectations rather than sig-
naling risk for depression. One study that compared the Beck Depres-
sion Inventory (BDI) and the Depression Scale (DEPS) within the
same population found significant gender differences on both scales,
but the differences were largely explained by the responses to the
items relating to crying and loss of interest in sex. The researchers
concluded that these items are psychologically and culturally related
to female gender, resulting in gender-biased results from measures that
include them (Salokangas, Vaahtera, Pacriev, Sohlman, & Lehtinen,
2002).
Anxiety Disorders
Community studies indicate that 31 percent of women and 19 per-
cent of men will have an anxiety disorder during their lifetime. This
gender difference in the rates emerges in childhood—one study found
that by age 10, 17.9 percent of girls compared to 8.0 percent of boys
had a history of anxiety disorder (Breslau et al., 1995).
Common features for anxiety disorders are symptoms of anxiety
and avoidance behavior, in addition to panic disorder (with and with-
out agoraphobia), agoraphobia (without history of panic disorder), sim-
ple phobia, social phobia, obsessive-compulsive disorder, posttraumatic
stress disorder, acute stress disorder, and generalized anxiety disorder,
among other categories. Related disorders include adjustment disorder
452 Psychology of Women
Comorbidity
Anxiety is comorbid with depression, particularly for women (Breslau
et al., 1995). Symptoms of anxiety disorders are correlated with other dis-
orders, complicating diagnosis. For example, the symptoms of PTSD
overlap with depression, including depressed mood, sleep and appetite
disturbance, social withdrawal, lowered self-esteem, and psychomotor
retardation or agitation (American Psychiatric Association, 1994). In par-
ticular, research that clarifies the origins and relationships among symp-
toms of anxiety and depression disorders is needed. Taken together,
these symptoms constitute a large proportion of women’s excess in psy-
chopathology.
Experiencing a mix of stressors that combine danger and loss is
strongly related to the development of comorbid anxiety and depres-
sion (Brown, Harris, & Eales, 1993). Comorbidity research suggests that
anxiety may serve as a pathway to depression for women (Breslau
et al., 1995). Anxiety disorders (generalized anxiety disorder, panic dis-
order, phobia) have been found to significantly predict increased risk
for developing major depressive disorder in women and men
454 Psychology of Women
(Hettema, Prescott, & Kendler, 2003). Both anxiety and depressive diag-
noses are also correlated with personality disorders (for a more com-
plete discussion of the implications of this overlap, see McGrath et al.,
1990). Misdiagnosis may account for some of that overlap, and possible
misdiagnosis of PTSD in women who have experienced physical and
sexual abuse, rape, or battering has been of particular concern
(McGrath et al., 1990; Russo & Denious, 2001).
Depressive Disorders
Women’s higher risk for depression compared to men is one of the
most consistent findings in the literature (Kessler, 2006; Weissman
et al., 1996). It is not explained by gender differences in willingness to
report symptoms or help-seeking, but appears to be a genuine effect
that may relate to differences in roles and life stress (Kuehner, 2003;
Mirowsky & Ross, 1995; Nazroo, Edwards, & Brown, 1998).
As the leading cause of disease-related disability among women
around the world (Murray & Lopez, 1996), depression has been consid-
ered to represent such a significant threat to women’s mental health
that the American Psychological Association (APA) established a Presi-
dent’s Task Force to study risk factors and treatment issues in women’s
depression, followed by an APA Summit on Depression (Mazure et al.,
2002). Women and Depression: A Handbook for the Social, Behavioral, and
Biomedical Sciences (Keyes & Goodman, 2006) provides the comprehen-
sive and up-to-date review of research findings.
Depressive disorders are classified along with ‘‘bipolar disorders’’
under the category ‘‘mood disorders’’ in the DSM-IV (American Psy-
chiatric Association, 1994). Key categories recognized in the DSM-IV
for this discussion include subtypes of major depression and dysthymic
disorder, and depressive disorder not otherwise specified (NOS).
Gender differences have not been substantiated for all depressive
subtypes—the gender gap is widest for major depression and dysthy-
mia, but there is no evidence of greater risk for bipolar disorder or sea-
sonal affective disorder (Kessler, McGonagle, Swartz, Blazer, & Nelson,
1993; Kessler et al., 2005). Thus, women’s excess in mood disorder
appears to be largely due to greater risk of unipolar depression.
Sets of symptoms that are persistent are defined as depressive syn-
dromes, some of which have become defined as disorders. It should not
be assumed that depression varies along a single continuum from com-
mon symptoms to major depression. Gender differences are also found
in minor depression (Kessler et al., 1997) or brief recurrent depression
(Angst and Merikangas, 1997).
Depressions differ in kind and severity (American Psychiatric Associ-
ation, 1994). Different depressive syndromes may have different precur-
sors (Hamilton, 1988). Psychological or pharmacological treatments that
Women and Mental Health 455
have been based on clinical trials for major depression may be totally
inappropriate for treatment of depressive symptoms (Weissman &
Myers, 1980; Weissman et al., 1987). Note also that some types of depres-
sion are sex specific, including postpartum depression, perimenopausal
depression, and premenstrual dysphoric disorder. As Kessler (2006)
points out, the extent to which these disorders may contribute to gender
differences in more general types of depression is unknown.
Eating Disorders
Eating disorders are characterized by gross disturbances in eating
behavior. Although anorexia and bulimia nervosa are distinct diagno-
ses, they can be related, and they typically begin in adolescence or
early adulthood. Since 1980, bulimia has been distinguished from ano-
rexia in the DSM (American Psychiatric Association, 1994).
Although eating disorders are uncommon in the general population,
they are comorbid with other disorders and role impairment, and they
are frequently undertreated, perhaps because they are viewed as nor-
mative behavior in some subpopulations. Lifetime prevalence estimates
of DSM-IV anorexia nervosa, bulimia nervosa, and binge-eating disor-
der are 0.9, 1.5, and 3.5 percent, respectively, among women, compared
to 0.3, 0.5, and 2.0 percent among men. Risk of bulimia nervosa and
binge-eating disorder has increased with successive birth cohorts
(Hudson, Hiripi, Pope, & Kessler, 2007).
All three disorders are significantly comorbid with many other
DSM-IV disorders, including anxiety, obsessive-compulsive disorder,
Women and Mental Health 457
Measurement Issues
The accuracy of prevalence estimates for eating disorders has been
subject to debate. Estimates vary considerably, depending on the crite-
ria used for diagnosis. Assessing bulimia is especially problematic, as
researchers have not agreed on definitions for such central concepts as
what constitutes a binge (e.g., number of calories versus duration of
eating) or how to document frequency of binging and purging. Com-
pounding these difficulties are the reluctance of many bulimic women
to report their behaviors and the inaccuracy of self-report measures.
Again, distinctions between symptoms and disorders need to be
made. In a discussion of methodological issues in bulimia treatment
outcome research, Wilson (1987) argues that change in bulimic behav-
ior alone is insufficient for evaluating improvement; changes in body
image disturbance, feelings of self-efficacy, nutrition, and eating pat-
terns must also be assessed. Research has provided some evidence that
there are differences in pathology associated with increasing severity of
the eating disorders (Mintz & Betz, 1988; Striegel-Moore et al., 1986).
Research is needed that continues to address these definitional, diag-
nostic, and treatment issues, including the relationship of disordered
eating to specific classes of stressful live events, such as sexual abuse
and assault (Root, 1991).
There are class as well as gender differences in eating disorders,
which typically involve women who are young, middle or upper class,
and white. Some researchers have even gone so far as to call eating dis-
orders a ‘‘culture-bound’’ syndrome, that is, a syndrome specific to a
458 Psychology of Women
A Stress-and-Coping Perspective
Approaches to understanding women’s excess in psychological dis-
tress and disorder can be placed in four categories:
does it appear promising (McGrath et al., 1990). Thus, they receive lit-
tle attention in this chapter.
A framework that includes both stress and coping provides a useful
interactionist model for conceptualizing the conditions that contribute
to increased risk for such mental disorders for women. A stress-
and-coping framework considers events in context and examines the
interaction of sources of stress, coping resources, coping strategies, and
social support, all of which may involve biological, psychological,
social, or environmental factors (Folkman & Moskowitz, 2004; Taylor &
Stanton, 2007). Although we focus here on proximal life events, it must
be noted that measures that typically assess ‘‘proximal’’ causes of dis-
tress in women’s lives (e.g., life event scales) neglect the ‘‘distal’’ condi-
tions that ‘‘govern the allocation of social and material resources in
relation to gender’’ (Stoppard, 2000, p. 84).
potential for stigma and social exclusion for women, making social
support a coping resource of direct relevance for dealing with the
issues posed by the particular stressor, with resulting physiological
benefits. Methods that assess number and quality of events are impor-
tant. For example, a higher number of events associated with humilia-
tion, entrapment, and bereavement has been found to contribute to
increased risk for depression in women (Fullilove, 2002). Also, sexism,
racism, and heterosexism appear to function as chronic stressors in
which cognitive appraisals mediate the relationship between perceived
discrimination and outcomes of discrimination-related stress (Klonoff
& Landrine, 1995; Meyer, 2003)
These findings support the work of Hobfoll (1986), who has pro-
posed a model of ecological congruence to predict the effectiveness of
specific resources in buffering the effects of stressful life events. In
Hobfoll’s model, resource effectiveness is situation dependent and is
related to personal and cultural values, time since the event, and stage
in the individual’s development, among other things.
Lazarus and Folkman (1984) also considered the fit between coping
resources and situational demands, but their work had a greater focus
on cognitive resources than Hobfoll’s model. Because stress and coping
are situation specific, study of specific types of events is needed to
assess matching stressful event, resource, and situation. This model sug-
gests that lack of congruence among gender-related attributes, attitudes,
and values of the person, the meanings of the coping responses (to the
person as well as the person’s reference groups), and the expected con-
sequences and meaning of coping processes may contribute to
increased risk of psychopathology in women (Taylor & Stanton, 2007).
Developmental Issues
The female excess in psychopathology begins to appear in adoles-
cence and changes developmentally in complex ways (Kessler, 2006;
Nolen-Hoeksema & Girgus, 1994). Given that adolescence and young
adulthood are major formative periods in the development of adult
gender-role identities, adolescence is a particularly interesting develop-
mental period for research on the origins of women’s excess in psycho-
pathology. In conceptualizing causal dynamics in the development of
gender differences in psychopathology, it is important to recognize that
personal attributes such as mastery, perceived control, and self-esteem
may be both a cause and a consequence of stressful life events. Further,
in additional to being stressful, adverse events, such as intimate vio-
lence, may undermine women’s access to important psychological,
social, and economic coping resources by interfering with their ability
to become educated and gain employment (Koss, Bailey, Yuan, Herrera,
& Lichter, 2003; Penze, Heim, & Nemeroff, 2006).
Measurement Issues
Kessler and McLeod (1985), and Taylor and Stanton (2007) discuss
methodological and conceptual issues in research on life events, life
stress, and life crises. Both longitudinal and experimental research
designs that are based on transactional models will be needed for
causal dynamics to be more fully understood. Even then, mental health
problems themselves can also be both a cause and a consequence of
gender-related stressful life events such as unwanted pregnancy, mari-
tal disruption, job loss, and stigma, prejudice, and discrimination.
Women and Mental Health 465
infant and was thus predicted to have longer-term effects than the
other three groups. Indeed, although there was no significant difference
in depression among the groups at the initial time, the group-by-time
interaction effect was significant. The spontaneous abortion and cesarean-
section acute-stress groups decreased more on depression than the pre-
term chronic stress or the normal delivery (considered baseline stress)
groups. This points to the importance of separating acute from chronic
sources of stress involved with reproductive-related events.
High self-esteem was found to be a personal resource associated
with lower depressive symptomatology at both times of measurement
for all groups. Intimacy with spouse was associated with lowered
symptomatology at the time of the event, but not later. Hobfoll and
Leiberman suggest that high self-esteem is a transituational personal
resource always available for women having it, while spouse support
was viewed as dependent on situational demands and constraints.
Postpartum illness may resemble several major categories of psychiat-
ric disorder, including depression, mania, delirium, organic syndromes,
and schizophrenia. ‘‘Baby blues’’ (i.e., mild postpartum dysphoria) is
distinguished from severe postpartum depression by the severity and
frequency of symptoms, timing of the course of the disorder, and epide-
miology. The illness, which is reported in between 39 percent and 85 per-
cent of women, occurs about the third or fourth day after delivery and
lasts from a day or two up to as much as two weeks. Severe postpartum
depression occurs in about 10 percent of women, may occur from six
weeks to four months after delivery, and can last from six months to a
year (Hamilton et al., 1988a; O’Hara, Zekowski, Phillips, & Wright, 1990).
Stern and Kruckman (1983) conducted a cross-cultural study of post-
partum depression that supports the conception of postpartum depres-
sion as socially constructed. They suggest that postpartum depression
in the United States may reflect a lack of social support for the wom-
en’s transition to her motherhood role and a lack of social structuring
during the postpartum period.
Whiffen (1988) also reported that mothers’ perceptions of their
infants as ‘‘difficult’’ were positively correlated with depression. Such
perceptions may be a result of depressed mood. However, research is
needed to assess whether mothers who are prone to depression are
more likely to have infants who cry more and are more temperamental,
thus creating a source of stress that results in depressive symptomatol-
ogy. Perceiving the infant as difficult was most strongly related to
depression if the mother had expressed optimistic expectations about
the child’s behavior before birth. Lack of congruence between expec-
tancies and outcomes may be particularly stressful for new mothers.
Researchers have linked postpartum depression to stress brought on by
the transition to a motherhood role (O’Hara et al., 1984), but the extent
to which unwanted pregnancy underlies these findings is unknown.
Women and Mental Health 467
SEXUALIZED OBJECTIFICATION
There has been a great deal of theoretical (Burnett, Baylis, & Hamil-
ton, 1994; Frederickson & Roberts, 1997), methodological (McKinley,
1996; McKinley & Hyde, 1996), and substantive work that has found
objectification, particularly sexualized objectification, to be a powerful
influence on women’s thoughts, feelings, and behaviors in Western cul-
ture (Klonoff & Landrine, 1995; Landrine, Klonoff, Gibbs, Manning, &
Lund, 1995; Landrine & Klonoff, 1997; Klonoff, Landrine, & Campbell,
2000). The body dissatisfaction and shame that can result from objecti-
fied body consciousness in a culture in which women’s bodies play a
central role in defining their worth and in which one ‘‘can never be too
rich or too thin’’ have profound mental health implications (Joiner,
Schmidt, & Wonderlich, 1997; Lin & Kulik, 2002; Denious et al., 2004;
Tiggemann & Kuring, 2004). The sexualized objectification of girls, in
particular, has become widely recognized as linked to a host of nega-
tive psychological, social, and behavioral outcomes (American Psycho-
logical Association, 2007).
Congruent with findings from Landrine et al. (1995), one study
found the most important contributors to the effect of frequency of
objectification experiences were being called degrading, gender-
stereotyped names and being the target of offensive (sexualized) ges-
tures. However, externalized self-perceptions (e.g., ‘‘I tend to judge myself
by how I think other people see me’’) moderated this relationship. Taken
470 Psychology of Women
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Women and Mental Health 483
Several years ago, an article appeared in the popular press about the
viability of creating a ‘‘women’s Viagra,’’ that is, a drug that would
enhance women’s sexual ‘‘performance’’ in the same way that Viagra
improves penile functioning (i.e., sustained erection) and thus perform-
ance for men. An accompanying illustration highlighted the difficulty
of the scientific task by portraying the differences between men’s and
women’s sexual response using light switches as an analogy: Men’s
response was presented as a simple toggle switch with on and off posi-
tions, whereas women’s response was illustrated as an entire light-
board with multiple switches, dimmers, color codings, and
complicated circuitry extending in all directions. Begging the question
of whether this illustration accurately represents actual differences in
men’s and women’s sexual response, we would contend that it prob-
ably does capture important aspects of the study of sexuality—that is,
an implicit belief that proper wiring leads to predictable response, con-
fidence that understanding the wiring allows the switch to be fixed so
it works correctly, utter bafflement about why women’s circuitry is so
mysterious and convoluted (i.e., different from men’s), and preoccupa-
tion with the properties and functionality of each individual wire.
These kinds of assumptive underpinnings in sexuality research have
led to a focus on women’s sexuality as homogenous and problematic
(particularly as it interferes with men’s access and pleasure), almost
exclusive attention to biological and physiological aspects of women’s
sexual functioning, disregard of contextual factors and individual dif-
ferences in sexual behavior and response, and the virtual invisibility of
Diverse Women’s Sexualities 485
HETEROPATRIARCHAL CONSTRUCTIONS OF
WOMEN’S SEXUALITY
Perhaps the manifestation of the sexological model that is most dele-
terious to women is the foregrounding of (heterosexual) men’s sexual
experience. This phallocentric conceptualization of sexuality privileges
Diverse Women’s Sexualities 489
suspicion arises that what 85% of heterosexual married couples are doing
more than once a month, and what 47% of lesbian couples are doing less
than once a month are not the same thing.
needs and are more likely than men to experience, guilt, fear, and anxi-
ety about sexual activity (Gilbert & Scher, 1999). Women’s erotic and
romantic fantasies are expected to have males as targets. Attractions to
or sexual encounters with other women are acceptable only as sexual
‘‘turn-ons’’ for men. And, of course, a woman’s sexual attractiveness is
to be flaunted only enough to attract a male or to shore up that male’s
virile image to others, lest she be viewed as sexually loose or overly
available, leaving her a very fine line to walk.
Female sexuality that exists in the absence of a male is either invisi-
ble or dangerous. Thus, for sexual minority (e.g., lesbian, bisexual)
women, most if not all of their sexual lives are cast as incomprehensi-
ble, unpleasant, immoral, and even criminal. Brown (2000) has pointed
out that a chief reason lesbians are threatening is because their very ex-
istence debunks the myth that women are not sexual—the act of claim-
ing a lesbian identity means declaring oneself as a person to whom a
sexual life and erotic preferences matter. Moreover, in addition to pub-
licly claiming that they are sexual beings, self-identified lesbian and
bisexual women also expose the fallacy that men are the only viable
path for meeting women’s sexual and relational needs. Combined with
the popular myth that sexual minority women (and men) seek to
recruit others into sexually deviant lifestyles, it is little wonder that
such women are perceived as threatening, especially by heterosexual
men.
This leads to a third problem with the heteropatriarchal approach to
sexuality: strict heterosexuality is viewed as normative, and deviations
from this expectation force public declaration, categorization and label-
ing, scrutiny, and continual defending. Nonheterosexual orientations
are rigidly categorized into a small, manageable number (with consid-
erable resistance to expanding the categories), and congruence across
all aspects of the erotic (e.g., desire, fantasy, behavior, attraction,
self-labeling) within each category is presumed. The act of claiming a
non-normative sexuality in a dominant discourse of ‘‘compulsory heter-
osexuality’’ (Rich, 1994) compels the individual to declare her (or his)
nonconformance, thereby making sexuality a public (vs. private) issue.
This helps to explain why ‘‘coming out’’ is viewed as such a prominent
developmental event for sexual minority individuals, and why it has
been privileged in gay-affirmative discourse as the ultimate indicator of
mature and comfortable acceptance of deviance (see McCarn & Fas-
singer, 1996, for a critique of this notion; also see Herek & Garnets,
2007). The need for public declaration of sexual nonconformity also dic-
tates that the biological sex of the partner will be privileged as the sin-
gle dimension that defines sexual orientation. This conflation of erotic,
gender expression, and role preferences into one variable—the biologi-
cal sex of the preferred partner—is especially constraining for women,
who, as we have noted, report a broader sexual experience.
492 Psychology of Women
to construct a sexual self, and society makes clear which is the ‘‘appro-
priate’’ choice. Any sexual activity apart from men and reproductive
goals is viewed as suspect and problematic in some way, and gendered
contradictions abound (e.g., young men are supposed to gain sexual
experience, girls are not; men are supposed to be sexually aggressive,
women are not; men are supposed to enjoy sex, women are not,
except—perhaps—in the confines of marriage). Research has docu-
mented many examples of this double standard of sexual behavior;
young women are judged more negatively than men, for instance,
when they provide a condom for protection or engage in sexual activ-
ity outside of a committed relationship (Hynie, Lydon, & Taradash,
1997). Women are permitted to experience desire only in certain cir-
cumstances, and only in certain acceptable ways. They are expected to
demonstrate ambivalence and control over sexual activity; women
(and, increasingly, girls) must be ‘‘sexy’’ but not ‘‘sexual.’’ It is women
who carry the burden of preventing pregnancy, as men are viewed as
having unbridled urges that women must monitor.
The sad irony of these social prohibitions against sexual activity in
young women is that these very same women are also at high risk for
sexual abuse and exploitation. Moreover, given that much abuse is per-
petrated within families, young women receive confusing messages
about men, power, family, marriage, and personal safety—messages
that render them helpless, uncertain, and unable to develop healthy,
assertive ways of enacting sexual desires and needs (see also chapters
7, 8, 16, and 17 in this volume). In addition, female sexual scripts per-
meate the mass media and are adopted by girls of increasingly young
ages. Not only does this sexualization of girls have a negative influence
on their ability to develop healthy sexual self-images and self-protec-
tive sexual behaviors, but it also has been linked to increased rates of
eating disorders, depression, anxiety, poor body image, and low self-
esteem (American Psychological Association, 2007).
It is important to note that many subcultures exist within the United
States, as do culturally specific dictates about sexuality, some of which
exaggerate even further the roles of women, men, and heterosexuality.
These cultural influences may include religious, socioeconomic, racial,
or ethnic norms (e.g., machismo, marianismo, silence about sexuality,
clitoral mutilation, etc.). It might also be noted that, while there are eth-
nic group–specific stereotypes of women, most of these also fall into
groupings that are either undersexualized or oversexualized. For exam-
ple, Latinas have been portrayed as either sensuous or virtuous in pop-
ular media, and African American women have been presented
according to ‘‘Mammy’’ and ‘‘Jezebel’’ images (Reid & Bing, 2000).
Older women and women with disabilities typically are portrayed as
asexual beings, when allowed to be visible at all (Crawford & Ostrove,
2003).
Diverse Women’s Sexualities 495
responsibility for preventing the spread of HPV solely on girls, and the
fervor with which this particular form of regulation of female sexuality
is being pursued is perhaps not surprising given the sex-negative cli-
mate in the United States at present. Indeed, one writer observed:
‘‘Never has compulsory use of a drug been pushed with such break-
neck speed . . . advanced largely through political and legislative chan-
nels instead of medical authorities and public education campaigns.’’
Similarly, the well-documented reluctance of men to use condoms
means that women bear the burden of preventing pregnancy as well as
sexually transmitted infection. A recent exploratory analysis of relation-
ships and sexual scripts among African American women illuminated
the ‘‘catch-22’’ that these women experience related to safer-sex behav-
iors. The researchers found two sexual scripts broadly endorsed by
their participants: men control sex; and women want to use condoms
but men control condom use (Bowleg, Lucas, & Tschann, 2004).
Clearly, the dangers of illness and unwanted pregnancy for women
are real (e.g., heterosexual women represent the proportionally largest
increase in HIV infections in recent years; Landrine & Klonoff, 2001),
and studies of menopausal women indicate increased sexual enjoy-
ment, which has been linked to a lack of pregnancy fears (Etaugh &
Bridges, 2001). While encouraging women and girls to protect them-
selves is important work for psychologists, it is imperative that men
take more responsibility for their sexual behaviors.
The medicalization of women’s sexuality often also seems to be
organized around attending to the (imagined) needs of the (imagined)
male partner. For example, ‘‘laser vaginal rejuvenation’’—that is, surgi-
cal procedures focused on reconstructing the hymen, tightening the va-
gina, and altering the appearance of the labia to look more attractive—
are touted as a way of enhancing women’s sexual pleasure (Boodman,
2007), but it seems clear that pleasing men is the actual goal of such
procedures, as they are not connected to any known paths to sexual
arousal for women. As another example of the medicalization of sex-
uality organized around male pleasure, the physical changes associated
with menopause (e.g., vaginal dryness) are publicly bemoaned and
widely medically treated, but most women report little or no change in
subjective arousal (Etaugh & Bridges, 2001), making clear that it is
men’s presumed needs that are being served by easier access to
women. Moreover, lesbians as a group appear to be less concerned
about menopause than heterosexual-identified women, perhaps due, in
part, to less body-image concern and less self-definition based on
mother and spouse roles (see Rothblum, 1994), suggesting more varied
responses to this developmental milestone than simple physiological
changes would imply (see also chapter 9).
In a socially and professionally endorsed system of ideologies that
so severely constrains women’s sexualities, any behavior or expressed
498 Psychology of Women
desire that strays from the social script for women will seem question-
able at best and wildly deviant at worst. As noted previously, much of
the existing study of women’s sexuality is organized around categoriz-
ing behaviors, attractions, responses, and identities as ‘‘normal’’ or
‘‘abnormal.’’ Traditionally, a heteropatriarchal standard has been used
for defining which aspects of sexuality are ‘‘normal’’—most specifi-
cally, a heterosexual identity prizing a narrow range of behaviors cul-
minating in vaginal intercourse between monogamously coupled
(ideally, married) other-sex partners. Many other aspects of sexuality
(e.g., masturbation, sexual dominance, polyamory, pornography, para-
philias) are rendered marginal through silence and invisibility or
through active proscription, although it is worth noting that increased
access to technology, particularly the Internet, has provided a virtual
space in which individuals engaging in marginalized behaviors or
occupying marginalized statuses can interact. An exhaustive discussion
of ‘‘fringe’’ sexual practices is beyond the scope of this chapter; more-
over, the very fact that these aspects of sexuality are relegated to the
margins means that limited empirical or even anecdotal information is
available about their role in women’s sexual lives. However, we note
here the example of masturbation as a sexual behavior unfortunately
relegated to marginalization.
Normative sexual scripts dictate that masturbation, while considered
appropriate (indeed necessary) for men, is unacceptable for women.
Studies have shown that reports of frequency of masturbation are sig-
nificantly higher for men than women, and these gender differences
are large and persistent across racial/ethnic groups (Laumann et al.,
1994). What is less clear is whether these reported differences reflect
actual differences in behavior, differences in reporting, or a combina-
tion of both. Cultural differences in messages about masturbation for
women likely exist, and sexual self-stimulation also may serve various
purposes for women. One recent study, for example, found more fre-
quent rates of masturbation among white women than African Ameri-
can women; interestingly, the authors also found a significant
relationship between masturbation frequency and positive body image
among white women, but no such association for African Amercian
women (Shulman & Horne, 2003).
Lesbian-identified women have been found to report more fre-
quent masturbation than heterosexual-identified women, and one
recent study found that heterosexual women were significantly less
likely than lesbians to report ever having masturbated (5% vs. 32%;
Matthews, Hughes, & Tartaro, 2005). These findings are difficult to
interpret given the stigma surrounding female masturbation, particu-
larly for heterosexual women, whose sole source of sexual pleasure
is expected to reside in a human penis; thus, these findings may
simply represent greater acceptance of masturbation among lesbians
Diverse Women’s Sexualities 499
Note
1. Although we make an argument here for the use of the term diverse
women’s sexualities to more accurately capture the experiences under considera-
tion in this chapter, we will use the more traditional terminology when refer-
encing traditional views found in the literature.
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504 Psychology of Women
Victimization of Women
Chapter 16
Men rape. This is Fact One, and no discussion of sexual assault should dis-
tract us from this reality. Historically, men have always denied and evaded
Fact One. That is Fact Two, and no discussion of the causes of sexual
assault should deflect us from this responsibility. Recognition of reality and
acknowledgment of responsibility can come with great difficulty to most
men. Evasions, denials, and defensiveness, however, miss the point and sim-
ply will no longer suffice.
—Charlie Jones
against Women now defines sexual assault as ‘‘any type of sexual con-
tact or behavior that occurs without the explicit consent of the recipient
of the unwanted sexual activity.’’ Its definition includes vaginal or oral
penetration with any object, forced oral sex, or forced masturbation.
This general definition of rape is reflected in many state laws.
Although there is significant variation among state rape laws, most
states include a description of physical acts such as oral, anal, and vag-
inal penetration. Most states also include circumstances when victims
cannot consent, such as when a person is unconscious, drugged, devel-
opmentally disabled, or mentally ill.
California has a particularly detailed and inclusive definition of rape.
According to a series of penal codes, rape is an act of sexual intercourse
that occurs against a person’s will under any of the following conditions:
by means of threat or force, when a person is intoxicated and cannot
resist, when a person is unconscious of the nature of the act (e.g., asleep,
the act was misrepresented), through the threat of future retaliation, or
through the threat of official action (e.g., incarceration, deportation)
(California penal codes 261, 262). Similar codes restrict unwanted oral
copulation (penal code 288a) and penetration by an object (penal code
289). In each case, any sexual act that was not fully consented to is
included in the definition. According to subsection 261.6, a person must
voluntarily and actively cooperate in the sexual act—if a person has not
consented in word and deed, it may be considered rape.
The way rape is defined affects prevalence rates. Definitional and
methodological differences may contribute to this variation (Koss, 1992).
Some studies rely exclusively on legal definitions of rape, but legal defi-
nitions are relatively narrow and may not fit women’s experiences
(Rozee, 2005). The terminology used in prevalence surveys can also
result in varying rates. Studies that define rape in behavioral terms (e.g.,
‘‘Have you ever been forced to have sex against your will?’’) find higher
rates than studies that use the word rape (Rozee & Koss, 2001). Screening
criteria, too, can affect prevalence rates. Studies differ in the time frame
about which they inquire. Some studies focus only on adult rapes
(versus lifetime), but the way adulthood is defined still differs from
study to study (e.g., 14 and over, 16 and over, 18 and over). The scope
of the survey also makes a difference. Some studies focus exclusively on
rape, while others combine rape, attempted rape, and sexual assault.
Finally, recruitment strategies can affect prevalence rates. Rape has one
of the lowest reporting rates for any violent crime (Kilpatrick, Edmunds,
& Seymour, 1992; Rozee & Koss, 2001), so studies that rely exclusively
on police reports have much lower estimates. As a result of these varia-
tions, there is great controversy about how to best assess prevalence
(DeKeseredy & Schwartz, 2001; Kilpatrick, 2004; Koss, 1996).
To obtain an understanding of how common rape is, it is therefore
necessary to look at the findings of multiple studies. Among the most
512 Psychology of Women
CAUSES OF RAPE
There are several theorized explanations for why rape occurs. Femi-
nist theories tend to focus at the macro level, examining the contribution
514 Psychology of Women
Feminist Theory
Feminist theory tends to rely on sociocultural explanations of sexu-
ally aggressive behavior. It draws on the larger cultural milieu as an
explanation for the behavior of individuals. In its most basic formula-
tion, feminist theory considers rape to be an element of oppression in a
male-controlled hierarchical structure (see, for example, Brownmiller,
1975; Griffin, 1979; Russell, 1984; Stanko, 1985). Bringing a critical eye
to the structure of society, feminist conceptualizations examine social
norms, beliefs, and practices that promote and normalize rape.
Feminist theory begins with the premise that rape is not natural or
inevitable in the realm of human sexual behavior. Sanday (1981) con-
ducted a study of a range of societies and concluded that there were
cultures that were more and less rape-prone. There were even some
cultures that were considered to be rape-free. If it is possible to have
cultures without rape, this suggests that cultures have a role in regulat-
ing rape, and that sexual practices that support rape are learned, not
simply instinctive responses.
Following from this premise, feminist scholars have focused on a
number of learned cultural beliefs and practices that enable rape to
occur. One such belief is that women should be passive and depen-
dent, while men should be dominant and in control. Men learn elements
of the masculine role throughout their lives in the context of social
interactions and through social learning (Bandura, 1979; Bandura,
Ross & Ross, 1961). The stereotypical masculine gender-role includes
the qualities of being forceful, powerful, tough, callous, competitive,
and dominant. Males are also discouraged from showing vulnerability.
Such gender-roles often simultaneously disempower women while
teaching men that the world is theirs for the taking.
These gender-roles then intersect with sexual scripts that dictate a
passive sexual role for women and a dominant one for men. Women
are taught to attract men; men are taught to pursue women. Such
beliefs are often reinforced by peers who share similar beliefs about vi-
olence, hostility toward women, and patriarchy (Schwartz & DeKeser-
edy, 1997). In fact, sexual violence often becomes normalized in groups
where women are viewed as objects to be sexually conquered (Koss &
Understanding and Preventing Rape 515
Dinero, 1988; Martin & Hummer, 1989). This may be particularly likely
in fraternities and athletic teams that promote hostility and degrading
treatment of women (Humphrey & Kahn, 2000).
Several empirical studies have found that members of fraternities
tend to have attitudes that are associated with sexual aggression. For
example, they are likely to have traditional attitudes toward women, to
endorse sexual promiscuity, and to believe in male dominance and in
rape myths (Koss & Dinero, 1988; Martin & Hummer, 1989; Sanday,
1981). Fraternities may actively create, or simply not challenge, hostile
attitudes within their membership.
In a recent study, Bleecker and Murnen (2005) surveyed men who
were and men who were not affiliated with fraternities on a college
campus. They also analyzed the images of women displayed in the col-
lege dormitory rooms of both groups of men. They found that frater-
nity men had more images of women displayed, and these images
were rated by an independent group of college women as more
degrading than the images of women in the rooms of nonfraternity
men. Fraternity men were also more likely to endorse rape myths.
Regardless of where such scripts are learned or how they are rein-
forced, sexual scripts often lead men to a view of sex as a commodity
that women withhold at will, leading some men to pursue sex even
when a woman says no. This is particularly true when male dominance
translates to a sense of male entitlement. If a man believes that sexual
access to a woman’s body is a right, rape is a justifiable response to a
woman who is withholding what is rightfully his (Herman, 1989). Sex-
ual scripts are also related to the belief that sex is a form of exchange
between men and women (Herman, 1989). Men expect that they will
receive sexual rewards for providing affection and gifts. According to
this script, the man who buys dinner for his date feels he has a right to
sex, even if it is by force (Goodchilds & Zellman, 1984). Such sexual
scripts can easily lead to rape. They can also make it difficult for both
men and women to distinguish coerced sex from noncoerced sex
because our understanding of sexuality includes male dominance even
in ‘‘romantic’’ interactions (Gavey, 2005).
This difficulty in identifying rape also results from prevailing rape
myths that our society continues to hold about what types of assaults
‘‘qualify’’ as rape and who should be held responsible for assaults that
occur. Some of these myths have to do with the narrow definition of
rape. These myths suggest that rape occurs only between strangers
(Ward, 1995). In fact, feminists have suggested that our society holds a
script about what constitutes ‘‘real rape’’ that includes the image of a
stranger conducting a surprise attack at night with a weapon (Estrich,
1987). As a culture, this image of rape is so consistently understood by
both men and women that it keeps women from reporting forced sex
perpetrated by someone they know since they are not sure it is ‘‘real’’
516 Psychology of Women
rape. This script also protects men from acknowledging that unwanted
sex with an acquaintance is rape. An acquaintance rapist believes that
he could not have raped since he is not a stranger to the victim (Gavey,
2005; Herman, 1989).
Other rape myths are based on inaccurate stereotypes or assump-
tions that allow men and women to avoid the truth that forced sex is
actually rape. These myths place the responsibility for fending off
assaults on the women. Rape myths dictate that all women can prevent
rape by keeping away from dangerous situations. Her action or inac-
tion has led to the rape. Observers might ask, ‘‘Why was she out so
late at night?’’ or ‘‘Why did she let him into her apartment?’’ (Medea &
Thompson, 1974; Ward, 1995). Essentially, the myth is that women are
responsible for their own rape, since men cannot be expected to control
themselves (Donat & White, 2000; Herman, 1989). Rape myths allow
men to ignore their coercive behavior, and they demand that women
blame themselves for their own victimization.
Burt (1980) found that men and women who believe that there is a
naturally adversarial relationship between males and females are more
accepting of rape myths. Importantly, males who believe in rape myths
are more likely to be sexually coercive and to report that they have
committed rape than men who do not believe in rape myths. Lonsway
and Fitzgerald (1995) also found that men with more hostility toward
women are more likely to accept rape myths.
Our culture also enables rape through the objectification of women.
Women are consistently portrayed as sexual objects in the media. Such
depictions dehumanize women and promote the idea that they are less
intelligent and less powerful in society (MacKinnon, 1987). This is par-
ticularly likely in pornography. Many pornographic depictions portray
reward or minimal punishment for engaging in sexual aggression.
When exposed to these contingencies, men learn that women enjoy
rape, that men will find sexual assault pleasurable, and that rape is an
appropriate way to sexually relate to women. Exposure to these depic-
tions has been found to lead to more hostile attitudes toward women,
more rape myth acceptance, and more behavioral aggression in both
experimental and correlational studies (Allen, Emmers, Gebhardt, &
Giery, 1995; Allen, D’Alessio, & Brezgel, 1995; Linz, Donnerstein, &
Penrod, 1984; Malamuth, Addison, & Koss, 2000).
These cultural supports for rape serve a political function. Ruth
(1980) describes rape as ‘‘an act of political terror’’ meant to keep
women in their place (p. 269). By perpetuating a system in which all
men keep all women in a state of fear, rape is a tool that maintains in-
equality by creating fear of this specific form of assault, which influen-
ces women’s mobility and freedom in daily life (Gordon & Riger, 1989;
Rozee, 2003). As a result of the pernicious effects of rape fear, women
seek protection from some men against the risk of abuse by other men.
Understanding and Preventing Rape 517
Evolutionary Theory
Evolutionary theorists have described rape as an evolutionarily
adaptive approach for mating (see, for example, Buss, 1994; Shields &
Shields, 1983; Symons, 1979; Thornhill & Palmer, 2000; Thornhill &
Thornhill, 1983). The premise of the theory is that women and men
have evolved gender-differentiated adaptations in response to different
biological structures and constraints in reproduction. For females, the
most adaptive approach to mating is to have fewer, high-quality part-
ners who can provide resources to assist in the care of offspring. In
pursuing access to females, males can potentially utilize several strat-
egies, including honest courtship, deceptive courtship, and forced sex.
Forced sex is only employed when the conditions are beneficial to
men—that is, when they cannot achieve sexual access using other strat-
egies (perhaps because of low status or poor genetic quality) or when
they perceive the potential risks (e.g., likelihood of punishment) to be
low relative to the potential benefit of successful mating.
Because the evidence needed to support these theories about the ev-
olutionary origin and primary motivation and purpose of rape is not
readily accessible to researchers, theorists in this area have developed
research predictions concerning specific aspects of sexual aggression.
For example, Thornhill and Thornhill (1983) suggested that men with
low status (and presumably less access to resources considered desira-
ble by women) would be more likely to rape than men of high status.
Vaughan (2001, 2003) tested this prediction utilizing data from the
British Prison Service, Law Reports, and Probation Probation Service
about reported rapes. She found that there were fewer high-status than
low-status offenders. In further analysis of the types of rape commit-
ted, she found that low-status men were more likely to rape strangers
than high-status men, and that high-status men were more likely to
rape partners and step-relatives than low-status men. However, as
Vaughn points out, high-status men may be more likely to avoid prose-
cution and conviction than low-status men. In addition, the operational
definition of status used in the study was occupation. This may be an
oversimplified approach to categorizing resources and may be quite
unrelated to the meaning of status in the early evolutionary
Understanding and Preventing Rape 521
Posttraumatic Stress
Sexual or physical assaults are the strongest predictors of posttrau-
matic stress disorder (PTSD)—more than other traumatic events such as
natural disaster, serious accidents or injuries, witnessing homicide, or
tragic death of a close friend or family member (Resnick et al., 1993).
PTSD is one of the most common effects of rape. It is characterized by
reexperiencing symptoms (such as distress caused by recurrent thoughts
or dreams of the rape), avoidance symptoms (such as efforts to avoid
anything associated with the rape or emotional numbing), and arousal
symptoms (such as hypervigilance, sleeping problems, or irritability).
Researchers have assessed the intensity and longevity of PTSD
symptoms on rape survivors and have found that, although symptoms
are most severe immediately after the rape, many women still have
PTSD symptoms even many years postassault. As many as 78 percent
of survivors have met the criteria for PTSD from two weeks up to a
year after the assault (Frazier, Conlon, & Glaser, 2001). Even several
years later, more than a third of survivors still met the criteria for
PTSD (Ullman & Brecklin, 2002a, 2002b, 2003) and report an average of
five current PTSD symptoms; reexperiencing the rape was the most
commonly reported symptom (Frazier, Steward, & Mortensen, 2004).
Sleep problems are a frequent symptom reported by rape survivors.
Poor sleep quality has been linked to PTSD symptom severity and has a
profound impact on daytime dysfunction and fatigue (Krakow et al.,
2001). Nightmare frequency has been linked to anxiety and depression
for survivors with PTSD (Krakow et al., 2002). Other stressors appear to
exacerbate PTSD symptoms in rape survivors. PTSD symptoms are ele-
vated among rape survivors who get pregnant, have an abortion, or test
positive for HIV. PTSD is also related to suicidal ideation, engaging in
self-hurting behaviors, and engaging in dangerous sexual behaviors
(Green, Krupnick, Stockton, & Goodman, 2005). Survivors with PTSD
also appear to have higher rates of drinking problems, related in part to
higher tension reduction expectancies and thinking that drinking could
help them cope (Ullman, Filipas, Townsend, & Starzynski, 2006).
The mental processes survivors experience in order to understand
their rape can have a substantial impact on how they cope. Some cogni-
tions increase PTSD symptom severity, including cognitive processing
style during the assault, appraisal of assault-related symptoms, negative
beliefs about the self and the world, and maladaptive control strategies
(Dunmore, Clark, & Ehlers, 2001). Reexperiencing rape also affects PTSD
Understanding and Preventing Rape 523
severity. Women who have more than one traumatic life event, includ-
ing rape, have higher rates of PTSD (Ullman & Brecklin, 2002b).
Self-Blame
Studies on rape survivors’ self-blame have been growing in number.
Survivors often use some form of external or internal blame to under-
stand what they have been through. Survivors can attribute the rape to
external factors, including rapist blame and social blame, or to internal
factors, including perceived controllable aspects of the survivor’s
behavior and uncontrollable aspects of her character.
While early research suggested that behavioral self-blame might
help survivors feel more in control of future rapes (Janoff-Bulman,
1989), most subsequent research has suggested that both behavioral
and characterological self-blame are detrimental to survivors’ health
(Frazier, 1990, 2003). The discrepancy appears to lie with the notion of
future control. While Janoff-Bullman (1989) assumed that blaming your
own behavior would help rape survivors feel in control of future
assaults, Frazier and colleagues (2004) have demonstrated that blame
and control are actually separate constructs. According to Frazier et al.
(2004), many survivors perceive future assaults as preventable or con-
trollable, even if they were not able to control their past assault.
This distinction is important, because it suggests that all forms of self-
blame should be avoided. Interestingly, recent research also suggests
that other forms of blame such as blaming the rapist or blaming society
may also be related to higher levels of emotional distress (Frazier, 2003;
Koss & Figueredo, 2004a). This may be because higher levels of blame
are reflective of rumination and the lack of cognitive resolution.
Depression
The impact of rape on depression can be temporary or long-term.
Rape survivors report higher immediate depression symptoms, and
524 Psychology of Women
still report higher levels up to a year after the rape (Frazier, 2003).
Rape survivors also have significantly elevated rates of suicidal idea-
tion during the first year (Stephenson, Pena-Shaff, & Quirk, 2006). Even
many years postassault, survivors report higher long-term rates of
depression, including lifetime major depression and dysthymia, when
compared to nonvictimized women (Dickinson et al., 1999; Frazier,
Steward, & Mortensen, 2004; Harris & Valentiner, 2002; Kaukinen &
DeMaris, 2005; Ullman and Brecklin, 2002a, 2003). Rape survivors also
report higher levels of suicidal ideation and of attempted suicide at
some point in their life, with a significantly increased risk for lifetime
suicide attempts among women who experienced both childhood and
adulthood sexual assault (Ullman & Brecklin, 2002a).
Social Adjustment
Many aspects of survivors’ lives can be impacted by rape, including
family, friends, and work. Work adjustment was impaired up to eight
months postassault (Letourneau, Resnick, Kilpatrick, Dean, & Saunders,
1996). The literature is limited in findings about other aspects of survi-
vors’ lives. As far as positive life changes, survivors report having
increased empathy, better relationships with family, and greater appreci-
ation of life as soon as two weeks after the assault (Frazier et al., 2001).
Several years afterward, rape survivors report that they have a fairly
high level of support and a moderate level of social conflict, perceived
stress, and conflict in interpersonal relationships (Ullman & Brecklin,
2002b), and social functioning only slightly below that of nonvictims
(Dickinson et al., 1999). Survivors who perceived having more control
over their recovery process had better psychological adjustment and
greater life satisfaction (Frazier, Steward, & Mortensen, 2004). Survivors
of acquaintance rape perceived a larger risk in intimacy when compared
to nonvictims (McEwan, de Man, & Simpson-Housley, 2002, 2005).
Sexual Functioning
The literature shows that the impact of rape on sexual functioning
can be extensive, but the quantity of research in the area is limited.
Survivors report many problems with sexual functioning, primarily
related to sexual avoidance or sexual dysfunction, and as many as
90 percent of survivors report a sexual disorder within the first year of
rape (Faravelli, Giugni, Salvatori, & Ricca, 2004). The absence of sexual
desire is the most reported symptom experienced by survivors, fol-
lowed by sexual aversion (Faravelli et al., 2004).
Rape survivors several years postassault had significantly higher
scores for sexual anxiety and avoidance than nonvictims did (Harris &
Valentiner, 2002). Almost half of survivors eight years after the assault
Understanding and Preventing Rape 525
had low sexual health risk, which included sexual avoidance, sexual
abstinence, fewer sexual partners, increased condom usage, and
decreased alcohol and/or drug usage during sex (Campbell, Sefl, &
Ahrens, 2004). In contrast, one-third of survivors showed patterns of
high sexual health risk, including increased sexual activity frequency,
reduced condom usage, and increased alcohol and/or drug usage dur-
ing sex (Campbell et al., 2004). College rape survivors report higher
rates of sexual dysfunction and dangerous sexual behaviors than others
in their cohort, including irresponsible sexual behaviors, potentially
self-harmful behaviors, or inappropriate usage of sex to accomplish
nonsexual goals (Green et al., 2005).
PHYSICAL HEALTH
Rape survivors have an increased rate of health problems through-
out their lifetime. Survivors report higher levels of somatization and
health anxiety (Stein et al., 2004); more health complaints and higher-
intensity complaints (Conoscenti & McNally, 2006); more frequent vis-
its to health care professionals (Stein et al., 2004; Conoscenti &
McNally, 2006); and multiple sick days (Stein et al., 2004). Forty-three
percent of women who were assaulted in childhood and adulthood
had lifetime contact with health professionals for mental health or sub-
stance abuse problems (Ullman & Brecklin, 2003). Survivors also report
more incidence of headaches, chest pains, overwhelming fatigue (Stein
et al., 2004), chronic medical conditions (Ullman & Brecklin, 2003), pel-
vic pain, painful intercourse, rectal bleeding, vaginal bleeding or
discharge, bladder infection, painful urination (Campbell, Lichty,
Sturza, & Raja, 2006), pregnancy, abortion, HIV testing, and STD infec-
tion (Green et al., 2005).
With higher frequency of mental and physical health problems, rape
survivors have a higher prevalence of taking prescription drugs and
alcohol. Rape survivors use antidepressants, alcohol, sedatives/tran-
quilizers, and other prescription drugs more than nonvictimized
women (Sturza & Campbell, 2005). Survivors with mental health
disorders such as PTSD or depression are as much as 10 times more
likely than nonvictims to use prescription drugs (Sturza & Campbell,
2005).
Despite such high levels of physical health problems, less than a
third of rape survivors have a medical examination or receive medical
care postassault (Monroe, Kinney, Weist, Dafeamekpor, Dantzler, &
Reynolds, 2005; Resnick et al., 2000). Major injuries during rape are
uncommon, with less than half of survivors sustaining injuries; minor
physical injuries, involving cuts, bruises, or soreness, are more com-
mon than serious injuries (Resnick et al., 2000; Ullman et al., 2006).
When survivors do seek medical care, a little more than half inform
526 Psychology of Women
their health care providers about the rape (Resnick et al., 2000). Fear of
having contracted an STD or HIV/AIDS is a major motivator to receive
medical care postassault (Resnick et al., 2000). Most survivors report
having some degree of fear or concern about contracting HIV from the
rape (Resnick et al., 2002). Less than half of postassault medical exams
included testing for gonorrhea, chlamydia, HIV, syphilis, and hepatitis
(Monroe et al., 2005).
While it is clear that rape can have profoundly negative psychologi-
cal and physical health consequences for survivors, the recovery pro-
cess allows many survivors to identify personal or relational strengths
they had not previously recognized. Although a variety of terms are
used to describe this aspect of recovery (e.g., personal growth, positive
change, stress-related growth), the most common term is posttraumatic
growth (Tedeschi & Calhoun, 1996). Posttraumatic growth is said to
occur when victims of traumatic events reassess their lives and adopt
new perspectives in a number of domains, including perceiving new
possibilities, relating better to others, perceiving new personal
strengths, experiencing spiritual change, and experiencing a greater
appreciation of life (Tedeschi & Calhoun, 1996). While posttraumatic
growth can be seen as a positive outcome in its own right, it has also
been linked to higher overall levels of psychological adjustment and
lower levels of distress and depression (Frazier et al., 2001).
It is therefore heartening that rates of positive growth are so high.
Across studies, between 50 and 60 percent of individuals who have
experienced a traumatic event subsequently experience some form of
positive change (Tedeschi & Calhoun, 1996). Women may be particu-
larly likely to experience positive growth after a traumatizing situation
(Park, Cohen, & Murch, 1996; Tedeschi & Calhoun, 1996) and African
American women may be more likely to experience positive changes
than Caucasian women (Kennedy, Davis, & Taylor, 1998). Among rape
victims in particular, Frazier and colleagues (Frazier, Steward, & Mor-
tensen, 2004) examined a number of immediate and long-term predic-
tors of posttraumatic growth. Social support, approach coping,
religious coping, and control over the recovery process were all signifi-
cant predictors of posttraumatic growth two weeks post assault. Fur-
thermore, increases in each of these variables were associated with
increases in posttraumatic growth over time.
Avoidance Coping
Avoidance coping involves efforts to suppress or avoid thinking about
the stressor or one’s emotional reaction to the stressor (Roth & Cohen,
1986). In the case of rape, survivors may engage in a number of avoid-
ance strategies such as keeping busy, isolating themselves, and suppress-
ing thoughts about the assault (Burt & Katz, 1987; Meyer & Taylor, 1986).
There is also a growing body of literature that suggests that many survi-
vors may use drugs or alcohol to help them suppress thoughts and
feelings associated with the assault (Sturza & Campbell, 2005; Miranda,
Meyerson, Long, Marx, & Simpson, 2002). Survivors may also actively
avoid people, places, and activities that remind them of the rape (Feuer,
Nishith, & Resick, 2005). While many survivors may use avoidance
coping strategies periodically, survivors with high levels of self-blame
and survivors who received negative social reactions tend to use avoid-
ance coping more frequently (Littleton & Breitkopf, 2006; Ullman, 1996a).
These efforts to avoid thinking about the rape may initially help sur-
vivors cope with overwhelming emotions (Cohen & Roth, 1987), but
using avoidance coping as a long-term strategy has been shown to be
detrimental to survivors’ recovery (Arata, 1999; Frazier & Burnett,
1994; Frazier, Mortensen, & Steward, 2005; Neville, Heppner, Oh, Span-
ierman, & Clark, 2004; Valentiner, Foa, Riggs, & Gershuny, 1996). This
is particularly true when survivors engage in cognitive avoidance that
prohibits them from integrating or making meaning of the assault (Boe-
schen, Koss, Figueredo, & Coan, 2001; Foa & Riggs, 1995).
Approach Coping
On the opposite end of the spectrum, approach coping involves dealing
directly with a stressor or with one’s emotional reaction to the stressor
(Roth & Cohen, 1986). In the case of rape, the assault itself cannot be
changed, so approach coping involves dealing directly with emotional
responses to the rape and the recovery process itself. Examples of
approach coping include strategies such as help-seeking, cognitive reap-
praisal, and letting one’s emotions out (Burt & Katz, 1987; Meyer & Tay-
lor, 1986). These strategies are consistently found to be beneficial to
survivors’ recovery (Arata, 1999; Arata & Burkhart, 1998; Frazier & Bur-
nett, 1994; Valentiner et al., 1996), particularly when they help survivors
feel in control of the recovery process (Frazier et al., 2005).
HELPING SURVIVORS
While rape survivors’ own coping strategies may help mitigate
harmful outcomes and promote posttraumatic growth, there is a
substantial amount that the larger community can do to assist rape
528 Psychology of Women
Legal System
Between 10 and 40 percent of rape survivors report the assault to the
police (Campbell, Wasco, Ahrens, Sefl, & Barnes, 2001; Filipas & Ullman,
2001; Fisher et al., 2003; Golding et al., 1989; Ullman, 1996a), and very
few of the cases that are reported ever result in jail time (Frazier &
Haney, 1996; Phillips & Brown, 1998). One study of 861 reported rapes
found that only 12 percent resulted in convictions and only 7 percent in a
prison sentence for the convicted rapist (Frazier & Haney, 1996).
Such low rates of sentencing are the result of attrition at each stage
of the legal process (Frazier & Haney, 1996; Lee, Lanvers, & Shaw,
2003). For example, both the patrol officers who respond to the crime
and the detectives who investigate it have been known to question vic-
tims’ credibility (Campbell & Johnson, 1997; Jordan, 2004) and have
even been known to subject survivors to polygraph tests (Sloan, 1995)
despite the fact that false claims of rape are no higher than for any
other felony. These doubts affect the amount of time and effort that
police put into investigating and building a case (Campbell & Johnson,
1997; Jordan, 2004), which may, in turn, affect the likelihood that a case
will be accepted for prosecution. Both the amount of corroborating
evidence (e.g., injuries, witnesses) and the extent to which the case
530 Psychology of Women
Medical System
Less than half of all rape survivors disclose the assault to medical
personnel (Ahrens et al., under review; Filipas & Ullman, 2001; Fisher
et al., 2003; Golding et al., 1989; Ullman, 1996). Survivors who do turn
to medical personnel are typically seeking sexual health-related ser-
vices such as STD screening and treatment, pregnancy tests and pre-
vention, and treatment for external and internal injuries (Osterman,
Barbiaz, & Johnson, 2001; Resnick et al., 2000). Survivors who disclose
the rape are also required to be given a forensic medical exam to col-
lect evidence for prosecution. Forensic evidence collection procedures
typically include the confiscation of survivors’ clothes, a gynecological
exam, documentation of external and internal injuries, swabs of
affected orifices, and collection of specimens from survivors’ hair, nails,
and pubic area (Ledray, 1995). According to the Violence against
Women Act of 1994, these forensic examinations should be free of
charge, but in one study, only a small percentage of women were
aware of this, and more than half were charged for their postassault
medical exam or related medical services (Monroe et al., 2005).
While most survivors who turn to the medical system are expecting
support and assistance, many survivors report feeling retraumatized by
their interaction with medical personnel. In some cases, survivors
appear to be retraumatized by the invasive nature of the forensic
532 Psychology of Women
Rape Resistance
While it is clear that efforts to reduce the prevalence of rape must
ultimately change the beliefs and behavior of potential perpetrators,
the fact that these programs have yet to work highlights the impor-
tance of helping potential victims remain safe. Rape avoidance training
targeted at women would benefit by focusing on:
Preventing Rape
Although prevention programs aimed at changing simple attitudes
about rape have not been effective in reducing rape incidence, feminist
efforts to change sociocultural conditions are still vital to rape reduction.
Continued efforts to challenge traditional gender-roles, sexual scripts,
and rape myths are clearly needed. If anything, the past decade has been
Understanding and Preventing Rape 539
. www.stopviolence.com/domviol/menagainst.htm
. www.mencanstoprape.org/
. www.menendingrape.org/index.htm
. http://menagainstsexualviolence.org/
. www.menstoppingviolence.org/index.php
540 Psychology of Women
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Understanding and Preventing Rape 553
Feminist researchers in the United States and Great Britain in the 1970s
and 1980s began to work with battered women and brought the prob-
lem of women being violently attacked by their husbands or boyfriends
to the forefront of general awareness (Frieze, 2005b). Such work has
had great impact on the public, as there is now widespread under-
standing of and much sympathy for the battered woman (Frieze, 2000).
Comparisons of studies over the last 30 years show decreasing accep-
tance of men who beat or batter their female partners in the United
States (e.g., Felson, 2002; Rothenberg, 2003; Simon, Anderson, Thomp-
son, Crosby, Shelley, & Sacks, 2001; Vandello & Cohen, 2003). There is
also a high awareness that couple violence does exist, as many individ-
uals report personally knowing someone involved in such a relation-
ship (Sorenson & Taylor, 2005).
Since the publication of our chapter ‘‘Research on Battered Women
and Their Assailants’’ (McHugh, Frieze, & Browne, 1993) in the earlier
edition of this volume, extensive changes have occurred in the research
on intimate partner abuse and in our understanding of the phenom-
enon. Approaches to domestic violence have evolved from viewing the
problem as being limited to women in severely violent marriages to
recognizing the prevalence of serious levels of physical violence and
psychological abuse in many types of intimate relationships. Within
the research on partner violence, some topics, such as the prevalence of
556 Psychology of Women
violence against women and the reactions of the victim, have continued
to receive attention. Researchers not only have identified more types of
victims but also have begun to examine patterns and types of conflict
and abuse within intimate relationships, including mutual violence
(McHugh & Frieze, 2006). In this review, we focus on the ways in
which intimate partner violence has been conceptualized, researched,
and treated.
The explosion of research on intimate violence makes it difficult to
summarize the entirety of this literature in a single chapter. Here, we
review this research, looking first at conceptions and measurement of
violence. We examine the research on battered women and male batter-
ers, but we also include recent research on other patterns of violence.
We then examine where we are in our attempts to intervene with vio-
lent partners.
We argue for new conceptualizations of intimate partner conflict,
including more complex conceptualizations of the role of gender in
intimate partner violence, and contend that conceptualizations of inti-
mate partner violence should include the sociocultural context of the
conflict. We also argue for more careful selection of treatment options.
initiate both minor and severe forms of physical violence with the same
frequency as men do.
Strauss (1979) interprets their findings as indicating gender symme-
try, arguing that both sexes engage in equal amounts of violence in
relationships. Others (Browne, 1987; Browne & Dutton, 1990; Dobash,
Dobash, Cavanagh, & Lewis, 1998) have challenged this conclusion.
The interpretation that men and women are equally combative ignores
the physical and economic power disparities between men and women
and fails to consider injury, motive, or consequences of the aggressive
acts (Johnson, 1995). In a study of women arrested for domestic vio-
lence, Hamberger (1997) found that about two-thirds of the arrested
women said they were battered and had used violence to protect them-
selves or to retaliate. Although many of the women acknowledged ini-
tiating violence, they generally did so in the context of a relationship in
which the male partner initiated violence more often and was likely to
have initiated the overall pattern of violence. However, some studies
have found that some women were being arrested for partner violence
that was not a response to prior violence from their partners (e.g.,
Buzawa & Austin, 1993).
Over time, there has been more and more research and clinical evi-
dence that women are sometimes violent toward their intimate part-
ners. For example, in a recent analysis of a national representative
sample, Anderson (2002) found that 10 percent of all couples reported
some type of violence toward each other in the previous year. Looking
at the patterns of violence in more detail, it was noted that in 7 percent
of the couples, both were violent; for 2 percent, only the woman was
violent; and for 1 percent, only the man was violent. This study shows
the same general pattern of more women reporting engaging in violent
acts toward their partner than men seen in results reported by Straus
and his colleagues (1980). Other studies of couples living together show
similar patterns (see a meta-analysis by Archer, 2000).
Williams & Frieze (2005) found similar data, again using a nationally
representative sample of 3,505 men and women in stable couple rela-
tionships. Overall, 18 percent of the sample reported some violence in
their relationship. To address questions raised about whether the vio-
lence was mutual and who was the more violent, the man or the
women, the violence group was divided into mutual and one-sided vio-
lence relationships. About 4 percent of the sample reported that both
they and their partner used severe violence, and 5 percent reported mu-
tual low-level violence. More men than women reported being the tar-
gets of one-sided violence, and more women than men reported being
the violent one in the couple. Recently, other researchers have similarly
documented multiple patterns of mutual violence in heterosexual cou-
ples (Milan, Lewis, Ethier, Kershaw, & Ickovics, 2005; Weston, Temple,
& Marshall, 2005). These data indicating female violence toward
Intimate Partner Violence 561
and the targets of the acts are classified as victims or as battered. Such
labels may not reflect how the person sees him- or herself, however. This
discrepancy between the researcher’s conception of violence and the per-
spective of the research participants is demonstrated in a study of
female employees at a large southeastern university. Women in this
study were asked if they had experienced any of a list of violent actions
(a procedure similar to the CTS). Then, for each of the events they expe-
rienced, they were asked if this was an instance of ‘‘physical abuse’’ and
if they thought of themselves as a ‘‘victim of violence.’’ They were also
asked if they thought of themselves as a ‘‘battered woman.’’ More than
a third of the women did not accept any of these three types of labels
for the acts they had experienced. Others accepted one or more of the
labels, but not all of them (Hamby & Gray-Little, 2000).
Use of the CTS has led to confusion over the mutuality of domestic
violence. The CTS does not distinguish between use of violence and
initiation of violence. Because of this, women defending themselves
against hostile or even deadly attacks would be classified as engaging
in mutual domestic violence, based on CTS scores.
The use of the Conflict Tactics Scale has been criticized by many
researchers (see Frieze, 2005a, or McHugh, 2005, for a fuller discussion
of these issues). The scale does not differentiate initiated violence from
acts of self-defense nor does it assess the seriousness of the injuries
inflicted. The CTS does not allow for consideration of the victims’ abil-
ity to repel or restrain offenders or to retaliate against them. The focus
of the measure is on violent behaviors, but it does not address the
meanings of those actions or the effects of these behaviors (Brush,
1990). For example, a large, strong man might slap a woman and injure
her severely, whereas a small woman might slap a larger man and he
hardly notices it, with no real injury at all. Using the CTS, these two
actions would count equally as violence. Because of this criticism,
Straus has revised his measure, calling it the CTS2 (Straus, Hamby,
Boney-McCoy, & Sugarman, 1996). The CTS2 includes questions about
violent actions, like the original CTS, but adds questions about how
serious ones injuries are. Both the CTS and the CTS2 assume that
couple violence is associated with disagreement and conflict.
Another problem inherent to the CTS is that it includes only a small
number of possible violent behaviors (Marshall, 1994). The severe vio-
lence items included on the CTS are kicking, biting, hitting with a fist,
hitting with an object, beating someone up, and using a knife or gun.
Three items assess ‘‘minor’’ violence: throwing something; pushing,
grabbing, or shoving; and slapping. However, there are many addi-
tional ways in which women have reported being hurt by their part-
ners. For example, the Tolman (1989) Maltreatment of Women Scale
has more than 50 items. To address this limitation in the CTS, many
researchers create new items when they use it.
Intimate Partner Violence 563
Partly as a result of reliance on the CTS, little research has been con-
ducted on the effects of psychological and sexual abuse within intimate
relationships. Psychological abuse has primarily been studied as an
aspect of a physically abusive relationship (e.g., Tolman, 1989; Walker,
1979). There is increasingly an understanding of both the prevalence and
the seriousness of psychological abuse (Chang, 1996; Tolman, 1992).
More than half of women in one study reported emotional abuse as the
reason for their divorce (Cleek & Pearson, 1985), and 27 percent of col-
lege women characterized at least one of their dating relationships as
involving some type of physical aggression (Raymond & Brushi, 1989).
Alternative measures to the CTS have been developed (Feindler,
Rathus, & Silver, 2003; Frieze, 2005b). For example, the Index of Spouse
Abuse (ISA) developed by Hudson and McIntosh (1981) is recom-
mended by Gondolf (1998). The 30 items of the ISA address psychologi-
cal as well as physical abuse. This scale measures only the respondents’
experience of violence by her partner. Instruments like the ISA may be
administered as a follow-up to screening questions about violence. How-
ever, these scales are less likely to be used. Reliance on a single scale,
the CTS, has limited our understanding of intimate partner violence
(McHugh et al., 2005).
There are some limitations of all of these measures. In an effort to
study those who are targets of violence, researchers generally rely on
the self-reports of victims and perpetrators (White & Kowalski, 1991).
This is true of the CTS as well as of most other measures. Such reports
may be suspect, as they are undoubtedly affected by social desirability.
The validity of self-reports is also dependent on the exactness of the
participant’s memory. We are presented with these difficulties any time
we rely on self-reports of behavior to know what people are actually
doing. But, the limitations of self-reports are a special problem in
studying violence and aggression (Yllo & Bograd, 1986).
Another issue is that people reporting on past incidences of physical
aggression may not report accurately. Some forms of violence may not
be recognized as something memorable and are simply forgotten. In
various settings and circumstances, pushing and hitting are not per-
ceived as violence and may be quickly forgotten. Such unrecognized
acts of physical aggression probably occur for much low-level violence
among acquaintances and partners—it is not extreme, and no one is
injured. Additionally, some researchers have investigated acts of hit-
ting, pushing, and wrestling that are experienced as playful aggression
and are not perceived by participants as acts of violence (Ryan and
Mohr, 2005). There is no reason we would tend to remember this hap-
pening, and we would never consider reporting this on a crime victim-
ization survey or to the police or to researchers asking about ‘‘violence’’
directly. However, some of these acts may be recorded as violence
using the CTS.
564 Psychology of Women
Frieze, 2005a; Vega & Malamuth, 2007), and yet this understanding is
rarely raised as a factor in the literature on relationship violence.
INTERVENTION
Psychological interventions for relationship violence are often complex
and difficult, and when ineffective, the results can be dire and even lethal.
Therefore, it is imperative that the clinician addressing this issue possess
both the breadth of knowledge and the finely calibrated expertise neces-
sary to treat such a multidimentional and serious problem. This section
seeks to contribute to the study of intimate violence with a discussion of
interventions, an evaluation of the utility of existing interventions, and
suggestions for improvement. Also, the recent acknowledgment that
females also perpetrate violence in their romantic relationships is a call
for interpersonal violence researchers to develop interventions aimed spe-
cifically at female perpetrators. The following offers some preliminary
suggestions in an effort to move in this direction.
Shelters as Solutions
As a result of research documenting the prevalence and seriousness
of intimate partner violence against women, a national network of shel-
ters for battered women has been established. Over the years, these
agencies have sheltered millions of women from violence. Yet, the shel-
ters cannot accommodate all battered women and may have inadver-
tently limited our attempts to intervene in intimate partner violence. It
has been argued that shelters have led researchers to focus on women
as victims, while at the same time holding women responsible for solv-
ing intimate partner violence (e.g., Krenek, 1998). Krenek (1998) points
out that now police and prosecutors may expect the battered woman to
go to the shelter and to leave the abuser and the domicile. She suggests
that in some localities police punish women who do not leave by arrest-
ing them. Krenek (1998) and Stahly (1996) both ask the same question:
Why should a woman and her children have to leave home to feel safe?
Intimate Partner Violence 571
Lastly, both male and female perpetrators are likely to have common
characteristics that will have serious clinical implications. These include
factors such as motivation to change, resistance, and denial. As stated
previously, only 40–60 percent of male batterers who attend the first ses-
sion of treatment actually complete the full course (Eckhardt et al.,
2004). Some researchers theorize that these high attrition rates are due to
the typical batterer’s lack of motivation to change and denial of respon-
sibility for their behavior (Eckhardt et al., 2004). If many of the female
perpetrators of interpersonal violence also find their way to treatment
via a court order, it is probable that they, too, evidence these characteris-
tics. Since lack of motivation, resistance, and denial will weigh so heav-
ily on the success of treatment, it is imperative that such issues be
addressed at the outset of therapy, for both men as well as women.
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Chapter 18
setting, men use a form of more direct violence against women than
with workplace sexual harassment, but the motivation is similar: to
keep women in their place and under the control of men.
We propose that there are several parallels between sexual harass-
ment and domestic violence. In both cases, the primary perpetrators
are male, and the majority of victims are female. Both processes
involve human rights violations. Intimate partner violence is more per-
sonal and physical because the male head of the family has more direct
control over his spouse than employers have over their employees.
Workplace perpetrators cannot beat or physically harm the women in
their employ, so the employer attacks them sexually to maintain his
power over women. In both types of behavior, the victim often feels re-
sponsible for her punishment (e.g., domestic violence victims may
think, ‘‘I have not been a good wife’’; sexual harassment victims may
believe that they ‘‘must have given the wrong signals’’), and some of
the physical and psychological consequences are comparable. There
also may be common characteristics of perpetrators in both types of
settings. In addition, conceptually similar terms might be used to
describe each setting: ‘‘hostile work environment’’ for workplace sexual
harassment, and ‘‘hostile home environment’’ for domestic violence.
This chapter provides a selective review of relevant theories and
cross-cultural studies designed to examine the proposed parallels in
the two types of violence against women. The focus is on settings in
which women are victims, since women still are the predominant vic-
tims both in the home and the workplace. Studies on same-sex domes-
tic violence and sexual harassment are not addressed here.
2. Job gender context: factors such as the ratio of male to female employees,
and whether or not the jobs are associated with traditional male or
female role structures.
Unwelcome sexual advances, requests for sexual favors, and other verbal
or physical conduct of a sexual nature constitute sexual harassment when
this conduct explicitly or implicitly affects an individual’s employment,
unreasonably interferes with an individual’s work performance, or cre-
ates an intimidating, hostile, or offensive work environment.
and gestures, and flirting. Despite political pressure, only about 1 per-
cent of companies in the country were reported to have adopted the
code by the late 1990s, thus prompting calls for stricter, more enforce-
able laws on the issue (McCarthy, 1997).
Aside from the ILO, which has been criticized by other world organ-
izations such as the International Labor Rights Fund for not having a
more specific convention against workplace sexual harassment (Kompi-
pote, 2002), much of the international momentum toward addressing
sexual harassment as a problem has come from the United Nations
Convention on Elimination of All Forms of Discrimination Against
Women (CEDAW), which was adopted in 1979 by the UN General
Assembly. According to this convention, discrimination against women
is defined as
Types of Perpetrators
In one of the earliest attempts to categorize perpetrators, Pryor (Pryor,
1987; Pryor, Lavite, & Stoller, 1993) established the Likelihood of Sexu-
ally Harassing (LSH) scale. Pryor proposed that men varied in terms of
their propensity to engage in sexual harassment behavior and indicated
that these individual tendencies would combine with a supportive work-
place climate to facilitate the expression of these types of behavior.
More recently, Lengnick-Hall (1995) developed the following three
classifications of workplace sexual harassers:
1. Hard-core harassers: Men who actively look for settings and situations
where they can harass victims
2. Opportunists: Men who engage in sexual harassment only when given an
opportunity
3. Insensitive individuals: Men do not realize that their behavior is causing
discomfort
perpetrators. Based on these cases, these authors clarified the types of men
who engaged in the most prevalent workplace sexual harassment as:
any act of gender-based violence that results in, or is likely to result in,
physical, sexual, or psychological harm or suffering to women, including
Violence against Women 599
Johnson and Ferraro suggest that the second form of intimate partner
violence is the most relevant to domestic violence, and this chapter
discusses only studies involving that type of violent interaction.
Latin America
Flake (2005) investigated domestic violence in Peru, which was iden-
tified by the investigator as a patriarchal culture. Information was
obtained from a ‘‘nationally representative household survey of more
than 27,000 women, aged 15 to 49’’ (p. 359). The final sample included
15,991 women. The survey, which requested information only on phys-
ical abuse, revealed that close to 40 percent of the sample had been
physically abused. Risk factors for abuse included early marriages, low
educational attainment for the woman, and violence in the natal family.
Other factors focused on alcohol consumption of the abuser and the
lack of marriage ties between the partners.
There were some inconsistent patterns related to the woman’s status.
On the one hand, higher status of the female partner seemed to be a
protective factor against abuse, but on the other hand, if the male part-
ner’s status was below that of the female, abuse seemed to be more
likely. This finding is congruent with the patriarchal culture interpreta-
tion of violence against women. In Latin America, the concept of
Violence against Women 601
Middle East
Recently, researchers have begun to explore domestic violence in
Middle Eastern countries. Many of these countries conform to the pa-
triarchal culture described earlier, and some of these countries are
characterized as ‘‘cultures of honor.’’ In addition, support for domestic
violence as a method of controlling female behavior and protection of
abusers are strong components of the cultural climate in these nations.
In a significant investigation in Israel, Haj-Yahia (2000) surveyed
1,111 Arab women to determine the extent of domestic violence they
experienced during the period of time of their engagement. In an
attempt to obtain a representative sample in a sensitive manner, the
author approached clergymen in the Arab community to obtain a list
of names of Arab women whose engagement had been announced.
The average engagement period was a little more than a year. The ma-
jority of women were Muslim, and all were going to marry partners of
the same religion. The study utilized women from the respondent’s
community as assistants and included the administration of the self-
report measure of the Revised Conflict Tactics Scale (CTS2; Straus,
Hamby, Boney-McCoy, & Sugarman, 1996), which was adjusted to be
culturally appropriate. Haj Yahia found that psychological abuse had
been experienced most often by the engaged women (close to 75% of
the women had been psychologically abused at least once), followed
by smaller percentages of physical abuse (just under 20%), and then by
sexual abuse (13%).
Haj Yahia’s investigation had many strengths, including the use of
the standardized Revised CTS, evaluated and adjusted for cultural
appropriateness; the involvement of community women as research
assistants to enhance the comfort and security of participants; the large
return rate (close to 80%); and the sensitive manner in which the sam-
ple was recruited. Again, issues arise in terms of the use of a self-
Violence against Women 603
report measure, and the nature of the sample, although in this case an
attempt was made to make the sample as representative as possible to
ensure generalization to other Arab women in Israel. Finally, it may be
questioned as to whether Arab women in Israel are comparable to
Arab women residing in Arab countries.
In another study by Haj Yahia (2002) conducted in Jordan, the coun-
try is described as a patriarchal society in which traditional gender-
roles are paramount and where men are considered to be dominant
both according to Islam as it is interpreted (although he mentions that
clearly there are other more egalitarian interpretations of the Koran)
and in society and the culture. Within this framework, Haj Yahia inves-
tigated attitudes toward wife beating among more than 350 Jordanian
wives, the majority of whom were Muslim. Respondents were
approached in public organizational settings such as health clinics in
three different locations: a city, a village on the outskirts of the city,
and a refugee camp. In the study measuring female attitudes, a stan-
dardized scale, the revised Inventory of Beliefs about Wife-Beating
(IBWB; Saunders, Lynch, Grayson, & Linz, 1987) and the Familial Patri-
archal Beliefs Scale (FPB scale; Smith, 1990), among other measures,
were administered to participants. All measures were modified to be
culturally appropriate.
Haj Yahia found that a strong tendency emerged among Jordanian
women in his sample to justify wife beating (from about 35% to close
to 70%, depending on the described behavior of the wife), particularly
if she is disobedient or does not respect her husband’s family. In gen-
eral, Jordanian women saw the women’s behavior as being the cause
of the beating and believed that the beating would help them to
become better wives. These wives also tended to dismiss the violent
behavior of the husbands (e.g., ‘‘They are men and that’s how men
are,’’ Haj Yahia, 2002, p. 288) and failed to support punishment for
abusive husbands. Haj Yahia stated that most Arab countries do not
have specific laws against domestic abuse. It could be inferred that, far
from seeing the abuse even as a ‘‘private family matter’’ as was indi-
cated in some of the studies performed in Latin America, these
respondents did not view the abuse as a problem at all, although Haj
Yahia did not reach this conclusion. Patriarchal beliefs also played a
role in predicting these attitudes.
This second Haj Yahia study also was a significant contribution to
cross-cultural investigations of domestic abuse in part because of the
standardized measures used, which were reviewed for cultural appropri-
ateness, and for the sensitive manner in which the materials were
administered. However, as Haj Yahia stated, the study still involved a
convenience sample, which would limit generalization of the results, and
all measures were self-reports. Most importantly, as indicated by the
author, the investigator did not ask if the women had been physically or
604 Psychology of Women
report stated that female participants believed that wife beating was
justified under some circumstances.
Sa interpreted these results in terms of the patriarchal culture of
Egypt. Even though Egypt seems to be more progressive than other
countries in the area, the traditional gender-role pattern prevails in the
society and in the home, where the woman is viewed as inferior and
the male head of the family has the power. Education is a mediating
variable, resulting in a lower level of spouse battering when the hus-
band or wife has a more advanced educational background than in
other cases. Sa concluded that although spousal abuse, or violence
against wives, is a serious problem in Egypt, again it is not publicized
and remains ‘‘covered under the veil’’ (Sa, 2004, p. 14). However, the
data in Sa’s report have to be interpreted with caution since, as the
author points out, they are based on self-report measures and most
likely are biased by underreporting.
Europe
McCloskey, Treviso, Scionti, and dal Pozzo (2002) compared charac-
teristics and risk factors of abused women in Italy with those in the
United States. Thirty-two battered women were recruited from a hot-
line service in Rome (the author indicated that it was unclear what the
response rate was for this sample), and their responses were compared
with 50 women recruited from shelters in the southwest part of the
United States, representing a response rate of 50 percent. The U.S. sam-
ple consisted of approximately equal numbers of Hispanic and Euro-
pean-American women. The researchers administered a modified
version of the CTS and a measure of psychopathology (the Brief Symp-
tom Inventory; Derogatis & Melisaratos, 1983).
All samples in the study demonstrated comparable levels of physical
abuse, but American women had experienced sexual abuse more fre-
quently than Italian women. One important difference was that Italian
women generally stayed in their marriages longer than American
women, which could be attributed in part to the Italian family structure,
which may be more patriarchal, according to the authors, making it
more difficult for the wives to leave. The researchers found that alcohol
was implicated in wife beating in the United States, but not in Italy.
McCloskey et al. (2002) reviewed several limitations of their study,
including the fact that the samples were self-selected and therefore gen-
eralization was limited, there was an absence of control samples of
women who were not abused, the measures were all based on self-
reports, and there might have been underreporting of the abuse. In addi-
tion, the numbers of respondents were small for both samples, and the
Italian group was recruited from a source (hotline) that was different
from the American sample, which was recruited from shelters.
606 Psychology of Women
Asia
Xu, in a study published in 1997, revealed that close to 60 percent of
a sample of 586 married women in Chengdu, China, in 1986 reported
spousal abuse by their husbands, with psychological abuse occurring
more frequently than physical abuse. Xu identified China as embody-
ing a patriarchal family culture similar to the Latin American and other
cultures. According to the author, Confucianism requires women to
obey their fathers first, then their husbands, and finally their sons. Con-
sistent with points made earlier, Xu suggested that domestic violence
Violence against Women 607
is seen as an issue for the family, not for the society. In addition, the
author found that frequent conflicts and poor communication were
associated with increased spousal abuse.
Xu (1997) pointed to limitations of the study in terms of an inability
to provide causal links between cultural aspects and spousal abuse as
well as a lack of information about abusers, an important issue that
also applies to several other cross-cultural studies. In addition, self-
report, the lack of standardized measures, and the fact that the data
were obtained so many years ago limited the conclusions that can be
drawn from this study.
More recently, Xu, Zhu, O’Campo, Koenig, and Mock (2005) pub-
lished another study of incidence of spousal violence in China. The ran-
domly selected sample in this investigation consisted of 600 women who
were recruited from a clinic in Fuzhou, China, in 2000. An impressive
proportion of close to 90 percent of those approached agreed to partici-
pate in the study. The measures were derived from the World Health
Organization (WHO) Multicultural Study on Women’s Health and Life
Experiences Questionnaire, a culturally appropriate measure based in
part on the standardized CTS. Physical, psychological, and sexual abuse
measures were administered by health care individuals in a face-to-face
setting. Close to 45 percent of the respondents had experienced spousal
abuse at least once during their marriage and about 25 percent in the
last year, with frequent altercations being associated with the last figure.
A large percentage of the women felt that if a husband found out that
his wife had been having an affair, he would be justified in abusing her
(with a higher percentage associated with women who had experienced
abuse than those who had not). The authors suggested that, although
the modern Chinese culture publicly supports equality between men
and women, the society—and many women in this sample—still
endorse the patriarchal society and family structure.
This study was a considerable improvement over the first reviewed
investigation by Xu in terms of the time of data collection and the
standardization of the measures. The response rate also was impres-
sive. Once again, however, self-reports could have produced biased
underreporting, particularly in a society where spousal abuse is not a
publicly discussed issue.
In Japan, another Asian country where domestic violence has been
considered a private matter and there is a patriarchal culture, Yoshi-
hama (2005) used a focus group approach to investigate spousal abuse.
Sixty-four women who had experienced physical, psychological, or sex-
ual abuse from male partners were recruited in three different Japanese
cities (Yokohama, Kobe, and Sapporo) by women’s organizations. More
than 50 percent of the sample were still married to the perpetrator of
the abuse. Women described a pattern of physical, psychological, and
sexual abuse with several specific examples of psychological abuse, for
608 Psychology of Women
example, ‘‘Who do you think you are? You are just a woman’’
(p. 1244.) A variety of tactics utilized by their partners were described,
including blaming the woman, denying that they had engaged in the
abuse, using threats, concealing any wounds the women may have
incurred by injuring them in hidden places, and preventing them from
contacting support systems. Yoshihama indicated that the abuse was
consistent with the patriarchal society of Japan, that the violence was a
means of controlling their partners, and that in-laws either seemed to
be ‘‘helpless bystanders, or at times, co-perpetrators in their son’s
abuse’’ (pp. 1253–1254). Therefore, according to Yoshihama, in-laws’
behavior ‘‘constitute a key component in the patriarchal clan system
that supports domestic violence’’ (p. 1254).
The author mentioned some difficulties with the study, in that the
sample was relatively small and basically self-selected and that only
self-identified abused women participated. The results may not gener-
alize to abused women in Japan in general, and the methodology did
not permit a comparison with nonabused women. In addition, the
focus group approach may have affected women in a positive way
(e.g., to share, understand, and talk about their experiences); however,
women also may have been directly influenced in a negative way by
this approach (e.g., possibly seeing the violence as more normative).
Kozu (1999) also described the Japanese patriarchal structure, partic-
ularly in the family, as contributing to the condoning of spousal abuse
(e.g., the wife calls her husband shujin, ‘‘master,’’ p. 51). In addition to
the adherence to traditional gender-roles, cultural expectations focus
on maintaining harmony in society or in the family and avoiding
shame at any cost. As a result, domestic abuse would most likely
remain a private matter. Kozu discussed one national study in 1992,
which found that almost 80 percent of the close to 800 respondents
reported having experienced domestic violence. According to Kozu,
these results should be regarded with caution, however, since the sur-
vey included all volunteers and may not have been representative of
Japanese women in general.
In India, Panchandeswaran and Koverola (2005) conducted inter-
views, including semistructured surveys, with 90 abused women seek-
ing help in Chennai (Madras) in Tamil Nadu. The authors indicated
that India is another patriarchal culture in which domestic violence is
considered to be a family issue. The majority of respondents were Hin-
dus and had been married at an early age. The participants were
recruited from counseling centers and were interviewed by a social
worker using the language of the community. Close to 80 percent of
the sample reported being abused every day, and more than 40 percent
stated that the abuse had started soon after their marriage. Although
some of the respondents had experienced severe physical abuse (70%
reported threats that their husbands would kill them), a higher
Violence against Women 609
Africa
Koenig et al. (2003) surveyed more than 5,000 women in a rural com-
munity in southwest Uganda (the Rakai area, where the majority of resi-
dents are of the Baganda ethnic group) in 2000–2001. The researchers
stated that the predominant pattern was ‘‘patrilineal’’ (i.e., where women
610 Psychology of Women
stay with their husband’s clan) and a significant number of men had
many wives or sexual partners. Women were questioned about domestic
violence with a revised form of the CTS, and the interviewers were expe-
rienced and of the same gender as the respondents. Approximately 40
percent of the women were found to be victims of psychological or
verbal violence, and a little over 30 percent experienced physical abuse.
Both failure to take care of the house or the husband and disobedience
by the wife were cited as common precipitants for violence, as well as
excessive drinking by the male spouse. A large majority of women (and
a higher percentage of men whose attitudes also were measured) con-
doned abuse of the female spouse in certain situations.
This study had many positive points, including the large sample,
the high response rate, the inclusion of attitude measures, and the use
of the basic standardized CTS. Questions that remain include whether
there was underreporting of abuse and how well the results would
generalize to other areas of Uganda.
In the second study, McClosky et al. (2002) utilized the Brief Symp-
tom Inventory (Derogatis & Melisaratos, 1983) to measure the psycho-
logical consequences of domestic abuse in the United States and Italy.
The most frequent psychological difficulty experienced by the abused
women in their sample was depression. More than 40 percent of the
battered women had thought about committing suicide and/or had
internalized the characterization of themselves as worthless.
In a relevant review article, Fischbach and Herbert (1997) discussed
several additional physical and psychological effects of wife beating,
including ‘‘dowry deaths,’’ ‘‘honor killings,’’ ‘‘bride burnings’’ that are
often concealed as ‘‘accidents,’’ and chronic pain, as well as psycholog-
ical effects such as depression, suicide, and substance abuse. The
authors point out that much of the evidence for psychological conse-
quences of domestic violence emanates from studies in ‘‘developed
countries’’ or Western nations. One of the difficulties in determining
the association between spousal abuse and psychological symptoms,
according to Fischbach and Herbert, is that mental illness is concep-
tualized differently in various cultures, and also that in many countries
psychological problems are seen as stigmatizing so that there is little
identification of individuals with these difficulties.
sexual harassment can be divided into two forms: quid pro quo and
hostile work environment; domestic violence also can be assigned cate-
gories: physical abuse (including murder), psychological abuse, and sex-
ual abuse. Although power and dominance issues are relevant to all
categories of sexual harassment and intimate partner violence, quid pro
quo can be seen as conceptually similar to physical abuse, and hostile
work environment appears to be more related to psychological abuse.
Both quid pro quo and physical abuse are clearer examples of inap-
propriate behavior and are more difficult to misinterpret than psycho-
logical abuse and hostile work environment. In legal cases, quid pro
quo harassment incidents have to happen only once to be actionable;
similarly, severe physical abuse clearly can lead to arrest and convic-
tions of the abuser. However, hostile work environment sexual harass-
ment is much more difficult to prosecute, as is psychological domestic
abuse, even though these types of behaviors probably occur more fre-
quently than the more severe forms of violence. In each case, there has
to be a pattern of behavior before action can be instituted.
The public view of psychological abuse and hostile workplace cli-
mate clearly is less negative than reactions to more severe forms of
abuse. The lesser forms of abuse are seen as relatively ambiguous, and
as not very serious, which can lead to legal problems in prosecution.
Physical evidence is readily available in physical abuse cases, but not
in psychological abuse.
Another similar aspect of both types of violence is that laws may be
passed prohibiting the behavior, but enforcement of these laws lags
behind the legislation in many countries, and not just in patriarchal soci-
eties. Abused wives often are discouraged and fail to report the abuse,
and the same pattern is true for victims of workplace sexual harassment.
CONCLUSION
In this chapter, we have reviewed a number of studies on interna-
tional workplace sexual harassment and domestic violence, and we
generally have found support for our contention that the integrated
model of sexual harassment and the power and socialization models of
domestic violence are productive frameworks within which to analyze
the results of these studies. In addition, we have examined a number
of intersecting concepts that relate the two areas of intimate partner vi-
olence and workplace sexual harassment. Our review was selective
and evaluative in terms of indicating a number of methodological diffi-
culties that complicate cross-cultural comparisons of these behaviors. It
is clear that conducting more specific comparisons across nations is
important, as is increased attention to physical and psychological
outcomes for victims, as well as characteristics and programs for
perpetrators.
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PART VI
Scholars and laypersons alike have long been concerned about women
and the why, or more often the why not, of their achievement. It was
not, however, until the late 1960s, growing substantially in the 1970s,
that psychologists began to take a serious look at the psychological
study of women, offering new theories, methods, techniques, and inno-
vative perspectives on women’s experiences, circumstances, and devel-
opment. These efforts were taking place within the larger context of
the women’s movement of the 1960s and the overall rediscovery of
important contributions of women to various segments of American
society.
In the last edition of this Handbook, we examined women and the psy-
chology of achievement in terms of theory and research related to
achievement motivation; the fears of success and failure; cognitive varia-
bles affecting gender and achievement; gender differences in causal attri-
butions for success and failure; and occupational aspiration and career
development of women, with special emphasis on women’s achievement
in mathematics and science-related fields; and methodological issues in
relation to the study of women’s achievement. The review, which syn-
thesized findings through the 1980s, also summarized what the litera-
ture, although then quite limited, had to say about minority women. The
current goal is to continue the story from the 1990s to the present,
addressing what researchers have been trying to explain, what kinds of
concepts are being studied, and how feminist perspectives continue to
affect the questions being asked, conclusions drawn, and perhaps
thoughts on the future.
626 Psychology of Women
Over the last half of the 20th century, 42 countries have had at least
one woman as president or prime minister (San Francisco Chronicle,
2007). These include Great Britain (Margaret Thatcher), Sri Lanka (Siri-
mavo Bandaranaike), Ireland (Mary Robinson), Rwanda (Agathe Uwi-
lingiyimana), Bermuda (Pamela Gordon), Jamaica (Portia Simpson
Miller), Liberia (Ellen Johnson-Sirleaf), New Zealand (Helen Clark),
Finland (Tarja Kaarina Halonen), India (Indira Gandhi), Israel (Golda
Meir), Canada (Kim Campbell), and France (Edith Cresson). Some of
these women, as well as other women country leaders, were elected;
others were appointed. Some followed their husbands or fathers into
political office, while others were elected or appointed based upon
their own political contributions and reputation. In 2007, there were
11 women leading governments, including seven presidents, one chan-
cellor, and three prime ministers.
While the increase in representation is welcome, the lack of women
in the political pipeline remains a serious barrier to further growth of
women in the upper echelons of elected officials.
The task force also concluded, consistent with the work of various
occupational segregation researchers (e.g., Reskin & Roos, 1990), that it
does not appear that the increased presence of women necessarily
leads to their increased status and influence within that profession and
the larger society.
Over the past 25 years, researchers began to consider whether men
avoided entering fields when a certain level of female participation is
reached. This fits with some scholars’ (e.g., Williams, 1993) notion that
the social construction of masculinity includes rejection of whatever is
seen as female. Interestingly enough, using national data, findings from
empirical research show that the higher the percentage of women
obtaining degrees in a field in a given year, the fewer men that entered
the field 4–7 years later (England et al., 2003). As a result, England and
colleagues (2003) concluded this men’s avoidance of fields as they ‘‘fem-
inize’’ may impede an integrated equilibrium such that as fields increase
their female population, fewer men enter them, which further increases
their percentage of females, which leads even fewer men to enter.
Although women have made remarkable strides in education over
the past three decades, these gains have not yet translated to full equity
in pay—even for college-educated women who work full-time. Thus, a
typical college-educated woman working full-time earns $46,000 a year,
compared to $62,000 for college-educated male workers—a difference
of $16,000 (Day & Hill, 2007). The gap, starting early, widens as time
goes by, such that 10 years after graduation, women have fallen further
behind, earning 69 percent of what men earn. A 12 percent gap
appears even when controlling for variables such as hours, occupation,
parenthood, and other factors known to directly affect earnings (Day &
Hill, 2007). This also may contribute to men’s seeming avoidance of
fields they perceive as ‘‘female.’’ England (1992), a sociologist, argues
that if young men taking courses see women as majors, graduate stu-
dents, teaching assistants, and young faculty members, they may con-
clude that this is a ‘‘female field’’ and avoid majoring in it and
applying for graduate study. This may, according to England, be
because they anticipate that if fields become ‘‘too female,’’ their pay
compensation will decline, as claimed by advocates of comparable
worth.
the past 15 years, consider the kinds of questions being formulated and
reformulated, and make projections for the early decades of the 21st
century. As with our original chapter, our overarching questions
remain: In what ways has a feminist perspective affected the questions
being asked regarding women and the psychology of achievement?
Have the phenomena being studied changed? If so, what is the nature
of the change? Have important, useful theories or perspectives been
developed? How have we dealt with integrating race, class, and ethnic-
ity into this work?
Much of psychology’s focus on achievement has centered on the con-
cept of motivation, particularly achievement motivation and related con-
cepts. Research often sought to answer a myriad of questions, such as:
Fear of Success
The concept of a motive to fear success was developed by Horner
(1968, 1972), and it generated a great deal of research shortly after its
appearance in the published literature. Horner created this concept in
an effort to better understand the basis of gender differences in
634 Psychology of Women
that fear of success has risen among men because men must now com-
pete with both women and men in the job market. Despite this conclu-
sion, the author further noted that women still may be particularly
susceptible to fear of success, since they may develop the fear from
gender-role stereotyping as well as from suboptimal early environ-
ments. Similarly, in arguing that fear of success is relevant to both men
and women, Fried-Buchalter (1997) investigated fear of success, fear of
failure, and imposter phenomenon among male and female marketing
managers. Her results demonstrated that female managers were signifi-
cantly higher than male managers on fear of success, but no significant
gender differences occurred on the fear of failure and imposter phe-
nomenon variables.
Self-Efficacy
The concept of self-efficacy, introduced by Bandura (1986), refers to
the belief or confidence that one can do the behaviors necessary to
achieve a designed goal. Bussey and Bandura (1999) argued that self-
efficacy develops in four ways:
Self-Handicapping
While much recent work has emerged in the literature on this topic,
self-handicapping strategies were identified in the 1970s as a way for
discounting ability attributions for probable failure while augmenting
ability attributions for possible success. In fact, the notion of self-
handicapping was introduced in the 1970s (Berglas & Jones, 1978) to
described as an individual’s attempt to reduce a threat to esteem by
actively seeking or creating factors that interfere with performance as a
causal explanation for failure. In other words, it is the process in which
an individual deliberately does the things that increase probability of
failure (Trice & Bratslavsky, 2000). The goals of self-handicapping are
to disregard ability as the causal factor for a poor performance and to
embrace ability as the causal factor for a success.
Contrary to what some researchers originally hypothesized, findings
from various studies demonstrate that men, more often than women,
self-handicap (e.g., Hirt, McCrea, & Kimble, 2000; Midgley & Urdan,
1995; Rhodewalt & Hill, 1995). Interesting enough, self-handicapping
behavior does not appear to reduce motivation to succeed, and in some
context, it may increase it (Rhodewalt, 1990). Lucas and Lovaglia (2005)
found that the idea of self-handicapping behavior is related to the
desire to protect a valued status position and that minorities and
women self-handicapped less often than did whites and men. They
argue that white men, in particular, generally enjoy (unearned) privi-
lege and higher status than other groups, which perhaps explains the
propensity for these men to self-handicap.
Stereotype Threat
Another cognitive factor that has been recently introduced into the psy-
chological literature to explain the underperformance of disadvantaged
groups, particularly in academic settings, is that of stereotype threat. Orig-
inally introduced and tested by Steele (1992, 1997, 1998, 1999) and later
examined by other investigators (e.g., Osborne, 2001; Steele, James, & Bar-
nett, 2002; Steele & Aronson, 1995), stereotype threat emphasizes the dele-
terious outcome stemming from the threat of being viewed through the
lens of a negative stereotype or the fear of doing something that would in-
advertently confirm that stereotype. Stereotype threat is thought to result
in uncomfortable feelings arising when individuals believe they are at risk
of confirming a negative stereotype in the eyes of others (Spencer, Steele,
& Quinn, 1999; Steele, 1997; Steele & Aronson, 1995).
640 Psychology of Women
not biological factors, are the reason for observed gender differences in
complex problem solving (Betz, 1992).
Closer inspection of the data resulted in conclusions that gender dif-
ferences are negligible across most skills tapped by mathematics stan-
dardized tests (Hyde, 2005; Hyde, Fennema, & Lamon, 1990). Hyde,
Fennema, and Lamon (1990), for example, reported that modest gender
differences favoring boys emerge by high school and college in com-
plex mathematical problem-solving tasks, which are viewed as critical
for success in mathematics-related majors and occupations. Other ex-
planatory factors put forth for gender differences in mathematics-
related choices include internalized beliefs systems about proficiencies
in mathematics (Hyde, Fennema, & Lamon, 1990), social environmental
variables such as discriminatory practices, absence of social support
(Betz, 1993), and how mathematics is taught (Meece et al., 1990). Recent
studies show that gender differences in mathematics and science-
related interests or academic choices may be partially mediated by self-
efficacy (Lent, Lopez, & Bieschke, 1993). Thus, when belief about one’s
ability was controlled, Lent et al. (1993) found that the contribution of
gender to the prediction of interest in and intention to pursue mathe-
matics or science was either eliminated or substantially reduced, sug-
gesting that perceived efficacy help account for men’s and women’s
differential enrollment patterns in college mathematics courses.
Psychologists have also studied the valuing of various educational
subjects and occupations as an explanation for gender differences in
mathematics-related subject interest in school and subsequent career
aspirations. At the elementary level, Eccles and Harold (1992) found
clear evidence of gender differences in the value attached to various
school subjects and activities. In their work, they found no gender dif-
ference in expectations for success in mathematics, but girls reported
liking mathematics less than did the boys and rated mathematics as
less useful than did boys. However, a review of the recent literature
suggests that gender differences in cognitive variables such as self-
efficacy may not be large enough to account for the wide disparity
observed in men’s and women’s participation in mathematics-intensive
fields. Researchers (e.g., Hyde, Fennema, Ryan, Frost, & Hopp, 1990)
conclude that men’s and women’s differential participation in
mathematics-related fields is determined by multiple factors (e.g., cog-
nitive, expectations, social, familiar, economic) and that no one or two
variables can explain all of the variance (Lent et al., 1993). Still, Hyde,
Fennema, Ryan, et al., 1990 argue that, since mathematics learning is a
long-term process, even small gender differences in self-beliefs about
ability can have a cumulative and, ultimately, potent effect on aca-
demic and career choices.
The argument continues and has high visibility in scholarly literature.
In a recent critical review article, Spelke (2005) discussed a long-standing
Women and Achievement 643
& Schleser, 2004) and school-related variables (e.g., teacher quality, cur-
riculum and instruction, classroom environment, teacher expectations),
as well as factors outside of school such as socioeconomic status and
parental influences (e.g., Darling-Hammond & Sykes, 2003; Ferguson,
1998; Jussim, Eccles, & Madon, 1996).
CONCLUSION
In the 1990s, some researchers called for reconsideration of what is
(and is not) achievement, since ‘‘success’’ was generally considered
within a masculine paradigm. Success was often represented by achieve-
ment in a high-level career, academic excellence, and other accomplish-
ments typically associated with the values of middle-class men. As a
result, accomplishments that were associated with women and traditional
feminine characteristics received little or no attention. Doyle and Paludi
(1995) called for a redefinition of achievement and achievement-related
issues in a way that does not keep women’s lives and realities invisible.
In a recent review of the literature on gender, competence, and
achievement, Hyde and Durik (2005) pointed out three overarching
issues that should frame the discourse in this field:
Since the last edition of this Handbook, there has been more compel-
ling evidence published to refute the ‘‘gender difference’’ or ‘‘gender
gap’’ hypothesis in many areas, including various aspects of achieve-
ment (e.g., cognitive abilities, mathematics). The findings of an analysis
of 46 meta-analyses that were conducted during the last two decades
of the 20th century underscores that men and women are basically
alike in terms of personality, cognitive ability, and leadership (Hyde,
2005). Using meta-analytical techniques that revolutionized the study
of gender differences starting in the 1980s, Hyde (2005) concluded that
males and females, from childhood to adulthood, are more alike than
different on most psychological variables, resulting in what she calls a
gender similarities hypothesis. With this notion, she has successfully
argued for ending the apparent endless effort of psychologists (mostly
male) to demonstrate female difference (i.e., generally inferiority).
Women and Achievement 645
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Chapter 20
Multiple work and family roles are the norm for the majority of Ameri-
can women; the challenge for women in the 21st century has become
balancing work and personal life (Frone, 2003; Gambles, Lewis, &
Rapoport, 2006). According to the U.S. Department of Labor, in 2006,
59 percent of American women age 16 or older were in the labor
force—66 million women. For women between the ages of 25 and 54,
the figure was 72 percent. The majority (75%) of employed women
worked at full-time jobs. Labor force participation rates were highest
for divorced and never-married women (67% and 61%, respectively).
Nonetheless, among married women, nearly 6 out of 10 (59%) com-
bined the roles of wife and worker (the figure is similar for separated
women). The proportion of married-couple families in which only the
husband worked hit an all-time low: 19.8 percent. Dual-worker fami-
lies, with both husband and wife employed, constituted the largest cat-
egory of workers (51.8%). In 6.5 percent of married couples, only the
wife worked (U.S. Bureau of Labor Statistics, 2007b).
A substantial proportion of employed women combine the roles of
mother and worker, or mother, wife, and worker. The majority of
mothers of young children are now members of the American work-
force, and adults of both genders are assuming greater caregiving
duties for aging relatives. In 2006, 67 percent of married mothers with
school-age children were in the labor force; the figure was 72 percent
Work and Family Roles 653
for unmarried mothers and 56 percent for mothers with children under
three years of age (U.S. Bureau of Labor Statistics, 2007b). Addressing
discrimination against working mothers, characterized as the ‘‘maternal
wall,’’ has emerged as the new frontier in the struggle for women’s
equality in employment (Biernat, Crosby, & Williams, 2004).
These statistics are a reminder that women balance the roles of
worker, wife, and mother in different combinations over the course
of their lives. The numbers also suggest that changes in the world of
work need to reflect an inclusive view of family that recognizes alter-
native family forms, including dual-worker couples and single-headed
households (Steil, 2001). Beyond these statistics, a more inclusive view
of family would also include lesbian, gay, and bisexual couples, cohab-
iting partners with and without children, and other unions involving
family or home life (Fassinger, 2000). Nonetheless, the world of work
has been slow to adapt to this new reality and continues to be largely
organized for the traditional family breadwinner/caregiver model that
assumes that mothers stay at home (American Psychological Associa-
tion, 2004; Halpern, 2005).
The changing norms, expectations, and circumstances in which
women perform their work and family roles present continual chal-
lenges with powerful implications for women’s mental health and
well-being. In particular, families that do not fit the traditional norm—
single-parent families or lesbian, gay, and bisexual couples and
families—must resolve work and family conflicts in a context of stigma
and discrimination, compounding their difficulties (Schultheiss, 2006).
Stereotyping and idealization of women’s work and family roles must
be replaced with an understanding of women’s diverse realities, and
the world of work needs to be realigned to reflect those realities
(American Psychological Association, 2004).
The literature on women’s mental health has proliferated across the
disciplines in the past two decades. For example, focusing only on
articles appearing in peer-reviewed journals, a PsycInfo search using
the keywords women, work, family, or multiple roles identified 776 articles
published in such journals from 1980 to 1989, 1,565 published between
1990 and 1999, and 2,503 published between 2000 and the April 2007.
This is an underestimation of the published literature, as using more
specific search terms (e.g., working mothers, role conflict) would have
increased the count. In addition, books, book chapters, and other publi-
cation venues were not tallied.
This chapter highlights new conceptualizations, methodological
issues, and selected research findings related to women’s work and
family roles. We focus on the literature published in the 1990s and
beyond, including reference to previous work only when it has a spe-
cial contribution to make to the point being discussed (see Green &
Russo, 1993; Bianchi, Robinson, & Milkie, 2006; and Gilbert & Rader,
654 Psychology of Women
Gender Stereotyping
Gender stereotypes and sexist discrimination are interrelated. In
most instances, it is illegal in the United States to discriminate by
assigning work roles on the basis of gender (although there are excep-
tions, such as actor and actress roles). Nonetheless, because expecta-
tions for the feminine gender-role are transituational, women take their
feminine gender-role, with its concomitant gender stereotypes, into the
workplace (see chapter 14 in this volume for a more complete discus-
sion of the definitions of gender-roles used here). Kite, Deaux, and
Haines, in chapter 7 of this volume, provide an in-depth discussion of
stereotyping. Here we focus on concepts we believe are particularly im-
portant for understanding the effects of stereotyping on work and fam-
ily life.
Women, particularly mothers, continue to be stereotyped as care-
takers and nurturers and are not taken seriously as committed workers,
despite the fact that women are single heads of households and the
contributions of married women to their household incomes keep
Work and Family Roles 655
many families above the poverty line. Gender myths and stereotypes
and women’s subordinate roles and status are mutually reinforcing
(Eagly & Karau, 2002; Eagly, Wood, & Dickman, 2000). Women are
seen as nurturing, submissive, dependent, and accommodating, and
thus are more likely to be viewed (and to view themselves) as suited
to service tasks and subordinate positions (DeArmond, Tye, Chen,
Krauss, Rogers, & Sintek, 2006). Stereotypes thus function to support
and justify the status quo (Jost & Kay, 2005; Kay & Jost, 2003). Occupy-
ing subordinate positions reinforces the impression of nurturance, de-
pendence, and lack of leadership ability (Eagly & Karau, 2002; Eagly
et al., 2000).
Stereotypes related to warmth and competence jointly affect percep-
tions of admiration and liking (warm þ competent), contempt (cold þ
incompetent), envy and disliking (cold þ competent), and pity (warm þ
incompetent) (Cuddy, Fiske, & Glick, 2004; Fiske, Cuddy, Glick, & Xu,
2002; Fiske, Cuddy, & Glick, 2002). These dimensions of warmth and
competence, which parallel the long-standing gender divide of home-
maker/breadwinner, are rooted in gender myths about the essential
natures of women and men that persist despite a mountain of studies
documenting their similarity and showing that distributions of traits
among women and men overlap and that warmth and agency are
human attributes held by both women and men (Hyde, 2005).
Stereotypes can affect feelings, thoughts, and behavior at an implicit
level, beyond conscious awareness and even when not consciously
accepted (Devine, 1989; Greenwald & Banaji, 1995). Humor may
enhance the implicit effects of stereotypes; it appears to increase toler-
ance for discrimination, perhaps because it generates a noncritical
mindset that leaves sexist attitudes and behavior unscrutinized (Ford,
2000). Although stereotyping and evaluation biases may be subtle, they
nonetheless have complex effects on how we evaluate others, such that
equal performance does not necessarily bring equal rewards for
women (Benokraitis, 1997; Fiske, 1998; Swim, Borgida, & Maruyama,
1989).
Stereotypes can function as double-edged swords, such that being
viewed as having ‘‘feminine’’ traits (e.g., being gentle, warm, and help-
ful) can lead to perceptions of incompetence, devaluation, and exploita-
tion (Cuddy et al., 2004), while having ‘‘masculine’’ traits (e.g., being
forceful, assertive, having leadership abilities, strong personality) can
lead to sanctions, including sexual harassment, in educational and
occupational settings (Berdahl, 2007). When men accommodate others,
the norm of reciprocity is engaged, and the others ‘‘owe’’ them favors
in return. In contrast, accommodating women are taken for granted.
Further, women’s reasons for not accommodating are seen as less cred-
ible, and women are required to be more assertive to reach their goals
than are men (Geis, Carter, & Butler, 1982).
656 Psychology of Women
pose an extra threat to women in that that they realize others (or they
themselves) may judge them or act based on the stereotype (Shapiro &
Neuberg, 2007).
Gender stereotyping has long been linked to distinct employment
issues for women, who must deal with evaluation bias, greater pres-
sure on their performance, exclusion from certain jobs and promotional
opportunities, differential supervision, overprotection, unprofessional
sexual remarks, incivility and harassment, unequal employment
rewards, and gender segregation between and within occupations.
Such concerns shape self-perceptions of occupational futures in com-
plex ways (e.g., see Chalk, 2005).
Discrimination
Over the last two decades, a variety of concepts have been offered
to refine our understanding of discrimination against women. As ‘‘old-
fashioned’’ overt sexism and racism have become illegal and increas-
ingly socially disapproved, the ‘‘isms,’’ including modern sexism, have
become more covert and subtle (Benokraitis & Feagin, 1995; Benokrai-
tis, 1997). As Meyerson and Fletcher (2000) so aptly observed:
The women’s movement [once] used radical rhetoric and legal action to
drive out overt discrimination, but most of the barriers that persist today
are insidious—a revolution couldn’t find them to blast away. Rather, gen-
der discrimination now is so deeply embedded in organizational life as
to be virtually indiscernible. Even the women who feel its impact are
often hard-pressed to know what hit them. (p. 127)
Research on the effects of ambivalent sexism (Glick & Fiske, 1996) has
distinguished between hostile sexism and benevolent sexism, which are in-
dependent clusters and attitudes that can be held in varying degrees by
the same person. Hostile sexism represents negative attitudes toward
women who are not stereotypically feminine or do not fulfill their
gender-roles. One example is the belief that women who are not home-
makers should be stigmatized. Benevolent sexism, by contrast, represents
1. derogatory attitudes—impersonal
2. derogatory attitudes—personal
660 Psychology of Women
By forcing sexual identities into high relief, men submerge the equality
inherent in the work and superimpose traditional dominant and subordi-
nate definitions of the sexes. Men have a stake in seeing women as sex-
ual beings because in no arena is male domination less ambiguous for
working-class men than sexuality. (Swerdlow, 1989, p. 381)
Gender Segregation
Although women are found in every occupation, gender segregation in
the workforce continues to be an issue for women in the 21st century
(Browne, 2006; Padavic & Reskin, 2002; Reskin, 1984). Patterns of segrega-
tion reflect both the individual choices of women as well as interpersonal
and institutional sexism. Betz (see chapter 22 in this volume) and Fouad
(2007) review the career choice literature, so we will not discuss it in depth
here except to say that is still not well understood why women tend to go
into one field of work rather than another, and there may be more than
one answer, depending on the particular field and employment context.
For example, stereotype threat may contribute to the gender segregation
seen in science, technology, engineering, and mathematics (STEM) fields
due to persistent and widespread cultural stereotypes about women’s in-
feriority in mathematics (Spencer, Steele, & Quinn, 1999; Steele, 1997). This
stereotype threat might not be operate the same way in other occupations.
Theories of career choice and persistence have emphasized the im-
portance of cognitive factors, such as self-efficacy, for the participation
and performance of college women in traditionally male-dominated
STEM fields (Lent et al., 2005; Fouad, 2007). Women who have confi-
dence in their math ability are much more likely than those who do
not to expect positive outcomes regarding math performance and to
have interest in math-related fields. Confidence, outcome expectations,
and interest in a domain all relate to major choice (Lent et al., 2005).
This may be particularly true for women in male-dominated areas such
as the STEM fields where disciplinary values mirror male gender-role
stereotypes and emphasize individualistic achievement, competence,
tough-mindedness, and intellectual detachment.
Recent reports by the National Science Board and National Science
Council (e.g., National Science Foundation, 2004, 2007), have expressed
664 Psychology of Women
Employment Rewards
Women’s increasing participation in the workforce has not been
matched by similar changes in employment rewards. A gender gap
persists in the earnings of full-time wage and salary workers: In 2005,
with regard to median weekly earnings, women earned $585 per week
compared with $722 for men (i.e., they earned 81¢ for every dollar
earned by men; U.S. Bureau of Labor Statistics, 2006). In general, theo-
ries of the wage gap have either focused on gender differences in per-
sonal characteristics and qualifications (human capital theories) or
emphasized gender differences in the experiences and contexts of
women (discrimination theories) (Blau, Simpson, & Anderson, 1998).
However, the reasons for the persistence of the wage gap between
women and men continue to be inadequately understood and may not
be revealed without more complex, multilevel explanatory frameworks.
Prokos and Padavic (2005) examined the role of cohort effects and glass
ceiling barriers on the income differences between male and female sci-
entists and engineers. Their results indicated a continuing pay gap that
was not fully explained by either factor. The gender pay gap in these
fields appeared to reflect unassessed barriers that do not change in in-
tensity as individuals age and have not diminished for recent cohorts.
Compensation goes beyond salary. Voluntary employer-paid benefits
(i.e., those not legally mandated, in contrast to Social Security benefits),
including pensions, insurance, vacation, and sick leave, constituted
nearly 20 percent of employee compensation in 2006 (U.S. Bureau of
Labor Statistics, 2007a). Women are less likely to receive pension benefits
than men. In 2004, among people over 65 years of age who received pen-
sions, the median pension income for men was $12,000, compared to
$6,600 for women. Among men, white men had the highest median pen-
sion benefit ($12,492), with black men close behind ($12,000). The figure
was substantially lower for Hispanic men ($8,400) compared to other
men, but it was nonetheless higher than the median for women, regard-
less of race/ethnicity. Among women, black women had the highest me-
dian pension benefit ($7,800), followed by white women ($6,500) and
Hispanic women ($6,000). The gender gap in pension benefits reflects the
intersecting effects of gender and race on occupational segregation. The
fact that a higher proportion of black women are former government
employees than are other women is the most probable explanation for
their higher median benefit (Joint Economic Committee, 2007).
Although working women’s rates of job-based coverage are similar
to that of men, they are less likely than men to be insured through
their own job (38% vs. 50%, respectively). Being in the labor force is no
guarantee of insurance coverage; only 21 percent of uninsured women
are in families without workers (Henry J. Kaiser Foundation, 2007). A
full analysis of factors influencing women’s employment rewards
668 Psychology of Women
Employment Satisfaction
Satisfaction derived from one’s work is an intangible, but nonethe-
less important, employment reward. Interestingly, women continue to
show similar levels of employment satisfaction compared with men,
despite receiving lower compensation. This ‘‘paradox of the contented
female worker’’ (Crosby, 1982) persists, even though gender discrimi-
nation is recognized as a social problem by both men and women and
women are aware, aggrieved, and outraged at its continued existence.
This is not explained by different job values or preferences (Major,
1987).
Crosby (1982) posits a theory of relative deprivation to explain this
paradox. Relative deprivation occurs when people believe that their
present condition is not as good as they both want it to be and believe
670 Psychology of Women
Pay Expectations
There are substantial differences in pay expectations: Men expect to
be paid more than women (Major, 1993). For example, in a study of
pay expectations of management interns, Major and Konar (1984)
examined the contribution of five factors gender differences in pay
expectations:
Do not trust your own impressions any more than you trust the impres-
sions of the women in your organization. Women may be motivated to
deny their own disadvantage; but nobody . . . should trust conclusions
based on unaggregated figures. Only by bringing all the data together
can one see patterns. (Crosby et al., 1989, p. 97)
33 percent of these wives earned more than their husbands (note that
this figure includes families in which the husband did not work; U.S.
Bureau of Labor Statistics, 2006).
Women’s economic status has both direct and indirect links to their
mental health and well-being. Income has been found to be positively
associated with mental health for both white and black women (Baruch &
Barnett, 1987). Although employment may create difficulties for women
in caring for children, it can also provide a buffer for other types of stress,
particularly for low-income women. Compared with housewives,
employed married women with lower incomes have been found to be
more affected by stress due to childrearing but less affected by other life
events. Thus, higher-income women’s ability to purchase assistance to
cope with time and work demands may mitigate stresses from childrear-
ing that women with lower incomes cannot avoid (Cleary & Mechanic,
1983).
Ross, Mirowsky, and Huber (1983) found that the higher a woman’s
income, the more her husband was likely to share in home responsibil-
ities (the correlation was with her income, not his). It may be that with
money comes power to negotiate roles, with concomitant mental health
benefits. However, women who make secondary or minimal contribu-
tions to family income may be ‘‘unable to redistribute obligations and
thus will suffer continued difficulties and dissatisfaction’’ (Thoits, 1987,
p. 19).
Education is a significant preventive against psychological distress
and depression, perhaps because it may lead to an increased sense of
mastery and sense of control, necessary conditions for the development
of active problem-solving approaches and successful negotiation of
stress and coping resources. There are also strong and complex rela-
tionships among education, work, and compensation, with educational
choices setting the foundations for later occupational segregation and
inequities in compensation (Day & Hill, 2007). Education also widens
‘‘possibilities for new role bargains suggested through reading, travel,
and lectures by ‘experts’’’ (Thoits, 1987, p. 18). It is a resource that
leads to effectiveness in both homemaker and work roles, and it needs
to be considered in research examining mental health effects of work
and family resources and responsibilities.
Female-Headed Households
Regardless of race or ethnicity, a large proportion of unmarried
women are mothers who head single-parent households. The number
of one-parent families went from 9.4 million in 1988 to about 18.5 mil-
lion in 2005. Approximately 14 million of these families—76%—were
maintained by women in 2005 (U.S. Bureau of Labor Statistics, 2007).
In 2005, there were more than 17 million children in female-headed
households, where financial difficulties are greatest. The median family
income for female-headed households without spouses was $22,037; for
male-headed households, it was $34,677 (U.S. Bureau of the Census,
2005a).
The reasons women maintain one-parent families differ by ethnic
group. White women are more likely to do so because of marital disso-
lution; in contrast, black single mothers are more likely to have never
married. As Zinn (1989) observes, race and ethnicity create ‘‘different
routes to female headship, but Whites, Blacks, and Latinos are all
increasingly likely to end up in this family form’’ (p. 78). The childcare
needs of such families are considerable, and lack of access to child care
has a differential impact on ethnic minority children.
678 Psychology of Women
Role Quality
Understanding when multiple roles do and do not promote mental
health requires consideration of the joint and interacting effects of the
qualities of those roles. Research has only recently begun to consider
the interactive effects of the family and work roles. Research that does
examine such effects suggests that the independent effects of marital
and occupational status are not sufficient to predict well-being for all
role combinations. It is necessary to look at specific role combinations
and to know whether or not a specific role is perceived as stressful.
As Baruch and Barnett (1987) have observed:
What really matters is the nature of the experiences within a role. Those
concerned with women’s mental health should now, therefore, turn their
attention to understanding how to enhance the quality of women’s expe-
riences within each of their many roles. (p. 72)
Work and Family Roles 681
Psychological Factors
The assumption that women are active agents implies that personal-
ity characteristics and other psychological variables should affect the
number, type, and quality of roles. In a classic study, Helson, Elliot,
and Leigh (1990) analyzed data from a longitudinal study of Mills Col-
lege graduates that assessed personality characteristics at age 21 and
number of roles (partner, parent, and worker) at age 43. Examination
of the differences among combinations of roles revealed that women
with one role were less happy, content, and organized and felt greater
alienation than women with multiple roles. There was no evidence that
the three-role group had any more role conflict or overload than the
other groups. The only difference between the three-role and two-role
groups was the greater communality (feelings of being similar to
others) of the former.
Those researchers affirmed that quality of roles was more important
than number of roles in predicting women’s psychological health. They
first examined the relationship between number of multiple roles and
psychological health at age 43 after antecedent personality characteris-
tics were controlled. Measures of two dimensions of psychological
health—well-being and effective functioning—were used. The number
of roles was not correlated with psychological health at age 43 after
controlling for such health at age 21.
Quality of roles (assessed through measures of marital satisfaction
and status at work), on the other hand, did continue to predict psycho-
logical health, even after controlling for previous psychological health.
Regardless of previous psychological characteristics, marital satisfaction
was associated with contentment, and status at work was associated
with effective functioning. Status level of work was also associated
with attributes of an enhanced self-autonomy, individuality, and com-
plexity. Unfortunately, the joint effects of marital satisfaction and work
status were not explored. Further, because the study is correlational, it
is difficult to separate the effects of work status on personality versus
the effects of personality on work status.
The findings of Helson and her colleagues (1990) suggest an expla-
nation for the psychological benefits of employment per se; that is,
employment, even when it is stressful, may contribute to a more auton-
omous sense of self, thus promoting mental health. Both job satisfaction
and being married have been found to be related to life satisfaction for
682 Psychology of Women
both black and white women (Crohan, Antonucci, Adelmann, & Cole-
man, 1989). Russo and Tartaro (see chapter 14) consider the relation-
ship between concepts such as mastery and women’s mental health.
Marital Quality
The effects of women’s employment on marital quality—that is, mar-
ital strain and marital satisfaction—appear to depend on a couple’s
attitudes toward the wife’s employment. Perceived control over the
choice to work is related to marital satisfaction in dual-career couples
(Alvarez, 1985). Research on dual-worker married couples with pre-
school children has reported couples similar in attitudes toward wom-
en’s roles to be higher in marital satisfaction levels (Cooper, Chassin, &
Zeiss, 1985).
The mix of the couple’s attitudes and personality characteristics has
been found to be important to marital satisfaction as well. Higher lev-
els of marital satisfaction and lower conflict surrounding domestic
tasks are associated with higher combined levels of instrumental and
expressive personality characteristics (Cooper et al., 1985; Gunter &
Gunter, 1990). Individuals with such characteristics may have the best
fit with the multiple agentic and communal qualities of work, mar-
riage, and parenthood roles.
Ross et al. (1983) found that if a wife wanted to work but had no
help from her husband with home responsibilities, her distress level
increased, while his did not. Husbands’ distress increased only in cou-
ples where the preference of both husband and wife was for the wife
to stay at home. The lowest distress levels were found in dual-career
couples who shared childcare and household responsibilities. It thus
may be that difficulties in negotiation of childcare tasks can explain the
finding of Gove and Zeiss (1987) that the presence of children affected
whether or not congruence between employment and wife’s preference
for working affected her happiness. Such findings point to the impor-
tance of research on marital power, multiple roles, and mental health.
Sharing of child care affects marital satisfaction for both men and
women (Barnett & Baruch, 1987).
The effects of intimate violence, including battering and marital
rape, are not often considered when studying the relationship of role
quality, marital power, and work roles. Albaugh and Nauta (2005)
investigated relationships among college women’s experiences of vio-
lence from intimate partners, career decision self-efficacy, and per-
ceived career barriers. Sexual coercion was found to be negatively
correlated with three aspects of career decision self-efficacy (self-
appraisal, goal selection, and problem solving) after adjusting for
symptoms of depression. In contrast, negotiation (a positive conflict tac-
tic) was positively correlated with goal-selection self-efficacy. Intimate
Work and Family Roles 683
Marital Power
Family roles are by definition reciprocal, that is, defined in terms of
rights and responsibilities toward one another. Thus, they depend on
shared expectations and agreements on the tradeoffs between employ-
ment and family responsibilities. How such tradeoffs are negotiated in
marriage clearly has mental health implications for women (Steil,
2001). A sense of power or influence in the relationship is related
to relationship satisfaction for women in both heterosexual (Steil &
Turetsky, 1987) and lesbian (Eldridge & Gilbert, 1990) couples.
Employment may enhance a wife’s ability to negotiate tradeoffs to
her satisfaction and mental health benefit. Employed wives have more
influence over decision making in the home than nonemployed wives
(Crosby, 1982). In a study of professional women, the amount a women
earned relative to her husband (i.e., her income disparity) was more
important than her absolute level of income in predicting her influence
in family decision making. Influence was also correlated with how im-
portant a woman perceived her career to be (Steil & Turetsky, 1987).
Factors that contribute to equality in marital power appear to oper-
ate differently for women when they have children, at least among pro-
fessional women (Steil, 2001). Steil and Turetsky (1987) found that for
professional women without children, the women’s perceived job im-
portance was positively correlated with their influence in marital deci-
sion making. In addition, relative economic status—that is, a smaller
negative or a positive income disparity relative to spouses—was associ-
ated with both greater influence in decision making and more freedom
from household responsibilities for women. For mothers, however,
reduced income disparity did not affect either influence in decision
making or responsibility for household or childcare tasks. The only
variable with an effect was psychological; the more a mother perceived
her job as important, the less her responsibility for the household.
Responsibility for child care was not affected by either variable.
Dominance of the husband in decision making per se did not relate
to women’s marital satisfaction. It was the outcome of the decision that
was important. Women who had husbands who were ‘‘dominant’’ in
decision making that resulted in shared responsibility for household
684 Psychology of Women
tasks were satisfied as wives. The greater the sharing of household and
childcare tasks, the greater the women’s marital satisfaction. Shared
responsibility also enhanced women’s psychological well-being, espe-
cially that of mothers. The more responsibility a woman had for child
care, the higher her depressive symptomatology (dysphoric mood and
somatic symptoms). For nonmothers, marital equality contributed to
well-being through its association with marital satisfaction. For moth-
ers, marital equality contributed to well-being even beyond its contri-
bution to marital satisfaction, suggesting additional relief for direct
stress from burdens of household tasks (Steil & Turetsky, 1987).
The burden of those tasks on women is considerable. It has been
estimated that wives spend somewhere between 30 and 60 hours per
week on household labor, compared with 10 to 20 hours per week
spent by husbands (Berardo, Shehan, & Leslie, 1987; Denmark, Shaw, &
Ciali, 1985). Further, women’s household labor involves tasks that are
more time-consuming and are of more immediate necessity (Gunter &
Gunter, 1990).
Women’s long hours combined with gendered stressors and lack of
access to resources are reflected in their rates of fatigue and tiredness
(Hamilton & Russo, 2006). For example, in one study, fatigue was ranked
first among their concerns by nearly 28 percent of women, and it was
among the top 10 of more than 80 percent (Stewart, Abbey, Meana, &
Boydell, 1998). Fatigue significantly predicts depressive symptom scores
and reports of sleep dysfunction (Lavidor, Weller, & Babkoff, 2003).
The gender-related factors that contribute to women’s fatigue extend
beyond those associated with role overload. Hamilton and Russo
(2006) suggest that the gender-related conditions that lead to fatigue
and increased risk for depression for women may reflect a complex
combination of factors, depending on their social and economic con-
text, including:
Child Care
The individuals who take themselves out of the job market alto-
gether to care for their children incur long-term career advancement
costs, often taking whatever jobs they can get upon reentry to the job
market. McDonald (2005) found that during midcareer, ‘‘reentry-level’’
nonsearchers (people who obtain their jobs without searching thanks to
unsolicited tips about job openings) tend to be women with little work
experience who have been out of the labor market taking care of family
responsibilities.
The literature is in conflict about gender differences in relation to
burnout and absence due to illness. Bekker, Croon, and Bressers (2005)
examined the contribution of childcare obligations, job characteristics,
and work attitudes to emotional exhaustion and absence in 404 male
and female nurses. Contrary to expectations and current stereotypes,
women did not have higher absence rates due to illness; further, men
reported significantly higher levels of emotional exhaustion than
women. Emotional exhaustion was associated with illness absence,
childcare investment, and number of hours worked.
Mental health benefits of mothers’ employment are increased when
women are satisfied with their childcare arrangements (Parry, 1986;
VanMeter & Agronow, 1982). Ross and Mirowsky (1988) found that a
686 Psychology of Women
strain for women, but not for men, perhaps because men rarely took
on the responsibility for housework. The fact that inequities in house-
work were associated with household strain is consistent with research
that inequities in division of household tasks are a source of grievance
for women (Crosby, 1982).
Lack of sharing of housework was found to be associated with
depressive symptomatology through its association with household
strain for both Hispanic and non-Hispanic women. Household strain
was associated with such symptomatology for both women and men,
regardless of employment, age, and socioeconomic status. Unfortu-
nately, the study provided no information about presence of children.
Responsibility for child care was not distinguished from other forms of
household responsibilities.
Lack of marital equality is associated with low education (Antill &
Cotton, 1988; Rexroat & Shehan, 1987), but lack of education does not
totally explain ethnic differences in marital equality. When Golding
(1990) conducted her analyses on individuals with a 12th-grade educa-
tion or above, the main effect for ethnicity that had been found for the
entire sample disappeared, but the interaction effect for gender and
ethnicity persisted.
may be bound up not only in what they do, but equally in what they do
not do. In other words, it may be as important to a sex-typed male not to
Work and Family Roles 689
Gunter and Gunter (1990) also found, however, that neither the hus-
bands’ nor the wives’ gender-role orientation was related to the reasons
given for performing household tasks. Women were more likely to report
they did a task because it was their job or because it would not be done
otherwise. Men, on the other hand, were more likely to report that
domestic tasks were not their job. Perhaps research on male feelings of
entitlement in the work setting (e.g., Major, 1987) may be helpful in
understanding male feelings of entitlement in the family setting.
In particular, factors contributing to inequities in the family appear
to differ for women who are mothers, underscoring the importance of
separating effects of the gender-role of wife from that of mother. The
gender-role that has least changed for women is that of mother, who
still is primarily responsible for child care, whether or not she is
employed, and faces the ‘‘maternal wall’’ of disadvantage in the work-
place (Biernat et al., 2004).
CONCLUSION
This brief portrait of women’s roles and status at work and in the
family suggests that although great changes have occurred in women’s
work and family roles, gender inequalities in rewards, resources, and
status persist. These inequalities are magnified for women of color and
have profound impact on the mental health and well-being of all
women, particularly mothers. Factors contributing to women’s disad-
vantaged status have been discussed, and some strategies for research
and action to empower women have been identified.
In the final analysis, however, it may be na€ive to focus our attention
on specific factors, such as gender segregation or husband–wife income
disparity, currently identified as contributing to gender-based inequi-
ties at work or in the family. As myths and stereotypes are rebutted,
myths are reinvented, and new rationalizations for the status quo
emerge (Barnett, 2004). As Reskin (1988), quoting Lieberson (1985),
pointed out, ‘‘Dominant groups remain privileged because they write
the rules, and the rules they write ‘enable them to continue to write
the rules’’’ (p. 60). She focused on gender segregation, reminding us
that it is but a symptom of the basic cause of the earnings gap—that is,
men’s desire to preserve their advantaged position. The principle goes
beyond the workplace. Attempts to eliminate inequitable outcomes that
fail to recognize the dominant group’s stake in maintaining its superior
status are incomplete (Reskin, 1988). Unless we can forge strategies that
promote human equality as a superordinate goal for men and women
of all races, women’s disadvantaged status is unlikely to change.
690 Psychology of Women
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Chapter 21
Interest in women’s roles, women’s issues, and the role of gender has
grown in both the scientific literature and the popular press as the
numbers of women in the workforce rise and women increasingly
demand equal rights in all domains of work, community, and society.
However, the study of women and leadership has been scant. Most
books and studies of leadership have been about men leaders within
corporations or the public eye. In the public press, being a leader typi-
cally means ‘‘having the corner office’’ or being the chief executive.
Women as chief executives are still a relatively new phenomenon, such
that they make news or the covers of Fortune magazine just by holding
the position (e.g., Harrington & Shanley, 2003).
Leadership theories and studies about good leadership and effective
leadership styles seldom distinguish characteristics related to gender.
While theories and studies of leadership have typically been based on
male leadership, their results are typically generalized as being universal
to both men and women. In the field of the psychology of women, the
study of leadership has been equally scant; this literature has focused on
issues of equity, the relationship between women and society, and psy-
chological and physiological processes of women. As women fought for
an equal place at the table, bolstered by the women’s movement, the
push to increase the numbers of women in leadership roles has been an
even more uphill battle. Indvik (2004) points to the scarcity of women in
higher levels of corporate leadership. While women made up 46.6 per-
cent of the workforce in the United States in 2002, they filled only 15.7
percent of corporate officer positions. She suggests that sex differences in
worldview, socialization, and life experience may result in different men-
tal models or ‘‘implicit theories’’ of leadership among women.
702 Psychology of Women
Studies of leadership have been largely confined to men for the simple
reason that they have historically held most of the leadership roles in soci-
ety and its institutions. Although there is general agreement that women
face more barriers to becoming leaders than men do, especially for leader
roles that are male-dominated (Eagly & Johannesen-Schmidt, 2001), there
is much less agreement about how women actually lead. There is much to
suggest that women lead differently from men, and feminist leadership
styles are different and more collaborative despite significant overlap
between the leadership styles of men and women. The intersection of iden-
tities across race, ethnicity, gender, class, and profession—that is, diverse
women leaders—contribute additional dimensions that may influence dif-
ferences in leadership styles (Chin, Lott, Rice, & Sanchez-Hucles, 2006).
Many women embrace feminist principles of inclusion, gender eq-
uity, collaboration, and social justice in their work and lifestyles. Femi-
nist women are concerned with how differential power and oppression
contribute to the unequal status of women compared to men in all
realms of work, family, and social environments. As president of the
Society for the Psychology of Women of the American Psychological
Association during 2002–2003, I created a presidential initiative, ‘‘Fem-
inist Visions and Diverse Voices: Leadership and Collaboration,’’ to
understand how feminist principles influenced women in their leader-
ship and leadership styles (Chin, 2004).
A yearlong dialogue among feminist women psychologists ensued
about women and leadership. Deconstructing existing theories of femi-
nism and leadership was necessary to understand what effective lead-
ership styles among women meant, and how they intersected with
feminist principles. Telecommunications technology was used to pro-
mote scholarship through 15 Web-based discussion boards coupled
with teleconferences and face-to-face meetings toward the goals of
enhancing a feminist process of collaboration. We considered this
approach innovative as a process to convene scholarly dialogue.
While many of the 100 feminist women participating in the initiative
had already played prominent roles as advocates for women’s issues
and social change, that is, ‘‘getting a seat at the table’’; promoting a
feminist agenda, that is, feminist policy; infusing feminist principles in
service, training, and research; and managing organizations, institu-
tions, and departments, few viewed themselves as ‘‘true leaders.’’ As
the literature on feminist leadership was scarce, it became apparent
that capturing the experiences of women and feminists as leaders was
as important as the empirical studies of women and leadership.
Style Approach
The style approach focuses exclusively on what leaders do (behavior)
and how they act (process), where style is understood as relatively stable
patterns of behavior. Northouse (2004) defines leadership as a process
whereby an individual influences a group of individuals to achieve a
common goal, emphasizing process or a transactional event over the
traits or characteristics residing in the leader. Two styles of leadership
have received considerable attention in the recent literature on leader-
ship. Transformational leaders act as catalysts of change (Aviolo, 1994)
and tend to be visionary (Tichy & Devanna, 1986), with a holistic picture
of how the organization should look when meeting its stated goals, while
transactional leaders are focused on getting things done (that is, task-
oriented), act with directedness, and use rewards to achieve an organi-
zation’s stated goals (Bennis, 1984; Sergiovanni, 1984).
Several studies (e.g., Bass & Avolio, 1994) found women to be more
attentive than men to ‘‘the human side of enterprise’’ (McGregor, 1985),
suggesting that female leaders tend to base judgments more on intuition
and emotions than on rational calculation of the relationships between
means and ends. Other studies identify women’s management styles as
more democratic and participatory than those typically adopted by men
(Mertz & McNeely, 1997). However, a meta-analysis by Eagly and Johnson
(1990) of research comparing the leadership styles of women and men
found a more complex relationship of gender differences. In organizational
studies of those holding leadership roles, female and male leaders did not
differ in their use of an interpersonally oriented or task-oriented style.
However, in laboratory experiments, women were somewhat more gender
stereotypic in using an interpersonal-oriented style in leadership studies.
A meta-analysis of transformational, transactional, and laissez-faire
leadership styles among women (Eagly, Johannesen-Schmidt, & van
Engen, 2003) found that female leaders were more transformational than
male leaders and also engaged in more of the contingent reward behav-
iors that are a component of transactional leadership. Male leaders were
generally more likely to manifest the other aspects of transactional lead-
ership (active and passive management by exception) and laissez-faire
leadership. Although these differences were small, the implications are
encouraging, because they identify areas of strength in the leadership
styles of women. A transformational style is also consistent with feminist
principles of inclusion, collaboration, and social advocacy.
Ethics-Based Leadership
Fine (2006) suggests that the literature on women and leadership tends
to focus on how women lead. The characteristics of women’s leadership
that are identified, such as collaboration, participation, communication,
and nurturance, are viewed in terms of their use as a means of reaching
organizational ends; Fine proposes shifting that focus to the underlying
values expressed in those means, namely, care for other people. This then
is consistent with the ethic of care revealed in women’s career choices
and their desire to help others. In her collection of narratives, women dis-
cursively constructed leadership through a moral discourse of leadership
that emphasized (1) leading in order to make a positive contribution in
the world, (2) collaboration, (3) open communication, and (4) honesty in
relationships—that is, the women imbue each element of their leadership
with a moral dimension. This is different from other approaches to
leadership.
Contextual Leadership
Studies have suggested that situational contexts influence leadership
styles. Madden (2003) suggests that, since behavior occurs within a
context and is influenced by the power relationships among the partici-
pants, we need to examine the contexts in which women lead—in other
words, ‘‘leadership is contextual.’’ Gender-role biases still exist and
influence the appraisal and expectations of women leaders. Eagly &
Karau (2002) suggest that the perceived incongruity between the female
gender-role and leadership roles leads to two forms of prejudice: per-
ceiving women less favorably than men as potential occupants of lead-
ership roles, and evaluating behavior that fulfills the prescriptions of a
leader role less favorably when it is enacted by a woman. One conse-
quence is that attitudes are less positive toward female leaders than
706 Psychology of Women
Collaborative Leadership
With advances in technology and communication, businesses and
corporations are increasingly engaged in an international and global
economy, resulting in an examination of the transferability of leader-
ship and management practices across cultures. Western businesses
that observed high levels of productivity in collective societies and
diverse ethnic cultures, for example, in Japan, began an examination of
these management practices and leadership styles with the goal of
importing them to Western businesses and organizations. At the same
time, non-Western businesses, in a race for a place in the international
marketplace, sought to import and emulate Western business manage-
ment practices. This resulted in identifying dimensions of team and
collaborative leadership different from that observed in the United
States. More recently, non-Western businesses have shifted from
merely adopting Western theories and practices to cherishing their
unique social and cultural factors, while using applications from
Western theories of management (Kao, Sinha, & Wilpert, 1999).
A collaborative style and process have also been viewed as essential
to a feminist leadership style. Feminist principles dictate that all will
be involved in planning and decision making, and consensus building
is valued. The feminist literature has shown that women tend to use
nurturance to engage, communicate, and lead. The use of a collabora-
tive process is viewed as leveling the playing field between leader
and follower and creating more egalitarian environments; these collab-
orative and egalitarian processes have been described as ‘‘shared
leadership.’’
Collaborative leadership has emerged recently as essential to the
skills and processes of the ‘‘modern’’ leader (Cook, 2002). Raelin (2003)
introduced the ‘‘Four C’s of Leaderful Practice’’ and says that leader-
ship in this century needs to be concurrent, collective, collaborative,
and compassionate. While he recommends a process closely akin to a
feminist process, he does not view gender as essential to the process,
nor does he introduce feminism as being among its principles. Feminist
708 Psychology of Women
Diverse Leadership
Diverse feminist groups differ in their leadership styles, and the
issues they face as leaders are influenced by and made more complex
when considering race, ethnicity, ability status, and sexual orientation.
For example, an African American woman may identify with the
values of straightforwardness and assertiveness in her leadership style.
An Asian American woman may identify more with values of respect-
fulness and unobtrusiveness. Others may perceive the African Ameri-
can woman to be intimidating and deem the Asian American woman
passive (Sanchez-Hucles, 2003).
Interpretation of the behaviors of diverse women leaders may vary
depending on the different ethnic and contextual perspective from
which it is viewed. Women leaders having multiple identities associated
with race, culture, gender, disability, and sexual orientation face addi-
tional challenges to their leadership roles as they grapple with their mul-
tiple identities and expectations. While individual differences contribute
greatly to how men and women lead, the commonalities that bond the
experiences of women, of racial/ethnic groups, and of disability and les-
bian groups contribute to how they function in leadership roles.
Women and Leadership 709
It didn’t take long for Dr. Joycelyn Elders, the first black and second
woman to hold the position of U.S. Surgeon General, to stir up
Women and Leadership 711
Yet, Dr. Koop did not receive criticism anywhere near that received by
Dr. Elders for speaking out on similar issues.
Both Joycelyn Elders and Hillary Clinton were limited by the expect-
ations of how women should behave. In choosing to define policy and
to be outspoken in their respective roles, they violated the norm of
silent, passive, and conforming women.
Andrea Jung, described as an Asian American wonder woman
(Goldsea, 2002) is CEO of Avon Products. Her leadership style has been
described as both assertive and feminist, perhaps because the business
that she leads is viewed as ‘‘feminine’’ (i.e., context) or because she did
not behave outside the expectations of the public (i.e., perceptions). In
2003, she was named by Fortune for the sixth time as one the 50 most
powerful women in American business.
This description of our House leaders reflects the gender bias and dif-
ferential language we use describing women leaders in masculinized
contexts. While the description points to Pelosi’s collaborative and
interpersonal strengths, it also reflects the tendency to ‘‘feminize’’
women leaders in ways that suggest weakness or to suggest incredulity
when women behave as decisive and effective leaders.
Women leaders face additional burdens, stressors, and challenges in
taking on leadership roles. Diane Halpern (2002), past president of the
American Psychological Association, sums it up nicely:
These examples suggest that women leaders still lead within contexts
that are male dominated; definitions of women leadership are still tem-
pered by comparisons with men; many women feel that they are often
expected to behave in ways consistent with ‘‘feminine roles.’’ This can
create a no-win situation where women leaders are made to feel margi-
nalized, diminished, or weak if they behave gender-prescribed ways (i.e.,
are too feminine) or are criticized if they step out of these roles (i.e., are
too masculine). These gender biases and gender attributions placed on
women’s behaviors are constraining. All too often, ‘‘feminine’’ behaviors
are rated negatively with respect to leadership; for example, tears signal
weakness, and nurturing leadership styles are viewed as lacking in sub-
stance. Conversely, women leaders adopting ‘‘masculine’’ behaviors are
also viewed negatively; an aggressive and direct male leader is often
viewed as forthright and taking charge, while the same behavior in a
female leader is viewed as overbearing and angry.
Some common negative attributions people make of ‘‘strong women
leaders’’ are: ‘‘She’s a bitch,’’ ‘‘What a dragon lady,’’ ‘‘She acts like a
man.’’ Equally negative attributions are often made when women lead-
ers ‘‘act like women’’; for example, sometimes characterizing a wom-
an’s leadership style as ‘‘maternal,’’ ‘‘nurturing,’’ or ‘‘persuasion and
smiles’’ is used to convey weakness and ineffectual leadership.
TRANSFORMING LEADERSHIP
To understand women and leadership, we need to transform current
leadership models to incorporate the relevance of gender and diversity.
Women and Leadership 713
core values that motivate those in leadership roles, and to identify effec-
tive leadership styles for men and women to achieve the outcomes they
envision for the organizations and institutions they lead. Transforming
leadership does not mean that men cannot or should not be leaders.
Rather, it means that women can and should be effective leaders without
needing to change their essence or adopting values that are not syntonic
with their gender or culture. It is about using feminist principles to pro-
mote pathways to leadership, recognizing the obstacles and drawing on
its strengths. It is about measuring and identifying effective leadership
styles that are not simply based on identifying the characteristics of
good male leaders. It is about how issues of power, privilege, and hier-
archy influence the contexts in which leadership occurs.
FEMINIST LEADERSHIP
While we examine women and leadership, we need to consider how
to incorporate ethics, collaboration, contexts, diversity, and transforma-
tional concepts into a new model of feminist leadership. An important
distinction from the feminist literature is that being female and being
feminist are not the same. We conclude that feminist leadership is a
goal—and it is a style. Feminist women who aspire to and achieve
leadership positions bring to these positions values and characteristics
that shape how they lead, but they are also shaped by the environ-
ments in which they find themselves. Based on feminist principles and
values, it is a goal of feminist women that they apply these principles
of collaboration, egalitarianism, and inclusiveness to leadership and to
the positions of leadership in which they find themselves; therefore, it
is a goal.
A feminist leadership perspective argues for gender-equitable envi-
ronments and against masculinized contexts; it argues against women
needing to act like men. A feminist leadership perspective introduces
ethics, social justice, collaboration, and inclusiveness as critical to their
motivations for seeking positions of leadership. For women leaders
and feminist leaders, the objectives of leadership include empowering
others through:
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716 Psychology of Women
It has only been since the 1960s that women’s work has been taken
seriously by at least some segments within psychology and society,
and the concept of women actually having careers, vocations other
than motherhood, received serious study. Today the study of women’s
career development is a vibrant and critically important field of
psychology—we now take women’s careers seriously.
Women today constitute a significant portion of the labor force, and
the vast majority of U.S. women work outside the home. In 2005, of
women age 25–44, 75 percent were employed (U.S. Bureau of Labor
Statistics, 2005). Of women with children under 18, 71 percent are
employed, and 62 percent and 57 percent of those with children under
age 6 and under age 3, respectively, are employed (U.S. Bureau of
Labor Statistics, 2005). The odds that a woman will work outside the
home during her adult life are over 90 percent (U.S. Bureau of Labor
Statistics, 2003). What this adds up to is that paid employment (versus
work inside the home) is now the rule, not the exception. There is no
category of women for whom the majority is not employed outside the
home (Barnett & Hyde, 2001).
Not surprisingly, the most common family lifestyle today is the ‘‘dual-
earner’’ family (Gilbert & Kearney, 2006). As described by Gilbert and
Kearney (2006) and by Barnett and Hyde (2001), we now have ‘‘work-
family convergence’’ (Gilbert & Kearney, 2006, p. 196), where both work
and family are considered important in the lives of both women and
men, and where many if not most workers prefer the two roles equally.
Thus, as psychologists, educators, and counselors, it is essential to under-
stand the issues facing women at work and the reality that both work and
family roles are salient in the lives of contemporary women and men.
Utilization of Abilities
Research has shown that the fulfillment of individual potential for
achievement is vitally important. Although the roles of homemaker
Women’s Career Development 719
and mother are important and often very satisfying, they do not allow
most women to fulfill their unique abilities and talents. These, rather,
must be fulfilled through career pursuits or volunteer and avocational
activities, just as they are in men. This is not to discount the impor-
tance of childrearing, but only to point out its insufficiency as a lifelong
answer to the issue of self-realization. Even if a woman spends a num-
ber of years creatively rearing children, these children inevitably grow
up and begin their own lives—lives that must of necessity be increas-
ingly independent from the parental home.
The evidence is strong that homemakers who do not have other outlets
for achievement and productivity are highly susceptible to psychological
distress, particularly as children grow and leave home. For example, of
the women in the Terman studies of gifted children (Terman & Oden,
1959), when followed up in their 60s (Sears & Barbie, 1977), the women
who reported the highest levels of life satisfaction were the employed
women. Least satisfied with their lives were those who had been
housewives all of their adult lives. The most psychologically distressed
women were those with exceptionally high IQs (above 170) who had
not worked outside the home. It seems fairly clear in the Terman study
that women with genius-level IQs who had not pursued meaningful
careers outside the home have suffered psychological consequences.
Kerr (1997; Kerr, Foley-Nicpon, & Zapata, 2005), in an extensive pro-
gram of research on gifted girls, notes that, although the aspirations of
girls are as high as are those of their gifted male counterparts, ‘‘the theme
of their lives is one of declining achievement goals’’ (Kerr et al., 2005,
p. 19). Gifted girls often experience pressure, subtle or not so subtle, to do
an ‘‘about-face’’ (Kerr, 1997; Reis, Callahan, & Goldsmith, 1996) during
adolescence—to shift their personal priorities and self-evaluations from
academic achievement to the achievement of romance.
Gifted girls were also quite concerned about the effects of their gifted-
ness on others’ attitudes toward them, fearing that these attitudes would
be negative (Kerr, Colangelo, & Gaeth, 1988). Not surprisingly, by the
sophomore year of college, gifted young women have likely changed their
majors to less challenging areas, by their senior year they have reduced
the level of their career goals, and by college graduation they have given
up their former career dreams altogether, all because of the pervasive
‘‘culture of romance’’ (Holland & Eisenhart, 1990; Kerr et al., 1988, p. 16).
It does not seem unreasonable to suggest that these young women of
today will experience the same eventual loss of self and the psychological
problems experienced by the gifted women in the older Terman studies.
Multiple Roles
In a related vein, there is strong evidence for the beneficial effects of
working outside the home on a woman’s psychological adjustment,
720 Psychology of Women
is fairly clear now that it is lack of math background, rather than lack
of innate ability, that is to blame for females’ poorer performance on
quantitative aptitude and mathematics achievement tests (e.g., Chipman
& Wilson, 1985; Eccles & Jacobs, 1986; National Center for Education
Statistics, 2004; Spelke, 2005). Thus, a critical issue is females’ avoidance
of math. Educational and counseling interventions capable of helping
young women to be full participants in an increasingly technological so-
ciety may be among the most crucial strategies in attempts to broaden
women’s career choices. These issues are dealt with more extensively in
the discussion of counseling implications.
Self-Efficacy Expectations
The concept of self-efficacy expectations has become one of the most
important in helping to understand the career options that people con-
sider. Self-efficacy expectations (Bandura, 1977, 1997) refer to people’s
beliefs that they can successfully complete specific tasks or behaviors to
reach goals. For example, an individual may perceive herself as able (or
unable) to solve algebraic equations, fix a flat tire, or care for an infant.
Self-efficacy expectations are postulated by Bandura (1977, 1997) to
have at least three behavioral consequences:
in careers in science and technology and the skilled trades, among others.
Twenty-five years of research has supported these postulates.
In education or job-content domains, college women tend to score
lower than college men on self-efficacy in domains having to do with
math, science, computer science and technology, mechanical activities,
and outdoor and physical activities (Betz & Hackett, 1981, 1997; Betz,
Borgen, Rottinghaus, Paulsen, Halper, & Harmon, 2003; Borgen & Betz,
2007). Women tend to score higher than men on self-efficacy in social
domains of activity, such as teaching and counseling. For example, we
asked college women and men to report whether or not they felt them-
selves capable of completing various educational majors (Betz & Hackett,
1981). Even though the men and women as a group did not differ in their
tested abilities, they differed significantly in their self-efficacy beliefs.
These differences were especially striking toward occupations involving
mathematics: 59 percent of college men versus 41 percent of college
women believed themselves able to complete a degree in that field.
Seventy-four percent of men, compared to 59 percent of women, believed
they could be accountants. Most dramatically, 70 percent of college men
but only 30 percent of comparably able women believed themselves able
to complete a degree in engineering.
We also found that self-efficacy was related to the range of career
options considered, and that self-efficacy for mathematics is linked to
choice of a science career (Betz & Hackett, 1981, 1983). Other studies
have shown that self-efficacy beliefs are related to performance and
persistence. For example, Lent, Brown, and Larkin (1984, 1986) showed
that efficacy beliefs regarding the educational requirements of scientific
and technical occupations were related to both the performance and
persistence (continuing enrollment) of students enrolled in engineering
programs. And some studies (e.g., Pajares, 1996) have suggested that
women tend to more accurately estimate their mathematical abilities,
while men often overestimate theirs. Overestimation is postulated to
lead to ‘‘approach’’ behavior—effort and persistence—and so may lead
to skill enhancement and expansion of options, more likely therefore to
characterize the efforts of young males than females.
Thus, low self-efficacy, especially in relationship to male-dominated
careers or careers requiring mathematical or technical expertise, may
reduce the self-perceived career options of women. Another concept in
Bandura’s (1997) social cognitive theory that is important for women is
that of outcome expectations, the belief that desired outcomes will fol-
low from successful behaviors. Given continuing discrimination in the
workforce, it would not be surprising if women felt that competent
work behavior might not be rewarded or might even be disparaged in
certain contexts. Women of color may have particularly low outcome,
as well as self-efficacy, expectations due to experiences with oppression
and racial bias (Byars & Hackett, 1998).
726 Psychology of Women
in how their vocational interests have developed and how they are
measured.
Using Holland’s (1997) vocational theory as an example, women
score lower on Realistic themes and higher on Social themes than men
when raw scores (simple number of items endorsed) are used to meas-
ure the Holland types (Lunneborg, 1979). The Realistic theme includes
technical, outdoor, and ‘‘hands-on’’ activities—the kinds of skills often
taught in high school ‘‘shop,’’ electronics, and trades courses or under
the tutelage of a parent comfortable with home and automobile repair.
Realistic interests are part of inventory suggestions for careers in engi-
neering, and thus lower scores on this theme constitute a significant
barrier to the suggestion of this occupational field to young women.
The Social theme includes social, interpersonal skills often thought im-
portant to teach girls but neglected in the teaching of boys (Tipping,
1997; Yoder, 1999).
When such measures are used, gender stereotypes tend to be perpe-
tuated by the test materials themselves. There is strong evidence that
these interest differences are in part due to stereotypic gender social-
ization, because boys are exposed to different types of learning oppor-
tunities growing up than are girls. Educational and career options are
thus restricted because of restricted interest development. Although
part of the answer to this problem is to increase the breadth of social-
ization experiences afforded to both genders, at a practical level we can
also address these problems by using interest inventories that are not
gender restrictive—that is, that do not perpetuate gender stereotypes.
This can be done using within-gender normative scores (comparing
raw scores to those of members of the same gender) and gender-
balanced interest inventories (where interest scales include items famil-
iar to both genders rather than primarily to just one). These approaches
will be discussed in the last section on implications for education and
interventions.
Multiple-Role Concerns
Fitzgerald, Fassinger, and Betz (1995) noted that ‘‘the history of
women’s traditional roles as homemaker and mother continue to influ-
ence every aspect of their career choice and adjustment’’ (p. 72), typi-
cally in the direction of placing limits on what can be achieved. The
research of Arnold and Denney (see Arnold, 1995) following the lives
of Illinois valedictorians provided a particularly vivid illustration of
how the aspirations of academically gifted women, but not those of
similarly gifted men, steadily decreased as they completed college and
entered career fields. In her longitudinal study of midwestern high
school students, Farmer (1997) noted that a large number of young
women interested in science chose to pursue nursing because they
Women’s Career Development 729
thought it would fit well with having and rearing children or with
being a single or divorced head of household. Men in the Farmer study
made no such compromises. In Farmer’s sample of women (high
school students in 1980) career motivation was inversely related to
homemaking commitment.
Kerr et al. (2005) noted that ‘‘a culture of romance which is viru-
lently inimical to female achievement still thrives in coeducational col-
leges and universities’’ (p. 30), and that it leads even gifted young
women to reduce their major and career aspirations, to be much more
likely than their male counterparts to follow their partner to his job
location, to take responsibility for child care, to give up full-time work
for part-time work, and to give up leadership positions as too demand-
ing to combine with domestic responsibilities. In essence, she takes full
executive responsibility at home (Bem & Bem, 1976), so it may be per-
ceived as an undue burden (and probably is!) to also take such respon-
sibility at work.
Women today may not be viewing home and career as an ‘‘either/
or’’ choice, but many do plan careers mindful of how they will inte-
grate these with home and family. In contrast, many men plan their
careers without needing to sacrifice levels of achievement to accommo-
date home and families (Farmer, 1997). Spade and Reese (1991) noted
that men reconcile the demands of work and family by ‘‘reverting to
the traditional definition of father as provider’’ (p. 319). As concluded
by Gerson (1986) and discussed further by Eccles (1987), women’s
choices about work continue to be inextricably linked with their deci-
sions about family, and thus family role considerations limit women’s
investment in the occupational world.
Although we have witnessed tremendous increases in workforce
participation among women in all marital and parental categories, the
relationship of marital/parental status to career attainment, commit-
ment, and innovation is still very strong. Studies have shown inverse
relationships between being married and having children and every
measurable criterion of career involvement and achievement (see Betz
& Fitzgerald, 1987, for a comprehensive review). This inverse relation-
ship is not true among men. Highly achieving men are at least as likely
as their less highly achieving male counterparts to be married and to
have one or more children. In other words, men do not have to down-
scale their aspirations in order to have a home and family. Women,
like men, deserve to ‘‘have it all.’’
One of the most basic and important concepts summarizing the dif-
ficulties faced by women in higher education is Freeman’s (1979) con-
cept of the null educational environment. A null environment is one that
neither encourages nor discourages individuals—it simply ignores
them (Betz, 1989; Freeman, 1979). Its outcome is to leave the individual
at the mercy of whatever environmental or personal resources to which
she or he has access.
The effects of null environments on women were first postulated by
Freeman (1979) following her study of students at the University of
Chicago. Students were asked to describe the sources and extent of
environmental support they received for their educational and career
goals. Although both male and female students reported being ignored
by faculty (thus experiencing what Freeman dubbed the null educa-
tional environment), male students reported more encouragement and
support from others in their environments, for example, parents,
friends, relatives, and significant others.
When added to the greater occurrence of negative messages regarding
women’s roles and, in particular, regarding women’s pursuit of careers
in fields traditionally dominated by men, the effect of the faculty simply
ignoring the women students was a form of passive discrimination—
discrimination through failure to act. As stated by Freeman (1979), ‘‘An
academic situation that neither encourages nor discourages students of
either sex is inherently discriminatory against women because it fails to
take into account the differentiating external environments from which
women and men students come,’’ where external environments refer to
difference in familial, peer, and societal support for career pursuits
(p. 221). In other words, professors do not have to overtly discourage or
discriminate against female students; society has already placed count-
less negative marks on the female student’s ‘‘ballot,’’ so a passive
732 Psychology of Women
Mejia, and Luna (2001) found that although Latina high achievers came
from families where traditional gender-roles were emphasized, most
also had nontraditional female role models—for example, their mothers
were often nontraditionally employed or, if homemakers, held leader-
ship roles in community organizations. On the other hand, Hackett,
Esposito, and O’Halloran (1989) and Weishaar, Green, and Craighead
(1981), among others, have reported that the presence of a supportive
male family member was important in girls’ pursuit of nontraditional
career fields. Many women pursuing nontraditional career fields relied
heavily on male mentors (Betz, 2002), since no female mentors were
available in their environments.
In addition to supportive family and mentors, much previous
research has shown the importance of personality factors such as instru-
mentality, internal locus of control, high self-esteem, and a feminist ori-
entation in women’s career achievements (Betz & Fitzgerald, 1987;
Fassinger, 1990). Instrumentality, one of the critical factors in Farmer’s
(1997) study, refers to a constellation of traits that were previously called
‘‘masculinity’’ but were seen eventually to reflect a collection of charac-
teristics having to do with independence, self-sufficiency, and the feeling
that one was in control of one’s life. It has also been described as
‘‘agency’’ and has much in common with self-efficacy (Bandura, 1997).
The possession of instrumental traits does not mean that one cannot
also possess the most traditionally feminine traits of nurturance and
sensitivity to others. These characteristics are now referred to as ‘‘expres-
siveness’’ or ‘‘communion.’’ Together, instrumentality and expressive-
ness form the ‘‘androgynous’’ personality style, which is thought to be
desirable for both women and men. Thus, positive factors related to sup-
port and mentoring from others, along with a personality characterized
by high self-esteem and self-efficacy and a sense of self-sufficiency and
instrumentality, can help women reach their career goals.
Sexual Harassment
Sexual harassment also continues to be a major problem in the
workplace, with serious consequences for both women and organiza-
tions. Sexual harassment is described in detail by authors such as
736 Psychology of Women
Multiple Roles
Another of the persistent conditions affecting women’s equity in the
workplace, and their job satisfaction, is that, while their workforce par-
ticipation has increased dramatically, their work at home has not
decreased. Although multiple roles are in general positive for mental
health, the picture becomes more complex when women are expected
to shoulder the major burden of homemaking and child care. As well
stated by Barnett and Hyde (2001), ‘‘there are upper limits to the bene-
fits of multiple roles’’ (p. 789) when the number of roles becomes too
great or the demands of one role become excessive—this would seem
to apply to the case where the woman is now expected to cope with
two full-time jobs, one outside and the other inside the home. Instead
of ‘‘having it all,’’ women are ‘‘doing it all’’ (Fitzgerald & Harmon,
2001, p. 215).
Women’s Career Development 737
the message ‘‘Girls can’t do math,’’ anxiety will likely accompany new
learning efforts. Thus teaching anxiety management techniques may also
be appropriate. Relaxation training and learning to consciously focus
self-talk on the task at hand rather than on the self can be helpful.
Finally, the psychologist or educator can serve as the woman’s ‘‘cheer-
leader’’ as she tries new things. This role includes generally encouraging
her that she can do it, and more specifically reinforcing her efforts as she
tries new things. Helping her set goals, reinforcing her when she
achieves them, and helping her to try again when she has temporarily
faltered are all important. Finally, the psychologist can counter beliefs
(such as ‘‘Girls can’t do math’’) that are getting in her way.
In addition to assessing self-efficacy expectations, outcome expecta-
tions should also be assessed. This is especially true for women of color,
who may expect more barriers to their success than white women have.
Similarly, women wishing to pursue traditionally male-dominated occu-
pations may have concerns about the extent to which their efforts will
lead to desired rewards and outcomes. Although these concerns may be
realistic, helping the woman to consider coping strategies and learn
about typical organizational/institutional grievance procedures may be
helpful. Assertiveness training, learning to seek social support, and exter-
nalizing rather than internalizing the causes of discrimination and ha-
rassment may be useful.
support for women’s working and help them gain self-efficacy for non-
traditional careers, we should also support men’s pursuits of nurturing
roles and help them gain self-efficacy with respect to nurturing and
multiple-role management. Gilbert (1994) and Harmon (1997) both sug-
gest that it is time to develop theories that conceptualize career devel-
opment and family life in a more interactive way. Such theory
development would hopefully increase the satisfaction and well-being
of both women and men in multiple life roles.
CONCLUSION
In summary, although women have made significant progress in
their attempts to fulfill their talents and interests and to achieve equity
and satisfaction in their work, there remain many barriers and inequi-
ties that continue to demand our attention. These barriers and inequi-
ties can be addressed at many levels—with the individual, in
institutions such as school and colleges, in business and military organ-
izations, and through legal, political, and societal change. As well, con-
tinuing research and study designed to examine the dynamics of
choice, success and satisfaction, and the mechanisms of positive change
are needed.
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Index
EDITORS
Florence L. Denmark, Ph.D., is the Robert Scott Pace Distinguished
Research Professor at Pace University in New York, where she served
as chair of the psychology department for 13 years. A social psycholo-
gist who has published extensively in the psychology of women and
gender, she has long been an energetic force in advancing psychology
internationally, particularly as it concerns the psychology of women and
human rights.
Dr. Denmark served as the 88th president of the American Psycho-
logical Association in 1980 and has been an active member of many of
its boards and committees, including the Council of Representatives
and Board of Directors. She is a Fellow of 13 APA divisions and
served as a president of APA Divisions 1, 35, and 52. In addition, she
was president of the International Council of Psychologists, Eastern
Psychological Association, New York State Psychological Association,
and Psi Chi and a vice president of the New York Academy of
Sciences.
Denmark has four honorary doctorates and is the recipient of many
regional, national, and international awards, including the American
Psychological Foundation’s Gold Medal for Lifetime Achievement in
the Public Interest and the Ernest Hilgard Award honoring Career
Contribution of General Psychology. Dr. Denmark is currently an APA
and an ICP NGO representative to the UN, and she continues to teach
graduate courses at Pace University.
CONTRIBUTORS
Courtney E. Ahrens is an assistant professor in the psychology
department at California State University, Long Beach. She completed
her doctoral training in community psychology at the University of Illi-
nois at Chicago. Dr. Ahrens’s research focuses on violence against
women, with a particular focus on the disclosure of sexual assault and
community resources for survivors. She also works closely with local
rape crisis centers and domestic violence agencies to help them evalu-
ate their services and conduct prevention programs on campus. In
addition to her community-based research, Dr. Ahrens also regularly
teaches psychology of women, community psychology, and a special-
ized class on domestic violence.
Jean Lau Chin, Ed.D., ABPP, is professor and dean of the Derner Insti-
tute for Advanced Psychological Studies at Adelphi University in New
York. Prior to her current position, she was systemwide dean of the
California School of Professional Psychology at Alliant International
University. Dr. Chin is a licensed psychologist with more than 35 years
of clinical, educational, and management experience in health and
mental health services. She has held the positions of president, CEO
Services; regional director, Massachusetts Behavioral Health Partner-
ship; executive director, South Cove Community Health Center; and
codirector, Thom Child Guidance Clinic. She was also an associate pro-
fessor at Boston University School of Medicine and assistant professor
at Tufts University School of Medicine.
Dr. Chin has published extensively, with nine books and more
than 200 presentations in the areas of culturally competent service
delivery and ethnic minority, Asian American, and women’s issues
in health and mental health. Her most recent books are Women and
Leadership: Transforming Visions and Diverse Voices and Learning from My
Mother’s Voice: Family Legend and the Chinese American Experience. She
serves on many national and local boards, including the Council for
National Register for Health Service Providers in Psychology, and the
Council of Representatives and the Board for the Advancement of
Psychology in the Public Interest of the American Psychological
Association.
University of New York. There she teaches such classes as social psy-
chology, personal adjustment, psychology of women, theories of ethnic
identity development, and issues in black psychology.
Dr. DeFour is currently a member of the board of directors of the
new york association of black psychologists and has served on the
board of directors of the national association. She is also active in sev-
eral divisions of the American Psychological Association. The theme of
her current research is the exploration of the various ways that vio-
lence in the form of racism and sexism as well as physical violence
affects the everyday lives of adolescent and adult black females.
Linda Dillon is in human resources for the New York State Education
Department. She is currently completing a certificate in human
resource management at Union Graduate College.
Kareen Hill began her military service in 1999, when she was drafted into
the Israel Air Force, where she was responsible for logistics of equipment
and supplies. In 2003, she enrolled in a B.A. program in behavioral scien-
ces at the Max Stern Academic College of Emek Yezreel, where she ma-
jored in psychology and criminology. She graduated in 2006. During her
studies, she was a research assistant to Dr. Khawla Abu Baker, whose
research focused on Arab women in Israel. Hill was responsible for seek-
ing and reviewing published literature in a variety of subjects related to
women, analyzing data, editing articles prior to publication, gathering
780 About the Editors and Contributors
subject matter for writing books and summaries, and active participation
in relevant seminars. Following her graduation, she began working as a
research assistant to Prof. Marilyn P. Safir at the University of Haifa. Hill’s
plans for the future include beginning M.A. studies in information science
at Bar Ilan University, beginning in October 2007.
Maria Klara received her B.A. from Boston College in 1999 and her
M.S. in counseling psychology from Northeastern University in 2003.
She is currently pursuing her Psy.D. in school-clinical child psychology
at Pace University. Her academic interests include women and gender
issues, psychological assessment, and clinical work with adolescents.
and 35. She has represented Divisions 9 and 35 on the coalition of Divi-
sions for Social Justice. Her areas of interest are interpersonal discrimi-
nation; the intersections among gender, ethnicity, and social class;
multicultural issues; the social psychology of poverty; and the social
psychology of dissent. Currently, she represents Division 9 (SPSSI) on
APA’s Council of Representatives and is a member of an Interdivi-
sional Minority Pipeline Project working on strategies to increase the
recruitment and retention of graduate students of color.
Pamela Trotman Reid, Ph.D., is the provost and executive vice presi-
dent at Roosevelt University and a professor of psychology. She previ-
ously held administrative and professorial ranks at the University of
Michigan, the City University of New York Graduate Center, and the
University of Tennessee–Chattanooga. Her research interests have
focused on gender and racial socialization. In particular, her more than
60 journal articles, book chapters, book reviews, and essays address the
intersections of discrimination based on social class, race, sex, and
784 About the Editors and Contributors
Tina Stern grew up in Cleveland and has lived in Atlanta since 1987.
She earned her undergraduate degree from Boston University, her mas-
ter’s degree from Cleveland State University, and her Ph.D. from the
University of Georgia. She is a professor of psychology at Georgia
786 About the Editors and Contributors
Perimeter College, where for many years she has taught courses on the
psychology of women. In addition, as a licensed psychologist, Dr. Stern
maintains a clinical practice. Since her days at Boston University, she
has been interested in, and written about, issues related to women and
in particular the psychology of women.