ASK DR. LEEDOM: Is there a gender bias against men in the diagnosis of sociopathy?

There is gender bias in our current mental health diagnostic system. This bias occurs for three reasons.

  1. There are genuine gender differences in the manifestation of behavioral disorders.
  2. Those creating the diagnostic categories are biased.
  3. Those making the diagnoses are biased.

Each of these reasons for gender bias is operative with regard to sociopathy. We would hope though that gender differences found in behavioral disorders reflect true physiologic differences between men and women. This week I will attempt to convince you that physiologic differences between men and women account for the higher prevalence of sociopathy in men.

That men and women are different physiologically is apparent from our appearance. Other than the obvious difference in external genitalia, men are on average taller, stronger, have facial hair, deeper voices and smaller breasts. But take each of these secondary sex characteristics individually and you will see where the problem lies. There are some women who are taller than many men. There are other women who are physically very strong and others who have deep voices. Much money is spent on fixing the “problem” of facial hair and small breast size in some women. The point is that gender differences represent group differences in aggregate qualities.

The real question is, “is there some physical difference between men and women that causes more men to develop into sociopaths?” Alternatively, maybe we just label men with aggressive behavior sociopaths and we fail to label women, or we call them something else.

Hormones and sociopathy

There are two fairly consistent hormonal findings in sociopaths as a group. Sociopaths tend to have higher levels of masculine hormones like testosterone (androgens). They also have lower stress hormone (cortisol) output in response to stress. Higher androgen levels have been found in both male and female sociopaths. However, the abnormal stress hormone response to stress has only been documented for male sociopaths. There is one study that shows this characteristic is not present in female sociopaths. Hold this thought in mind because I am going to come back to it.

Borderline personality disorder is more common in women

Although more men than women are diagnosed with sociopathy, there is a sister condition to sociopathy that overwhelmingly more women get diagnosed with. That condition is borderline personality disorder (BPD). There is even more gender bias in the diagnosis of BPD than there is in the diagnosis of antisocial personality disorder (ASPD/sociopathy). It is relatively unusual for men to be diagnosed with borderline personality disorder.

The DSM-IV defines BPD as: “a pervasive pattern of instability of interpersonal relationships, self-image, and affects, and marked impulsivity beginning by early adulthood and present in a variety of contexts.” If you have been involved with a sociopath, you may be saying, “Wow that sounds like my ex!” In fact many with ASPD could also be diagnosed with BPD and vise versa. Nearly 40% of a clinical population met criteria for BOTH disorders in one study.

Many psychoanalysts consider those with ASPD to have an “underlying borderline personality organization.” I can’t really comment on that because it all sounds like psychobabble to me. But I can comment on why there is so much over lap between borderline and antisocial personality disorders, and why one is more common in men and the other in women.

Over the course of human evolution, there has been substantial selection pressure for women to have empathy and self control. Simply speaking, a woman without these had much less chance to survive and reproduce. Empathy is important, but differentially important for males. Therefore, when our nervous systems develop under the influence of our sex steroids, it is relatively more unusual for a woman to develop completely devoid of empathy. Lack of empathy is a central characteristic of ASPD but is not as pronounced in BPD.

The development of ASPD and BPD

Mother Nature also selected for women who are more cautious, less risk taking and more fearful. This is why anxiety disorders are much more common in women. Fearlessness and risk taking are part of the ASPD diagnosis. Anxiety is a central feature of BPD.

On this blog, I have written a great deal about the human social dominance drive. This drive is also called the power motive or need for power. I have explained that this need for power motivates much of the sociopath’s behavior. The power motive is also largely under the influence of testosterone in both men and women. The power motive causes women with BPD to be “manipulative.” But they do not show the proactive aggression that characterizes ASPD. If they did, they would be called ASPD rather than BPD.

So why is there a gender difference in the manifestation of the power motive? The reason is stress hormones. There is an interesting overlap between sex hormones and stress hormones. The interplay between sex hormones and stress hormones is partly responsible for the development of ASPD, and an excessive focus on power in relationships. I believe this is the major reason why we more commonly see BPD in women and ASPD in men.

The hormonal stress response is different in males and females. In boys and men, stress activates the sympathetic nervous system and also releases cortisol from the adrenal gland. The sympathetic nervous system stimulates the testis to release more testosterone. This is likely why childhood stress is related to the development of ASPD in boys and is also why harsh punishment increases, not decreases aggressive behavior in problem boys. Stress substantially increases testosterone in many boys and testosterone increases power motivated behavior.

In social interactions, children learn submissive behavior due partly to cortisol released in response to encounters with adults who are dominant or more powerful. When the average at-risk boy has these power encounters with adults, his body releases more testosterone than cortisol. Thus, power struggles increase dominance/aggressive behavior in at risk boys because these boy’s adrenal glands do not release enough cortisol in response to stress.

Since women do not have testis, they do not have this androgen boost in response to stress. The adrenal glands of some women do release more androgens in response to stress, this is why stress is associated with the development of ASPD in some girls. Remember also, nearly all cultures pressure girls from an early age to suppress their dominance drives, whereas boys are encouraged to be competitive and aggressive.

Most women with BPD were sexually molested as young girls. A history of sexual molestation is also common in incarcerated women and in women diagnosed with ASPD. It is very likely that the body’s response to childhood stress dictates whether a woman develops ASPD as opposed to BPD.

There are many adults with ASPD and BPD who did not experience excessive childhood stress. Many of these adults had ADD/ADHD as children. Impulsivity is a primary symptom of ADHD, BPD and ASPD. In antisocial individuals this impulsivity is associated with the enjoyment of aggression and power over others. In BPD others are manipulated but the aggression is primarily directed at the self.

To sum it all up then, an out of control drive for social dominance is required for the full manifestation of ASPD. Sociopaths thrive on power. Physiologically, boys and men are predisposed to develop an excessive dominance drive. This difference in the power motive is responsible for part of the gender differences found in ASPD and BPD. The other part of the gender gap is explained by increased levels of anxiety in women.

Comment on this article

46 Comments on "ASK DR. LEEDOM: Is there a gender bias against men in the diagnosis of sociopathy?"

Notify of

I had the misfortune of coming across a female recently who exhibited what seemed to me, a diabolical form of Narcissism. She had brought an entire garden club under her spell, and it wasn’t until she threatened and brought arrest charges against some of them, that anyone caught on.

When a member failed to call her “Madame President” out at the garden, she brought an accusation of assault against her. Although she didn’t show a single sign of having been assaulted, she charmed the police into pressing the arrest. Fortunately, there was an eye-witness to the entire interaction between the two women and although the case has not been tried yet, it seems to be clear that it will be dismissed.

In several meetings, she ordered people out of the room who disagreed with her and threatened them with arrest for “disrupting” her meeting. She also tried to block someone she didn’t like from entering the meeting by closing the door on her.

When asked to step aside as President she fought back by exaggerating and maliciously fabricating wrong doing by club members.

We became aware that she had recently lost custody of her children and that she had cyber-stalked her husband so badly that he had to hire an internet “sweeper” to protect his reputation.

Although many people clearly saw her antics, they were unable to grasp the disturbed nature of her behavior. And it gave me pause to ponder the difference between how a male with Anti-Social tendencies behaves, opposed to how a woman behaves.

It occurred to me that a man may have been physically violent or verbally abusive when his power was undermined, whereas, because of her slighter stature, she chose to employ the police to do her bidding- a far more devious way of causing harm.

It seemed to support that testosterone plays a part in how anti-socials behave, and underscore why there may be less females than males who have these tendencies.


In response to the hypothesis that there is “gender bias” against men when it comes to diagnosing Sociopaths (and we all know most of them are never diagnosed), I would like to ask and answer the following question:

Is there gender bias in how much money women make? Yes, there is. If all women made the same salaries as most men, we would leave, kick them out, get better attorneys, and escape them. THAT is a gender bias that causes much more pain than an abusive man being ‘misdiagnosed’ with Sociopathic tendencies. If women were in charge of making the most money, the count for male Sociopaths would go down and the count for homeless men would go up.

Alright for fks sake isn’t it time we put this gender bullsht to rest? The whole gender thing is just based on stupid stereotypes and here’s the best way to pop the bubble- by stopping the bullsht about “women being such big manipulators”- for one thing It’s MEN who manipulate WOMEN on a regular basis, show of hands how many men have MANIPULATED a woman into sleeping with them? Guys with your eye’s on the floor stop bullshtting and get those hands up! So if anything MEN would be the manipulative fragile unstable one’s and women the strong one’s.- Childbirth- yeh you think men are more likely to be aspd cos you think having a useless bit of skin they barely know what to do with hanging from between thier legs makes them some how stronger than women? Pfffffff the fact that men have been going on about how strong they are like little boys showing mummy how “growed up” they are just shows how weak they are. (Sorry decent men but I’m sure that for everytime you have read what I am saying now about men, about women you can just sit quietly and let me have this one right?)Point being if any gender bs was true (which it isn’t) it would be the other way round with men being dx with bpd more and women with aspd- It makes a whole lot more sense if you have ever given birth/seen it or seen a mother defend her kids. (Shush now decent dads we know you exsist but this isn’t about you and hey men say this kind of unflattering, insulting bullsht that makes women look weak and pathetic about women everyday- just take it ~LIKE A MAN~ 🙂

Just to clarify I actually think it’s weird that there is any gender difference either way, makes it seem weird to me. We are different physically not mentally except for the fact that every INDIVIDUAL is different mentally. It has nothing to do with gender unless you are a “sheep” or gender stereotype conformer which let’s face it, most people just aren’t- underneath the front they put on in social gatherings to fit in. (Some of us don’t even do that.)

1 3 4 5

Send this to a friend