There is gender bias in our current mental health diagnostic system. This bias occurs for three reasons.
- There are genuine gender differences in the manifestation of behavioral disorders.
- Those creating the diagnostic categories are biased.
- 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.
I found this to be a very interesting article in that I have been a victim of 2 men with ASPD and 1 woman friend of 11 yrs with BPD. My experiences with these types have left me with the feeling that if someone were to be involved with them and this person (with ASPD or BPD) abandons you and leaves you alone, count yourself as lucky!! I feel like I’m never going to rid myself of mine. I share my children with my 2 ex’s and the friend has managed to manipulate my other friends into her little web of deception. Although I no longer have anything to do with any of them, they have found ways to get to me through their modes of operation which is extreme manipulation. I even moved a few miles from town to get away from them but they are quite persistent at defaming my character to others. With them it was all about power and control and what they could take from me….I felt very used! My only defense mechanism is to not let it bother me and to keep raising my children with the good morals I learned from my family and to work hard at my job earning a living the good old-fashioned way!!
While I must agree with the author that there is gender bias in diagnosis, I must disagree with key points in this article. I recognize it as a valiant attempt in analysis to blend behavior with medical aspects. While many physicians, in fact most, believe that “chemistry causes behavior” few have ever considered that “behavior causes chemistry.”
It is from that assumption that I operate. Having provided services as a psychologist in maximum security prisons (Level 5 Security complete with Condemned Row aka Death Row) for 5 years, I can assure the reader that equating ASPD with sociopathy is completely off the mark. Indeed, this is a debate for professionals. It is complex and multi-faceted, and in my opinion, it may represent the last great undiscovered & uncharted territory in psychology.
BUT REMEMBER: The Map is Not the Territory.
While this article conveys the horrible state our diagnostic science is in, it is not accurate. For one, we do not have the data on hormone levels in female sociopaths. For another, female sociopaths are underdiagnosed. Finally, the categories of Borderline Personality Disorder, Anti-Social Personality Disorder and Sociopaths [Note: There is no parallel construction in this list because there is no equivalency between the two formally recognized diagnostic categories and sociopathy!] are not discrete–even in conceptualization!
Moreover, the true sociopath is so apposite the typical ASPD that the two should not be included in the same categories, but they are. This shows the paucity of our current diagnostic nosology to describe must less address the differences AND treat them!
The female psychologists with whom I worked in the penitentiaries hated working with female inmates. My colleagues said that this was because female felons were so much more manipulative and, in their opinions, FAR MORE DANGEROUS.
While we have just started diagnosing BPD in male inmates with ASPD, females are hardly even diagnosed with ASPD! Furthermore, female sociopaths are so much better equipped than male sociopaths in my opinion that we almost never detect them! We are blind and the female sociopath is far more vicious and is far more talented than most of the many male felons I have treated. It is indeed humbling to realize that the female in our species, as in the wild animal kingdom, is far more deadly than the male!
Do not call a Sociopath, do not diagnose a sociopath with Anti-Social Personality Disorder. While I realize that ASPD is the only recognized disorder by which to label sociopaths in our current diagnostic system, it paints a completely different picture than the vast bulk of those with functional Anti-Social Personality Styles, traits, features as well as the disorders.
My suspicion is that sociopaths do not develop as a result of some great drive for power but rather that they are some how traumatized to such a horrible degree that they learn early to dissociate and they overcompensate in areas to make them immune from hurt/harm. And thereafter they learn the advantages their new “talents” give them over the average person. BUT, it comes at a price–the inability to attach and to ever feel love, to feel close and enjoy the full riches of being fully human!
Finally, we must recognize that these are not discrete categories and there are wide degrees of sociopathy. Some may even be amenable to treatment, but, that said, the sociopath challenges the strictly behavioral models and assumptions from which I operate. It will be a rich discussion indeed as we unravel what makes a sociopath and try to rescue a few of them from themselves.
I would agree that there isn’t much out there on female psychopaths, and this chemical explaination leave me a little short too. It doesn’t really help me to understand for my ex wife, who turned out to be the most domineering, deceptive, abusive and manipulative person I ever met. Let me provide examples to illustrate, in case you’re doing what even I would do if I read a man writing something like that (doubting him). It might help some other poor sap out there trying to wrap his mind around the living hell a she devil has placed him in.
I really don’t know what she was in terms of lables, and don’t know if it matters. She constantly lied, manipulated, mislead, withheld information, got drunk to “decompress”, acted absurdly jealous, and talked down to me every day in a way that reminded me of one of my frat brothers joking around and trying to “punk me”. At first, I laughed it all off.
Nevertheless, I was the greatest fool. The first red flag I chose to ignore came when she spit on the guy parking the cars on our first date when we first me. It was so far out, I thought it was amusing. Looking back, I see how stupid this is. Next, she told me in seriousness that she would shoot her step father dead if she saw him again. I laughed and jokingly offered to help, thinking she had to be joking about some really powerful feelings she was trying to get over. So I can’t say she didn’t come with a warning lable. Nevertheless, I married her, because I though she was unique, funny, smart, beautiful and basically a good person (yes, I can be very stupid sometimes).
Soon after we married, the hell began. She accused me of working her like a slave, and called the police on me as a reflex at least 10 times over 2 years, lying right to their faces in order to punish me. I stood by the truth, and was never really hurt too badly, but it was always gut wrenching when police took my liar’s word a face value time and again, in spite of her pattern of deception. However, let me say that I was once nearly killed, was falsely arrested and jailed, was professionally investigated the entire time, was robbed of thousands by check fraud and credit card fraud, was falsely detained based on her report that I was carrying drugs interstate, and was humiliated in front of friends and family, and was many more things that would have made the TV news if it were the other way around. It seems the system counts on that (men not making too much of the harm they suffer vs. protecting woman from the well known and broadly publicised danger of wife beating, which was made so in wake of OJ. They call it the “OJ effect” as one policeman put it). I like to call it “superbowl sunday syndrome”, because of the national PR about all the wife beating that takes place when losing team fans take out frustrations on their wives.
On the other hand, there is my reality. My wife once ran me over with her car. After getting out of the ER, where the doctor told me I was nearly killed (the massive trauma was close to the liver), I reported it, and the police did nothing, telling me it was a “he said, she said” situation, even though I had emergency room documentation. Police just told me over and over to leave, stay away and get a lawyer. When wifezilla was questioned, she just walked out of the police state “to feed the meter”, and bragged to me about never going back. She is a licensed private detective, and the most unethical professional person I’ve ever seen in action.
When we went for therapy the first time and the therapist was no good because she read the definition of love from the bible to us. At that point, I didn’t know she needed thousand of dollars in fertility treatments for us to have a chance at having a baby, time was running out, and it was all my fault from her point of view.
The second therapy we went for was worse, as I found out she could not have children, was blaming me for it, and was demanding we adopt ASAP, even though we were broke. With the second psychologist, I found that she was calling him each week privately to voice her problems with me, trying to get me to go for private sessions. I found out later she was lying to him about me when the truth about us came out in due course. Soon thereafter, this second therapist’s work came to an end when she got the answer to the question she ask him: “is a person who has had several love relationships harder to treat, or is a person who has never been in love, or had few (by the age of 40)?” He told her a person who has lived without loving anyone was harder to treat, and she quit because that was her. She thought she had proof that our problems where really just mine because I had several relationships in 20 years, where feelings of love existed. She thought she would establish that I was at fault in some way more than she. But she was shocked when the psychologist told her it was harder to treat someone who did not really feel love toward anyone for 20 years (since childhood). On the ride home, she just smoked hard, pulling all the smoke she could, and saying “huh” (as in suprise) all the way home for 20 minutes.
When the next therapist asked her if she was molested, she said she was (which she never admitted to me until then), until a week later when she told me she was just lying to the doctor about being molested. She’d done that before, when she told me that she tried to commit suicide when she was 15, then told me months later that this was a lie. She never could answer why she’d lie when asked. She did it again when she told me her best friend proposed to her after we were engadged, but with a special plan. He said he would marry her “when our marrage did not work out”. There again, months later, she said it was a lie too. So it was month after she told me all her male friends ask her to have sex when she told them she was getting married.
When I left, she trumped up an affair to push her agenda, which is still ongoing. While she admits to “never trusting” me, she calls herself “a pioneer” for marrying me (whatever that means). Every time she got angry with me, she’d post a personal ad online, with a false age and marital status. She told me it was a way of “releasing”. She has trouble with booze too. There are just too many instances of fraud and lying to recount. Whether it’s to “protect herself”, or some chemical thing does not make a bit if difference to anyone who’se living the nightmare.
So is there a bias? It does not matter brother, if you are dealing with a she devil like mine. You just better listen to people around you and run like hell, no matter what you heart or chemicals, or a therapist are telling you because you can bet the only thing her heart is telling her a sounds of silence and to pick your bones Jim. It’s reptile or insect politics, and you are just dead meat; your fear, obligation or guilt can just be wasted energy when you are outrunning that crocodile.
gr8ful70x7 is very insightful to conclude: “My suspicion is that sociopaths do not develop as a result of some great drive for power but rather that they are somehow traumatized to such a horrible degree that they learn early to dissociate and they overcompensate in areas to make them immune from hurt/harm. And thereafter they learn the advantages their new “talents” give them over the average person. But, it comes at a price”“-the inability to attach and to ever feel love, to feel close and enjoy the full riches of being fully human!”
I am aware of studies which show that men who go on to become violent criminals have experienced harsh corporal punishment in childhood. Read Philip Greven’s book, “Spare the Child.” He asserts that during the corporal punishment act, the child, to survive, leaves his body and dissociates from his painful disempowerment. He leaves his body and identifies with the powerful adult. That is the formative experience for the sociopath’s drive to dominate others. But the experience has different repercussions for the two sexes. Dr. Leedom skillfully presents information regarding the differences in biological reactions to stress.
The biology clearly has implications because females are far less likely to commit violent crime than males. Simply look around you. Read the newspaper. Men are more violent. Dr. Leedom presents evidence as to why this is. I am not saying that there are not cruel and manipulative women. There are. But the reality is that men are more prolifically violent.
Female Sociopaths are prevalent in our society. We have created this problem by not addressing it. Male Sociopaths are prevalent as well. Our current Legal system, Family Law in particular is creating the ideal environment for the creation of Sociopathic personalities by the hundreds of thousands every year. The system enables and supports Sociopaths because lying in court almost never matters in Family Court, if they are smart about it. They don’t have time to allow for the truth to be exposed, and there is NO CONSEQUENCE for FALSE ALLEGATIONS or PERJURY! I agree, the PSychological profession is way behind the times. Sociopathy in my layman’s opinion as a victim is a combination of several disorders. As my Ex’s PSyche Evaluation stated, she exhibits behaviors associated with Narcissistic, Histrionic, Paranoid, and Borderline personality disorders! But no definitive diagnosis, so she gets the kids???????? It is absilutely destroying our society and our children. The Psychologists gave in to the LAwyers abusive power long ago. Scratch my back, I scratch yours………we don’t want anything definitive because that stops the money making! We won’t consider your field as relevant if you don’t do what we want.If you do what benefits us, we will let you benefit from other people’s misery too! First and foremost, NO ONE should be able to call themselves either a PSychologist or a Social Worker if they have not undergone a full Psychological Evaluation themselves!!!!!! That must be the LAW! Also, PErjury and False Accusations must have definitive consequences under the law including jail time for repeated offenses! Sociopaths have no reason to change or even try to change because there are no laws to protect us from their BULLYING! We can create laws that protect us, we have laws that should protect us, but they are not enforced because it does not benefit the Lawyers pocketbook to do so! Sociopathic women are just as prevalent as men, we just don’t properly identify it and diagnose it and it is going to destroy our society. There are Many Sociopaths in high Corporate positions, PSychologists, Social Workers, Politicians, Lawyers! We need to change the laws and we need to impose definitive consequences! We need to Enforce existing laws! Perjury is a felony, but it is almost never prosecuted! False Accusations proven to be false must be prosecuted! That might create some incentive for the SPaths to change! Just like a druggie, if you don’t confront them, or impose consequences on them, they won’t give up the drugs!
Dear Perniciousfamilycourts,
Thanks for bringing this older thread up, and it DOES APPLY!
I agree with you about the family courts. I am assuming from your posting that you are male and that you ended up losing custody of your kids to a female with X-personality disorder (fill in the blank which one) and the problem is that ALL the PDs “overlap” in symptoms too…so the bottom line as far as I am concerned is “Personality disorder=personality disorder” and it doesn’t matter WHICH one! ALL ARE TOXIC!
The courts DON’T generally get it and everyone gets $$$$ for trying to sort this carp out, and everyone is presumed to be “telling the truth” and “having the best interests of the kids at heart” and more CARP! NOT every parent has the best interests of the kids at heart, and some parents DO use the kids as weapons to bash at the other parent for sport, damn what it does to the kids!
Glad you are here! Thanks for your post, and for bringing up this great older thread out of the archives.
I think there is a hell of a lot more to psychopathy than just hormone levels . From my own experience with a female psychopath , thats my diagnosis , and me being a male , I am convinced that there are certainly as many if not more female psychopaths than male ones . The male ones may tend more towards more violent acts of aggression than the female ones, however the female ones I am sure are more covert and sneaky and perhaps more dangerous . I think the female ones being generally weaker and smaller than their potential male victims realise that for the most part that out right violence will not get them anywhere so they cunningly attack from a different direction , namely the psychological . From my own first hand experience I would say my X had more psychological tricks and head games up her sleave than what most trained psychologists would ever be able to keep track of . I often asked myself , where on earth did she learn all this crap , why would she bother to learn it and what was the purpose . It would appear that more male ones end up in jail because of the violence , the female ones being less outwardly violent are less likely to end up in jail . That does not mean they are less likely to kill , in fact I would be more tempted to think that the way female psychopaths operate is more covert . Perhaps poisoning their victims slowly over time .
quest,
mine poisoned me with different things for 25 years. I was sick, couldn’t work, constant pain. it was supposed to make me commit suicide.
gr8ful70x7 claims to be (and indeed, may well be) “a psychologist in maximum security prisons”.
That is all well and good, but those of us who come here have lived lives and survived experiences that most medical professionals – psychologists included – will never in their wildest dreams encounter or properly understand.
Also, intending no disrespect to gr8ful70x7 or any other psychologist out there, it is the field of psychiatry which researches, treats and deals with mental disorders, personality disorders and anomalies of the psyche – not the field of psychology (which, in my country at least, does not even require a medical degree in order to be practiced, as does psychiatry).
I also note that these comments are from over 3 1/2 years back – and that considerably more research has since been made available on this topic.
That being the case, I would prefer the available evidence of psychiatric research and treatment, which overwhelmingly suggests an overlap between “sociopathy”, BPD and ASPD, and which generally interchanges the terms ASPD and sociopathy. My own personal experience confirms that my ex-husband meets every current available criteria in the both the American DSM and the aligned European version, of ASPD and/or sociopathy/psychopathy. It is also true that his doctors, when trying to pin a diagnosis on him back in 2006/2007, wavered around ASPD and BPD, having earlier dismissed their thoughts of Bi-Polar and/or schizoprenia (which often co-occur and both of which have some similar traits to the Personality Disorders).
My spath stopped attending appointments and refused to undergo further testing, stating that there was “nothing wrong with him” – and to my knowledge, never went back and is still out there, walking around pretending that he is a normal person. To me, this in itself is a clear marker of ASPD and/or sociopathy. I don’t need a psychologist to tell me the spath is not those things.
I lived it and I continue to live with the aftermath.
This was not my first failed relationship – but it is the ONLY one to have unfolded in this particular, disturbing way and to have dragged on and on the way that it is still doing.
It is NOT like anything else I have ever known.
WE know who we are; and WE know WHAT THEY ARE.
Aussie,
You go girl!!!!! You are so correct… we know whow they are!!! Peeling off the mask just kills them!!!