Whenever I try to communicate with Minnie, she insists that we are just two mugs, which raises the interesting question. Are there any differences between men and women when it comes to personality disorders?
And this is today's topic. Are there any differences between men and women? And are there any differences between the same gender with the same disorder?
For example, borderline women and borderline men, but also borderline women and narcissistic women. So are there gender differences inside the same diagnosis and other gender differences between diagnoses?
And so before I go there, tomorrow, Richard Grannon and I are going to launch a new event intended to torture you, even more than we had done in the past few years. It's a joint questions and answers session. You're going to ask the questions and we are going to try to provide the answers.
And even when we don't know the answer, we're going to pretend that we know the answer. We're going to fake it till we make it.
If you don't believe me, join us tomorrow.
So there's a link in the description, click on the link and join the studio. You'll be able to post questions. We won't be able to answer all your questions. The event will be limited to two hours, but it will be a joint event. The inimitable Richard Grannon and the horror show Sam Vaknin. Don't miss it for the world.
Resign your job. Leave your family. Divorce if you have to. Travel far and wide. Just be with us tomorrow.
And as promised, we will get straight to the issue of gender and personality disorders.
Only just to find my text. Here it is.
The first important thing to understand is that the variation, the intra, intra diagnostic variation is higher than the inter diagnostic variation.
Now that's the kind of thing that academics likes like to say because they know that no one will understand the word and that makes them feel superior, omniscient and godlike.
Intradiagnostic variation simply means variation between diagnosis. So for example, borderline woman versus narcissistic man. They are both women.
But what is going to trump, excuse me for the expression, what is going to trump diagnosis or is diagnosis going to trump gender?
Intradiagnostic variation between diagnosis.
And then there is inter diagnostic variation. For example, borderline women versus borderline men. They both share the same diagnosis, but they have different gender.
Well, until recently.
Anyhow, it seems that intra diagnostic variation, the variation between diagnosis is higher than inter diagnostic variation.
To translate this into colloquial English, a borderline man would be almost the same like a borderline woman. A narcissistic man would be almost the same like a narcissistic woman, but a borderline woman would be different to a narcissistic woman. She would also be different to a borderline man. Got it?
Shoshanim.
My name is Sam Vaknin. I'm the author of Malignant Self-Love and Narcissism Revisited and I'm professor of psychology.
Before we go further, it's important to understand that psychology was created at the end of the 19th century by German, Austrian and much later American white males embedded in their culture and their society, rigid, hierarchical, Victorian and very misogynistic.
In the Diagnostic and Statistical Manual, the diagnoses are gender neutral. When you read the diagnostic criteria of, for example, borderline personality disorder, there is no mention there if they apply to women or they apply to men. The language is gender neutral. Same goes for antisocial personality disorder and narcissistic personality disorder, bipolar, I mean, you name it.
The whole manual on purpose is gender neutral. The message, the implicit and to my view explicit messages, gender is not a component.
Gender is not a differentiating factor. Gender has no influence on how a mental illness manifests.
Feminists have long criticized psychology and psychiatry as instruments of social control, a part of the famed patriarchy.
Ever since Freud, there's been a debate brewing in the psychological community.
The diagnosis that we are coming up with, some of them are very masculine, for example, psychopath. It's hard to imagine a woman, female psychopath, a woman psychopath, although it's possible.
But the initial reaction, the kind of knee-jerk reaction is psychopath is a man. Narcissist is the same. It's a man, initially.
Of course, within a split second, we realize it's not true if there are narcissistic women, psychopathic women and so on.
But the identification over the last 120 years had been so strong, the indoctrination, the brainwashing had been so strong that there are intuitive associative linkages in our mind between specific mental health disorders and gender.
And what the DSM is trying to communicate and the ICD and all the major diagnostic texts is that it's not true.
Gender has no impact on how a disorder manifests.
In a minute, we'll examine this contention critically.
But before we go there, why? Why were some disorders associated mostly with women?
Ever since Freud, more women than men sought therapy. To this very day, that's the case. Every YouTuber would tell you that women watch mental health content much more than men.
Men are far less likely to attend therapy than women. Consequently, mental health practitioners, psychologists, therapists, psychiatrists have been exposed mostly to women. That's a fact.
In other words, it's what we call in statistics, a biased sample, a sample wrongly constituted. It's also a self-selecting sample.
These women who do attend therapy, they consider themselves as having gone awry. They think they have a problem.
So when they approach mental health practitioners, these women would tend to communicate that something is wrong with them, with the women, not with the practitioner.
So over the last 150 years, mental health practitioners have been exposed to broken damage, problematic, self-confessing, self-loathing women. And that tended to have a mild impact on how we have construed psychology over the generations.
Terms like, for example, hysteria. They're intimately connected to female physiology because hysteria comes from the Greek word for womb, alleged female psychology. Women are hysterical.
The DSM, the Diagnostic and Statistical Manual, which is the Bible of the psychiatric profession, expressly professes gender bias.
Personality disorders such as borderline and histrionic are supposed to be more common among young women. And no, I am not contradicting myself. The language used to describe the disorders is gender neutral.
But when you read the description, the analysis of the disorder later on, when you go from the diagnostic criteria to a description of what we know about the disorder, suddenly you come across sentences such as narcissistic personality disorder is 75% diagnosed among men. That's in the DSM-3. Or you come across sentences like histrionic personality disorder is much more common among women. So the diagnostic texts themselves are gender neutral.
But then in the back door, through the back door, the DSM openly and overtly is sexist. It is sexist because the claims made by the DSM are unqualified and consequently, they are wrong. It is wrong to say that a certain personality disorder is associated more than women.
And not to mention that women self-diagnose and then approach mental health practitioners in numbers which are much larger than men. The context is crucial, right?
The DSM is aware, the DSM-5, the latest edition, the latest iteration is aware of this and they have tried to balance the scales.
So for example, they changed the text from 75% of people with narcissistic personality disorder are men. They changed it and now it's 50 to 75% are men, etc.
They've changed the language in many, many diagnostic criteria and the description.
Narcissistic personality disorder, antisocial personality disorder, schizotypal, obsessive compulsive, schizoid, paranoid, and so on and so forth.
And they have alluded that these are more common among men, but possibly this is the outcome of misrepresentation in clinical settings.
Why is this gender disparity even behind the scenes, even through the back door?
There are a few possible answers.
Maybe personality disorders are not objective clinical entities, for example, like tuberculosis or cancer. Maybe personality disorders are culture-bound syndromes, syndromes that reflect societal and cultural mores, edicts and expectations.
In other words, maybe they reflect biases. Maybe they reflect value judgments embedded in a specific context, time in history and place on the globe.
Some patriarchal societies, for example, societies where men dominate are also highly narcissistic. They emphasize qualities such as individualism and ambition often identified with virility, aggression.
The preponderance of pathological narcissism among men can easily be attributed to the expectations of society from men, to how society molds boys into men in the twin processes of socialization and acculturation.
We may be breeding narcissism among men, but it doesn't mean that men are biologically or psychologically predisposed to being narcissists more than women do.
Women, on the other hand, are widely believed to be emotionally labile, clinging, needy, dependent. And this is why most border lines and dependents happen to be female.
This is not biology. This is not even psychology. This is culture. This is society.
And as culture and society are changing and women have become a lot more masculine, we have seen an explosion of diagnoses such as narcissistic personality disorder and psychopathy among women.
Today, 50% of all narcissism diagnoses are female and 50% of all borderline diagnoses are among men, upbringing and environment.
The process of socialization, cultural mores, expectations, dictates on how to behave, sexual scripts, they all play an important role in the pathogenesis of personality disorders.
These views are not fringe views, by the way, what I'm saying right now.
There are serious scholars, for example, Kaplan and Panton, who claim that the mental health profession is inherently sexist.
And then again, we cannot completely ignore the genetic and to some extent physiological difference between female bodies and male bodies.
And if we are not dualists, if we believe that the brain has something to do with psychology, that they are one and the same in effect, the mind and the brain are one and the same, then it raises questions.
Genetics may be at work. Physiology may be at work.
Men and women do differ. They do differ as far as their bodies go.
Does this mean that this difference is translated into the mind? It may account for the variability of the occurrence of specific personality disorders among men and women.
It's another hypothesis which has to be tested.
Some of the diagnostic criteria are ambiguous, or even considered to be normal by the majority of population.
So you could read a lot of diagnostic texts in the likes of the DSM or even in college textbooks, where if you ask the majority of people in the street, they would say, nothing's wrong with that. I do that. My neighbor does that. My wife does that. My children do that. My boss does this. I mean, I have no problem with it.
Consider, for example, what the DSM says about histrionic personality disorder. The DSM says that histrionics consistently use physical appearance to draw attention to themselves.
No kidding. Who doesn't?
Women and men today are doing this. Who doesn't in Western society, at least? Why?
When a woman clings to a man, it is labeled codependency or borderline. But when a man relies on a woman to maintain his home, take care of his children, choose his attire, prop his ego, do him and comfort him.
This is not lability. This is not clinging. This is not codependency. It's companionship.
Walker in 1994 analyzed texts, psychological texts, and had shown this double standard, this sexism.
Female behavior is always characterized negatively. The same identical behavior on the part of men is characterized charitably, positively.
The less structured the interview, the more fuzzy the diagnostic criteria, the more the diagnostician relies on stereotypes, according to Widiger in 1998.
So let's examine one case.
I've received a question whether borderline women differ to narcissistic women, and I'm going to dedicate a special video to that.
But today I would like to discuss the differences between female narcissists and male narcissists.
Everyone and his dog seem to claim that female narcissists are very different to male narcissists.
They imply in the background that they are more vicious somehow, more passive aggressive, and so on and so forth.
Is there any clinical support for this? No, there is none actually. No clinical support for this.
In my view, all these videos, even videos made by women, which imply that female narcissists are worse, more egregious than male narcissists, all these videos reflect misogyny because they don't rely on any studies or scholarly literature.
Throughout my early writings, because I started this whole record in 1995, and for 10 years, I've been the only voice on narcissism online. I've maintained the only website and the only six and all of the six available support groups.
And initially when I had written my texts, I was under the influence. I was under the influence of the DSM and other psychology textbooks at the time. And I kept using the male third person singular, because at the time, most people diagnosed with narcissistic personality disorder, 75%, were male. Today, it's more like 50-50.
But even then, I insisted and I still insist to this very day, nothing in 26 years has changed my mind, that there is little difference between the male and the female narcissist.
In the manifestation of the narcissism, in the ways the narcissism is expressed outwardly to a layman observer, female and male narcissists inevitably do tend to differ, but they tend to differ because they operate in different environments.
Not because they are different, not because the disease is different, the disorder is different, not because the etiology, the reason for the disorder, not because the dynamics of the disorder, psychodynamics are different. None of this is different.
Male and female narcissists are indistinguishable as far as their psychology or psychopathology. This is especially true in today's day and age when women have become men.
We have unigender.
Women describe themselves today exclusively in what used to be masculine terms. They regard themselves as men. They see no difference between themselves and men.
In any way, shape, form or field.
So this is the ethos of society nowadays.
And of course today the distinctions between male and female in any field, let alone in clinical and abnormal psychology is blurring. The differences are reasonable.
Many women would mock texts written 25 years ago describing how females are different to male.
But females and males do emphasize different things in life, do have different priorities, do look out for different signs and signals from the environment and from others.
So yes, their narcissism outwardly manifests differently. They transform different elements of their personalities and of their lives into the cornerstones of their disorder.
Women, for example, tend to concentrate on their bodies. Many women have body image problems, body dysmorphic disorders. Many women somatize psychological problems when they are depressed, when they are anxious, they have strong somatic symptoms. Many women suffer from eating disorders, anorexia nervosa and bulimia nervosa and so on. This is much more common among women than among men.
It seems that women emphasize their body more. They flaunt their bodies. They exploit their physical charms, their sexuality, their socially and culturally determined femininity. They secure their narcissistic supply through their more traditional gender role to this very day.
So women are now proud of being sluts. They are slut walks and so on and so forth. Being a slut is self objectification, converting oneself into a sexually desirable object. Of course, sexually desirable to men. The male gaze had come to define female narcissism.
Female narcissists adapt themselves and psychopathic females, women who are psychopaths and narcissists, adapt themselves, had assimilated the male chauvinistic objectifying gaze and had conformed to it.
Indeed, studies show repeatedly and clearly and beyond any doubt that promiscuous women, women who compulsively sex and cam, perform sex on camera, women who are promiscuous in the sense that they are indiscriminate and they sleep with strangers and get drunk. These kind of women, numerous studies have shown, they have dark personalities, subclinical psychopaths, they are subclinical narcissists.
And yet they define themselves through the male gaze. There is an inversion here. These women feel empowered because they can exert power over men by conforming to male stereotypes of how an easy, loose woman should look. It's a bit ironical. It's like, you know, leveraging the opponent's momentum against him. It's like these women are saying, okay, that's the way you want us. Sluts, you know, scantily dressed, promiscuous, we're going to be this way. But by being this way, we're going to gain power over you. This is going to empower us. That's at least the narrative. Of course, it's nonsense.
Ultimately, men are the big winners. But this is an example of how female narcissism and female psychopathy manifest in a uniquely female way, which conforms to conservative traditional gender roles, actually.
Similarly, women, even career women, even the most advanced ninth wave feminists, still emphasize the home, her children, her husband, her spouses, her spouse, the still an emphasis of domesticity and the narcissism of such a woman, of such women manifest itself in these arenas with their children who become sources of narcissistic supply.
With a home, she's competitive against other women within her wardrobe, her possessions, her home, material goods, and so on and so forth. These women would tend to choose careers which reflect on their grandiosity. They gravitate towards careers that enhance grandiosity and expose them to an admiring audience.
It is no wonder that narcissists, both men and women, are chauvinistic and conservative.
Let's say irony. There is a totally false image of narcissist as libertarian. They're not.
Narcissists, both men and women, are actually more conservative and traditional than the rest of the population. They depend to such an extent on the opinions of people around them that with time they're transformed into ultra-sensitive seismographs of public opinion, barometers of prevailing social fashions and guardians of conformity.
The narcissist cannot afford to seriously alienate his constituency by being, I don't know, avant-garde, by being libertarian, by being a rebel and a reformer. He needs people around him and people turn to walk away if you are too out there, if you're over the top.
So the people who reflect on the narcissist, his false self, the people who help the narcissist sustain his grandiose self-image, the narcissist needs to conform to their beliefs, expectations and values. He needs to reflect the average traditional conservative point of view.
The very proper and ongoing functioning of the narcissist's ego or ego substitute depends on the goodwill and the collaboration of his human environment, of his neighbors, his co-workers.
And so he needs to be in the good graces of everyone around him, narcissists are pro-social, they're pro-social, they're communal, they're not psychopaths. It's another huge campaign of misinformation online by self-styled experts who have no idea what they're talking about.
It is true that besiege and consumed by pernicious guilt feelings some narcissists finally seek to be punished. The guilt is unconscious, narcissists are overtly, openly egodystonic, they don't feel guilt, they don't feel shame, but Masterson and others have proven that narcissism is actually a reaction, a compensatory reaction to deeply embedded shame and guilt.
And so narcissists are self-destructive, they are self-defeating, they seek to be punished.
Here too females differ from males, males seek to be punished by behaving anti-socially, by committing crimes, by getting caught. Women seek to be punished mostly via their sexuality, they become sexually self-trashing, they get drunk, they sleep with a million strangers, that's a woman's way, the narcissistic woman's way, to self-pinalize and to reaffirm her self-perception is essentially bad, flawed, unworthy object, a whore.
A self-destructive narcissist plays roles, the role of a bad guy or the role of a bad girl, but even then it is within the traditional socially allocated roles to ensure social opprobrium, in other words, attention.
The narcissist exaggerate these roles to a caricature at the same time ascertaining and securing his or her self-annihilation, his or her negation and self-punishment.
But as you see female narcissists do it with sex, male narcissists do it with aggression and anti-social behavior.
A woman is likely to labor herself, a whore and a male narcissist to self-style himself a vicious unrepentant criminal, these are of course exaggerations but variations of this are very common among narcissists, yet these again are traditional social roles.
Men are likely to emphasize intellect, power, aggression, money or social status. Women are likely to emphasize their bodies, looks, charm, sexuality, feminine traits, homemaking, children and child rearing, even as they compete in the workplace, make more money than men in some age groups and so on.
So the traditional gender roles still define the permissible way to express one's narcissism.
A woman would express narcissism only in traditionally or socially sanctioned ways, ironically both men and women sublimate their narcissism, convert it into socially acceptable methods or manners of expressing narcissism so as not to lose the audience, they need the audience for narcissistic supply.
Another difference is in the way the genders react to treatment. Women are more likely to resort to therapy, treatment I mean psychotherapy, women are more likely to resort to therapy because they are more likely to admit to psychological problems and distress.
But while men may be less inclined to disclose or to expose their problems to other people, that's the macho man thing, it doesn't necessarily imply that they are less prone to admit it to themselves.
Women are also more likely to ask for help than men, men don't ask for help, men don't cry and yet the prime role of narcissism must never be forgotten.
The narcissist uses everything around him, everyone around him to obtain his or her narcissistic supply.
Children for example, children happen to be more attached to the female narcissist, to the mother because of the way that society structures the fact that women are the ones who give birth.
For some reason because women are the ones to carry to term and give birth, society gives them custody over the children in the majority of cases and assumes that almost automatically the children should be with the mother.
So there is this linkage, unbroken linkage, mother, child, child, mother, mother, child. So female narcissist would succumb to this unwritten social rule or to this even legal mortifying.
She would use her children, she would leverage her children as her sources of narcissistic supply and she would think herself a good mother for doing this.
It is easier for a woman to think of her children as her extensions because they once were her extensions, her physical extensions and because her ongoing interaction with her children is both more intensive and more extensive.
And this means that the male narcissist is more likely to regard his children as a nuisance than as a source of rewarding narcissistic supply, especially as the children grow older and become autonomous and disagree with the narcissist and criticize him.
Who needs this as a source of supply?
Devoid of the diversity of alternatives available to men, the narcissistic woman fights in order to maintain her most reliable source of supply, her children.
Through insidious indoctrination, guilt formation, emotional sanctions, deprivation and other psychological mechanisms, the narcissist woman tries to induce in her children a dependence which cannot be easily unraveled, sometimes never at all to life's end.
But this is all external manifestation, these are all behaviors.
Many of these behaviors are acquired behaviors and many men and women, narcissistic women, no longer conform to any of this. They remain single, they remain childless, they have a career and they don't have a home. They live in the rental department, so their outlet for their narcissism is identical to a men's outlet for his narcissism.
Genitalia is equipment, it's not who you are. It's important to understand that whichever the source of supply, child, children, money, intellect, it's immaterial. They are all psychodynamically indistinguishable from each other. There's no psychodynamic difference between male and female narcissists.
The only difference is in choices of narcissistic supply.
There are mental disorders which afflict one sex more than the other, or at least more often.
And this has to do with hormonal or other physiological dispositions with social and cultural conditioning through the socialization process and with role assignment through gender differentiation process.
None of these seem to be strongly correlated to the formation of malignant narcissism.
Narcissistic personalities, as opposed to for instance bipolar disorder, seems to conform to social mores into the prevailing ethos, mainly the ethos of capitalism, actually. It's not an accident that capitalism is on the right and so is narcissism.
Social thinkers like Christopher Lash speculated that modern American culture, a narcissistic, sub-centered culture bordering on psychopathy, increases the rate of incidence of narcissistic personality disorder.
Kahnberg himself said the following, the most I would be willing to say is that society can make serious psychological abnormalities, which already exist in some percentage of a population, seem to be at least superficially appropriate.
Another quote from the literature. It's from the article, Gender Differences in the Structure of Narcissism: A Multi-Sample Analysis of the Narcissistic Personality Inventory. It was authored by Brian Chance, Carolyn Morff, Charles Turner, and it was published in Sex Roles, a journal of research in May 1998. And it said, I'm quoting, specifically past research suggests that exploitive tendencies and open displays of feelings of entitlement will be less integral to narcissism for females than for males.
For females, such displays may carry a greater possibility of negative social sanctions, because they would violate stereotypical gender role expectations for women who are expected to engage in such positive social behavior as being tender, compassionate, warm, sympathetic, sensitive, and understanding.
In females, exploitativeness entitlement is less well integrated with the other components of narcissism, as measured by the narcissistic personality inventory.
Components such as leadership authority, self-absorption, self-admiration, and superiority or arrogance.
In males, exploitativeness and entitlement are much more closely integrated with these factors.
Male and female narcissist in general showed striking similarities in the manner in which most of the facets of narcissism were integrated with each other.
Igli Klonski and others in gender and the evaluation of leaders, a meta-analysis in Psychological Beauty, in volume 111 wrote this, women leaders are evaluated negatively if they exercise their authority and are then perceived as autocratic.
I also refer you to articles by Butler and Jules, non-verbal affect response to male and female leaders, and to Carly, Leung, non-verbal behavior, gender, and influence in the Journal of Personality and Social Psychology, volume 68, where they have written, competent women must also appear to be sociable and likable in order to influence men. Men must only appear to be competent to achieve the same results with both genders.
Summary. Within the same diagnosis, there is very little difference between, within the same diagnosis of narcissistic personality disorder. There's very little difference between men and women on the psychodynamic level.
The processes, the psychological constructs, the etiology, the traits, they're all identical.
But the way the disorder manifests itself outwardly in behavior is subject to social and cultural strictures, mores, constraints, and expectations. That's what makes female narcissists look very, very different to male narcissists.
More generally, the variation between men and women within diagnosis, especially behavioral variation, is much higher than the variation between diagnosis.
I'm sorry, I repeat, the variation between men and women between diagnosis is much higher, especially behaviorally.
The variation between men and women inside the same diagnosis is very low, almost non-existent.
So men and women who are both narcissistic will be the same, but a narcissistic woman and a borderline man would be very different. A narcissistic woman and a borderline woman would be very different.
There are big differences between diagnosis when it comes to gender, but there are small differences inside the same diagnosis, even when we take gender into account.
Thank you, girls, girls, and guys, and all of you who are in between girls and guys.