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Personality Disorders Gender Bias

Uploaded 8/27/2010, approx. 3 minute read

My name is Sam Vaknin. I am the author of Malignant Self-Love, Narcissism Revisited.

Ever since Sigmund Freud, more women than men sought therapy. Consequently, terms like hysteria are intimately connected to female anatomy and alleged female psychology.

The Diagnostic and Statistical Manual, DSM, the Bible of the psychiatric profession, expressly confesses to gender bias. Personality disorderssuch as borderline and histrionic, are supposed to be more common among women. Luckily, the DSM is pretty even-handed.

Other personality disorderssuch as narcissistic, antisocial, schizotypal, passive compulsive, schizoid and paranoid, these other personality disorders are more prevalent among men.

But why this gender disparity to start with? Why some personality disorders are more common among women than others among men?

Well, maybe personality disorders are not objective clinical entities at all. Maybe they are culture-bound syndromes. In other words, maybe personality disorders reflect biases and value judgments and prejudices of the prevailing culture.

Consider patriarchal societies, but triarchal societies are also narcissistic. They emphasize qualities such as individualism and ambition, and these are identified with virility. So, we would expect to find these qualities among men rather than among women.

Since they also define pathological narcissism, the preponderance of pathological narcissism would be among men. Women, on the other hand, are widely believed to be emotionally labile and clingy, and this would tend to explain why there are more women among borderline personality disorder and dependent personality disorder patients.


Another possible reason is that upbringing and environment, the process of socialization and cultural mores, all play an important role in the pathogenesis of personality disorders.

These views are not fringe. Serious scholars such as Kaplan and Pantoni claim that the mental health profession is inherently sexist.

But then again, that may not be the case. Genetics may be at work. Men and women do differ genetically. This may account for the variability of the occurrence of specific personality disorders in men and women.

Ultimately, I think the problem is the ambiguity and equivocation of the diagnostic criteria. Some of the diagnostic criteria for personality disorder are ambiguous. Some of them are even considered normal by the majority of the population.

Consider one of the diagnostic criteria for histrionic personality disorder. It says that the histrionic consistently uses physical appearance to draw attention to self.

Well, who doesn't do that in Western society? Everyone. So everyone ought to be labeled a histrionic.

Why when a woman clings to a man, this is labeled co-dependence. But when a man relies on a woman to maintain his home, take care of his children, choose his attire, and from his ego, this is called companionship.

This observation was made by Walker in 1994. Even structured interviews and psychological tests fail to remove gender bias. The less structured the interview, the more fussy the diagnostic criteria, the more the diagnostician relies on stereotypes. This was discovered by Widiger in 1998.

Gender bias is everywhere, especially since the psychiatric profession was overwhelmingly invented, written, researched, studied, propagated by males. Women have been caged into niches of mental health diagnosis.

Certain personality disorders are female personality disorders. Others are male personality disorders.

And it is not surprising that many, finally, scholars and laymen alike finally say that there are no such things as personality disorders.

It's all cultural. The Diagnostic and Statistical Manual Committee is currently considering this possibility. And we are heading for a revolution in the science of personality disorders, which may also remove a lot of the gender bias hitherto so painfully apparent.

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Study: Weak Self of Covert Narcissists, Secondary Psychopaths

A study has found that individuals with Cluster B personality disorders, specifically those with dark triad traits, have a weak, unstable, and unclear sense of self. The study's authors suggest that recognizing these traits is important in predicting behaviors and avoiding destructive, impulsive, and callous behaviors. The study also found that high-level dark triad traits are associated with a weaker sense of self, regardless of gender and age. However, when analyzing sub-traits of narcissism, psychopathy, and Machiavellianism, the study found that vulnerable narcissism and secondary psychopathy are most strongly correlated with a weaker or unclear sense of self.


Body Language of the Personality Disordered

Patients with personality disorders have a body language specific to their personality disorder. The body language comprises an unequivocal series of subtle and not-so-subtle presenting signs. A patient's body language usually reflects the underlying mental health problem or pathology. In itself, body language cannot and should not be used as a diagnostic tool.


Borderline's Miracle Healing

Borderline personality disorder (BPD) is less prevalent than commonly believed, affecting about 1-2% of the general population, yet it accounts for a significant portion of mental health treatment cases due to crises. The prognosis for BPD is generally positive, with many individuals experiencing spontaneous remission or significant improvement through therapies like Dialectical Behavior Therapy (DBT), leading to a high percentage of patients no longer meeting diagnostic criteria over time. While symptoms related to impulsivity and behavior tend to remit more quickly, some underlying traits and dysfunctional behaviors may persist even after the disorder itself has resolved. Effective treatment should not only address the core symptoms of BPD but also focus on helping individuals develop functional skills for social and vocational success, particularly in younger populations.


Narcissists and Negativistic (Passive-Aggressive) Personality Disorder

Negativistic, passive-aggressive personality disorder is characterized by chronic pessimism, resistance to authority, and a tendency to undermine others in social and workplace settings. Individuals with this disorder often exhibit behaviors such as procrastination, neglect, and sabotage, while feeling unappreciated and victimized by their circumstances. They display a range of negative emotions, including irritability and envy, and often react to perceived slights with sulking or the silent treatment. Despite their obstructive behavior, they may seek forgiveness and promise change when confronted, but these promises typically go unfulfilled.


Borderline Woman as Dissociative Secondary Psychopath

Borderline Personality Disorder and Psychopathy may not be as different as previously thought. Recent studies suggest that Borderline and Histrionic Personality Disorders may be manifestations of secondary type psychopathy in women. Survivors of Complex Post-Traumatic Stress Disorder (CPTSD) also exhibit psychopathic and narcissistic behaviors. Borderline Personality Disorder can be described as a subspecies of Dissociative Identity Disorder, with mood lability and emotional dysregulation being outward manifestations of changes in self-states.


Psychopath Hopeful Breakthroughs: Oxytocin, Schema Therapy, Reciprocal Altruism (Literature Review)

Recent studies suggest a shift in understanding antisocial personality disorder (ASPD) and its treatment, particularly regarding psychopathy, which has historically been viewed as untreatable. Emerging research indicates that ASPD may be linked to cognitive distortions rather than being classified strictly as a mental illness, with environmental and genetic factors playing significant roles in its development. New therapeutic approaches, such as schema therapy and EMDR, show promise in improving outcomes for individuals with ASPD, especially those with a history of trauma. Additionally, findings indicate that while psychopathic traits remain stable over time, behaviors may change, leading to better social conformity in later life. Overall, there is newfound hope for effective interventions in treating ASPD and psychopathy, challenging long-held beliefs about their incurability.


Passive-Aggressive (Negativisitic) Patient Therapy Notes

Negativistic or passive-aggressive personality disorder is not formally recognized in psychiatric diagnoses but is commonly treated by practitioners. In a simulated therapy session, Mike, a 52-year-old man, displays emotional detachment and resentment towards his wife's demands, viewing therapy as a con. He expresses feelings of being unappreciated at work and copes by ignoring those he deems unworthy, admitting to sulking and engaging in arguments. Despite acknowledging his behavior, he remains dismissive and contemptuous towards the therapeutic process.


Over-sexed: Histrionic Personality Disorder and Narcissism

Histrionic personality disorder is more commonly diagnosed in women, leading to questions about whether it is a real mental health problem or a reflection of a patriarchal society. Histrionics crave attention and are uncomfortable when not at the center of it, similar to narcissists. They are preoccupied with physical appearance and sexual conquests, and often act flirtatious and seductive. Histrionics are enthusiastic and emotional, but their behavior can be exhausting and off-putting to others.


From Borderline to Psychopath to Narcissist: Abuse of Language and Self States

Psychopathy, narcissism, and borderline personality disorders may represent different facets of a single underlying condition characterized by dissociation and fragmented self-states. These disorders often exhibit comorbidity, as individuals may shift between traits of narcissism, borderline, and psychopathy depending on stressors and emotional triggers. The communication patterns of these individuals, often marked by palindromic speech and manipulative language, serve to obscure their internal chaos and maintain their grandiosity or emotional needs. Ultimately, these personality disorders can be viewed as variations of malignant self-love, where the absence of a cohesive self leads to adaptive but dysfunctional behaviors in response to early trauma and unmet emotional needs. The interplay between these disorders suggests a continuum rather than distinct categories, with individuals transitioning fluidly between them based on their circumstances.


International Classification of Diseases (ICD-10)

The International Classification of Diseases (ICD) has evolved significantly since its inception, particularly in its approach to mental health disorders. The ICD-8 introduced a descriptive and operational framework but struggled with issues of comorbidity and diagnostic clarity. The ICD-10 improved upon this by incorporating extensive research and providing multiple sets of diagnostic criteria tailored for different users, including practitioners and researchers. Despite some criticisms regarding its reliability for diagnosing personality disorders, there remains potential for further development and refinement of the ICD.

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