Gender Bias in Diagnosing Personality Disorders
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Ever since Freud, more women than men sought
therapy. Consequently, terms like "hysteria' are intimately connected to
female physiology and alleged female psychology. The DSM (Diagnostic and
Statistical Manual, the bible of the psychiatric profession) expressly
professes gender bias: personality disorders such as Borderline and Histrionic
are supposed to be more common among women. but the
DSM is rather even-handed: other personality disorders (e.g., the Narcissistic
and Antisocial as well as the Schizotypal, Obsessive-Compulsive, Schizoid, and
Paranoid) are more prevalent among men.
Why this gender disparity? There are a few possible answers:
Maybe personality disorders are not objective clinical entities, but
culture-bound syndromes. In other words, perhaps they reflect biases and value
judgments. Some patriarchal societies are also narcissistic. They emphasize
qualities such as individualism and ambition, often identified with virility. Hence the preponderance of pathological narcissism among men.
Women, on the other hand, are widely believed to be emotionally labile and
clinging. This is why most Borderlines and Dependents are females.
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 (e.g., Kaplan and Pantony,
1991) claim that the mental health profession is inherently sexist.
(continued below)
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Then again, genetics may be is 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.
Some of the diagnostic criteria are ambiguous or even considered
"normal" by the majority of the population. Histrionics
"consistently use physical appearance to draw attention to self."
Well, who doesn't in Western society? Why when a woman clings to a man it is labeled "codependence", but when a man relies on
a woman to maintain his home, take care of his children, choose his attire, and
prop his ego it is "companionship" (Walker, 1994)?
The less structured the interview and the more fuzzy
the diagnostic criteria, the more the diagnostician relies on stereotypes (Widiger, 1998).
Quotes from the Literature
"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 expectancies for
women, who are expected to engage in such positive social behavior as being
tender, compassionate, warm, sympathetic, sensitive, and understanding.
In females, Exploitiveness/Entitlement is less
well-integrated with the other components of narcissism as measured by the
Narcissistic Personality Inventory (NPI) - Leadership/Authority,
Self-absorption/Self-admiration, and Superiority/Arrogance- than in males -
though 'male and female narcissists in general showed striking similarities in
the manner in which most of the facets of narcissism were integrated with each
other'."
Gender differences in the structure of narcissism: a multi-sample
analysis of the narcissistic personality inventory - Brian T. Tschanz, Carolyn C. Morf, Charles
W. Turner - Sex Roles: A Journal of Research - Issue: May, 1998
"Women leaders are evaluated negatively if they exercise their authority
and are perceived as autocratic."
Eagly, A. H., Makhijani, M. G., & Klonsky, B. G. (1992). Gender and the
evaluation of leaders: A meta-analysis. Psychological
Bulletin, 111, 3-22, and ...
Butler, D., & Gels, F. L. (1990). Nonverbal affect responses to male
and female leaders: Implications for leadership evaluations. Journal of
Personality and Social Psychology, 58, 48-59.
"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."
Carli, L.
L., Lafleur, S. J., & Loeber,
C. C. (1995). Nonverbal behavior, gender, and
influence. Journal of Personality and Social Psychology, 68, 1030-1041.
Gender and the Narcissist - click HERE!
Homosexual and Transsexual Narcissists - click HERE!
Sex and Gender - click HERE!
Many additional Frequently Asked Questions (FAQs) about Personality Disorders - click HERE!
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