Abstract
Gender is an important variable in the study of mental health because of the actual and perceived differences between men and women. Relatively little is known how males and females differ in their manifestations of antisocial personality disorder (ASPD). Demographic and clinical features of 323 participants with ASPD were assessed and recorded. Women had fewer episodes of antisocial behavior involving or not involving police, higher scores on the Childhood Trauma Questionnaire (CTQ) and on Emotional Abuse and Sexual Abuse subscales of the CTQ compared to men. CTQ scores positively correlated with the number of episodes of antisocial behavior involving police in men but not in women. The percentage of patients with comorbid borderline and histrionic personality disorders was higher and the percentage of participants with cocaine use disorder was lower among women compared to men. Comorbid alcohol use disorder was frequent in both groups, while a higher percentage of women had comorbid mood disorders compared to men. Logistic regression analysis demonstrates that CTQ scores, histrionic personality disorder, and antisocial behavior involving the police drive the difference between the groups. Our findings indicate that treatment of individuals with ASPD should focus on the management of comorbid psychiatric disorders
Introduction
Antisocial personality disorder (ASPD) describes individuals with a pervasive pattern of disregard for, and violation of, the rights of others that begins in childhood or early adolescence and continues into adulthood (American Psychiatric Association, 1994 and American Psychiatric Association, 2013). The recently released revision of the DSM, the DSM-5, retains the same diagnostic criteria for ASPD as were included in the previous edition (American Psychiatric Association, 2013). Criteria include behaviors such as repeatedly performing acts that are grounds for arrest, repeated lying, repeated fights or assaults, disregard for the safety of oneself and others, repeated failure to sustain consistent work behavior, and mistreating other individuals. The requirement in DSM-IV that conduct disorder beginning before the age of 15 must be present has been removed, but predisposing traits are assumed to be stable from childhood to adulthood.
ASPD is an important public health and social issue (American Psychiatric Association, 1994 and American Psychiatric Association, 2013; Fazel and Danesh, 2002; National Collaborating Centre for Mental Health (UK), 2010). ASPD is common in prison settings. Studies of prisoners worldwide indicate a prevalence of ASPD of about 50% for men and about 20% for women (Fazel and Danesh, 2002). There are high costs of criminal behavior including emotional and physical damage to victims, damage to property, police time, involvement with the criminal justice system and prison services (Cohen and Miller, 1998; National Collaborating Centre for Mental Health (UK), 2010).
ASPD is more common among the first-degree biological relatives of those with the disorder than in the general population (Viding et al., 2008; Ferguson, 2010; Meier et al., 2011). Substantial evidence from twin and adoption studies shows that both genetic and shared environmental factors play a substantial role in the liability to antisocial behavior (Rhee and Waldman, 2002, Maes et al., 2007 and Silberg et al., 2007). The risk to biological relatives of females with the disorder tends to be higher than the risk to biological relatives of males with the disorder.
Gender is an important variable in the study of mental health because of the actual and perceived differences between men and women. The Epidemiological Catchment Area survey showed that between 2% and 4% of men and between 0.5% and 1% of women fulfilled DSM-III-R criteria for ASPD (Regier et al., 1994). The National Comorbidity Study (Kessler et al., 1994) also found higher rates of ASPD in males than in females (5.8% vs. 1.2%). It has been proposed that men are over-diagnosed with ASPD (Warner, 1978, Hamilton et al., 1986, Ford and Widiger, 1989 and Becker and Lamb, 1994). Men with borderline personality disorder (BPD) may be diagnosed with ASPD because of the frequent presence of antisocial features in men with BPD (Sansone and Sansone, 2011 and Banzhaf et al., 2012).
Relatively little is known how males and females differ in their manifestations of ASPD. We have conducted a study to compare demographic and clinical features of men and women with ASPD. We hypothesized that men with ASPD are more impaired compared to women with ASPD.
Conclusion
We have observed that men with ASPD commit more antisocial acts compared to women with ASPD and women with ASPD are more likely to be victims of sexual or emotional abuse compared to men. The severity of childhood trauma positively correlates with the number of occurrences of antisocial behavior involving police in men but not in women. In our sample, a high percentage of both men and women had comorbid alcohol and drug abuse and personality disorders. It is possible that male ASPD and female ASPD are two different subtypes of this disorder. Our findings indicate that treatment of individuals with ASPD should focus on the following: (a) management of comorbid substance use disorders which is important both for men and in women; (b) prevention of antisocial acts which is more important for men; and (c) management of mood and personality disorders which is more important for women.
Some studies on gender differences in ASPD have been conducted over the past few decades. However, ASPD remains a relatively unstudied condition. Psychological and neurobiological studies of ASPD are needed to develop new treatment modalities for ASPD.
