Sex Differences In Antisocial Personality Disorder: Patterns And Manifestations
Antisocial personality disorder (ASPD) is a mental health condition in which a person has a pattern of exploiting, manipulating, or violating the rights of others without remorse or empathy. This behavior is often severe and persistent and can affect nearly every aspect of life. ASPD can look different in people of different sexes. Looking at these differences in research derived from the National Epidemiological Survey on Alcohol and Related Conditions may help individuals understand ASPD and how it may present in different people.
Sex differences in antisocial personality disorder
Men are diagnosed with ASPD three times more than women, but little is known about how men and women differ in their manifestations of this condition. According to the American Psychiatric Association, antisocial personality disorder may be one of the most misunderstood mental disorders. Some experts believe the condition often goes untreated and undiagnosed.
People with ASPD may have symptoms like failing to conform to social norms concerning lawful behaviors, lying, using aliases, being aggressive and irritable, having a reckless disregard for the safety of themselves or others, or having a lack of remorse. Though these are the general symptoms of ASPD, research into the differences between how this condition affects men and women is somewhat lacking. While people with this condition qualify under the same diagnostic criteria found in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), men and women with the cognition may present differently.
Data collected from the early 1980s found that women with ASPD were more likely to have had multiple sexual partners, while men were more likely to have a history of arrests and traffic offenses. Some data also suggests that women were more likely to lack remorse, be impulsive, or run away from home, whereas men were more likely to use weapons, initiate fights, set fires, or engage in animal cruelty. While there are limited studies directly on this topic, data extracted from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) has provided researchers with useful information about how this personality disorder affects men and women differently.
Data from the NESARC
The National Epidemiologic Survey on Alcohol and Related Conditions (NESARC) is a national survey of 46,500 US adults. Researchers conducting the survey collected data on alcohol use disorder and associated disabilities to explore various aspects of these disorders and their risk factors, prevalence, health disparities, and other areas. Data from this survey was used to obtain information about the sex differences in ASPD. Below is a summary of what researchers found:
- Adverse life events and trauma: Women with ASPD were more likely to report childhood adverse events, verbal abuse, physical abuse, sexual abuse, physical neglect, and emotional neglect.
- Parental connections: Women were more likely to report parent-related childhood adverse events and a parental history or family history of antisocial behavior or a mood disorder.
- Adult adverse events: Women were more likely to have experienced adult adverse events, including molestation, sexual assault, or rape. They were also more likely to have been beaten up or physically attacked by an intimate partner or to have lived with or been married to a problem drinker or alcoholic.
- Alcohol use disorder and comorbid conditions: Men with ASPD were more likely than their female counterparts to have alcohol use disorder, alcohol dependence, a history of substance use, and narcissistic personality disorder (NPD); women were more likely to have major depressive disorder, a mood disorder, dysthymia, anxiety disorders, specific phobia, panic disorder, and post-traumatic stress disorder (PTSD).
- Psychiatric disorders: Men and women in this survey were more likely to have psychiatric disorders, bipolar disorder, attention-deficit hyperactivity disorder (ADHD), social anxiety disorder, and all personality disorders except narcissistic personality disorder, like borderline personality disorder (BPD) or schizoid personality disorder (SPD).
Other findings
Data from this survey found that women with APSD were more likely than men to have engaged in the following:
- Run away from home overnight
- Lie
- Miss work or school
- Forge a signature
- Get into a physical fight with an intimate partner
- Struggle to find a regular place to live for at least one month
- Threaten, harass, or blackmail someone
Men are more likely to have participated in the following behaviors:
- Hurt themselves or others
- Had their driver's license suspended or revoked
- Gotten three or more traffic violations for causing accidents and driving recklessly
- Destroyed other’s property
- Made money illegally
- Started a fire on purpose (arson)
- Participated in behavior they could have been arrested for
- Hit someone so hard they cause injury
- Physically hurt an animal on purpose.
Overall, these results found that women with ASPD had higher rates of childhood emotional neglect, sexual abuse, and parent-related childhood adverse events than their male counterparts. Women with ASPD also report higher rates of adult adverse events than men with ASPD. Researchers do not yet know how these factors are linked to ASPD.
Another general finding from this data that was in line with previous research was that men with ASPD were more likely to be involved in violent or illegal actions, while women with ASPD were more likely to commit nonviolent antisocial behaviors. Researchers speculate that this difference could lead to misdiagnosing or under-recognizing ASPD in women.
How is ASPD treated?
There is no standard treatment for ASPD, and ASPD symptoms often persist throughout one’s life. According to a paper published in the Journal of Nervous and Mental Disease, childhood-onset ASPD “appears to identify a more polysymptomatic and violent form of ASPD.” Thus, early treatment intervention for children displaying signs of conduct disorder is considered the most effective and least costly way to treat and prevent ASPD. Psychotherapy may be helpful in treating certain aspects of the disorder, but research into empirically based treatment is limited.
Men and women with ASPD may not believe that there is anything wrong with their behavior, and they may not seek treatment. People with ASPD may request treatment at the request of a close friend or family member because of the stress that ASPD behaviors put on the relationship. Your relationship may be challenging if you have a friend or loved one with ASPD. Even if they attempt to learn how to manage their symptoms, the relationship can still have periods of stress, anger, anxiety, or frustration. While you may want to do whatever you can to help them, caring for yourself is important, too. Considering therapy may help you move forward and cope with these challenges.
Alternative support options
Finding accessible therapy can be difficult if you’re living with ASPD or have a loved one with the condition. Online therapy platforms like BetterHelp may be more accessible than in-person therapy, allowing you to receive support from home.
Online therapy can help you work through any complicated feelings you have about your relationship and recover if you find yourself emotionally or mentally drained from supporting someone with ASPD or living with the condition. With an online platform, you don’t have to worry about being put on a waiting list for an in-person appointment or commuting to an office across town. Online therapy allows you to meet with a licensed, qualified mental health professional via phone, video, or live chat and offers resources like weekly support groups.
In addition to being flexible and convenient, research shows that online therapy is effective. A meta-analysis published in Clinical Psychology: Science and Practice in 2022 found that online and in-person therapy often have the same client outcomes.
Takeaway
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