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Sex Differences in Personality Disorders

  • Personality Disorders (K Bertsch, Section Editor)
  • Published:
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Abstract

Purpose of Review

This review aims to give an overview on the current literature on sex differences in personality disorders and to highlight the potential of dimensional approaches.

Recent Findings

Empirical findings on sex differences in personality disorders are inconsistent and appear to be highly dependent on study settings. Current studies have mainly focused on borderline and antisocial personality disorder and the question whether these are sex-specific representations of a common substrate. In general, sexes differ in the manifestation of personality disorders as well as in comorbidities. Criticism of the established categorical model led to an additional dimensional model of personality disorders in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.

Summary

Investigations on sex differences in personality disorders are sparse and mainly limited to antisocial and borderline personality disorder. The introduction of a dimensional model offers the chance to re-think the construct of “personality disorder” and thereby also opens the possibility for a better understanding of sex differences.

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References

Papers of particular interest, published recently, have been highlighted as: • Of importance

  1. Association AP. Personality disorders. Diagnostic and statistical manual of mental disorders. 5th ed. Washington, DC; 2013.

  2. Huang Y, Kotov R, de Girolamo G, Preti A, Angermeyer M, Benjet C, et al. DSM-IV personality disorders in the WHO World Mental Health Surveys. Br J Psychiatry. 2009;195(1):46–53.

    Article  PubMed  PubMed Central  Google Scholar 

  3. Soeteman DI, Hakkaart-van Roijen L, Verheul R, Busschbach JJV. The economic burden of personality disorders in mental health care. J Cli Psychiatry [Peer Reviewed]. 2008;69(2):259–65.

    Article  Google Scholar 

  4. Feingold A. Gender differences in personality: a meta-analysis. Psychol Bull. 1994;116(3):429–56.

    Article  CAS  PubMed  Google Scholar 

  5. Costa PT, Jr., Terracciano A, McCrae RR. Gender differences in personality traits across cultures: robust and surprising findings. J Pers Soc Psychol. [Peer Reviewed]. 2001;81(2).

    Article  Google Scholar 

  6. Paris J. An overview on gender, personality and mental health. Personal Ment Health. 2007;1(1):14–20.

    Article  Google Scholar 

  7. Paris J. Gender differences in personality traits and disorders. Curr Psychiatry Rep. 2004 Feb;6(1):71–4.

    Article  PubMed  Google Scholar 

  8. Corbitt EM, Widiger TA. Sex differences among the personality disorders: an exploration of the data. Fal, 1995. Clin Psychol Sci Pract. [Peer Reviewed]. 1995;2(3).

    Google Scholar 

  9. Torgersen S, Kringlen E, Cramer V. The prevalence of personality disorders in a community sample. Arch Gen Psychiatry [Peer Reviewed]. 2001;58(6):590–6.

    Article  CAS  PubMed  Google Scholar 

  10. Grant BF, Hasin DS, Stinson FS, Dawson DA, Chou SP, Ruan W, et al. Prevalence, correlates, and disability of personality disorders in the United States: results from the national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry. 2004;65:948–58.

    Article  PubMed  Google Scholar 

  11. Crosby JP, Sprock J. Effect of patient sex, clinician sex, and sex role on the diagnosis of antisocial personality disorder: models of underpathologizing and overpathologizing biases. J Clin Psychol. 2004;60(6):583–604.

    Article  PubMed  Google Scholar 

  12. Ford MR, Widiger TA. Sex bias in the diagnosis of histrionic and antisocial personality disorders. J Consult Clin Psychol. 1989;57(2):301–5.

    Article  CAS  PubMed  Google Scholar 

  13. Braamhorst W, Lobbestael J, Emons WHM, Arntz A, Witteman CLM, Bekker MHJ. Sex bias in classifying borderline and narcissistic personality disorder. J Nerv Ment Dis. 2015;203:804–8.

    Article  PubMed  Google Scholar 

  14. Disney KL. Dependent personality disorder: a critical review. Clin Psychol Rev. 2013;33:1184–96.

    Article  PubMed  Google Scholar 

  15. Grant BF, Chou SP, Goldstein RB, Huang B, Stinson FS, Saha TD, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV borderline personality disorder: results from the Wave 2 National Epidemiologic Survey on Alcohol and Related Conditions. J Clin Psychiatry. 2008;69:533–45.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Sansone RA, Wiederman MW. Sex and age differences in symptoms in borderline personality symptomatology. Int J Psychiatry Clin Pract. 2014;18:145–9.

    Article  PubMed  Google Scholar 

  17. Hoertel N, Peyre H, Wall MM, Limosin F, Blanco C. Examining sex differences in DSM-IV borderline personality disorder symptom expression using Item Response Theory (IRT). J Psychiatr Res. 2014;59:213–9.

    Article  PubMed  Google Scholar 

  18. • Silberschmidt A, Lee S, Zanarini M, Schulz SC. Gender differences in borderline personality disorder: results from a multinational, clinical trial sample. J Personal Disord. 2015;29:828–38 This recent study finds that gender differences converge in borderline PD.

    Article  Google Scholar 

  19. Barrachina J, Pascual JC, Ferrer M, Soler J, Rufat MJ, Andión O, et al. Axis II comorbidity in borderline personality disorder is influenced by sex, age, and clinical severity. Compr Psychiatry. 2011;52:725–30.

    Article  PubMed  Google Scholar 

  20. Sher L, Siever LJ, Goodman M, McNamara M, Hazlett EA, Koenigsberg HW, et al. Gender differences in the clinical characteristics and psychiatric comorbidity in patients with antisocial personality disorder. Psychiatry Res. 2015;229:685–9.

    Article  PubMed  Google Scholar 

  21. Cale EM, Lilienfeld SO. Sex differences in psychopathy and antisocial personality disorder: a review and integration. Clin Psychol Rev. 2002;22:1179–207.

    Article  PubMed  Google Scholar 

  22. Fazel S, Danesh J. Serious mental disorder in 23000 prisoners: a systematic review of 62 surveys. Lancet. 2002;359:545–50.

    Article  PubMed  Google Scholar 

  23. Alegria AA, Blanco C, Petry NM, Skodol AE, Liu SM, Grant B, et al. Sex differences in antisocial personality disorder: results from the National Epidemiological Survey on Alcohol and Related Conditions. Personality Disorders: Theory, Research, and Treatment. 2013;4:214–22.

    Article  Google Scholar 

  24. Rogstad JE, Rogers R. Gender differences in contributions of emotion to psychopathy and antisocial personality disorder. Clin Psychol Rev. 2008;28:1472–84.

    Article  PubMed  Google Scholar 

  25. Yang M, Coid J. Gender differences in psychiatric morbidity and violent behaviour among a household population in Great Britain. Soc Psychiatry Psychiatr Epidemiol. 2007;42:599–605.

    Article  PubMed  Google Scholar 

  26. Raine A, Yang Y, Narr KL, Toga AW. Sex differences in orbitofrontal gray as a partial explanation for sex differences in antisocial personality. Mol Psychiatry. 2011;16:227–36.

    Article  CAS  PubMed  Google Scholar 

  27. Kuepper Y, Alexander N, Osinsky R, Mueller E, Schmitz A, Netter P, et al. Aggression—interactions of serotonin and testosterone in healthy men and women. Behav Brain Res. 2010;206:93–100.

    Article  CAS  PubMed  Google Scholar 

  28. Paris J, Chenard-Poirier MP, Biskin R. Antisocial and borderline personality disorders revisited. Compr Psychiatry. 2013;54:321–5.

    Article  PubMed  Google Scholar 

  29. • Chun S, Harris A, Carrion M, Rojas E, Stark S, Lejuez C, et al. A psychometric investigation of gender differences and common processes across borderline and antisocial personality disorders. J Abnorm Psychol. 2017;126:76–88 This study examines the potential overlap between borderline and antisocial PD.

    Article  PubMed  Google Scholar 

  30. Hunt E, Bornovalova MA, Patrick CJ. Genetic and environmental overlap between borderline personality disorder traits and psychopathy: evidence for promotive effects of factor 2 and protective effects of factor 1. Psychol Med. 2015;45:1471–81.

    Article  CAS  PubMed  Google Scholar 

  31. Kendler KS, Aggen SH, Knudsen GP, Røysamb E, Neale MC, Reichborn-Kjennerud T. The structure of genetic and environmental risk factors for syndromal and subsyndromal common DSM-IV axis I and all axis II disorders. Am J Psychiatr. 2011;168(1):29–39.

    Article  PubMed  Google Scholar 

  32. Beauchaine TP, Klein DN, Crowell SE, Derbidge C, Gatzke-Kopp L. Multifinality in the development of personality disorders: a biology × sex × environment interaction model of antisocial and borderline traits. Dev Psychopathol. 2009;21:735–70.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Sansone RA, Sansone LA. Gender patterns in borderline personality disorder. Innov Clin Neurosci. 2011;8(5):16–20.

    PubMed  PubMed Central  Google Scholar 

  34. Banzhaf A, Ritter K, Merkl A, Schulte-Herbrüggen O, Lammers C-H, Roepke S. Gender differences in a clinical sample of patients with borderline personality disorder. J Personal Disord. 2012;26:368–80.

    Article  Google Scholar 

  35. Cale EM, Lilienfeld SO. Histrionic personality disorder and antisocial personality disorder: sex-differentiated manifestations of psychopathy? J Personal Disord. 2002;16:52–72.

    Article  Google Scholar 

  36. Triebwasser J, Chemerinski E, Roussos P, Siever LJ. Paranoid personality disorder. J Personal Disord. 2013;27(6):795–805.

    Article  Google Scholar 

  37. Pulay AJ, Stinson FS, Dawson DA, Goldstein RB, Chou SP, Huang B, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV schizotypal personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions. Prim Care Companion J Clin Psychiatry. 2009;11:53–67.

    Article  PubMed  PubMed Central  Google Scholar 

  38. Guo ME, Collinson SL, Subramaniam M, Chong SA. Gender differences in schizotypal personality in a Chinese population. Personal Individ Differ. 2011;50:404–8.

    Article  Google Scholar 

  39. Miettunen J, Jääskeläinen E. Sex differences in Wisconsin schizotypy scales-a meta-analysis. Schizophr Bull. 2010;36:347–58.

    Article  PubMed  Google Scholar 

  40. Raine A. Sex differences in schizotypal personality in a nonclinical population. J Abnorm Psychol. 1992;101(2):361–4.

    Article  CAS  PubMed  Google Scholar 

  41. Bora E, Baysan Arabaci L. Effect of age and gender on schizotypal personality traits in the normal population. Psychiatry Clin Neurosci. 2009;63:663–9.

    Article  PubMed  Google Scholar 

  42. Badcock JC, Dragović M. Schizotypal personality in mature adults. Personal Individ Differ. 2006;40(1):77–85.

    Article  Google Scholar 

  43. Hummelen B, Pedersen G, Wilberg T, Karterud S. Poor validity of the DSM-IV schizoid personality disorder construct as a diagnostic category. J Personal Disord. 2015;29:334–46.

    Article  Google Scholar 

  44. Triebwasser J, Chemerinski E, Roussos P, Siever LJ. Schizoid personality disorder. J Personal Disord. 2012;26(6):919–26.

    Article  Google Scholar 

  45. Sprock J. Gender-typed behavioral examples of histrionic personality disorder. J Psychopathol Behav Assess. 2000;22:107–22.

    Article  Google Scholar 

  46. Stinson FS, Dawson DA, Goldstein RB, Chou SP, Huang B, Smith SM, et al. Prevalence, correlates, disability, and comorbidity of DSM-IV narcissistic personality disorder: results from the wave 2 national epidemiologic survey on alcohol and related conditions. J Clin Psychiatry. 2008;69(7):1033–45.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Yang W, Cun L, Du X, Yang J, Wang Y, Wei D, et al. Gender differences in brain structure and resting-state functional connectivity related to narcissistic personality. Sci Rep. 2015;5.

  48. Kubarych TS, Aggen SH, Kendler KS, Torgersen S, Ted RK, Neale MC. Measurement non-invariance of DSM-IV narcissistic personality disorder criteria across age and sex in a population based sample of Norwegian twins. Int J Methods Psychiatr Res. 2010;19:156–66.

    Article  PubMed  PubMed Central  Google Scholar 

  49. Tanaka Y, Ishitobi Y, Inoue A, Oshita H, Okamoto K, Kawashima C, et al. Sex determines cortisol and alpha-amylase responses to acute physical and psychosocial stress in patients with avoidant personality disorder. Brain and Behavior. 2016;6:e00506.

    Article  PubMed  PubMed Central  Google Scholar 

  50. Bornstein R. Sex differences in dependent personality disorder prevalence rates. Clin Psychol Sci Pract. 1996;3:1–12.

    Article  Google Scholar 

  51. Coid J, Yang M, Tyrer P, Roberts A, Ullrich S. Prevalence and correlates of personality disorder in Great Britain. Br J Psychiatry. 2006;188(5):423–31.

    Article  PubMed  Google Scholar 

  52. Grant JE, Mooney ME, Kushner MG. Prevalence, correlates, and comorbidity of DSM-IV obsessive-compulsive personality disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions. J Psychiatr Res. 2012;46:469–75.

    Article  PubMed  Google Scholar 

  53. Kanehisa M, Kawashima C, Nakanishi M, Okamoto K, Oshita H, Masuda K, et al. Gender differences in automatic thoughts and cortisol and alpha-amylase responses to acute psychosocial stress in patients with obsessive-compulsive personality disorder. J Affect Disord. 2017;217:1–7.

    Article  CAS  PubMed  Google Scholar 

  54. Skodol AE, Clark LA, Bender DS, Krueger RF, Morey LC, Verheul R, et al. Proposed changes in personality and personality disorder assessment and diagnosis for DSM-5 part I: description and rationale. Personality Disorders: Theory, Research, and Treatment. 2011;2:4–22.

    Article  Google Scholar 

  55. • Herpertz SC, Huprich SK, Bohus M, Chanen A, Goodman M, Mehlum L, et al. The challenge of transforming the diagnostic system of personality disorders. J Personal Disord. 2017;31:577–89 This article critically reviews the radical changes of the diagnostic system proposed by ICD-11.

    Article  Google Scholar 

  56. Bertsch K, Hillmann K, Herpertz SC. Behavioral and neurobiological correlates of disturbed emotion processing in borderline personality disorder. Psychopathology. 2018;51(2):76–82.

    Article  PubMed  Google Scholar 

  57. Domes G, Schulze L, Bottger M, Grossmann A, Hauenstein K, Wirtz PH, et al. The neural correlates of sex differences in emotional reactivity and emotion regulation. Hum Brain Mapp. 2009;31(5):758–69.

    Article  Google Scholar 

  58. • Herpertz SC, Nagy K, Ueltzhoffer K, Schmitt R, Mancke F, Schmahl C, et al. Brain mechanisms underlying reactive aggression in borderline personality disorder-sex matters. Biol Psychiatry. 2017;82(4):257–66 This article describes sex-specific differences of borderline patients in aggression and emotion regulation.

    Article  PubMed  Google Scholar 

  59. Kozak MJ, Cuthbert BN. The NIMH Research Domain Criteria Initiative: background, Issues, and pragmatics. Psychophysiology. 2016;53(3):286–97.

    Article  Google Scholar 

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Authors and Affiliations

  1. Department of Psychiatry, Psychotherapy and Psychosomatics, Faculty of Medicine, RWTH Aachen University, Aachen, Germany

    Barbara Schulte Holthausen & Ute Habel

  2. Institute of Neuroscience and Medicine: JARA-Institute Brain Structure Function Relationship (INM 10), Research Center Jülich, Jülich, Germany

    Ute Habel

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  1. Barbara Schulte Holthausen
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  2. Ute Habel
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Correspondence to Barbara Schulte Holthausen.

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This article is part of the Topical Collection on Personality Disorders

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Schulte Holthausen, B., Habel, U. Sex Differences in Personality Disorders. Curr Psychiatry Rep 20, 107 (2018). https://doi.org/10.1007/s11920-018-0975-y

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