Antisocial Personality Disorders in Women

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Outline

Antisocial personality disorder is a condition that is associated with the patient’s inability to respect or recognize other people’s rights. It develops over a period of time and can only be diagnosed in adults over the age of eighteen. Most of the symptoms of this disorder will surface at the age of fifteen. The occurrence of this disorder in women is a little bit challenging compared to their male counterparts. It may thus not be easy for the doctors to diagnose it unless they are acquainted with the patient’s lifestyle. It usually displayed in males through their physical aggressiveness, yet in women, it is kind of manipulative behavior.

Introduction

In administering therapy to a patient, most physicians will use observation method before carrying out other detailed diagnosis. When it comes to matters of psychology, it is usually more of the patient’s background and upbringing that will determine the kind of therapy to be administered. Even though it remains the best foundational diagnosis that has realized results, most psychiatrists have made wrong judgments and conducted a wrong diagnosis. The majority of research on the construct of psychopathy using Hare’s criterion (1980) has focused on Caucasian male populations and is therefore limited in its generalizations.

Hare (1998) states that there is no reason to expect that the validity of the Hare Psychopathy Checklist-Revised (PCL-R) would not be applicable to females. Cleckley’s (1941) original work included two female patients who both demonstrated chronic patterns of lying, stealing, truancy, and a high degree of sexual promiscuity, with little regard for moral responsibility or insight into problematic behaviors. It is generally expected that when a female gender grows up, they are to display the feminine nature by adapting to various responsibilities. When they display such characters contrary to what is expected, they need to be examined to find out the reason behind their ‘weird’ behavior. However, Cleckley (1941) initially recognized gender differences in the manifestations of psychopathic characteristics. He pointed out that these “women demonstrated the prototypical lack of empathy observed with the male subjects but that this characteristic expressed itself without any sense of malicious intent or sense of heartlessness” (Cleckley, 1982). Even though some researchers have acknowledged that psychopathy is found in both males and females, to date, the application of psychopathy to females has garnered relatively little attention in research and has resulted in a limited amount of empirically supported findings.

Characters associated with masculinity and violence is not expected of the female gender, they are expected to display care, concern and a general trend of responsibility. Although the young girls under the age of eighteen may be immature to display such characters, they are expected to display such feminine roles. Young girls who display a nature of aggressiveness and violence that may not be common to the female gender need to be diagnosed and treated earlier for antisocial behavior. In finding solution to such kind of behavior, the psychiatrist will first of all consider the family history of the patient to determine whether the problem is hereditary or not. It is through such diagnosis that the psychiatrist will know the kind of treatment to administer.

Such diagnosis is usually done in stages which may make it misleading. The cause of disorder in a growing child may not necessarily be hereditary even when a similar condition has been recorded in the family. Any positive results recorded during the first stages of diagnosis will be used to administer treatment to the patient. The other stages that may have important information about the patient are ignored. Such ignorance may cause the psychiatrists to give treatment that may not be of great assistance to the patient. This will only result in the problem being solved partially or not being solved at all.

Recent research has examined psychopathy in females in terms of investigating the PCL-R’s structure, relevant cut-off scores, and associated traits and behaviors. Initial gender research in psychopathy focused on establishing the existence of gender differences in prevalence rates of psychopathy. Salekin et al. (1997) administered the PCL-R to 103 female inmates and found, when using a cut-off score of 29 on the PCL-R, that only 15% were psychopathic. This figure is relatively low compared to the male correctional samples that showed percentages ranging between 15% and 30% in with a cut-off score of 30 (Hare, 1998). Forth et al. (1996) conducted a gender comparison study of psychopathic traits using an undergraduate college sample. Findings indicated that males scored significantly higher than women on total scores using the PCL-R: Screening Version (PCL-R: SV, 1999). Zagon and Jackson (1994) found similar results when they administered the Self Report Psychopathy Scale-II (SRP-II; Hare 1991), a self-report measure modeled after the PCL-R for undergraduate college students. Finally, a recent study by Vitale, Smith, Brinkley, and Newman (2002) found a relatively low base rate of 9% among a sample of 528 non psychotic female offenders. They attributed this result to either a lower base rate of psychopathy among women or inclusion of items in the PCL-R that do not adequately capture this personality construct among women.

Despite the above findings that females score lower than males on psychopathy measurements, which indicate the existence of either fewer psychopathy females or inadequate assessment tools. Additional research has indicated that female psychopathy does exist and has a large impact on society, implying the need for more specific studies aimed at explaining the gender differences. In particular, a rise in female adolescent and adult contact with the criminal justice system has been demonstrated (Weizmann-Henneelius, Viemero, & Eronen, 2004). Furthermore, there is a higher rate of recidivism and institutional infractions among women with psychopathic traits than among women without these characteristics (Dutton & Nicholls, 2005). Dutton and Nicholls also suggest that females with either serious mental disorders or intellectual impairment may exhibit an aggression level that rivals, and sometimes surpasses, the prevalence rates and severity of aggression among their male counterparts (2005). These research findings have been particularly evident in cases of intimate partner and child abuse. To date, women represent approximately 40% and 10% of populations within civil and forensic psychiatric hospitals, respectively (Nicholls et al., 1997).

The Construct of Psychopathy: Historical Development

During the 18^th century, psychiatrist Philippe Pinel introduced the existence of a distinct pattern of human behaviors marked “by utter remorselessness and a complete lack of restraint” (Hare, 1991), which he categorized under the rubric manie sans delire. Individuals demonstrating these behaviors appeared to have normal intellect but exhibited deviations in what might be termed “moral behavior.” Since that time, considerable theoretical and empirical attention has been directed toward understanding psychopathic personality characteristics and behaviors. Most contemporary conceptualizations are linked to Cleckley’s (1982) seminal work, The Mask of Sanity. From an analysis of 15 case studies, Cleckley delineated 16 core personality traits (see table A) associated with psychopathy, including guiltlessness, incapacity for object love, impulsivity, emotional shallowness, superficial social charm, and an inability to profit from experience (Millon, Simonsen, Birket-Smith, 1998). These individuals have no sense of responsibility, regard for the truth, or insight into their condition. Furthermore, Cleckley (1982) suggested that a regressive deterioration of morals, social obligations, and responsibilities exists within these individuals, which creates the inability to follow consistently any fulfilling life plan.

In addition to Cleckley’s (1982) work, which provided an interpersonal foundation for the development of psychopathy as a construct, a behavior-based approach has also been applied, signaling a shift toward a less subjective and inferential conceptualization. This behavioral perspective has contributed to the criteria for antisocial personality disorder (ASPD; APA, 2000). The DSM-IV (APA, 2000) suggests that a girl with ASPD is characterized by a history of delinquent and irresponsible behaviors (prior to age 15) that endure into adulthood. The essential feature of these behaviors is the evident disregard for, and violation of, the rights of others (APA, 2000). Women with ASPD fail to conform to social norms with respect to lawful behavior. They persist in criminal offences that involve the destruction of property that may earn them severe punishment. Such persons may not be able to respect other people’s rights. They are frequently deceitful and manipulative in order to gain personal profit or pleasure (APA, 2000). Some specific behavioral attributes of those with ASPD include irritability and aggressiveness, as indicated by repeated physical fights or assaults. The criteria for ASPD and psychopathy have some commonalities, including disregard of others’ rights, deceitfulness, and manipulation. However, an ASPD diagnosis is specifically based on a history of antisocial, criminal, or otherwise irresponsible behaviors, whereas a labeling of psychopathy is defined primarily in terms of personality traits (Lilienfeld, 2001).

Gender Roles and Psychopathy

Although the literature suggests that males score higher than females on measures of psychopathy, researchers know little about how males and females differ in their manifestation of psychopathic features, if at all. Several researchers have examined gender differences in various psychopathological and behavioral correlates of psychopathy (Warren, Burnette, South, Chauhan, Bale, Friend et al., 2003; Hamburger, Lilienfeld, & Hogben, 1996). Hare (1980) proposed that the reason for gender differences in mean scores may be due to different expressions of psychopathy by males and females and, therefore, some items on the PCL-R might require modification. The PCL-R diagnosis of psychopathy is a moderately strong predictor of recidivism in male offenders. Hart, Kropp, & Hare (1988), and Salekin et al. (1998) confirmed this association, albeit less strongly, in their sample of female inmates. However, only Factor 1 characteristics were significantly correlated with recidivism in females, whereas both Factor 1 and Factor 2 scores were predictive of recidivism in prior studies of males. Zagon and Jackson (1994) conducted a study comparing male and female college students and reported a profound difference in scores with regard to gender for both personality traits and socially deviant behaviors, with females demonstrating fewer psychopathic traits on both factors.

Researchers Hamburger, Lilienfeld, and Hogben (1996), conducted an empirical study in an attempt to investigate gender biases in diagnosing psychopathy, hypothesizing that psychopathic males tended to exhibit symptoms of anti-social personality disorder, while psychopathic females were labeled to have histrionic personality disorder traits. However, the tertiary hypothesis provided the foundation for more in-depth reasoning on why the gender differences existed. The results indicated that scores of the masculine items of the gender role measure were significantly positively correlated with scores on the psychopathy and ASPD measures. Scores of the feminine items from the gender role measure were negatively correlated with scores on the psychopathy and ASPD measures. While the additional hypothesis primarily aimed to support the study’s principal prediction further, the findings imply a connection between psychopathic manifestations and the gender differences in interpersonal and behavioral development mediated by gender role socialization.

ASPD is characterized by ones inability to appreciate other people’s rights. Such a person will find it difficult to comprehend the amount of harm he may be causing to others. As is usually the case, women show sympathy and concern and display certain emotions according to the surrounding. However those with ASPD display no reaction. They do not display any feeling of emotion no matter the magnitude of destruction that they cause. This is the reason why most of them persist in violence and appear guiltless even after they have harmed somebody. There is usually a similarity between the characters displayed by ASPDs and psychopaths that make it difficult for psychiatrist to diagnose. Such disorders are usually caused by biochemical imbalances, environmental and genetic influences. Treatment of such is given in accordance with the cause. If the problem is not diagnosed and correct treatment given in time, it may lead the victim to a future of more irresponsive behavior such as drug and other substance abuse. Such females also risk being prosecuted and consequently serving long terms in jails. The criminal court may not be in a position to realize that they have a psychological problem for them to be treated accordingly. They have to face similar punishment as per the law.

Gender role socialization is the process by which females and males are conditioned to think, feel, and behave in ways consistent with masculine and feminine norms of their culture (Krause, DeRosa, & Roth 2002). Women and men internalize gender-typed personality traits, gender-typed behaviors, and attitudes regarding rights afforded each gender and their consequent roles in society (McCreary & Rhodes, 2001). For example, women and men of western societies are socialized to express emotions that are stereotypically associated with their traditional gender roles. More specifically, women are encouraged to express emotions of warmth care and responsibility, which are related to the typically female role of primary caregiver of children (Wester, Vogel, Pressly, & Heeseacker, 2002). These authors go further in expressing how male psychologists can overcome the female gender schema by overcoming their own biases of women – a valuable tool that could be used in therapy with anti-social female clients. This also provides a fine example of how misdiagnosis occurs. It has been assumed that the women gender is less violent and can therefore be managed easily. When carrying out a diagnosis for ASPD the doctors may tend to ignore the magnitude of harm that a woman may cause. When such a trend continues, the women become even worse as they can continue carrying out their violent behaviors without being discovered.

Gender-specific Socializations of Psychopathic Traits

Several researchers hypothesized that adherence to gender roles influences the development of both adaptive and maladaptive personality traits. Therefore, researchers have examined sex differences in early externalizing (i.e., conduct disordered, oppositional) behaviors, which are associated with adult ASPD (APA, 2000). In samples of children and young adults, Crick and his colleagues (Crick, 1997; Werner & Crick, 1999) have distinguished between two types of aggressive behavior, overt and relational aggression, with males endorsing the former at a higher prevalence than females. Compared with overt forms of aggression (i.e., behaviors that harm others via physical damage or threats of physical damage) such as fighting and fire setting, relational aggression includes behaviors whereby relationships serve as the means for a youth’s antisocial behavior like threatening classmates and spreading rumors about others [Crick, 1997]). Crick and Grotpeter (1996) specifically defined relational aggression as manipulation of others with the goal of causing harm to the relationship and the victim through behaviors such as excluding a female from a social group, gossiping about a certain female so that the other females will reject her, or threatening termination of a friendship unless the female does what the aggressor wants.

While gender differences in aggression have been consistently demonstrated throughout research (Hazler, Powell & Carney, 1995; Lescheid, Cummings, Van Brunschot, Cunningham, & Saunders, 2001; Moffitt, Caspi, Rutter, & Silva, 2001) the findings have been mainly based upon youth populations within school settings. The investigation of gender difference with regard to aggression amongst the adult population has been limited to samples within the workplace. However, the findings suggest that aggressive styles are subject to developmental change during one’s life course while retaining the same intentions. During the early stages of childhood, verbal skills are limited, so physical aggression is the predominant mode. While an individual’s verbal skills improve, so does the individual’s tendency to utilize language for aggressive purposes. By adulthood, when social skills are further developed, even more sophisticated strategies of aggression are facilitated with the aggressor who is able to harm a targeted person without even being identified (Bjorkqvist, K., Osterman, K., & Lagerspetz, K, 1994). While the development of aggressive styles reflects interpersonal and cognitive development, the changes also represent society’s sanctioning and punishment of particular behaviors. Physical aggression causes more social risk of condemnation and consequences for an adult, such as loss of employment or long-term imprisonment, than for a child. Therefore, individuals are more inclined to express aggressive tendencies through undetectable ways.

Research has shown that adult males and females endorse covert, or disguised, aggression (Bjorkqvist, K., Osterman, K., & Lagerspetz, K, 1994; Kaukiainen, A. et al., 2001) within the work setting. Gender differences are indicated through the varying forms of indirect aggression that are expressed, with males exhibiting rational-appearing aggression and females endorsing social manipulation strategies. The social manipulation closely resembles the female adolescent relational aggression.

One explanation for these gender differences in aggression relates to the intention behind the aggressive behaviors. Some researchers theorized that aggression is directed toward damaging the goals found most important to the specific gender peer groups. For example, males perceive social power and dominance over their peers as important; therefore, aggressive actions are directed towards diminishing another’s level of superiority (Block, 1983). This theory coincides with the research findings that males implement instrumental, physical, and verbal aggression (Hoffman, Cummings & Lesheid, 2004). These types of peer group concerns are not as salient for most females. In contrast to males, females are more likely to focus on relational issues during social interactions (e.g., establishing close, intimate connections with others [Block, 1983]). Therefore, females who attempt to harm others focus on relational issues and implement aggressive behaviors that are intended to significantly damage another female’s friendships or feelings of inclusion in the peer group.

Conclusion

The above research investigates the relationship between gender and psychopathic traits; more specifically, the correlation between individuals’ gender role orientation (traditional or non-traditional) and their expression of psychopathic characteristics. It has always been assumed that women who are inclined to gender roles will not display traits of a psychopath compared to those that are not inclined to them. The opposite results are proposed for the male population, in that traditional males will exhibit more psychopathic traits than non-traditional males. This research is an attempt to add further insight into the construct of psychopathy, which would have implications in clinical settings, prisons, and future research. Most specifically, in terms of assessment and applied measures, we would be better able to identify differing psychopathic-like traits exhibited by females and males.

Overall, the research supports a significant prevalence of female psychopathy, even if the rate appears less than males. Therefore, the accurate assessment of female offenders’ recidivism and violent tendencies in forensic, clinical, and community environments is just as important and necessary as it is for male offenders. Due to the potential gender differences, however, it has become more imperative to further understand the specific aspects of female psychopathy, rather than depending on generalizations obtained from male psychopathy research.

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