My name is Sam Vaknin. I am the author of Malignant Self-Love, Narcissism Revisited.
Ever since Sigmund Freud, more women than men sought therapy. Consequently, terms like hysteria are intimately connected to female anatomy and alleged female psychology.
The Diagnostic and Statistical Manual, DSM, the Bible of the psychiatric profession, expressly confesses to gender bias. Personality disorderssuch as borderline and histrionic, are supposed to be more common among women. Luckily, the DSM is pretty even-handed.
Other personality disorderssuch as narcissistic, antisocial, schizotypal, passive compulsive, schizoid and paranoid, these other personality disorders are more prevalent among men.
But why this gender disparity to start with? Why some personality disorders are more common among women than others among men?
Well, maybe personality disorders are not objective clinical entities at all. Maybe they are culture-bound syndromes. In other words, maybe personality disorders reflect biases and value judgments and prejudices of the prevailing culture.
Consider patriarchal societies, but triarchal societies are also narcissistic. They emphasize qualities such as individualism and ambition, and these are identified with virility. So, we would expect to find these qualities among men rather than among women.
Since they also define pathological narcissism, the preponderance of pathological narcissism would be among men. Women, on the other hand, are widely believed to be emotionally labile and clingy, and this would tend to explain why there are more women among borderline personality disorder and dependent personality disorder patients.
Another possible reason is that 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 such as Kaplan and Pantoni claim that the mental health profession is inherently sexist.
But then again, that may not be the case. Genetics may be 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.
Ultimately, I think the problem is the ambiguity and equivocation of the diagnostic criteria. Some of the diagnostic criteria for personality disorder are ambiguous. Some of them are even considered normal by the majority of the population.
Consider one of the diagnostic criteria for histrionic personality disorder. It says that the histrionic consistently uses physical appearance to draw attention to self.
Well, who doesn’t do that in Western society? Everyone. So everyone ought to be labeled a histrionic.
Why when a woman clings to a man, this is labeled co-dependence. But when a man relies on a woman to maintain his home, take care of his children, choose his attire, and from his ego, this is called companionship.
This observation was made by Walker in 1994. Even structured interviews and psychological tests fail to remove gender bias. The less structured the interview, the more fussy the diagnostic criteria, the more the diagnostician relies on stereotypes. This was discovered by Widiger in 1998.
Gender bias is everywhere, especially since the psychiatric profession was overwhelmingly invented, written, researched, studied, propagated by males. Women have been caged into niches of mental health diagnosis.
Certain personality disorders are female personality disorders. Others are male personality disorders.
And it is not surprising that many, finally, scholars and laymen alike finally say that there are no such things as personality disorders.
It’s all cultural. The Diagnostic and Statistical Manual Committee is currently considering this possibility. And we are heading for a revolution in the science of personality disorders, which may also remove a lot of the gender bias hitherto so painfully apparent.
