E CAMDEN SCHIZOPH

Article

International Journal of

The influence of gender role

Social Psychiatry
58(4) 409­–416
© The Author(s) 2011
on the prediction of antisocial Reprints and permissions:
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behaviour and somatization DOI: 10.1177/0020764011406807

isp.sagepub.com

Yessenia Castro,1 Joyce L. Carbonell2 and Joye C. Anestis2

Abstract
Background: Previous research has demonstrated a sex-differentiated relationship between antisocial behaviour and
somatization. One explanation posited is that societal expectations about male and female behaviour may influence a
sex-differentiated expression of a common diathesis, but this idea has not been directly tested.
Aims: The current study examined the potential contribution of gender role in the prediction of antisocial and somatic
symptomatology, controlling for biological sex, impulsivity and negative affect.
Methods: Linear regression was used to examine the influence of gender role on somatic and antisocial symptomatology.
Path analysis was used to examine whether relationships among these variables differed significantly for men and women.
Participants were 349 undergraduate students in southeastern USA.
Results: Masculine gender role was positively related to antisocial behaviour, while feminine gender role was negatively
related to antisocial behaviour. Gender role did not predict somatization.
Conclusions: Gender role may be important to the expression of antisocial behaviour, but does not influence somatic
symptoms. Current findings underscore the need to consider that observed sex differences in antisocial behaviour might
actually be affected by gender role, and highlight the importance of considering societal expectations of male and female
behaviour when examining apparent sex differences in behaviour.

Keywords
antisocial behaviour, gender, gender role, sex differences, somatization

Introduction
There exists a differential lifetime prevalence for somatiza-
tion disorder of 0.2%–2% in women and less than 0.2% in
men (American Psychiatric Association [APA], 2000).
This finding holds across a variety of populations, including
community samples (Haug et al., 2004; Ladwig et al.,
2001; Piccinelli and Simon, 1997; Rief et al., 2001), alcohol
abuse samples (Milani et al., 2004), individuals with
depression (Silverstein, 1999, 2002) and college samples
(Wilson et al., 1999). In contrast, antisocial personality
disorder (ASPD) and antisocial symptomatology have long
been known to exist with greater prevalence and severity
in men compared to women, with differential prevalence
rates of 3% and 1%, respectively (APA, 2000). This find-
ing also generalizes across a variety of populations,
individuals and within families, and the co-occurrence
within families tends to be gender-differentiated, with
women showing more somatic symptoms and men showing
more antisocial symptoms (Bohman et al., 1984; Cloninger
and Guze, 1970a, 1970b; Cloninger et al., 1975a, 1975b;
Cloninger et al., 1984; Sigvardsson et al., 1984; Woerner
and Guze, 1968).
Family studies suggest a common etiological process
for somatization and antisocial behaviour whose expres-
sion depends on the sex of the afflicted person (Cloninger
1Department of Health Disparities Research, The University of Texas MD
Anderson Cancer Center, Houston, Texas, USA
2Department of Psychology, The Florida State University, Tallahassee,

including mental health outpatients (Grilo and Grilo, 2002; Florida, USA
Zlotnick et al., 2001; Zlotnick et al., 2002), drug treatment
Corresponding author:
patients (Barber et al., 1996; Grella et al., 2003) and
Yessenia Castro, The University of Texas MD Anderson Cancer Center,
college samples (Cale and Lilienfeld, 2002; Lilienfeld and Department of Health Disparities Research, Unit 1440, PO Box 301402,
Hess, 2001). Additionally, research indicates that somati- Houston, Texas 77230-1402, USA
zation and antisocial personality tend to co-occur within Email: ycastro1@mdanderson.org

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410 International Journal of Social Psychiatry 58(4)
et al., 1975b). However, researchers in this area have also
implied that gender socialization and expectations about
male and female behaviour may drive apparent sex differ-
ences in the expression of somatization and antisociality
(Cloninger et al., 1975b; Lilienfeld, 1992). Specifically,
differential expression of the same underlying vulnerabil-
ity may occur because it is perceived to be more socially
appropriate for men to exhibit antisocial symptoms and
women to exhibit somatic symptoms. However, in spite of
the presumed influence of social expectations of gender on
somatization and antisocial behaviour, no published work
has directly examined the influence of gender socialization
on somatization and antisocial behaviour. Thus, the pur-
pose of the current study was to examine the influence of
gender role identification on antisocial behaviour and
somatization, while taking into account known predictors
of these pathologies.
Relevance of gender role
Bem (1978) captures one’s internalization of gendered
expectations of behaviour with the Bem Sex Role Inventory.
Within Bem’s model, individuals who endorse traits tra-
ditionally or stereotypically associated with women are
feminine in gender role, whereas those who endorse traits
traditionally or stereotypically associated with men are
masculine in gender role. The majority of men and women
subscribe strongly to gender roles congruent with their
biological sex (Bem, 1978), which provides some support
for making assertions about the influence of gender sociali-
zation on somatization and antisocial behaviour based on
data about sex differences in these behaviours. However,
no published work to our knowledge has directly examined
indices of gender socialization for their influence on
antisocial and somatic symptom expression.
Research on gender role indicates that individuals who
identify strongly with either gender role are likely to engage
in behaviour that is consistent with that role, regardless of
their sex (Bem and Lewis, 1975; Bem et al., 1976), and
that individuals will often refrain from engaging in certain
behaviours if they are inconsistent with the social expecta-
tions of the individual’s sex (Carbonell, 1984; Carbonell
and Castro, 2008). Thus, to the extent that antisocial behav-
iour and somatization are described in traditionally or stere-
otypically gendered terms (e.g. antisociality is associated
with ‘male’ terms such as risk taking, aggressive; somatiza-
tion is associated with ‘female’ vulnerability), higher mas-
culinity and femininity could increase the odds of displaying
antisocial or somatic behaviour, respectively. Further, mas-
culinity and femininity could serve as protective traits
against somatic and antisocial behaviour, respectively. Also,
it is important to note that the gender role with which one
identifies may not necessarily be analogous to one’s sex (i.e.
there are masculine women and feminine men), nor does
identification with one set of traits preclude identification
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with the other. Thus, it is important to examine the level of
identification with each gender role, within each sex, as a
model that considers gender role over biological sex may
help explain why some men and women still experience
somatic and antisocial symptoms, respectively.
Other important influences
Impulsivity (the tendency to act without planning or con-
sideration of the consequences of one’s actions; Moeller
et al., 2001) has been linked to a variety of disinhibited
behaviours, including the diagnosis and symptom level of
ASPD (Fossati et al., 2004; James and Taylor, 2007;
Komarovskaya et al., 2007; Luengo et al., 1994; Miller and
Lynam, 2001; Warren and South, 2006; Whiteside and
Lynam, 2003; Whiteside et al., 2005). In fact, the Diagnostic
and Statistical Manual of Mental Disorders (4th edn, Text
Revision) lists impulsivity or a failure to plan ahead as a key
criterion for an ASPD diagnosis (APA, 2000). Additionally,
somatization and antisocial behaviour have both been
found to relate to a variety of negative affects including
anxiety and depression (Bland et al., 1998; Dhossche et al.,
2001; Goodwin and Hamilton, 2003; Haug et al., 2004;
Powell et al., 1997; Rief et al., 1992; Sareen et al., 2004;
Simon and VonKorff, 1991; Teplin et al., 1996), and anger
or hostility (Burt et al., 2009; Haertzen et al., 1990; Kellner
et al., 1985; Kellner et al., 1992; Koh et al., 2005; Sinha
and Watson, 2006). Thus, research attempting to uncover
predictors of these pathologies should ideally demonstrate
the utility of proposed predictors above and beyond
the effects of impulsivity and negative affect, as well as
biological sex.
The current study
The current study examined the predictive utility of gender
role (masculinity and femininity) on antisocial behaviour
and somatization. It was predicted that femininity would
positively predict somatic symptoms and negatively pre-
dict antisocial symptoms, whereas masculinity would neg-
atively predict somatic symptoms and positively predict
antisocial symptoms. These relationships were predicted to
be significant above and beyond the influence of other
strong predictors of these pathologies (namely, sex, impul-
sivity and negative affect). Further, it was predicted that
the endorsement of feminine and masculine traits would be
similarly predictive of antisocial and somatic symptoms
for both men and women.
Methods
Participants
Participants were 349 undergraduate students at a south-
eastern state university who received course credit for their
Castro et al. 411
participation in this study. All students were treated in
accordance with the ethical guidelines for research put
forth by the APA and the university’s internal review board.
The sample consisted of 137 (39.3%) male and 208 (59.6%)
female participants – four (1.1%) individuals did not report
their sex. The average age of the sample was 19 years
(SD = 1.38). Regarding race, 222 (63.6%) self-identified as
white, 27 (7.7%) as black, 6 (1.7%) as Asian, 2 (0.6%) as
American Indian or native Hawaiian, and 92 (26.4%) did
not report race. Regarding ethnicity, 42 (12%) participants
self-identified as Hispanic/Latino, 295 (84.5%) as non-
Hispanic/Latino, and 12 (3.4%) did not report ethnicity. All
statistics regarding participant characteristics were con-
sistent with the demographics of the university from which
the sample was taken.
Instruments
Barratt Impulsiveness Scale-11 (BIS-11; Patton et al.,
1995). The BIS-11 is a 30-item self-report questionnaire
designed to assess general impulsiveness. It consists of
three subscales that reflect factors of the construct of
impulsiveness as argued by Patton et al. (1995). These are
attentional impulsiveness, motor impulsiveness and non-
planning impulsiveness. A total impulsiveness score can
also be derived by summing the subscales, as in the current
study. Participants rated themselves on each of the items on
a scale of 1 (‘rarely/never’) to 4 (‘almost always/always’).
Internal consistency reliability (Cronbach’s α) for the BIS-
11 total score in this sample was .82.
Bem Sex Role Inventory – Short Form (BSRI-SF; Bem,
1978). The BSRI-SF is a 30-item self-report questionnaire
designed to assess the extent to which a person describes
himself or herself with traditionally or stereotypically
masculine and feminine characteristics. It consists of two
subscales, masculinity and femininity, each of which com-
prises personality characteristics that have been rated as
more socially expected of men or women in American soci-
ety. Participants rate these characteristics on a scale from 1
(‘never or almost never true’) to 7 (‘always or almost
always true’) in reference to the extent to which they feel
that that characteristic is true of them. Test takers can be
divided into four categories depending on their scores on
the masculinity and femininity scales: androgynous (high
on both scales), undifferentiated (low on both scales),
masculine (high on masculinity and low on femininity) or
feminine (high on femininity and low on masculinity); or
the scores on masculinity and femininity can be examined
dimensionally, as in the current study. In this sample, inter-
nal consistency scores were .83 for masculinity and .90 for
femininity.
Structured Interview for the DSM-IV, Axis II, Personality
Disorders (SCID-II; First et al., 1997). The SCID-II is a
semi-structured interview designed to assist in diagnosing
any of the 10 personality disorders listed in the DSM-IV
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and is accompanied by a self-report screening questionnaire.
The participant completes the screening questionnaire by
answering ‘Yes’ or ‘No’ with regards to whether or not they
feel the item applies to them. Participants in this study
completed all items of the screener relevant to cluster B
personality disorders only. In this study, the interviewer
inquired only about those items that were answered ‘Yes’,
except for the items of the ASPD module that measure cri-
terion A of the disorder (i.e. ‘a pervasive pattern of disre-
gard and violation of the rights of others since age 15’).
Participants in this study were administered all criterion A
items at interview. Further, this study was concerned only
with items of the ASPD module; specifically, the seven
items that measure criterion A of ASPD and the 15 items
that measure criterion B of ASPD (i.e. ‘some evidence of
conduct disorder before age 15’). The seven items of crite-
rion A were considered individually in the current analy-
ses, whereas the 15 conduct disorder items were used to
compute a single variable measuring ‘some evidence of
conduct disorder before age 15’. Trained student raters
coded each symptom as any of the following: ? = ‘inade-
quate information’, 1 = ‘absent or false’, 2 = ‘sub thresh-
old’, 3 = ‘threshold or true’. Inter-rater reliability (Cohen’s
κ) was computed for a sub-sample of 84 participants (24%
of the sample). For the seven items of criterion A, scores
ranged from .84 to .97 with a mean κ of .90, demonstrat-
ing acceptable inter-rater reliability. κ for six of the 15 indi-
vidual conduct disorder items could not be computed
because they were not endorsed on the screener by any of
the 84 participants, and thus these items were not rated
at interview. For the remaining nine conduct disorder
items, κ ranged from .90 to 1 (M = .96). Symptom counts
were weighted in order to capitalize on the presence
of subthreshold symptoms in this non-clinical sample.
As such, symptoms were recoded in the following manner:
1 = 0 (not present), 2 = 0.5 (present subthreshold), 3 = 1
(present).
Symptom Checklist 90 Revised (SCL-90-R; Derogatis,
1994). The SCL-90-R is a 90-item self-report inventory
of psychological symptoms. It comprises nine non-
overlapping symptom indices and three global distress
indices. Participants were asked to rate how much they
have been distressed or bothered by the symptom
described in each item over the past two weeks.
Participants rated each item from 0 (‘not at all’) to 4
(‘extremely’). This study utilized the somatization symp-
tom index, which measures perceived bodily dysfunc-
tion. Internal consistency for the current sample was .82
for somatization.
Positive and Negative Affect Schedule (PANAS; Watson
et al., 1988). The PANAS is a 20-item self-report inventory
of adjectives designed to broadly and independently meas-
ure positive and negative affect. Each affect subscale ranges
from scores of 10 to 50, with higher scores indicating higher
positive and negative affect. The current study utilized only
412 International Journal of Social Psychiatry 58(4)

the negative affect subscale. Internal consistency for the Results

current sample was .85 for negative affect.
Means and standard deviations for all measures were calcu-
lated separately for men and women (Table 1). Independent
Procedure samples t-tests were computed for all means. The results
Participants completed the abovementioned question- indicate that men and women differed significantly on three
naires, other measures as part of a larger study and an measures: women demonstrated higher levels of negative
interview administering the cluster B modules of the affect and femininity, and men reported higher levels of
SCID-II in a 2.5-hour time block. Participants completed antisocial behaviour. Correlations among all variables used
the questionnaires in groups of up to three, and the clinical in this study are presented in Table 2.
interview was administered individually. Most partici- Two hierarchical multiple regression analyses were
pants were administered the SCID-II by a single, trained conducted to examine the influence of masculinity and
student rater. However, a sub-sample of 84 participants femininity in the prediction of antisocial behaviour and
were administered the SCID-II with a primary rater, who somatization. This pair of regression analyses tested the
conducted the interview, and a secondary rater, who did hypothesis that masculinity and femininity would provide
not participate in the interview but rated the participant’s predictive information for somatization and antisocial
responses. The primary and secondary raters did not con- behaviour above and beyond the effects of sex, impulsiv-
sult each other regarding the ratings; this was to provide a ity and negative affect. Thus, we controlled for sex, nega-
sub-sample of participants for whom inter-rater reliability tive affect and impulsivity in step 1, and then masculinity
could be computed. After the measures and interview and femininity were entered in step 2. In the first regres-
were completed, the participants received a debriefing sion analysis, a model including sex, negative affect and
form that articulated the aims of the study and contained impulsivity significantly predicted antisocial behaviour
contact information to be used if they had any questions and accounted for 15.2% of the variance (F[3, 325] =
about the study. 19.36, p < .001). The addition of masculinity and femi-
ninity in step 2 significantly improved the model and
accounted for an additional 4.6% of the variance in anti-
social behaviour (F[2, 323] = 9.29, p < .001). Examination
Table 1.  Means and standard deviations for all measures of the unique effects of each variable indicated that all
variables except sex significantly contributed to the pre-
  M (SD) diction of antisocial behaviour (p < .01 for all: negative
Women Men p
affect β = .174, impulsivity β = .243, masculinity β =
.166, femininity β = −.168). In the second analysis, a
BIS-11 64.46 (11.31) 64.93 (10.48) .70 model including sex, negative affect and impulsivity sig-
BSRI-SF Femininity 5.60 (0.87) 5.17 (0.96) < .001 nificantly predicted somatization and accounted for
BSRI-SF Masculinity 4.81 (0.84) 4.78 (0.89) .80 28.5% of the variance (F[3, 327] = 43.53, p < .001).
PANAS negative affect 18.94 (5.63) 17.37 (5.26) .09 Adding masculinity and femininity in step 2 did not sig-
SCID-II ASPD ‘liberal’ 0.72 (1.22) 1.05 (1.45) .027 nificantly improve the model and only accounted for an
symptom count
additional 0.08% of the variance in somatization (F[2,
SCl-90-R somatization 0.58 (0.47) 0.48 (0.48) .01
325] = 1.78, p = .17). Examination of the unique effects of

Table 2. Correlations

1 2 3 4 5 6
BIS-11 - −.28* −.003 .197* .285* .156**
BSRI-SF femininity -.065 - .035 −.010 -.189* -.165**
BSRI-SF masculinity .140 .238* - .043 .131 -.074
PANAS negative affect .406* −.106 .069 - .196* .483*
SCID-II ASPD ‘liberal’ .392* −.194† .231* .342* - .074
symptom count
SCl-90-R somatization .278* −.006 −.038 .562* .228* -
Gendera .018 −.257* −.013 −.143* .141* −.115**
Note: Above diagonal = women, below diagonal = men
aCorrelations in this row are Spearman’s ρ, where male = 1 and female = 0

*p < .01, **p < .05

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Castro et al. 413

impulsivity

.224(.067)*/.267(.079)*
.030(.063)/.076(.077)*

.127(.065)/.23(.075)*
antisocial
masculinity behavior

-.079(.06)/-.104(.073)

-.144(.066)*/-.212(.075)*

-.142(.061)**/.082(.072)
femininity somatization

.145(.066)**/.195(.08)** .438(.056)*/.547(.067)*

negative
affect

Figure 1.  Individual path coefficients for men and women

Note: Standardized path coefficients and standard errors (in parentheses) left of the diagonal are for women, right of the diagonal are for men. R2s for
antisocial behaviour are .135(.045)*/.265(.065)*. R2s for somatization are .268(.054)*/.332(.066)*.
* p < .01, ** p < .05

each variable revealed that only negative affect signifi-
cantly contributed to the prediction of somatization (β =
.511, p < .01).
To examine the hypothesis that masculinity and femi-
ninity would be similarly useful predictors for both men
and women, regression coefficients for men and women
were computed via a multiple group path analysis, and
statistical tests of equality of the unstandardized path
coefficients were performed. Figure 1 depicts the path model
that was tested and shows the standardized path coefficients
for each sex. Tests of equality of unstandardized coeffi-
cients indicate that the paths from masculinity and femi-
ninity to somatization and antisocial behaviour did not
significantly differ for men and women (p > .05 for all).
Masculinity antisocial behaviour: z = −0.81; femininity
antisocial behaviour: z = 1.03; masculinity somatization:
z = 0.81; femininity somatization: z = 1.60). Among all
paths, only the path negative affect somatization was
significantly different for men and women (z = −4.72,
p < .001). Specifically, negative affect was a stronger
predictor of somatization for men than women.
Discussion
Early research in behavioural genetics established that
somatization and antisociality co-occur at greater than
chance levels both within individuals and within families,
and proposed that these two disorders share a common
genetic diathesis that is expressed differentially depending
on the biological sex of the individual. Researchers study-
ing the relationship between antisocial behaviour and
somatization proposed that gender socialization might play
a role in the expression of this common diathesis. The cur-
rent study represents the first test, to our knowledge, of this
hypothesis. It was predicted that femininity would posi-
tively predict somatic symptoms and negatively predict

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414 International Journal of Social Psychiatry 58(4)
antisocial symptoms, whereas masculinity would nega-
tively predict somatic symptoms and positively predict
antisocial symptoms, and that these relationships would be
equal for both men and women. The current study found
support for four of these predictions.
Masculinity and femininity were significant predictors
of antisocial behaviour even after accounting for sex,
impulsivity and negative affect. In line with study
predictions, antisocial behaviour was positively associ-
ated with masculinity but was negatively associated with
femininity. Also, masculinity and femininity were equally
useful predictors of antisocial behaviour for both men and
women. While masculinity and femininity exerted similar
influences on somatization for both men and women, they
were not significant predictors of somatization (contrary
to study predictions). In fact, no other variable significantly
predicted somatization beyond negative affect.
The nature of the relationships between each gender role
and antisocial behaviour was found to be in line with previ-
ous research examining the effect of gender role on gender-
typed behaviour. Previous research has found that individuals
who identify strongly with their gender role are more likely
to engage in behaviours consistent with their gender role,
regardless of their biological sex. The positive relationship
between masculinity and antisocial behaviour suggests that
those who hold a strong masculine gender role may be more
prone to exhibiting antisocial behaviour. The negative rela-
tionship between femininity and antisocial behaviour may
suggest that those who hold a strong feminine gender role
may be less prone to exhibiting antisocial behaviour. These
findings could account in part for the notable, but not abso-
lute, sex difference in antisocial behaviour. This finding also
has intriguing treatment implications, as it suggests that a
re-education of the meaning of masculinity might influence
antisocial behaviours committed with the goal of maintain-
ing a masculine self-image (e.g. ‘masculine’ need not be pri-
marily associated with violence or aggression, but perhaps
instead with leadership or protection).
That neither masculinity nor femininity predicted
somatic symptomatology may suggest that somatization is
not as strongly gender-typed as has been suggested. In fact,
although women in the current sample reported higher mean
levels of negative affect, this variable was more strongly
associated with somatization among men. It is noteworthy
that while all four dependent variables significantly contrib-
uted to the prediction of antisocial behaviour, only negative
affect significantly predicted somatization. The very strong
relationship between negative affect and somatization is not
a novel finding. Current results underscore the importance
of considering negative affect when attempting to explain
the common relationship between somatization and antiso-
cial behaviour (as suggested in Lilienfeld, 1992). Women
in the current sample reported slightly higher levels of
negative affect than men. This mean difference has been
repeatedly noted in previous literature. However, the
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sex-differentiated relationship between negative affect and
somatization has not been previously demonstrated, to our
knowledge, and should be replicated in future research.
Limitations
The current study has limitations. For example, the study
was a cross-sectional analysis, and thus cannot speak to the
temporal relationships among the variables examined.
While the current findings regarding gender role are new
and require replication, it might be particularly important
for future research to examine the influence of gender role
on antisocial behaviour longitudinally. Another limitation
of the current study lies in the use of a non-clinical sample,
which necessarily limits variability and the amount of psy-
chopathology that could be measured to test the current
hypotheses. Further, use of a young college sample places
particular limits on the degree of somatic symptomatology
that can be uncovered, given that the criteria for this disor-
der allows for an initial manifestation of symptoms up to
age 30. A more appropriate sample would be one that
allows for sufficient variability in somatic and antisocial
symptoms for both men and women, as well as more vari-
ability in age. Thus, an adult sample, and particularly an
adult incarcerated sample, would be an obvious extension
of this study.
Conclusions
In sum, gender role identification may be important to the
expression of antisocial behaviour, but it does not appear
to influence the expression of somatic symptoms. The cur-
rent study is among the first to examine the effect of gen-
der role on somatic and antisocial symptomatology, and
so an obvious recommendation for future research is the
replication of these findings. Other recommendations
include longitudinal analyses and a more diverse sample.
Nevertheless, the positive findings of the current study
underscore the need to consider that observed sex differ-
ences in antisocial behaviour might actually be affected by
gender role. More generally, it highlights the importance
of considering societal expectations of male and female
behaviour when examining apparent sex differences in
behaviour. Interestingly, where previous work highlight-
ing this necessity has focused on prosocial behaviour and
resolving gender-based injustices (Eagly and Koenig,
2006), the current study extends this idea to pathological
behaviour. It is anticipated that the current study might
encourage more research on the influence of gender social-
ization on pathological behaviour.
Acknowledgements
At the time of this data collection, Yessenia Castro was affiliated
with the Department of Psychology, The Florida State University;
she is now affiliated with the Department of Health Disparities
Castro et al. 415
Research, The University of Texas MD Anderson Cancer Center.
This study is based in part on the doctoral dissertation of the first
author and was funded in part by the Hyde Graduate Student
Research Grant awarded by the APA’s Division 35, Society for the
Psychology of Women.
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