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Personality disorders are a diverse collection of disorders characterised by

difficulties in establishing a stable positive sense of self and maintaining intimate,
constructive relationships. We all act, think, and feel in ways that resemble personality
disorder symptoms from time to time, but a personality disorder is defined by the severe,
inflexible, and maladaptive ways in which these features are manifested. People with
personality disorders have challenges with their identity and relationships in a variety
of areas of their lives, and these issues can last for years. Personality disorders have
broad and long-lasting symptoms. A personality disordered individual has difficulty in
perceiving and relating to situations and people. Relationships, social activities, job, and
school are all hampered as a result of this. It is often difficult to recognize personality
disorders since the style of thinking involved in it and the way in which an individual
behaves appears to be natural majority of the times.

The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition

(DSM-5) is a manual used by doctors and mental health practitioners to diagnose mental
illnesses. For a diagnosis of a personality disorder, certain criteria must be met. To
establish the type of personality disorder, a primary care doctor or mental health expert
will ask you questions based on these criteria. In order to make a diagnosis, the
behaviours and feelings must be consistent throughout a wide range of situations. In at
least two of the following areas, they should cause significant distress and impairment:
the manner in which one perceives or understands oneself and others, the manner in
which one interacts with others, the adequacy of one’s emotional reactions and how
well one can manage their emotions.

The DSM-5 divides personality disorders into three categories: A, B, and

C. Coming to Personality disorders with a cluster A, according to Mental Health
America, these diseases are marked by unique and eccentric conduct (MHA). Cluster A
personality disorders include Paranoid personality, schizoid personality disorder,
schizotypal personality disorder. Cluster B personality disorders include disorders
which are marked by emotional, dramatic, or erratic conduct. Examples of personality
disorders which come under Cluster B include antisocial personality disorder,
borderline personality disorder, histrionic personality disorder and narcissistic
personality disorder.
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Cluster C disorders are characterised by anxiety and fear-based behaviours.

It includes avoidant personality disorder dependent personality disorder , obsessive-
compulsive personality disorders. An individual must meet specific criteria to be
diagnosed with a personality disorder. According to MHA, these disorders are most
likely caused by a mix of hereditary and environmental factors. The widest features of
psychopathology are paralleled by these groupings. As a result, cluster A belongs to a
cognitive dimension, whereas clusters B and C correlate to the externalising and
internalising dimensions, which account for the majority of other symptoms in
children and adults, respectively.

Personality differences between men and women are quite prevalent as

they develop early in life, and remain stable over time. Reviewing a significant amount
of data on temperament of children over 30 years ago, Maccoby and Jacklin (1974)
noticed consistent findings demonstrating that boys are more aggressive and dominant,
while girls are more apprehensive. Males were more aggressive and had better self-
esteem, while females were higher in extraversion, anxiety, trust, and nurturance,
according to a meta-analysis of the literature in adults (Feingold, 1994). However, not
every personality trait was affected by gender; social anxiety, impulsivity, activity,
reflectiveness, locus of control, and orderliness revealed no variations.

Goodwin & Gotlib (2004) discovered in their study that neuroticism,

agreeableness, conscientiousness, and etraversion were higher for women, whereas
openness to experience was higher in men, when they explored this topic from the
perspective of the Five Factor Model of Personality in a large community
sample.Gender variations in personality are also anchored in genetics, despite the
influence of socialisation theories in recent decades (Renzetti & Curran, 2002). While
cultural factors can increase or diminish these effects, Costa, Terracciano, and McCrae
(2001) discovered that identical gender effects on attributes can be seen in societies all
across the world. This demonstrates that, while socialisation may perpetuate gender
variations in personality, they are not socially produced.Hence, it can be noted that there
are certain differences which are prevalent in the personalities of different genders.
Some evidence of systemic gender bias in the diagnostic criteria for DSM-IV-TR
personality disorders has been discovered in psychometric research, and this topic
warrants further examination. More information is also needed to determine whether
personality disorders have different effects on men and women's social functioning.
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The rationale of this paper was to gain a comprehensive and in-depth perspective
regarding whether personality disorders have different effects on men and women's
social functioning. This paper also aims to explore the systemic gender bias in the
diagnostic criteria for diagnosing women and men with personality disorders as per the
Diagnostic and Statistical manual for Mental Disorders (DSM). Another purpose of this
paper was also to investigate if any differences existed in the forms of treatment for
treating personality disorders in both men and women.
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REVIEW OF LITERATURE

Jang et al’s study (1998) which focussed on genetic and environmental

contributions to gender differences in traits employed biometric genetic analyses in
order to ascertain if gender-specific genetic and environmental influences influence
features that define personality disorders. Six hundred and eighty-one pairs of twins
from the general population were included in the study (128 monozygotic males, 208
monozygotic females, 75 dizygotic males, 174 dizygotic females, and 96 dizygotic
opposite sex pairings) were included in the study. The Dimensional Assessment of
Personality Pathology (DAPPBQ) was completed by all twin pairs, yielding 18 basic
and four high-order aspects of personality disorder. All characteristics were
significantly heritable, with the exception of Submissiveness in males and Cognitive
Dysfunction, Compulsivity, Conduct Problems, Suspiciousness, and Selfharm in
females, according to heritability analyses. The genetic influences underlying all but
four DAPPBQ dimensions (Stimulus Seeking, Callousness, Rejection, and Insecure
Attachment) were found to be specific to each gender in a sex-by-genotype analysis,
whereas the environmental influence was found to be the same in both genders across
all dimensions. Except for female dissocial personality traits in females, which had no
heritable basis, all four higher order dimensions were heritable across sex and common
to both genders.

Paris (2007) in his paper titled ‘An overview on gender, personality and mental
health’ addresses the relationship between personality traits and psychological
symptoms and further asserts the differences observed in these aspects amongst both
men and women. In order to establish this association, Paris employed a system wherein
the symptoms are divided into externalising and internalizing dimensions or
components and this has gained widespread acceptance for both childhood and
adulthood. Internalizing symptoms and behaviours allude to a tendency to respond to
difficulties with inner anguish, whereas externalising symptoms and behaviours
indicate to a desire to deal with problems by action. This distinction does not account
for all psychopathology (especially cognitive symptoms in psychoses), but it is useful
in comprehending common mental illnesses. When it comes to gender effects, this
broader approach has a lot of advantages. Symptoms associated with an internalising
dimension are more common in girls during childhood, while those associated with an
externalising dimension are more common in boys. These differences remain
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throughout time, resulting in a male predominance in externalising illnesses and a

female predominance in internalising disorders in adults.

Oltmanns and Powers (2012) in their paper titled ‘Gender and Personality
Disorders’ elaborate on the nature of gender inequalities in the diagnosis of Personality
Disorders (PD). They purported in their study that one of the main topics of dispute in
this realm has been the impact of gender bias on PD prevalence estimates, as well as
whether true differences in the type of personality illness exist between men and
women. Many researchers have suggested that the diagnostic criteria for Parkinson's
disease represent characteristics that could lead to a gender bias in its diagnosis. Others
have argued that clinicians and researchers utilise diagnostic criteria in a biased way
when they are diagnosing patients. These challenges have not been completely resolved
despite substantial investigation. Oltomanns and Powers addressed Lynam and
Widiger’s independent model of personality in their paper which mapped DSM-IV-TR
PD symptoms onto the FFM by constructing prototype profiles of facet-level
personality features to increase understanding of how gender operates in personality
pathology. These facets were integral in aiding to describe each of the five personality
trait domains: neuroticism, extraversion, agreeableness, conscientiousness, and
openness to experience. Anxiety, angry hostility, sadness, self-consciousness, fragility,
and impulsiveness, for example, are all aspects of neuroticism. Lynam and Widiger
created a depiction of all 10 PDs by combining features from each of the five domains.

Jane et al’s (2007) paper titled ‘Gender Bias in Diagnostic Criteria for
Personality Disorders: An Item Response Theory Analysis’ consisted of the researchers
focusing on the gender bias in the diagnostic criteria for personality disorders in the
Diagnostic and Statistical Manual of Mental Disorders (4th ed., text revision; American
Psychiatric Association, 2000). To establish the reasons responsible for this, they
conducted a study wherein participants (N = 599) were chosen from two large,
nonclinical samples based on self-report questionnaires and peer nominations that
indicated the presence of personality pathology. The Structured Interview for DSM–IV
Personality was used to interview all of them .The authors analysed data from 315 men
and 284 women using item response theory methodologies, looking for evidence of
differential item performance in the diagnostic criteria of 10 personality disorder
categories. For six particular criteria, the results revealed considerable but mild gender
measurement bias. To put it another way, men and women of equal stature supported
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the items at different rates. The findings revealed that men were more likely to accept
the biased items for one paranoid personality disorder criterion and three antisocial
categories. Women were more likely to support the biased items for two schizoid
personality disorder criteria.

On similar lines, Johnson et al (2003) conducted a research to investigate

gender differences in borderline personality disorder. According to the researchers,
majority of research on borderline personality disorder (BPD) focussed on the
occurrence of the disorder in women or did not examine gender differences in clinical
manifestations. Men with BPD were more likely to be diagnosed with substance use
disorders, as well as paranoid, passive-aggressive, narcissistic, sadistic, and antisocial
personality disorders, according to certain research (PDs). Furthermore, women with
BPD appeared to be more likely to disclose experiences of adult physical and sexual
abuse, as well as satisfy diagnostic criteria for PTSD and eating disorders. The goal of
this study was to dig deeper into gender variations in BPD. Men and women with BPD
were compared on current axis I and II disorders, BPD diagnostic criteria, childhood
trauma histories, psychosocial functioning, temperament, and personality traits using
baseline data from the Collaborative Longitudinal Personality Disorders Study (CLPS).
Women with BPD were more likely to have PTSD, eating disorders, and the BPD
criterion of identity disruption, while men with BPD were more likely to have substance
use disorders and schizotypal, narcissistic, and antisocial PDs. In general, clinical
presentations of women and men with BPD resembled each other more than they
differed. The changes that did emerge are consistent with those observed in psychiatric
epidemiological studies, and hence do not appear to be unique to BPD. Furthermore,
many gender disparities reported in epidemiological studies are no longer present. As a
result, BPD disorder may be a prevalent classification that blurs traditional gender
divides.

Coming to the differences in the treatment plans administered to both male and
female patients, Dehlbom and al (2021) did an integral study to unravel this. In order to
accomplish this, the researchers identified all patients diagnosed with BPD (n = 5530)
in Stockholm County from 2012 to 2016 by with the help of Swedish health and
administrative registries. They gathered data on sociodemographic variables, comorbid
psychiatric diagnoses, and all mental health care utilisation, including psychiatric
medication and psychological therapies, in both inpatient and outpatient settings.
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During the study period, the researchers 802 males and 4,728 women with BPD. Men
with BPD were less likely than women to be treated with psychotherapy in addition to
psychiatric medication. The majority of the disparities in psychological therapy
treatment between men and women with BPD were nonsignificant in the multivariate
model, indicating that they are most likely the result of differences in sociodemographic
factors and comorbidity. At the time of their first BPD diagnosis, men with BPD were
on average four years older than women, had less education, and were more likely to
receive social welfare assistance. Finally, compared to women, less males are diagnosed
with BPD, and those who are likely to get less psychiatric medication and psychological
therapy. To promote help-seeking and detection of this crippling disorder in men and
enable fair treatment, researchers and clinicians must focus more on men with BPD.

Sher and Siver’s (2015) research focussed on gender differences in the clinical
characteristics and psychiatric comorbidity in patients with antisocial personality
disorder. Research in this area hasn’t been explored to a greater extent. Very little is
known about how antisocial personality disorder manifests differently in males and
females (ASPD). In order to discover and determine that, the researchers selected 323
people with ASPD for evaluation while their demographic and clinical characteristics
were documented. It was found that in comparison to men, women reported fewer
instances of antisocial conduct including or not involving police, higher scores on the
Childhood Trauma Questionnaire (CTQ), and higher scores on the CTQ's Emotional
Abuse and Sexual Abuse subscales. The frequency of occurrences of antisocial
behaviour involving police was positively connected with CTQ scores in males but not
in women. Women had a higher number of patients with comorbid borderline and
histrionic personality disorders, while men had a lower percentage of participants with
cocaine use disorder. It was also found that comorbid alcohol use disorder was common
in both groups, but women had a higher rate of comorbid mood disorders than men. The
difference between the groups is driven by CTQ scores, histrionic personality disorder,
and antisocial activity involving the police, according to a logistic regression analysis.
The final findings suggested that the management of concomitant psychiatric diseases
should be a priority in the treatment of people with ASPD.
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Weldon’s (2021) research purported the same. As per the metanalysis conducted
by him, several studies have reported a gender bias in the prevalence of antisocial
personality disorder (ASPD); however, determining the cause of such biases remains to
be accomplished. The dominant explanation for gender bias is a bias within the
diagnosis and diagnostic criteria of ASPD. Previous research has primarily focused on
male populations when examining ASPD resulting in males being the standard of
comparison, and thus not generalizable to female populations. In attempt to challenge
this standard, researchers have examined ASPD in female populations and reported a
difference in the prevalence of ASPD between the genders. Researchers have since
further investigated this difference and reported it might be attributed to biases in the
diagnostic criteria of ASPD. In addition to gender biases in ASPD, there are reported
observed gender biases in psychopathy. The explanation for the differences in gender
is that some PCL-R (psychopathy checklist revised) items are biased towards gender,
which results in different prevalence rates between the genders. To contribute to the
existing research, the researcher completed a systematic literature review examining the
observable gender patterns in ASPD, conduct disorder (CD), and psychopathy. The
culmination of articles in the review revealed that there are significant differences in
gender in ASPD, CD, and psychopathy diagnoses. Although, the explanation for the
differences in ASPD diagnoses have yet to be identified

LaRue’s study (2019) focusses on how gender bias can influence diagnostic
decision-making. Because the root of the disordered behaviours that led to their
incarceration is not addressed, inaccurate diagnoses owing to clinician bias may lead to
the encouragement of improper mental health therapy and a poor prognosis for treating
clients presenting concern. This study aimed to evaluate if clinician’s gender bias and
clinician’s setting bias affects the diagnosis of Antisocial Personality Disorder and
Borderline Personality. Clients in correctional facilities are in a state of disarray. It is
critical to determine whether bias influences the diagnosis of these diseases among
clients in correctional settings in order to ensure that they receive proper mental health
treatment. Incarcerated people who receive appropriate mental health care may have
lower recidivism rates, which would be beneficial to society. In order to ascertain this,
the researcher surveyed 124 mental health professionals to see if gender and/or setting
bias influenced their ability to effectively diagnose Borderline Personality Disorder.
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The findings imply that setting bias has an impact on mental health practitioners' ability
to diagnose Borderline Personality Disorder accurately.

Klonsky et al’s (2002) study purported that many researchers have proposed
that personality disorders and gender roles are linked (i.e., masculinity and femininity).
However, no studies have looked into whether men or women are more likely to fit the
criteria for personality disorders. The purpose of this study was to see if college students
(N = 665, 60% women) with more masculinity or femininity had more symptoms of the
10 DSM-IV personality disorders. Except for antisocial personality disorders, feminine
males exhibited more features of all personality disorders. Dependent qualities were
linked to a higher level of femininity and a lower level of masculinity. Antisocial
personality traits have been linked to masculinity. Participants who normally behaved
in accordance with their gender had more narcissistic and histrionic characteristics,
whereas those who typically behaved in accordance with their gender had more Cluster
A personality disorder characteristics.

There is also a scarcity of research on overall disparities in psychosocial

functioning between men and women. Funtowicz and Widiger (1999) looked at how
clinicians rated gender differences in impairment domains across the 10 DSM-IV-TR
PDs. They discovered that histrionic and dependent PD (female-typed PDs) were
associated with lower levels of social and occupational dysfunction than paranoid,
antisocial, and obsessive-compulsive PD (male-typed PDs). Personality Disorders and
Gender. Male-typed PDs, on the other hand, were linked to lower levels of personal
distress. Borderline PD (also known as female-typed PD) was linked to a lot of
psychological, social, and vocational discomfort. Gender disparities in functioning
across various PDs have mixed empirical evidence. According to one study, women
with antisocial symptoms are more likely to have unfavourable life outcomes, such as
increased rates of divorce and marital separation.Compared to men, women have a
higher rate of long-term unemployment. Alternatively, some borderline research Males
and females may both express PD, according to PD.The harmful impact of symptoms
on global health is different for borderline symptoms and distress.The functioning of
both sexes appears to be comparable (Boggs et al., 2005; Zlotnick et al., 2002).
Unfortunately, the majority of research on psychosocial effects associated with PDs is
limited.Instead of examining gender differences, it adjusts for their potential influence.
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The research described earlier may be particularly important in trying to establish

ways that gender moderates how PDs affect functioning. For example, if women have
higher incidences of interpersonal stressors, then we might expect PDs to have a
stronger influence on female interpersonal functioning. On the other hand, personality
pathology may affect occupational functioning more seriously in men. Kendler et al.’s
(2001) finding on men’s reaction to divorce also fits with the research showing that
married men function better than single men (Levenson et al., 1993), suggesting that
PDs specifically detrimental to how one relates to his spouse could have a particularly
profound influence on male functioning. Women who are unable to develop an adequate
social network as a result of a PD (like in the case of avoidant PD) may also show
substantial declines in functioning in many areas of their life, while such effects related
to social support may be less observable in men.These examples demonstrate how men
and women behave in the world differently in various ways. As our research progresses
toward a new way of thinking about personality illness, the unique consequences of
gender are very important to investigate. Discovering how gender influences functional
impairment in all areas of life in people with PDs will lead to a more thorough diagnosis
and treatment of these debilitating conditions.
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CONCLUSION

Gender is linked to a variety of personality disorders in a variety of ways. Up until now,

much of the research has concentrated on gender disparities in the prevalence of various
PDs. Some research have looked into the impact of different types of gender bias on
prevalence rates. We also indicated in this chapter that the relationship between gender
and PDs could be better understood by looking at gender differences in normal
personality traits, which could be especially important as the research moves toward
dimensional measurement of personality pathology.

It may be time for research to shift beyond quantifying differences in the frequency with
which men and women qualify for a diagnosis of Parkinson's disease and instead
explore how PDs impact men and women differently. Future research could go in a
number of different areas. Comorbidity between PDs and a variety of Axis I illnesses is
well documented, and it is generally indicative of more severe psychopathology or
poorer functioning. It's possible that gender variations in comorbid diseases like
depression or substance abuse disorders mediate the impact of PDs. Understanding the
role of gender in comorbid disease could be very helpful in determining therapy options
and developing tailored treatment regimens.
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