Antisocial personality disorder in women

Antisocial personality disorder is a condition that can include disruptive and harmful behaviors. It typically emerges in adolescence and affects more men than women, although it can occur in people of any gender or age. Women with antisocial personality disorder often present differently than males with the condition and may require different types of treatment.

What is antisocial personality disorder?

Antisocial personality disorder (ASPD) is a mental health condition that impacts a person’s mood, behavior, relationships, and functioning. Signs and symptoms of ASPD often emerge in childhood, with a condition called conduct disorder. Common traits of individuals with ASPD include a lack of empathy, aggressive and criminal behaviors, and issues forming and maintaining relationships ^[1][2].

ASPD is around three times more common in males than females. It is believed to occur in about 6% of males in the general population and about 2% of females in the general population. It is not known why the condition is more common in males, although this difference may partly be related to diagnostic criteria, risk factors, and differences in presentation ^[3][4].

Psychopathy, which many professionals consider a severe presentation of ASPD, is also more prevalent among males than females. For example, studies have found that half as many female prisoners meet the criteria for psychopathy as male prisoners ^[5][6]. Again, this may partly be due to criteria, as the Psychopathy Checklist (PCL-R) was designed to identify psychopathy in males ^[7].

Signs of antisocial personality disorder in women

ASPD can present differently from person to person. Common signs of ASPD in women can include ^[1][3][6]:

• Impulsive, reckless, or dangerous behaviors
• Breaking the law
• Frequently lying to others
• Deceiving, blackmailing, or manipulating others for personal gain
• Struggling to maintain employment
• Frequent absences from school or work
• Irritability and hostility toward others
• Becoming bored easily
• Lack of remorse, guilt, or empathy
• Verbal aggression
• Fighting with others
• Interpersonal difficulties, particularly with romantic partners
• Arguing or fighting with romantic partners
• Poor planning for the future, such as with housing or finances
• Spending money and getting into debt with no plans or means to repay
• Sexual promiscuity
• Alcohol or drug use
• Delinquent, aggressive, or criminal behaviors in childhood
• A history of sexual abuse or neglect in childhood
• Co-existing mental health issues, such as depression and anxiety

Diagnosing antisocial personality disorder in women

When diagnosing ASPD in females, clinicians will utilize diagnostic criteria from the DSM-5. Diagnostic criteria for ASPD include ^[2]:

• Acting in ways that go against social norms or expectations, such as unlawful or unethical behaviors, in the pursuit of personal gain
• Lacking empathy and remorse, with no concern for the well-being or needs of others
• Manipulating, controlling, or deceiving others for personal gain
• Impaired ability to form genuine intimacy and relationships
• Aggression and hostility toward others
• Irresponsible, impulsive, or reckless behaviors with no concern for own or others’ safety

Qualified clinicians will take a complete mental and physical health history, including gathering information about any abuse or adverse events that occurred in childhood. They will ask questions about the individual’s symptoms, such as their mood, behaviors, and current mental state, when symptoms emerged, and how they affect their quality of life and functioning.

If their symptoms meet diagnostic criteria, the individual will receive a diagnosis of ASPD. However, in some cases, this process may lead to misdiagnosis, as females with ASPD often present differently from males and may be less likely to have a diagnosis of conduct disorder in childhood. As such, women may experience barriers to receiving an appropriate diagnosis ^[4][8].

Treating antisocial personality disorder in women

Treating ASPD can be challenging, as many people with this condition do not seek professional diagnosis or treatment. As such, evidence for the most effective treatments for ASPD is limited. Additionally, there is little evidence for gender-specific treatments for ASPD, highlighting a need for further research into this topic ^[4][10].

Many studies recognize the importance of early intervention, such as social support and psychotherapy, particularly in children with behavioral issues. Early intervention may help to prevent the onset of ASPD in adulthood, thus reducing the need for later treatment ^[9].

It is believed that females with ASPD have different treatment needs than males with ASPD. For example, women are found to have reduced social support and more functional impairments while also experiencing more mental health comorbidities. As such, females may require more extensive treatment for ASPD than males ^[4].

Potentially effective treatments for ASPD include cognitive behavioral therapy (CBT) and mentalization-based therapy, which can help identify and adjust harmful thoughts and behaviors. Therapy may also be beneficial in managing comorbid conditions, such as alcohol or substance use disorders and mood or anxiety disorders ^[9][10].

There are no FDA-approved medications for the treatment of ASPD, although various medications may be prescribed to help manage symptoms of ASPD or comorbid conditions. This may include antidepressants, mood stabilizers, and antipsychotics ^[1][10].

Does antisocial personality disorder present differently in males and females?

ASPD typically presents differently depending on gender. Although the condition can vary from person to person, the following are typical differences between males and females with ASPD ^[4][6][8]:

• Females typically present as less violent and engage in fewer criminal activities.
• Males show more physical aggression than females, while females show more verbal aggression, manipulation, and self-directed harm.
• Women are more likely to run away from home, regularly miss work or school, and lie to others.
• Women are less likely to be cruel to animals, set fires, harm others, destroy property, and commit driving violations.
• Comorbid conditions in females are more likely to involve mood, anxiety, or depressive disorders. In contrast, males are more likely to have comorbid alcohol or drug use disorders.