518 Chapter 13rates of what are referred to asexternalizing problems(e.g., substance abuse, antisocial disorders;
Rosenfield & Smith, 2010). These differences hold across most cultures (Seedat et al., 2009). Here
I review some of the specific mental illnesses for which gender plays a role. Most of the infor-
mation described here is taken from theDiagnostic and Statistical Manual of Mental Disorders
(4th ed. text revised; American Psychological Association, 2000).
Schizophreniais a form of psychopathology. It is a form of psychosis that includes paranoia,
delusions, hallucinations, disorganized speech, and flattened affect. There is a slightly higher inci-
dence among men than women. Major symptoms differ for women and men. Women are more
likely to show affective disturbances, paranoia, and hallucinations, whereas men are more likely
to show flat affect and social withdrawal. The age of onset also differs. Men are at highest risk for
schizophrenia between the ages of 18 and 25, whereas women are at highest risk between 25 and- The role of hormones may be implicated in female schizophrenia, as there is an increase in late-
onset schizophrenia (after menopause) in women (Lewine & Seeman, 1995). The genetic compo-
nent of schizophrenia is also stronger in women than men. A great deal of attention has focused on
the brain to understand sex differences in schizophrenia. Some research shows that different hemi-
spheres of the brain are affected in women and men (Purcell et al., 1998), and other research shows
that there are differences in the brain structure of women and men (Guerguerian & Lewine, 1998).
Antisocial personality disorderis characterized by a disregard for others, breaking the law,
aggression, deceit, manipulation, and lack of empathy. It is a diagnosis made among adults, and
one feature of the disorder is that the individual must have a history of conduct disorder as a
child. Conduct disorder includes aggression toward people or animals, destruction of property,
and serious violation of rules. Both antisocial personality disorder and conduct disorder are
much more common in men than women. The emphasis on aggression may account for some
of its lower prevalence among women. The psychological and behavioral correlates of antisocial
personality disorder are similar for women and men (Cale & Lilienfeld, 2002a, 2002b). For ex-
ample, a history of sexual and physical abuse is predictive for both sexes.
Borderline personality disorderis characterized by unstable interpersonal relationships and
maladaptive interpersonal functioning. Symptoms include fear of abandonment, low self-esteem,
and impulsivity, including suicide attempts. About three quarters of the people diagnosed with
this disorder are women. Among patients with borderline personality disorder, men and women
show equal levels of impairment (Zlotnick, Rothschild, & Zimmerman, 2002).
Histrionic personality disorderincludes excessive emotionality and attention seeking. People
with this disorder may be dramatic, inappropriately sexually seductive, and use physical appearance
to draw attention to themselves. Women are diagnosed with this disorder more than men. Clearly,
gender-role stereotypes may play a role in this differential diagnosis. The same behavior in men may
not be viewed as pathological. There is some support that among personality disorders, histrionic
personality disorder is the female version and antisocial personality disorder is the male version. In a
study of actors, psychopathology was more strongly correlated with histrionic personality disorder in
females and antisocial personality disorder in males (Cale & Lilienfeld, 2002a, 2002b).
Dependent personality disorderis a disorder related to interpersonal functioning. People
with this disorder are passive, indecisive without reassurance from others, and clingy and in-
secure in relationships, and want to be taken care of by others. Women are diagnosed with this
disorder more than men. It is also one of the most frequently diagnosed personality disorders.
Narcissistic personality disorderis characterized by feelings of self-importance and superi-
ority, inflation of abilities, entitlement, and a lack of empathy. More men than women are diag-
nosed with this disorder.
Panic disorderis characterized by recurrent panic attacks and concerns about future panic
attacks. A panic attack is the presence of an intense fear without a basis in reality. Females are more
likely than males to suffer from panic disorder. Sex role stereotypes could play a role here as women
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