By contributor Zoe Lauckner
In the Nav’s Valentine’s Day issue, the Mental Health Matters column was about sex bias (that is, biological/natal sex) in regards to how females are diagnosed with mental illnesses and how stereotypes and labels can affect the latter.
The same can be said for men, as sex differences exist in diagnoses that reflect stereotypes portraying men as more violent, antisocial, and criminal in nature. According to the World Health Organization (WHO), men dominate the statistics for alcohol dependence (twice as likely as women to be diagnosed) as well as antisocial personality disorder (ASPD) where men are three times as likely to be diagnosed with it than women. While men are more likely to become alcoholics, women self-harm at an alarmingly high rate in comparison to men, according to the Canadian Institute for Health Information. Is this a reflection of societal perceptions of gender roles—where men drown their sorrows and women partake in more dramatic acts of emotional expression?
Other questions arise as to whether these sex differences are due to diagnostic bias, meaning that similar traits are labeled one way for women and another way for men. For example, let’s compare the diagnostic criteria of two disorders: ASPD, and borderline personality disorder.
Core features of ASPD as outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are: ego-centrism, lack of empathy, risk-taking behaviours, deceit, manipulation, and hostility. Borderline personality disorder criteria include: unstable interpersonal relationships, mistrust, mood swings, anxiousness, impulsivity, and hostility. Borderline personality disorder emphasizes instability in interpersonal relationships (neediness/abandonment) and does not have the same focus on violent and criminal behaviour as ASPD, but it is not difficult to see where overlap could occur.
Speaking of overlap—even more similar to ASPD is narcissistic personality disorder (NPD). Some researchers have claimed that if the labels of the disorders are removed, it is very difficult to tell the diagnoses apart. In fact, they are both characterized by behaviours that deviate from social norms, a complete disregard for the feelings of others (aka lack of empathy), and self-indulgent or ego-centric behaviours. At this time, Canadian statistics on the prevalance of NPD are all but nonexistent, making it difficult to compare sex differences between ASPD and NPD diagnoses.
According to the Public Health Agency of Canada’s 2002 Report on Mental Illness, up to one half of prisoners have antisocial personality disorder, though they do not specify natal sex ratios. However, according to a Statistics Canada report in 2013-’14, men made the majority of persons in prison (85 per cent), so it isn’t too far-fetched to imagine that the majority of those with ASPD who are incarcerated are men.
At this time, the conversation about sex bias in diagnosis is ongoing among professionals and in the general public, and the DSM is constantly changing and evolving. Whether these differences are due to actual biased diagnostic criteria, differences in rates of people seeking treatment, or are a reflection of a society that is rooted deeply in gender norms, we can’t be sure. These are all ideas worth considering, discussing, researching, and being curious about.
There you have it—more grey areas. While nothing in the realm of mental health is clear-cut, it certainly is interesting.
I hope you’ve enjoyed this column. As the term comes to a close, I will say this: it has been a slice researching and writing for you, and I hope this column has stimulated a curiosity that will last beyond the school term. Here are my parting words. Get engaged in conversations about mental health. Confront individuals perpetuating stigma with compassion. Reach out for help when you need it. Know you are not alone.
Stay sane(ish), VIU. Bon voyage.