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Gender Skewed Occurrence of ASPD

Shashwat Goyal

4th blog post

ASPD shows a gender skewed occurrence humans, occurring roughly 6 times more often in men than women (Smith, 2018) and with a prevalence ratio of 3:1 for men versus women (Alegria et al., 2013). What could be causing this gender skewedness? This post will look at the possible theories explaining this, ranging from diagnostic bias to evolutionary theory.
ASPD is defined as “A pervasive pattern of disregard for and violation of the rights of others, occurring since age 15 years” (The Diagnostic and Statistical Manual of Mental Disorders, 1994). It often manifests with symptoms like violent behaviour, lack of empathy and impulsive behaviour.  80 percent of ASPD patients show symptoms by age 11 (Smith, 2018), which suggests either a genetic basis or a strong effect of early childhood. As the stress diathesis model tells us, it is both.
What is the reason that women are underrepresented in ASPD figures, are they less susceptible to ASPD? The simplest answer is perhaps that they are no less susceptible, but are rather misdiagnosed or remain undiagnosed due to societal gender roles as well as symptomatic presentation. A report showed that doctors are more likely to diagnose women with depression compared to men even with the same scores on standardized tests or similar symptoms (“WHO | Gender and women’s mental health,” 2013). Another article expounds that there are reporting biases in men and women (Briggs, 2000). While they may not refer to ASPD, they certainly shows that gender roles cause diagnostic and reporting biases that could affect ASPD diagnosis rates. Another factor is that women with ASPD often show non-violent manifestation/behaviour compared to men (for eg. missing classes vs. starting fights) (Alegria et al., 2013), which could contribute to misdiagnosis of women with ASPD.
However, let’s consider for a moment that the gender skewedness persists after accounting for the biases. Another possible theory is that there’s an evolutionary advantage for men to display behaviour seen in ASPD. This theory assumes at least a partial genetic basis of ASPD. In organisms where the females gestate the progeny, males are subject to intrasexual competition with other males for mating with females. In this case, being more violent, aggressive, and displaying other typically masculine traits are considered advantageous for the male competing with other males. In a community without rules like ours, ASPD symptoms may help an organism be the dominant male in the community, thereby securing mating with females and thus siring more progeny with ASPD alleles.  
However, we live in a society with rules, and ASPD patients have low lifespans due to substance abuse, crime, etc. (Smith, 2018). So why is ASPD increasing in frequency (Eddy, 2018) and not slowly being removed from the population (as its alleles would be selected against). One answer could be that the mutation(s) that cause(s) the allele(s) responsible for ASPD are common. However, mutations are generally rare and a better explanation can be that it still has a benefit.
One theory to explain this benefit would be a stress diathesis model. The nurture part of ASPD can’t be ignored as it is clearly correlated with early childhood neglect, abuse, adversity, etc. (Alegria et al., 2013). Hence, consider a stress diathesis model where certain genes that give vulnerability to ASPD might be naturally selected for since they allow the organism to respond with violence and protect itself from a hostile environment (as exemplified by abuse, adversity, etc.). This would also make sense from the perspective that hyper aggressive individuals are more likely to get injured or die, thereby reducing the benefit of ASPD for individuals living in a relatively less hostile environment. The fact that women display higher resilience to risk factors and show less violent manifestations of ASPD (Alegria et al., 2013) also supports this, as females don’t face the intrasexual competition that males do and instead focus all their energy on producing healthy progeny. Thus, in this case, the stress diathesis model itself is an adaptive feature.
The last explanation (in lieu of this post) for a possible benefit manifestation of ASPD symptoms in males can be that women prefer aggressive, typically masculine males (Giebel, Weierstall, Schauer, & Elbert, 2013; Puts, 2010; Snyder et al., 2011), which ties into the intrasexual competition in males.
As one might notice, all these theories are dependent on ASPD having an appreciable genetic basis at the very least, which it does (Alegria et al., 2013). However, the action of environment, while demonstrated, needs to be clarified fu           rther to assess whether the reason for ASPD’s gender skewedness is evolutionary or if it is an artefact of our social structure and/or biological development.

References
Alegria, A. A., Blanco, C., Petry, N. M., Skodol, A. E., Liu, S.-M., Grant, B., & Hasin, D. (2013). Sex differences in antisocial personality disorder: results from the National Epidemiological Survey on Alcohol and Related Conditions. Personality Disorders, 4(3), 214–222. https://doi.org/10.1037/a0031681
Briggs, L. (2000). The Race of Hysteria: Overcivilization and the Savage in Late Nineteenth-Century Obstetrics and Gynecology. American Quarterly, 52(2), 246–273. https://doi.org/10.1353/aq.2000.0013
Eddy, B. (2018). Are Narcissists and Sociopaths Increasing? | Psychology Today. Retrieved May 4, 2019, from https://www.psychologytoday.com/intl/blog/5-types-people-who-can-ruin-your-life/201804/are-narcissists-and-sociopaths-increasing
Giebel, G., Weierstall, R., Schauer, M., & Elbert, T. (2013). Female attraction to appetitive-aggressive men is modulated by women’s menstrual cycle and men’s vulnerability to traumatic stress. Evolutionary Psychology : An International Journal of Evolutionary Approaches to Psychology and Behavior, 11(1), 248–262. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/23531810
Puts, D. A. (2010). Beauty and the beast: mechanisms of sexual selection in humans. Evolution and Human Behavior, 31(3), 157–175. https://doi.org/10.1016/J.EVOLHUMBEHAV.2010.02.005
Smith, K. (2018). Antisocial Personality Disorder (Sociopathy): Causes and Symptoms. Retrieved May 3, 2019, from https://www.psycom.net/antisocial-personality-disorder/
Snyder, J. K., Fessler, D. M. T., Tiokhin, L., Frederick, D. A., Lee, S. W., & Navarrete, C. D. (2011). Trade-offs in a dangerous world: women’s fear of crime predicts preferences for aggressive and formidable mates. Evolution and Human Behavior, 32(2), 127–137. https://doi.org/10.1016/J.EVOLHUMBEHAV.2010.08.007
The Diagnostic and Statistical Manual of Mental Disorders. (1994) (Fourth edi). Association, American Psychological.
WHO | Gender and women’s mental health. (2013). WHO. Retrieved from https://www.who.int/mental_health/prevention/genderwomen/en/

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