 Whenever I try to communicate with Minnie, she insists that we are just two mugs which raises the interesting question. Are there any differences between men and women when it comes to personality disorders? And this is today's topic. Are there any differences between men and women and are there any differences between the same gender with the same disorder? For example, borderline women and borderline men, but also borderline women and narcissistic women. So are there gender differences inside the same diagnosis and other gender differences between diagnosis? And so before I go there, tomorrow, Richard Granum and I are going to launch a new event intended to torture you. Even more than we have done in the past few years. It's a joint questions and answers session. You can ask the questions and we are going to try to provide the answers. And even when we don't know the answer, we're going to pretend that we know the answer. We're going to fake it till we make it. If you don't believe me, join us tomorrow. So there's a link in the description. Click on the link and join the studio. You'll be able to post questions. We won't be able to answer all your questions. The event will be limited to two hours, but it will be a joint event. The inimitable Richard Granum and the horror show Sam Vaknin. Don't miss it for the world. Resign your job. Leave your family. Divorce if you have to travel far and wide. Just be with us tomorrow. And as promised, we will get straight to the issue of gender and personality disorders. Allow me just to find my text. Here it is. The most important thing to understand is that the variation, the intra, intra diagnostic variation is higher than the inter diagnostic variation. Now, that's the kind of thing that academics likes, like to say, because they know that no one will understand the world. And that makes them feel superior, omniscient and Godlike. Intra diagnostic variation simply means variation between diagnosis. So for example, borderline woman versus narcissistic woman. They are both women. But what is going to trump, excuse me for the expression, what is going to trump what is gender going to trump diagnosis or is diagnosis going to trump gender. Intra diagnostic variation between diagnosis. And then there is inter diagnostic variation. For example, borderline women versus borderline men. They both share the same diagnosis, but they have different gender. Well, until recently. Anyhow, it seems that intra diagnostic variation, the variation between diagnosis is higher than inter diagnostic variation. To translate this into colloquial English, a borderline man would be almost the same like a borderline woman. A narcissistic man would be almost the same like a narcissistic woman. But a borderline woman would be different to a narcissistic woman. She would also be different to a narcissistic man. And a narcissistic woman would be different to a borderline woman. And she would also be different to a borderline man. Gotit Shoshanim. My name is Sam Vaknin, I'm the author of Malignant Self-Love and Narcissism Revisited and I'm a professor of psychology. Before we go further, it's important to understand that psychology was created at the end of the 90th century by German, Austrian and much later American white males embedded in their culture and their society, rigid, hierarchical, Victorian and very misogynistic. In the Diagnostic and Statistical Manual, the diagnosis are gender-neutral. When you read the diagnostic criteria of, for example, borderline personality disorder, there is no mention there if they apply to women or they apply to men. The language is gender-neutral. Same goes for antisocial personality disorder and narcissistic personality disorder, bipolar, I mean you name it. The whole manual on purpose is gender-neutral. The message, the implicit and to my view explicit message is that gender is not a component. Gender is not a differentiating factor. Gender has no influence on how a mental illness manifests. Feminists have long criticized psychology and psychiatry as instruments of social control, a part of the famed patriarchy. Ever since Freud, there's been a debate brewing in the psychological community. The diagnosis that we are coming up with, some of them are very masculine, for example, psychopath. It's hard to imagine a woman, female psychopath, a woman psychopath, although it's possible. But the initial reaction, the kind of knee-jerk reaction, is psychopath is a man. Losses is the same, it's a man initially. Of course, within a split second we realize it's not true if there are narcissistic women, psychopathic women and so on, but the identification over the last 120 years has been so strong. The indoctrination, the brain washing has been so strong that there are intuitive, associative linkages in our mind between specific mental health disorders and gender and what the DSM is trying to communicate and the ICD and all the major diagnostic texts is that it's not true. Gender has no impact on how a disorder manifests. In a minute, we'll examine this contention critically, but before we go there, why? Why were some disorders associated mostly with women? Ever since Freud, more women than men saw therapy. To this very day, that's the case. Every YouTuber would tell you that women watch mental health content much more than men. Men are far less likely to attend therapy than women. Consequently, mental health practitioners, psychologists, therapists, psychiatrists have been exposed mostly to women. That's the fact. In other words, it's what we call in statistics a biased sample, a sample wrongly constituted. It's also a self-selecting sample. These women who do attend therapy, they consider themselves as having gone awry. They think they have a problem. So when they approach mental health practitioners, these women would tend to communicate that something is wrong with them, with the women, not with the practitioner. So over the last 150 years, mental health practitioners have been exposed to broken damage, problematic, self-confessing, self-loathing women. And that tended to have a mild impact on how we have construed psychology over the generations. Terms like, for example, hysteria. They're intimately connected to female physiology, because hysteria comes from the Greek word for womb. Alleged female psychology. Women are hysterical. The DSM, the Diagnostic and Statistical Manual, which is the Bible of the psychiatric profession, expressly professes gender bias. Personality disorders such as borderline and histrionic are supposed to be more common among young women. And no, I am not contradicting myself. The language used to describe the disorders is gender neutral. But when you read the description, the analysis of the disorder, later on, when you go from the diagnostic criteria to a description of what we know about the disorder, suddenly you come across sentences such as narcissistic personality disorder is 75% diagnosed among men. That's in the DSM3. Or you come across sentences like histrionic personality disorder is much more common among women. So the diagnostic texts themselves are gender neutral. But then in the back door, through the back door, the DSM openly and overtly is sexists. It is sexist because the claims made by the DSM are unqualified and consequently they are wrong. It is wrong to say that a certain personality disorder is associated more than women and not to mention that women self-diagnose and then approach mental health practitioners in numbers which are much louder than men. The context is crucial, critical. The DSM is aware, the DSM5, the latest edition, latest iteration is aware of this and they have tried to balance the scales. So for example, they changed the text from 75% of people with narcissistic personality disorder are men. They changed it and now it's 50 to 75% are men, etc., etc. They've changed the language in many, many diagnostic criteria and the description. Narcissistic personality disorder, antisocial personality disorder, schizo-tipo, obsessive-compulsive, schizoid, paranoid and so on and so forth. And they have alluded that these are more common among men but possibly this is the outcome of misrepresentation in clinical settings. Why is this gender disparity even behind the scenes, even through the back door? There are few possible answers. Maybe personality disorders are not objective clinical entities, for example like tuberculosis or cancer. Maybe personality disorders are culture-bound syndromes, syndromes that reflect societal and cultural mores, edicts and expectations. In other words, maybe they reflect biases, maybe they reflect value judgments embedded in a specific context, time in history and place on the globe. Some patriarchal societies, for example, societies where men dominate are also highly narcissistic. They emphasize qualities such as individualism and ambition, often identified with virility, aggression. The preponderance of pathological narcissism among men can easily be attributed to the expectations of society from men to how society molds boys into men in the twin processes of socialization and acculturation. We may be breeding narcissism among men but it doesn't mean that men are biologically or psychologically predisposed to being narcissists more than women do. Women, on the other hand, are widely believed to be emotionally labile, clingy, needy, dependent and this is why most borderlines and dependence happen to be female. This is not biology, this is not even psychology. This is culture, this is society and as culture and society are changing and women have become a lot more masculine. We have seen an explosion of diagnosis such as narcissistic personality disorder and psychopathy among women. Today 50% of all narcissism diagnosis are female and 50% of all borderline diagnosis are among men, upbringing and environment, the process of socialization, cultural mores, expectations, dictates on how to behave, sexual scripts, social scripts, they all play an important role in the pathogenesis of personality disorders. These views are not fringe views by the way, what I'm saying right now. There are serious scholars for example Kaplan and Bantoni who claim that the mental health profession is inherently sexist and then again we cannot completely ignore the genetic and to some extent physiological difference between female bodies and male bodies and if we are not dualists, if we believe that the brain has something to do with psychology, that they are one and the same in effect, the mind and the brain are one and the same, then it raises questions. Genetics may be at work, physiology may be at work. Men and women do differ, they do differ as far as their bodies go. Does this mean that this difference is translated into the mind? It may account for the variability of the occurrence of specific personality disorders among men and women. It's another hypothesis which has to be tested. Some of the diagnostic criteria are ambiguous or even considered to be normal by the majority of the population. So you could read a lot of diagnostic texts in the likes of the DSM or even in college textbooks where if you ask the majority of people in the street they would say nothing's wrong with that, I do that, my neighbor does that, my wife does that, my children do that, my boss does this, I mean I have no problem with that. Consider for example what the DSM says about histrionic personality disorder. The DSM says that histrionics consistently use physical appearance to draw attention to themselves. No kidding, who doesn't? Women and men today are doing this. Who doesn't in western society at least? Why? When a woman clings to a man it is labeled codependency or borderline but when a man relies on a woman to maintain his home, take care of his children, choose his attire, prop his ego, soothe him and comfort him, this is not liability, this is not clinging, this is not codependency, it's companionship. Walker in 1994 analyzed text, text, psychological text and had shown this double standard, this sexism. Female behavior is always characterized negatively. The same identical behavior on the part of men is characterized charitably, positively. The less structured the interview, the more fuzzy the diagnostic criteria, the more the diagnostician relies on stereotypes according to Whitaker in 1998. So let's examine one case. I've received a question whether borderline women differ to narcissistic women and I'm going to dedicate a special video to that but today I would like to discuss the differences between female narcissists and male narcissists. Everyone and his dog seem to claim that female narcissists are very different to male narcissists. They imply in the background that they are more vicious somehow, more passive aggressive and so on and so forth. Is there any clinical support for this? No, there is none actually, no clinical support for this. In my view all these videos, even videos made by women, which imply that female narcissists are worse, more egregious than male narcissists, all these videos reflect misogyny because they don't rely on any studies or scholarly literature. Throughout my early writings, because I started this whole racket in 1995 and for 10 years I've been the only voice on narcissism online. I've maintained the only website and the only six and all of the six available support groups and initially when I had written my texts I was under the influence of the DSM and other psychology textbooks at the time and I kept using the male third person singular because at the time most people diagnosed with narcissistic personality 75% were male. Today it's more like 50-50 and but even then I insisted and I still insist to this very day, nothing in 26 years has changed my mind, that there is little difference between the male and the female narcissists. In the manifestation of their narcissism in the ways that the narcissism is expressed outwardly to a layman observer, female and male narcissists inevitably do tend to differ but they tend to differ because they operate in different environments, not because they are different, not because the disease is different, the disorder is different, not because the etiology, the reason for the disorder, not because the dynamics of the disorder, the psychodynamics are different, none of this is different. Male and female narcissists are indistinguishable as far as their psychology or psychopathology. This is especially true in today's day and age when women have become men, we have unigender, women describe themselves today exclusively in what used to be masculine terms, they regard themselves as men, they see no difference between themselves and men in any way, shape, form or field. So this is the ethos of society nowadays and of course today the distinctions between male and female in any field, let alone in clinical and abnormal psychology, is blurring. The differences are reasonable, many women would mock texts written 25 years ago describing how females are different to males. But females and males do emphasize different things in life, do have different priorities, do look out for different signs and signals from the environment and from others, so yes their narcissism outwardly manifests differently, they transform different elements of their personalities and of their lives into the cornerstones of their disorder. Women for example tend to concentrate on their bodies, many women have body image problems, body dysmorphic disorders, many women somatize psychological problems when they are depressed, when they are anxious, they have strong somatic symptoms, many women suffer from eating disorders, anorexia nervosa and bulimia nervosa and so on, this is much more common among women than among men, it seems that women emphasize the body more, they flaunt their bodies, they exploit their physical charms, their sexuality, their socially and culturally determined femininity, they secure their narcissistic supply through their more traditional gender role to this very day. So women are now proud of being sluts, they are slut walks and so on so forth, being a slut is self-objectification, converting oneself into a sexually desirable object, of course sexually desirable to men, men, the male gaze had come to define female narcissism, female narcissists adapt themselves and psychopathic women who are psychopaths and narcissists adapt themselves, had assimilated the male chauvinistic objectifying gaze and had conformed to it, indeed studies show repeatedly and clearly and beyond any doubt that promiscuous women, women who compulsively sexed and can perform sex on camera, women who are promiscuous in the sense that they are indiscriminate and they sleep with strangers and get drunk and these kind of women, numerous studies have shown, they have dark personality, personalities, they are subclinical psychopaths, they are subclinical narcissists and yet they define themselves through the male gaze, there is an inversion here, these women feel empowered because they have, they can exert power over men by conforming to male stereotypes of how an easy loose woman should look, it's a bit ironical, it's like you know leveraging the opponent's momentum against him, it's like these women are saying okay that's the way you want us, sluts you know scantily dressed from miscreants we're gonna be this way but by being this way we're gonna gain power over you, this is going to empower us, that's at least the narrative, of course it's nonsense, ultimately men, men are the big winners but this is an example of how female narcissism and female psychopathy manifest in a uniquely female way which conforms to conservative traditional gender roles actually, similarly women, even career women, even the most advanced ninth wave feminists still emphasize the home, her children, her husband, her spouses, her spouse, the stolen emphasis of domesticity and the narcissism of such a woman, of such women manifests itself in these arenas with their children who become sources of narcissistic supply, with the home she's competitive against other women, with her wardrobe, her possessions, her home, material goods and so on and so forth, these women would tend to choose careers which reflect on their grandiosity, they gravitate towards careers that enhance grandiosity and expose them to an admiring audience, it is no wonder that narcissists, both men and women, are chauvinistic and conservative, let's say irony, there is this totally false image of narcissists as libertarian, they're not, narcissists, both men and women, are actually more conservative and traditional than the rest of the population, they depend to such an extent on the opinions of people around them that with time they are transformed into ultra sensitive seismographs of public opinion, barometers of prevailing social fashions and guardians of conformity, the narcissists cannot afford to seriously alienate his constituency by being, I don't know, avant-garde, by being libertarian, by being a rebel and a reformer, he needs people around him and people are, people tend to walk away if you are too out there, if you're over the top, so the people who reflect on the narcissist, his false self, the people who help the narcissist sustain his grandiose self-image, the narcissist needs to conform to their beliefs, expectations and values, he needs to be, he needs to reflect the average traditional conservative point of view, the very proper and ongoing functioning of the narcissist's ego or ego substitute depends on the goodwill and the collaboration of his human environment, of his neighbors, his co-workers, and so he needs to be in the good graces of everyone around him, narcissists are pro-social, they are pro-social, they are communal, they are not psychopaths, it's another huge campaign of misinformation online by self-styled experts who have no idea what they are talking about, it is true that besieged and consumed by pernicious guilt feelings, some narcissists finally seek to be punished, the guilt is unconscious, narcissists are overtly, openly, eco-syntonic, they don't feel guilt, they don't feel shame, but Masterson and others have proven that narcissism is actually a reaction, a compensatory reaction to deeply embedded shame and guilt, and so narcissists are self-destructive, they are self-defeating, they seek to be punished, here too females differ from males, males seek to be punished by behaving anti-socially, by committing crimes, by getting caught, women seek to be punished mostly via their sexuality, they become sexually self-trashy, they get drunk, they sleep with a million strangers, that's a woman's way, the narcissistic woman's way, to self-pinalize and to reaffirm her self-perception is essentially bed, flawed, unworthy object, a whore, a self-destructive narcissist plays roles, the role of a bad guy or the role of a bad girl, but even then it is within the traditional socially allocated roles, to ensure social opprobrium, in other words attention, the narcissists exaggerate these roles to a caricature at the same time, ascertaining and securing his self-annihilation, his self-negation and self-punishment, but as you see female narcissists do it with sex, male narcissists do it with aggression and anti-social behavior, a woman is likely to label herself a whore and a male narcissist to self-style himself a vicious, unrepentant criminal, these are of course exaggerations, but the variations of this are very common among narcissists, yet these again are traditional social roles, men are likely to emphasize intellect, power, aggression, money or social status, women are likely to emphasize their bodies, looks, charm, sexuality, feminine traits, homemaking, children and child rearing, even as they compete in the workplace, make more money than men in some age groups and so on, so the traditional gender roles still define the permissible way to express one's narcissism, a woman would express narcissism only in traditionally or socially sanctioned ways, ironically both men and women sublimate their narcissism, convert it into socially acceptable methods or methods of expressing narcissism, so as not to lose the audience, they need the audience for narcissistic supply, another difference is in the way the genders react to treatment, women are more likely to resort to therapy, treatment I mean psychotherapy, women are more likely to resort to therapy because they are more likely to admit to psychological problems and distress, but while men may be less inclined to disclose or to expose their problems to other people, that's the macho man thing, it doesn't necessarily imply that they are less prone to admit it to themselves, women are also more likely to ask for help than men, men don't ask for help, men don't cry, and yet the prime role of narcissism must never be forgotten, the narcissist uses everything around him, everyone around him to obtain his or her narcissistic supply, children for example, children happen to be more attached to the female narcissists, to the mother because of the way that society structures the fact that women are the ones who give birth, for some reason because women are the ones to carry to term and give birth, society gives them custody over the children in the majority of cases and assumes that almost automatically the children should be with the mother, so there is this linkage, unbroken linkage, mother child, child mother, mother child, so female narcissists would succumb to this unwritten social rule or to this even legal moring, she would use her children, she would leverage her children as her sources of narcissistic supply and she would think herself a good mother for doing this, it is easier for a woman to think of her children as her extensions because they once wear her extensions, her physical extensions, and because her ongoing interaction with her children is both more intensive and more extensive, and this means that the male narcissist is more likely to regard his children as a nuisance than as a source of rewarding narcissistic supply, especially as a children grow older and become autonomous and disagree with the narcissistic and criticize it, who needs this as a source of supply, devoid of the diversity of alternatives available to men, the narcissistic woman fights in order to maintain her most reliable source of supply, her children, through insidious indoctrination, guilt formation, emotional sanctions, deprivation, and other psychological mechanisms, the narcissist woman tries to induce in her children a dependence which cannot be easily unraveled, sometimes never at all, to life's end, but there is no, but this is all, these are all external manifestations, these are all behaviors, many of these behaviors are acquired behaviors and many, many women, narcissistic women, no longer conform to any of this, they remain single, they remain childless, they have a career and they don't have a home, they live in rented apartments, so their outlet for their narcissism is identical to a men's outlet for his narcissism, genitalia is equipment, it's not who you are, there is, it's important to understand that whatever the source of supply, child, children, money, intellect, it's immaterial, they're all psychodynamically indistinguishable from each other, there's no psychodynamic difference between male and female narcissists, the only difference is in choices of narcissistic supply, they are mental, they are mental disorders which afflict one sex more than the other, or at least more often, and this has to do with hormonal or other physiological dispositions, with social and cultural conditioning through the socialization process and with role assignment, role assignment through gender differentiation process, none of these seems to be, seem to be strongly correlated to the formation of malignant narcissism, narcissistic personality disorder, as opposed for instance to, I don't know, bipolar disorder, seems to conform to social mores and to the prevailing ethos, mainly the ethos of capitalism actually, it's not an accident that capitalism is on the right and so is narcissism, social thinkers like Christopher Lash speculated that modern American culture, a narcissistic, self-centered culture bordering on psychopathy, increases the rate of incidence of narcissistic personality disorder, Kanberg himself said the following, the most I would be willing to say is that society can make serious psychological abnormalities which already exist in some percentage of a population seem to be at least superficially appropriate, another quote from the literature, it's from the article gender differences in the structure of narcissism, a multi-sample analysis of the narcissistic personality inventory, it was authored by Brian Chance, Caroline Morph, Charleston, and it was published in Sex Rolls, a journal of research in May 1998 and it said, I'm quoting, specifically past research suggests that exploitative tendencies and open displays of feelings of entitlement will be less integral to narcissism for females than for males, for females such displays may carry a greater possibility of negative social sanctions because they would violate stereotypical gender role expectations for women who are expected to engage in such positive social behavior as being tender, compassionate, warm, sympathetic, sensitive, and understanding. In females, exploitativeness entitlement is less well integrated with the other components of narcissism as measured by the narcissistic personality inventory, components such as leadership authority, self-absorption, self-admiration, and superiority or arrogance. In males, exploitiveness and entitlement are much more closely integrated with these factors. Male and female narcissists in general showed striking similarities in the manner in which most of the facets of narcissism were integrated with each other. Eagley Klonsky and others in Gender and the Evaluation of Leaders, meta-analysis in psychological ability in volume 111 wrote this, women leaders are evaluated negatively if they exercise their authority and are then perceived as autocratic. I also refer you to articles by Butler and Gels, non-verbal effect response to male and female leaders, and to Carly, Lafleur, Lebe, non-verbal behavior, gender, and influence in the Journal of Personality and Social Psychology, Volume 68, where they have written, competent women must also appear to be sociable and likable in order to influence men. Men must only appear to be competent to achieve the same results with both genders. Summary. Within the same diagnosis, there is very little difference between, within the same diagnosis of narcissistic personality disorder, there's very little difference between men and women on the psychodynamic level, the processes, the psychological constructs, the etiology, the traits, they're all identical, but the way that this order manifests itself outwardly in behavior is subject to social and cultural strictures, mores, constraints, and expectations. That's what makes female narcissists look very, very different to male narcissists. More generally, the variation between men and women within diagnosis, especially behavioral variation, is much higher than the variation between diagnosis, I'm sorry, I repeat, the variation between men and women between diagnosis is much higher, especially behaviorally. The variation between men and women inside the same diagnosis is very low, almost non-existent. So men and women who are both narcissistic will be the same, but a narcissistic woman and a borderline men would be very different. A narcissistic woman and a borderline woman would be very different. There are big differences between diagnosis when it comes to gender, but there are small differences inside the same diagnosis, even when we take gender into account. Thank you girls, girls, and guys, and all of you who are in between girls and guys.