Epidemiology and Gender

Another important epidemiological issue concerns the extent to which gender differentially affects the prevalence of personality disorders among older adults. According to the DSM-IV-TR, three personality disorders (borderline, dependent, and histrionic) are more prevalent in females, and six personality disorders (antisocial, paranoid, schizoid, schizotypal, narcissistic, and obsessive-compulsive) are more prevalent in males. Sadistic Personality Disorder was also thought to be more common in males, whereas Self-Defeating Personality Disorder was thought to be more prevalent in females. No information was provided by the DSM for the Passive-Aggressive Personality Disorder regarding gender. Finally, the Depressive Personality Disorder was thought to occur with equal frequency in both genders.

It is unclear to what extent these gender differences apply to older individuals because most studies from which these data are summarized did not include older adults. At least one study of community-dwelling older persons (Segal, Hersen, et al., 1998) failed to find support for the claims in DSM-IV regarding gender differences for the personality disorders. Instead, results suggested that older females were more likely to be diagnosed with Avoidant and Schizoid Personality Disorders compared with older males. No gender differences were identified for the remaining personality disorder diagnoses. Our recent study (Coolidge et al., 2006) of 114 older adults (31 males, 83 females) generally supported the Segal, Hersen, et al. (1998) findings regarding limited gender differences for most of the personality disorders, at least in community samples. We found only two significant elevations for males compared with females. They were on the antisocial and sadistic personality scales and both had moderate effect sizes. On the 12 other personality disorder scales, there were no significant differences between the genders.

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