Are Psychopathic and Borderline Personality Disorder Distinct, or Differently Gendered Expressions of the Same Disorder? An Exploration Using Concept Maps

Abstract

Research findings on gender differences in prevalence and clinician gender bias in the diagnosis of Psychopathic Personality Disorder (PPD) and Borderline Personality Disorder (BPD) have led some to suggest that PPD and BPD are not distinct disorders, but rather differently gendered expressions of the same disorder. This paper explores gender differences in conceptualization using prototypicality ratings of PPD and BPD symptoms from the Comprehensive Assessment of Psychopathic Personality (CAPP; Cooke, Hart, Logan, & Michie, 2004, 2012) and the Comprehensive Assessment of Borderline Personality (CABP; Cook et al., 2013). Findings indicated that symptoms of PPD and BPD are gendered, but did not appear consistent with the view that PPD and BPD are differently gendered variants of the same disorder. Unfortunately, the implications of our findings for clinical practice are not clear at this time. Future research should explore effective methods to mitigate clinician bias and/or explore the development of gender-fair measures.

Keywords:

• gender issues
• psychopathy
• psychopathic personality disorder
• borderline personality disorder

ACKNOWLEDGMENT

Portions of these data were presented at the 2014 meeting of the International Association of Forensic Mental Health Services.

Funding

Simone Viljoen was supported by a doctoral scholarship from the Social Science and Humanities Research Council of Canada. Alana N. Cook was supported by a doctoral scholarship from the Social Science and Humanities Research Council of Canada and a student grant-in-aid from the American Psychology-Law Society (Div. 41 of the American Psychological Association). Brianne K. Layden was supported by a doctoral scholarship from the Canadian Institutes of Health Research.

Notes

¹ As a concept, PPD is synonymous with psychopathy, sociopathy, and antisocial or dissocial personality disorder. The terms are simply different names for the same disorder. This is explicitly recognized in authoritative treatises such as the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5; American Psychiatric Association, 2013) and in the tenth edition of the International Classification of Diseases and Related Health Problems (ICD-10; World Health Organization, 1992). Similarly, BPD is synonymous with emotionally unstable personality disorder. At an operational level, however, the various procedures for assessing and diagnosing PPD or BPD are definitely not equivalent. For further discussion of the distinction between concepts (constructs, definitions) versus operations (measures, diagnostic criteria) of mental disorders, see Hart and Cook (2012).

² Readers familiar with past research on the CAPP may recall reference to 9 foil symptoms. One of the original CAPP foils, Dependent, was subsequently included in the CABP as a symptom based on systematic literature review. For this reason, we removed it from the list of foil symptoms and included it as a CABP (and CABP-Only) symptom in the present study.

³ We compared our gender prototypicality ratings for the CAPP symptoms, which were made predominantly by professionals and trainees from North America, with those reported by Kreis and Cooke (2011), made predominantly by professionals from Europe. We calculated Model 3 intraclass correlation coefficients (ICCs), that is, two-way mixed model ICC for single measures. The ICC for consistency was .863, 95% CI [.759, .924], p < .001, and the ICC for absolute agreement was .851, 95% CI [.729, .919], p < .001. This indicates a high level of agreement between samples, according to standard interpretive guidelines (Cicchetti & Sparrow, 1981).

⁴ We did not conduct a multivariate analysis for Foil symptoms as the symptoms were selected to be diverse in nature and therefore we had no reason to believe they would be significantly correlated.