Sex differences in personality disorders in a Chinese clinical population

Sex differences in the frequency and severity of personality disorders (PDs) have been widely reported in Western countries. However, limited literature suggests a similar sex distribution in the Chinese clinical population. This study investigated sex differences in self-reported and interviewed patients with PDs in a clinical population in China.

The participants were 1,389 consecutive outpatients with a mean age of 30.5 years, including 634 (45.6%) males and 755 (54.4%) females. Self-reported PD traits were assessed using the Personality Diagnostic Questionnaire Fourth Edition Plus (PDQ-4+). PDs were diagnosed according to the Structured Clinical Interview for Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition (DSM-IV) Axis II (SCID-II).

Male outpatients reported more paranoid, schizotypal, antisocial, and passive-aggressive PD traits, whereas females reported more borderline PD traits on the PDQ-4+. Self-reported PD traits in male outpatients were more likely to reach the positive threshold of antisocial PD than in females (χ² = 5.293, p = 0.021). Males were more likely to meet the criteria for schizoid (χ² = 5.050, p = 0.025), narcissistic (χ² = 27.244, p < 0.001), antisocial (χ² = 11.430, p = 0.001), avoidant (χ² = 5.098, p = 0.024), and obsessive-compulsive PD (χ² = 5.496, p = 0.019) diagnoses in the SCID-II. In contrast, females were more likely to meet the criteria of histrionic (χ² = 12.327, p = 0.001), borderline (χ² = 28.538, p < 0.001), and dependent (χ² = 4.919, p = 0.027) diagnoses.

These findings indicate gender differences in the traits, frequency, and pattern of PDs when assessed in a Chinese clinical population.