One study found that patients with ASPD exhibited higher levels of primary cognitive distortions than nonpatients. Although cognitive distortions and aggression were generally more prevalent among patients with ASPD, cognitive distortions were strongly associated with aggression compared to nonpatients. This may be due to reduced emotional responses in patients with ASPD, diminishing the need to justify aggressive behavior. 


Scripps College

Within the field of psychology, several researchers have investigated the supposed relationship between male and female individuals with ASPD

Gender Differences in ASPD

Sijtsema, J., Rijckmans, M., Lobbestael, J., & Cima, M. (2026). Cognitive distortions in male patients with antisocial personality disorder. Psychology of Violence. 

Cognitive Distortions in Male Patients with ASPD

Current research indicates females are substantially underdiagnosed due to exclusionary diagnostic criteria in the DSM5. Similarly, results indicated that the proportion of males and females with ASPD from a psychiatric facility were near equal. Furthermore, findings revealed trauma to be a significant etiological factor in ASPD in female participants and females are more likely to be accurately diagnosed with ASPD when diagnostic criteria include relevant descriptions of personality traits.


ASPD in females

Cognitive Distortion in Male Patients

According to one study,  female cases with ASPD was 5.1 times more likely to get misdiagnosed than a male case with ASPD. Conclusions Categorical classification of personality disorders in DSM leads to gender bias in in the diagnosis of ASPD and BPD. The present study shows that female cases with ASPD are misdiagnosed as BPD which may result in treatment attempts without evidence. 


Gender Bias in ASPD

One study found that the proportion of males and females from the psychiatric facility with clinically significant levels of antisocial traits were near equal—differing from the prevalence ratio identified by DSM-5-TR criteria. Furthermore, results revealed trauma to be a significant etiological factor in ASPD in female participants and females were more likely to be accurately diagnosed with ASPD when diagnostic criteria include relevant descriptions of personality traits 

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