‘Female narcissism is often misdiagnosed’: how science is finding women can have a dark streak too | Psychology

Picture a psychopath. Who do you see in your mind’s eye? Chances are it’s a man. And chances are your answer would be similar if you were asked to picture a narcissist. From Charles Manson and Ted Bundy to Joseph Stalin, Adolf Hitler and Donald Trump, most famous people we consider psychopathic or narcissistic are male. That’s even the case for fiction – think Hannibal Lecter, Patrick Bateman or Norman Bates.

Scientists long assumed that women were simply too wonderful to be significantly psychopathic or narcissistic, and didn’t bother to study the possibility much, according to Ava Green from City St George’s, University of London. But research over the past few decades is increasingly challenging this stereotype, suggesting women can have a dark streak, too. Much like in autism or ADHD, such traits just express themselves slightly differently in women – making them harder to spot with diagnostic tests that were essentially developed for men.

Most of us have some level of the dark personality traits. These are often combined into what scientists call the “dark triad” of psychopathy, narcissism and machiavellianism (that is, striving for control and power by being manipulative and unethical). While only about 1-5% and 1% of people have clinical levels of narcissism and psychopathy respectively – and many of them are in prison – people with sub-clinical levels can cause damage too. You’ve probably come across a few, given that about a third of the population have above-average levels of dark traits. Such people have a hunger for power and control and are often selfish, unempathetic, manipulative, deceptive and remorseless to some degree.

Recent research by Antonella Somma at the Vita-Salute San Raffaele University in Milan and her colleagues investigated dark traits and other personality features in nearly 1,000 Italian women. They found that women with elevated levels of such traits were more likely to have high levels of aggression. The way they express it, however, may be different from men. “You get more rumour-spreading and backstabbing among females and more direct aggression among males,” says Somma.

Narcissism, for example, is often seen as a rather male trait – think the scarf-wearing cad in Carly Simon’s song You’re So Vain. But “the core of narcissism is the same in men and women: they express entitled expectations, grandiose fantasies and a lack of empathy,” says Green.

Researchers have discovered that narcissism can come in two types: grandiose and vulnerable. And Green has shown that while men are more likely to have grandiose narcissism, boasting high self-esteem and extroversion, women more commonly display the vulnerable form, involving introversion, defensiveness and low self-esteem. They may be more brittle and less boastful.

Green believes this is because bragging and chest-thumping simply aren’t socially acceptable for women. “Narcissistic women are abusing in ways that society allows,” she argues. “They often leverage their femininity, present themselves as soft-spoken, but it is cunning; it’s premeditated.” They may still lie, cheat and control others.

In Somma’s study, women with high levels of psychopathy, machiavellianism and grandiose narcissism scored low on agreeableness (how friendly you are) and high on social deviance (breaking rules or norms). Women with vulnerable narcissism, however, were less socially deviant and more agreeable than women with other dark traits. They also had more paranoid thoughts and the worst mental health of all. This is potentially because they are more insecure and eager to fit in. “They’re often better at faking empathy,” says Green.

But we may fail to recognise these traits as narcissistic. “Female leaders with narcissistic traits can cause as much reputational damage, staff turnover, bullying, as male ones – they just go about it in a more sneaky way,” says Green. “Male leaders can be more aggressive and socially dominant to establish authority. But female leaders may blame the higher-ups for why they had to fire you – even if they orchestrated it.”

There’s certainly aggression beneath the surface. Vulnerable narcissism is more strongly linked to aggression in relationships, as well as physical and verbal bullying, than the grandiose type. “These are uncomfortable truths, painting women in the same light as men,” says Green.

When taking into account the vulnerable features of narcissism, Green found subclinical levels of the trait to be as common, if not more prevalent, in women. But many diagnostic protocols, including the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), are skewed towards men, focusing on grandiose narcissism. Female narcissism is therefore often misdiagnosed as borderline personality disorder, according to Green. The European diagnostic manual, International Classification of Diseases 11 (ICD-11), she says, is actually more likely to capture female narcissists as it includes vulnerable traits.

This matters because high levels of narcissism are linked to crime. Green is planning a new study in British prisons to assess how the system fails to capture female inmates’ vulnerable narcissistic traits.

Psychopaths

Men typically score higher than women on machiavellianism and its more severe cousin, psychopathy. These traits are similar, but machiavellian people tend to have better impulse control and ability to play the long game compared with their psychopathic peers.

However, some researchers believe standard tests may be underestimating machiavellianism in women. After all, the entire psychological construct was inspired by the ideas of a man – the Italian diplomat and philosopher Niccolò Machiavelli. Research shows that while machiavellian men and women are equally cynical, machiavellian men tend to be more confident, assertive and selfish, while machiavellian women are more conscientious, anxious and more likely to doubt and cheat on their partner. Recent studies have therefore put forward new tests that are less skewed towards men.

The same could be true for psychopathy. Psychopaths, after all, have high levels of charm and charisma. “One of the key things they want is power and control. And they gain that control however they can,” says Clive Boddy from Anglia Ruskin University. “For a man it may be more physical, such as through violent intimidation, whereas for a woman it may be more through manipulating people’s feelings.” He adds that women with psychopathic traits often use their sexuality to gain power and control, highlighting Ghislaine Maxwell and the fraudulent entrepreneur Elizabeth Holmes as possible examples.

“They ultimately tend to weaponise anything that society allows them to use,” says Green. This means they may be more successful using their children against their partner, or making false accusations of abuse, than physically threatening someone.

Common assessment tools such as the Psychopathy Checklist-Revised (PCL-R), which is often used in prisons, were developed based on male offenders. Even measures to assess subclinical levels of psychopathy in the general population, such as the Levenson Self-Report Psychopathy Scale, are “loosely based on the PCL-R”, according to Boddy.

Both test what is called “primary psychopathy”, which includes traits such as callousness, remorselessness and manipulation, along with “secondary psychopathy”, which is more about impulsivity and antisocial behaviour. As women are less likely to be violent or criminal, they often score lower on secondary psychopathy, which can reduce their overall scores. Boddy therefore thinks primary psychopathy should be emphasised when assessing women.

In 1995, Michael Leveson, creator of the Leveson scale, suggested that a whopping 23% of men, but only 6% of women, had high enough levels of psychopathy to cause trouble for others. Boddy, however, has long been sceptical of such numbers. Based on three of his previous studies of 913 people (including 570 women) in the US, UK and Australia, he found, in analysis yet to be published, that 28% of men and 19% of women had high enough scores on primary psychopathy to be toxic.

Biases among assessors may also play a role. “Male clinicians and psychopathy researchers may be relatively unwilling to give a diagnosis of psychopathy to the nice, charming woman in front of them,” suggests Boddy.

This is a problem. Women with such traits may create havoc in workplaces, relationships, families and society at large. According to Boddy, CV fraud is common among those who make it to the top in companies, as is a lack of moral consideration about things such as sustainability, equality or diversity.

Psychopathy has not been studied much in female offenders either. One 2015 study suggested that only 11-17% of female criminals are psychopathic, compared with 31% of male ones. In a recent series of studies of female murderers in Italy, Prof Felice Carabellese from the University of Bari and colleagues discovered that most suffered from some sort of psychosis, and had no or reduced criminal responsibility. But in the small group that had full criminal responsibility, about 40% had clinically relevant levels of psychopathy.

In another recent study on murderers, he showed female killers were likely to score higher on primary traits such as manipulation than male ones, while male psychopaths scored higher on antisocial behaviour. “In women, the psychopathic component can be underestimated or undervalued because the diagnostic tools are not as refined as those for men,” says Carabellese. All this suggests that we might be better off using a slightly lower cut-off score for criminal women, or a test with less emphasis on antisocial behaviour.

Female psychopaths may also be such brilliant manipulators that assessors fail to even spot their psychopathic tendencies. And we know that poor parenting is linked to psychopathy in women, but there are no questions about it in the PCL-R.

If we are to rehabilitate those who commit crimes, male or female, we need to get the psychological profiling right. People with psychopathy are much harder to treat and more likely to reoffend than others.

Many people feel uncomfortable hearing negative things about women. “I often get a bit anxious when I present to the public about whether women will walk out in the middle of my talk,” says Green. “When these negative traits are being shone on women, it’s almost like we’re taking a step back. But I personally think that by shying away from depicting women as having this breadth of behaviour – that they can also be cruel, selfish and deeply flawed – we’re actually doing a disservice to the very notion of equality.”

What’s more, if we insist that women are just hardwired to be soft and nurturing, we may subconsciously assume they are unsuitable for roles such as leadership, policing or politics. Ultimately, all human beings have the capacity for good and bad. And if women have learned to rein in some of their aggression as a result of societal pressures, the chances are that men could too.