Being Female: Protected From Autism But at Risk of Psychosis

The diametric model shows why risk of autism varies inversely with psychosis.

Posted Mar 20, 2014

Good news if you are a woman: a new study suggests that being female protects you against an autism spectrum disorder (ASD) at a very basic level: that of genetics. According to these findings, more genetic mutations are required to cause ASD in girls than in boys. Indeed, in the words of one of the authors quoted in New Scientist, “Females function a lot better than males with similar mutations. There’s something that’s protecting their brain development.” (8 March 2014, p.12) But as a recent textbook notes, "Current psychiatric conceptualizations are ... unable to account for sex differences in presentation of psychopathological signs and symptoms." 

Nevertheless, as I pointed out in the previous post, a high-functioning ASD such as Asperger’s syndrome does indeed spare females at the expense of males by at least 10:1. But as I also argued, the overwhelmingly female incidence of hysteria in the 19th century suggests that high-functioning psychotic spectrum disorder may work the opposite way round.

And hysteria is just the start of it. In the UK, women are 40 percent more likely to be hospitalized for a mental illness than are men (the excess being mainly accounted for by depression). And although many more men than women are treated for sexual dysfunction as such, a woman is 30 times more likely than a man to seek help for psychiatric problems related to fertility. Anxiety disorders are twice as common in women, borderline personality disorder is much more prevalent in young women, and anorexia/bulimia is 90-98 percent female. Despite having a male literary model in the Jekyll and Hyde story, multiple personality disorder became an overwhelmingly female affliction once it got going in the 1970s and, as I hinted in the previous post, appears to be a modern equivalent of 19th century hysteria. As a classic analysis that gives full credence to feminist and neo-Marxist accounts and to social, cultural, and political determinants of mental illness concludes:

Modern-day research confirms that women are more susceptible than men to anxiety, depression, multiple personality, eating disorders, and several forms of what used to be called hysteria. Women’s excess risk of these disorders is real; it cannot be accounted for by use of different diagnostic criteria in men and women, by greater willingness of women to admit to psychological symptoms, or by help-seeking behavior by women patients. (Brant Wenegrat: Illness and Power, 1995,  p. 1)

So what can account for it? Evolutionary insights can certainly explain some apparent paradoxes, such as the fact that although erotomania (the delusion that others are in love with you) is a predominantly female form of paranoid schizophrenia, delusional jealousy is an equivalent that mainly afflicts men. Here the insight is that a woman’s reproductive success—the bottom line for evolution—is determined by the number of offspring she can bear. For a man, on the other hand, the number of women he can successfully inseminate is the critical factor for reproductive success, explaining why men are much more likely to seek medical—albeit seldomly psychiatric—help for sexual dysfunction. Uncertainty of paternity—the bane of internal female fertilization—explains why men are more likely to become delusional about their female partner’s fidelity: Mother’s baby—father’s? Maybe! But a woman’s need for a male to fertilize her in the first place explains why some women become delusional about potential partners being attracted to them.

Another example is post traumatic stress disorder (PTSD), which affects at least twice as many females as males and whose complex epigenetics I explained in a previous post. I pointed out that PTSD fits the predictions of the imprinted brain theory, and only its diametric model of mental illness can explain why being female may both protect you from ASD and put you at risk of a psychotic spectrum disorder such as PTSD.

The reason is that the diametric model proposes that autistic and psychotic disorders are at opposite ends of a spectrum of mentalism where tendencies to hyper-mentalize pull a person’s cognitive configuration in the psychotic direction, but contrary tendencies to deficits in mentalism pull it in the opposite direction toward autism (above). Only this can explain the paradox of why being female can both protect you from autism, but also put you at risk of psychosis.