Sex differences in early childhood

Differences in several aspects of the developing personality in boys and girls are described. These differences affect mainly modes of impulse control and drive expression: boys tend to discharge aggression through muscular discharge; girls are more contained and show a greater propensity for involvement of affective changes. A particular carry-over of modes characteristic of the oral phase throughout development is suggested in girls. These and other sex differences are discussed in relation to their multiple determinants occurring at different stages of development. The contribution of early appearing sex differences to the selection of various sex-linked personality factors (symptoms, identifications, conflicts, and the like) is discussed.A preliminary version of this paper was presented at the meeting of the American Association of Psychiatric Clinics for Children, New York City, in November 1968. The author is indebted to Dr. P. B. Neubauer for his valuable suggestions.     

Sex differences in autonomic correlates of conduct problems and aggression

ObjectiveTo examine sex differences in autonomic nervous system functioning in children and adolescents with conduct problems and to evaluate the role of aggression in predicting autonomic nervous system functioning, over and above the effects of disruptive behavior. Although deficiencies in autonomic responding among boys with oppositional defiant disorder and/or conduct disorder are well documented, it remains unclear whether such findings extend to girls or apply only to children with aggressive forms of conduct problems.MethodElectrodermal responding, cardiac pre-ejection period, and respiratory sinus arrhythmia were recorded while boys (n = 110; 53 with conduct problems, 57 controls) and girls (n = 65; 33 with conduct problems, 32 controls) between the ages of 8 and 12 sat for an extended baseline, then played a game with conditions of reward and frustrative nonreward.ResultsBoth sex effects and aggression effects were found. Aggressive boys with conduct problems demonstrated reduced autonomic functioning, consistent with previous research. In contrast, aggressive girls with conduct problems exhibited greater electrodermal responding than controls, with no differences in cardiovascular reactivity to incentives.ConclusionsObserved sex differences in the autonomic correlates of conduct problems and aggression may suggest different etiological mechanisms of externalizing psychopathology for girls compared with boys. J. Am. Acad. Child Adolesc. Psychiatry, 2008; 47(7):788–796.     

Subjective anger and overt aggression in psychiatric outpatients

BackgroundThe attention given to anger and aggression in psychiatric patients pales in comparison to the attention given to depression and anxiety. Most studies have focused on a limited number of psychiatric disorders, and results have been inconsistent. The present report from the Rhode Island Methods to Improve Diagnostic Assessment and Services (MIDAS) project sought to replicate and extend prior findings examining which psychiatric disorders and demographic characteristics were independently associated with elevated levels of anger and aggression.Method3800 individuals presenting to the Rhode Island Hospital Department of Psychiatry outpatient practice underwent a semi-structured interview to determine current Axis I (N = 3800) and Axis II (N = 2151) pathology. Severity of subjective anger and overt aggression within the past week were also assessed for each patient, and odds ratios were determined for each disorder. Multiple regression analyses were conducted to determine which diagnoses independently contributed to increased levels of anger and aggression.ResultsAlmost half of the sample reported moderate-to-severe levels of current subjective anger, and more than 20% endorsed moderate-to-severe levels of current overt aggression. The frequency of anger was similar to the frequencies of depressed mood and psychic anxiety. Anger and aggression were elevated across all diagnoses except adjustment disorder. Anger and aggression were most elevated in patients with major depressive disorder, panic disorder with agoraphobia, post-traumatic stress disorder, intermittent explosive disorder, and cluster B personality disorders.ConclusionsAnger is as common as depressed mood and psychic anxiety amongst psychiatric outpatients, and problems with anger cut across diagnostic categories. Given the high prevalence of problems with anger in psychiatric patients, more research should be directed towards its effective treatment.     

Sex differences in structural brain asymmetry predict overt aggression in early adolescents

The devastating social, emotional and economic consequences of human aggression are laid bare nightly on newscasts around the world. Aggression is principally mediated by neural circuitry comprising multiple areas of the prefrontal cortex and limbic system, including the orbitofrontal cortex (OFC), anterior cingulate cortex (ACC), amygdala and hippocampus. A striking characteristic of these regions is their structural asymmetry about the midline (i.e. left vs right hemisphere). Variations in these asymmetries have been linked to clinical disorders characterized by aggression and the rate of aggressive behavior in psychiatric patients. Here, we show for the first time that structural asymmetries in prefrontal cortical areas are also linked to aggression in a normal population of early adolescents. Our findings indicate a relationship between parent reports of aggressive behavior in adolescents and structural asymmetries in the limbic and paralimbic ACC and OFC, and moreover, that this relationship varies by sex. Furthermore, while there was no relationship between aggression and structural asymmetries in the amygdala or hippocampus, hippocampal volumes did predict aggression in females. Taken together, the results suggest that structural asymmetries in the prefrontal cortex may influence human aggression, and that the anatomical basis of aggression varies substantially by sex.     

Self-mutilative behaviors in male substance-dependent inpatients and relationship with anger and aggression: mediator effect of childhood trauma

The aim of this study was to investigate the relationship of self-mutilation (SM) with anger and aggression in male substance-dependent inpatients. Also, we wanted to evaluate the mediator effect of childhood trauma on these relationships while controlling variables such as age, substance of dependence (alcohol/drug), and negative effect. Participants were consecutively admitted 200 male substance-dependent inpatients. Patients were investigated with the Self-mutilative Behaviour Questionnaire, the Childhood Trauma Reports, the Buss-Perry's Aggression Questionnaire, the State-Trait Anger Expression Inventory, the Beck Depression Inventory, and the State-Trait Anxiety Inventory. Rate of being married, current age, and age onset of regular substance use were lower, whereas being unemployed and history of childhood trauma (HCT) were higher in group with SM (n = 124, or 62.0%). Higher mean scale scores were found in SM group. Predictors of SM were being younger, impaired anger control, and physical aggression in logistic regression model. Being younger and the outward expression of anger (anger-out) predicted SM in the subgroup of patients without HCT, whereas being younger, severity of anger, and the inward expression of anger (anger-in) predicted SM in the subgroup of patients with HCT. Thus, to reduce self-mutilative behavior among substance-dependent patients, clinicians must improve anger control, particularly in younger patients. Type of strategy for coping with anger, which must be worked on, may differ in different subgroup patients, that is, focusing anger toward self among those with HCT, whereas anger toward others among those without.     

Sex differences in the activation of language cortex during childhood

Sex differences have been well documented in the behavioral literature but have occurred inconsistently in the neuroimaging literature. This investigation examined the impact of subject age, language task, and cortical region on the occurrence of sex differences in functional magnetic resonance imaging. Two hundred and five (104 m, 101 f) right handed, monolingual English speaking children between the ages of 5 and 18 years were enrolled in this study. The study used fMRI at 3T to evaluate BOLD signal variation associated with sex, age, and their interaction. Children completed up to four language tasks, which involved listening to stories, prosody processing, single word vocabulary identification, and verb generation. A sex difference for behavioral performance was found for the prosodic processing task only. Brain activation in the classical left hemisphere language areas of the brain and their right homologues were assessed for sex differences. Although left lateralization was present for both frontal and temporal regions for all but the prosody task, no significant sex differences were found for the degree of lateralization. Sex x age interaction effects were found for all but the task involving single word vocabulary. However effect sizes associated with the sex differences were small, which suggests that relatively large sample sizes would be needed to detect these effects reliably.     

Inability to control anger or aggression after stroke

Using the 10-item Spielberger Trait Anger Scale, the authors interviewed 145 patients with stroke regarding inability to control anger or aggression (ICAA). Poststroke depression and emotional incontinence were also assessed. ICAA was present in 47 patients (32%) and was closely related to motor dysfunction, dysarthria, emotional incontinence, and lesions affecting frontal-lenticulocapsular-pontine base areas. ICAA seems to be one of the major behavioral symptoms in patients with stroke.     

愤怒与攻击行为的脑电生理学研究进展

近年来攻击行为的发生率不断上升,导致暴力犯罪率逐年增长,引起了国内外各界的关注.目前,对人类攻击性行为的研究一般集中在生物、社会环境和认知因素三个方面,本文主要从心理学相关因素--愤怒的角度对攻击行为进行阐述.大量研究表明:攻击与暴力是情绪失调的结果,个体越是对负性情绪调节不完善,越是具有攻击与暴力的危险.本文就愤怒与攻击行为的基础生理学及脑电生理学研究进展进行综述.     

Gender differences in reactive and proactive aggression

The purpose of our investigation was to study gender differences in proactive and reactive aggression in a sample of 323 clinically referred children and adolescents (68 females and 255 males). Proactive aggression and reactive aggression were assessed using the Proactive/Reactive Aggression Scale. Demographic, historical, family, diagnostic, and treatment variables were entered into stepwise regression analyses to determine correlates of proactive and reactive aggression in males and females. Results reveal high rates of aggression in both males and females in the sample. Self reported drug use, expressed hostility, and experiences of maladaptive parenting were correlated with proactive aggression for both genders. Hyperactive/impulsive behaviors were correlated with male reactive aggression. An early age of traumatic stress and a low verbal IQ were correlated with female proactive aggression. Gender differences in correlates of proactive and reactive aggression may provide possible targets for research, prevention, and treatment efforts focused on reducing maladaptive aggression in clinically referred youth.     

Personality and attempted suicide. Analysis of anger, aggression and impulsivity

Suicide is one of the leading causes of death worldwide, mortality from suicide being approximately 2%. Attempted suicide appears to be a major risk factor for suicide completion. Anger, aggression and impulsivity are personality traits associated with suicide attempt. In this study we analysed a part of a previously reported sample in order to test anger, impulsivity and temperament/character scales as predictors of aggression and self-aggression in suicide attempters and to compare anger- and aggression-related traits between impulsive and premeditated suicide attempts as well as between violent and non-violent suicide methods.One-hundred-eleven consecutively admitted inpatients with a lifetime history of attempted suicide were assessed for anger (State-Trait Anger Expression Inventory, STAXI), aggression (Questionnaire for Measuring Factors of Aggression, FAF) and temperament/character (Temperament and Character Inventory, TCI).Higher aggression scores, as measured by FAF, were predicted by being male, meeting criteria for borderline personality disorder and having higher angry temperament scores as assessed by STAXI; low cooperativeness was also associated with aggression but not after controlling for STAXI scales. TCI dimensions associated with self-aggression were high harm avoidance, high impulsivity and low self-directedness; state anger, inwardly directed anger and inhibition of aggression were also predictors of self-aggression.In conclusion, impulsivity and harm avoidance have emerged as temperament dimensions independently associated with self-aggressive tendencies in personality. Such interactions could explain the correlation between temperament and suicidality but further research is needed. Anger and self-directedness appear to have some effects on suicide attempt.     

Sex differences in stroke

Increasing evidence suggests that sex differences exist in the etiology, presentation, treatment, and outcome from stroke. The reasons for these sex disparities are becoming increasingly explored, but large gaps still exist in our knowledge. Experimental studies over the past several years have demonstrated intrinsic sex differences both in vivo and in animal models which may have relevance to our understanding of stroke in clinical populations. A greater understanding of the differences and similarities between males and females with respect to the risk factors, pathophysiology, and response to stroke will facilitate the design of future clinical trials and enhance the development of treatment strategies to improve stroke care in both sexes. This article reviews the current literature on sex differences in stroke with an emphasis on the clinical data, incorporating an analysis of bench research as it pertains to the bedside.     

Sex differences in autism

Comparisons were made between male and female children with autism, 384 boys and 91 girls, aged 3 years to 8 years, on nonverbal measures of intelligence, adaptive functioning, receptive vocabulary, perception, and eye-hand integration, and on ratings of affect, play, and relating and human interest. Males showed more advanced performances on eye-hand integration and perception skills on the Psychoeducational Profile (PEP) and had higher nonverbal IQs social quotients, and Peabody Picture Vocabulary Test (PPVT) IQs than females. When nonverbal IQ was controlled, the main effect of sex remained; however, sex differences on PPVT scores and on eye-hand integration and perception scale disappeared. Males showed more unusual visual responses and less appropriate, more stereotypic play than females. These results are discussed in terms of hypotheses concerning sex differences in genetic thresholds and in hemispheric lateralization.Our thanks are extended to the parents and children who participated in the initial TEACCH diagnostics, and to Robert DeVellis and Barbara Renner for help with computer programming and statistical advice.     

Sex differences in schizophrenia

Evidence suggests sex differences in schizophrenia reflect differences in both neurodevelopmental processes and social effects on disease risk and course. Male:female incidence approximates 1.4:1 but at older onset women predominate. Prevalence differences appear smaller. Men have poorer premorbid adjustment and present with worse negative and less depressive symptoms than women, which may explain their worse medium term outcome according to a range of measures. Substance abuse is a predominantly male activity in this group, as elsewhere. Findings of sex differences in brain morphology are inconsistent but occur in areas that normally show sexual dimorphism, implying that the same factors are important drivers of sex differences in both normal neurodevelopmental processes and those associated with schizophrenia. There are sex differences in antipsychotic responses but sex-specific endocrine effects on illness and response to antipsychotics are potentially complex. Oestrogen's role as an adjunctive medication is not yet clear due to methodological differences between the few randomized controlled trials. Services that are sensitive to differences in gender can better meet their patients’ specific needs and potentially improve outcome.     

Sex differences in stroke

Sex differences in stroke are observed across epidemiologic studies, pathophysiology, treatments, and outcomes. These sex differences have profound implications for effective prevention and treatment and are the focus of this review. Epidemiologic studies reveal a clear age-by-sex interaction in stroke prevalence, incidence, and mortality. While premenopausal women experience fewer strokes than men of comparable age, stroke rates increase among postmenopausal women compared with age-matched men. This postmenopausal phenomenon, in combination with living longer, are reasons for women being older at stroke onset and suffering more severe strokes. Thus, a primary focus of stroke prevention has been based on sex steroid hormone-dependent mechanisms. Sex hormones affect different (patho)physiologic functions of the cerebral circulation. Clarifying the impact of sex hormones on cerebral vasculature using suitable animal models is essential to elucidate male–female differences in stroke pathophysiology and development of sex-specific treatments. Much remains to be learned about sex differences in stroke as anatomic and genetic factors may also contribute, revealing its multifactorial nature. In addition, the aftermath of stroke appears to be more adverse in women than in men, again based on older age at stroke onset, longer prehospital delays, and potentially, differences in treatment.     

Sex differences in schizophrenia

Evidence suggests sex differences in schizophrenia reflect differences in both neurodevelopmental processes and social effects on disease risk and course. Male:female incidence approximates 1.4:1 but at older onset women predominate. Prevalence differences appear smaller. Men have poorer premorbid adjustment and present with worse negative and less depressive symptoms than women, which may explain their worse medium term outcome according to a range of measures. Substance abuse is a predominantly male activity in this group, as elsewhere. Findings of sex differences in brain morphology are inconsistent but occur in areas that normally show sexual dimorphism, implying that the same factors are important drivers of sex differences in both normal neurodevelopmental processes and those associated with schizophrenia. There are sex differences in antipsychotic responses but sex-specific endocrine effects on illness and response to antipsychotics are potentially complex. Oestrogen's role as an adjunctive medication is not yet clear due to methodological differences between the few randomized controlled trials. Services that are sensitive to differences in gender can better meet their patients' specific needs and potentially improve outcome.     

Sex differences in schizophrenia

Demographic and clinical characteristics of 275 schizophrenics consecutively admitted to seven hospitals were examined. Males were younger than females when first hospitalized, diagnosed and treated. Psychiatrists rated on two rating scales by using a structured interview to compare the symptomatology. Female schizophrenics were more agitated, inappropriate, silly, irrelevant, over-talkative, and exhibiting more flight of ideas, while male schizophrenics were more slowed, hypoactive, grandiose, withdrawn, and showing more blocking, auditory hallucinations and poor communications. Katz Adjustment Scales were rated by the patients and their relatives. Female schizophrenics were perceived by relatives to be more helpless and withdrawn-depressed than male schizophrenics.     

A combined drama-based and CBT approach to working with self-reported anger aggression

BACKGROUND: A drama-based programme, called 'Insult to Injury', was designed to explore the processes of anger, aggression and violence. The aim of the programme was to enable offenders to identify and generate strategies and skills for dealing with potentially volatile situations, and to provide a safe and supportive environment in which to practice and evaluate these strategies. AIMS An active drama-based approach combined with cognitive-behavioural techniques was used to explore issues such as masculinity, power and control, pride and shame and victim awareness. Reductions in anger were hypothesized. METHOD A single group pre/post design assessed the levels of anger before and after the course. RESULTS Sixty-two adult male offenders from six prison establishments in the UK took part in the nine-day course. As hypothesised, significant reductions in anger were found in pre- to post-course assessment. CONCLUSIONS: These results suggest that a drama-based approach may be a promising adjunct to traditional anger management programmes for violent offenders.