What We Know and Still Need to Know about Gender Aspects of Delusional Disorder: A Narrative Review of Recent Work

While gender differences in the psychopathology and clinical course of schizophrenia have been extensively reported, the potential for analogous differences in delusional disorder has been understudied. Our aim in this paper is to focus on the recent literature on delusional disorder and to explore gender aspects. This is a non-systematic, narrative and critical review. The review is divided into the following main sections: gender differences in epidemiology, symptomatology, phenotypic factor analyses, psychiatric comorbidity, response and adherence to medications, and clinical trajectories. Culture-bound delusional syndromes are also addressed, and potential causes for gender differences and their treatment are critically discussed. Although DMS-5 reports no gender differences in the frequency of delusional disorder or in delusional content, several studies have found erotomania to be more frequent in women. There seem also to be gender differences in affective and substance abuse comorbidity, which may prove clinically important. The loss of the neuroprotection conferred by estrogens during the reproductive period in women may trigger depressive symptoms after menopause. The interaction of age and gender has been insufficiently studied as is also the case for selective cultural pressures on men and women and their impact on the content of delusions. Studies designed to focus on gender differences in response to treatment are currently needed in delusional disorder