Gender differences in forensic psychiatry in criminal justice settings: integrative review of the comparative literature and implications for the brazilian gap

Abstract

Introduction: Part of the criminological and forensic psychiatric literature has historically focused on male populations, neglecting gender specificities of female offenders. Understanding these differences is crucial for effective interventions. Objective: To review the international literature on women and gender differences in forensic psychiatry in criminal justice settings, with emphasis on comparative studies, and to highlight the Brazilian gap in this context. Methods: Integrative review structured by PECO, with reporting assessed using adapted STROBE domains, of observational studies (2008–2025) in PubMed, BVS, SciELO and PsycINFO on women, gender comparisons or forensic risk instruments. Results: Of 740 records, 84 underwent full-text reading and six were included in the final analysis. All were observational studies from high-income countries. Cluster B disorders predominated, with more borderline diagnoses in women and antisocial diagnoses in men. Discussion: The Cluster B dichotomy may reflect not only phenomenological differences but also gender bias in diagnostic attribution, with female emotional dysregulation read as borderline and male conduct as antisocial, with repercussions for forensic assessment. Prior victimization, especially childhood sexual abuse, emerged as a distinctive factor in female trajectories. Conclusion: Beyond the diagnostic profile, the asymmetry of childhood victimization, women's greater social integration at the time of the offence and their more frequent prior contact with health services stand out, signalling missed windows for prevention. The absence of Brazilian comparative studies in the synthesis limits generalization and reinforces the urgency of national gender-comparative research and of approaches sensitive to trauma and socioeconomic context.