Psychopathy, Stress and Attachment

By Anne Brudevold, January 2015

Revised February 2016

Denne artikkelen er oversatt til svensk, og er en av fem kapitler i den nordiske antologiboken: "För vära barns bästa",  som kom ut på det svenske Nomen Förlag oktober 2016, der boken kan bestilles.



The Complexity of Psychopathy 
What is Psychopathy?
How is Psychopathy developed?
How is it that some of us become such a Monster?
Psychopathy and Attachment
Psychopathy is the most dangerous we have to deal with.
Stress in Women 
The Stress Mechanism 
What are the Lions that create Stress today? 
Stress can lead to many Illnesses and Disorders 
Stress is ruled by Fear 
Do Women have a lower Self-Esteem than Men? 
Women’s Distinctive Character. 
The Good Girl Syndrome 
Women give Birth 
Men’s Distinctive Character 
To value our Distinctive Character 
Children, Primary Caret akers and the Society 
How can we prevent Psychopathy, promote Empathy and obstruct Stress? 



The Complexity of Psychopathy

Psychopathy is the most dangerous we have to deal with. Why? Because the basic personality structure of the psychopaths is mean, and can lead to the most gruesome events in the world. Many wars have been started by psychopaths, and many of the criminals, murderers, terrorists, and rapists are psychopaths, likewise many dictators and leaders of totalitarian regimes. But psychopaths are dangerous also because they can hide this and behave and manipulate in the most subtle and disguised way in our everyday life, and ruin lives of their family, colleges, friends and everywhere in the society to get their way.

How is it possible to make such terrible acts? What are the reasons that create psychopathy? 

There is a complex of factors that operate together and influence the development of psychopathy, although at the end there is only one cause: the primary caretaker fails to put up goodenough boundaries when the child is about 12 to 18 months. It is the mother who mostly is the primary caretaker. Then it is of crucial importance to investigate what makes it difficult for women to raise their children with enough firmness and strength, together with understanding and care, so that they are able to put up good enough boundaries to create empathy. The way our society and the politicians want us to believe in gender equality between men and women, and how we form our lives accordingly, affect the frame of reference of how we manage to bring up our children. There are strong indications that women are more disposed for stress than men. Can this be a result of the society’s way of claiming gender equality between men and women?



What is Psychopathy?

Psychopathy consists of grandiosity, which means to perceive oneself as greater as and better than everyone else, and total lack of the ability of empathy, which means lack of the ability to feel and experience other’s feelings and situations. In addition to these two criteria, psychopaths also lack the abilities to moral, caring, closeness and love emotions and of moral learning, sensibility and self-insight.

The lack of ability to experience empathy is the cause of grandiosity, which means that psychopaths see themselves as the greatest of everyone, with the right to do, say and mean whatever they want, with no attention to whatever consequences that may bring to others. The lack of these abilities: empathy, moral, caring, closeness and love emotions, and of moral learning, self-insight and sensibility, lie permanently in the structure of their personality from they are around 18 months of age. That means that the nevrons, nerves and nerv synapses that provides these emtions, cannot be altered or canged after this age, exept for getting certain illnesses. This is the reason why psychopaths are the most dangerous persons we have to deal with.

Out of this structure we get the psychopathic personality traits. That is to be manipulative, lying, false, cold, lack of emotions, superficial, cynical, egoistic, perfidious, and aggressive, to mention the most commons. All psychopaths have these traits, but they can easily be disguised, as I soon shall come back to. First it is necessary to underline that many people that are NOT psychopaths also can have these personality traits and show such behavior. The difference is that these people are NOT grandiose, and they have them to a much lesser extent and occurance.

Many of us think that we easily can detect who is a psychopath. They are so terrible. But that is not always so. Psychopaths have many different ways in which they can appear. They are champions at pretending and show off. Without scruple they can portray to be the most charming, self-sacrificing, caring, devoted, generous, capable and lovable in the world, all that they genuinely are not, and cannot be. They can seem good, kind, modest, and nice, everything that is looked upon as worthy and valuable, but their true nature behind this mask is bad, mean, selfish, egoistic, and emotionally and mentally defective. Also when they for a long time have shown good behavior for some reason, they can suddenly turn to behave mean, ruthless, unscrupulous, criminal, violent, be rapist, do psychic terror, pester and exploitation. If someone behaves towards them in a way that they don’t like, many psychopaths can be very good at crying, and look as if they are very hurt. That is because they easily feel treated with unjust. Some also pretend that they are sorry, although all psychopaths never think that they are wrong. That is due to their grandiosity.

When we look at how the personality structure of the psychopaths is, how the psychopaths function and behave, it becomes obvious that they can be dangerous, not only to the people that they interact with in their daily life, but also in the society on all levels, and across borders to all nations. They can for instance often have positions as leaders in business and politics. Then their power can, as I have mentioned, lead to the most gruesome behavior, because they believe that they are above all rules and laws, and because they are without the ability of empathy of others. To have a brain, as I soon shall explain, that makes the person convinced that he or she is entitled to, and in their righ to get whatever they want in order to reach their goal, no matter the consequences of others, can lead to disaster. Some psychopaths, however, are so smart that they understand by their intellect that it can be unwise to behave ruthless, and can adjust their behavior to look quite nice, when they want.

How is Psychopathy developed?

How is it that some of us become such a monster? 

Nobody is born a psychopath, and there are no prove of genetic inherits. A baby cannot be empathic or mean, a baby IS. For a baby the existence is a question of survival, of getting care, food, of not being cold or hungry, but being well and secure. The baby shall by instinct get everything it needs. For the baby, the baby is, and shall be, the center of life.

Then the child approaches one year, and has become more conscious of his or her demands. The child needs to be socialized and learn that it is no longer appropriate to get all what it wants. The child must learn to take regard of other people, to be considerate, and treat others with dignity and respect. This process involves the new experience of frustration.This is what can lead to the development of empathy in the child.

Empathy means the ability to feel and experience the feelings of others. It is not to know or understand what others feel. That is an intellectual knowledge. The ability of empathy is developed through emotional experience, and not by being explained intellectually. 

Let’s go back to the baby at around one year. That is the time when the part of the brain that is the center for the ability to feel empathy, starts to develop. This part is situated in the Frontal Lobes of the brain and is called Orbito Frontal Cortex, which is the frontal nucleus of the Orbito Prefrontal Cortex nucleus. The Orbito Prefrontal Cortex nucleus consists of four nuclei, and all of them are essential in the development of relational feeling abilities. If the development of this frontal nucleus failes, the development of psychopathy takes place. As already mentioned, the Orbito Frontal Cortex, (OFC), is developed from about twelve to about eighteen months of age, as is the case for the whole Orbito Prefrontal Cortex. The primary caretaker’s interaction with the child must at this age be of a different kind than before. During these around six months, the primary caretaker must raise the child by putting up good-enough boundaries and limits, and learn the child about right and wrong in a caring and understanding way. The frustration the child then can experience is crucial for the development of Orbito Frontal Cortex, (Hart, Susan, 2006), and the rest of Orbito Prefrontal Cortex, because this frustration leads to the development of serotonin receptors in Orbito Frontal Cortex, necessary for the ability to feel empathy, and also for the development of the other three nuclei of Orbito Prefrontal Cortex, which I shall come back to.

If the primary caretaker accepts most of what the child does limitless, the child will remain in the experience of being the most important person in the world that shall have all its desires fulfilled. Investigations, including fMRI (functional magnetic resonance imaging) tests, which show lack of blood flow in the Orbito Frontal Cortex, indicate that psychopathy relates to lack of function in the Orbito Frontal Cortex, (Lapierre, D., et al., 1995, Hare, Robert D. and Babiak, Paul, 2006, Raine, Adrian and Yang, Yaling, 2006, Rogers, Robert D., 2006, Kiehl, Kent A., 2006, Gao, Yu, et al., 2009). If the Orbito Frontale Cortex failes to develop, the rest of Orbito Prefrontal Cortex also fail to develop, and the child becomes a psychopath. This means that psychopathy starts at about 1 ½ year of age!

Beside of being the center of empathy, Orbito Frontal Cortex is also the center of the self, (Hart, Susan, 2006). That means that psychopaths have no self, and are therefore not capable of self-insight. That is one of the reasons why it is not possible to do therapy with psychopaths. But there are therapists, family members, or others that think they have managed to change the difficult or psychopathic person. But what psychopaths are very good at, is to change behavior when they can profit from it. This is no genuin psychological change, but just a play for the gallery. And they can play very convincingly! Some scientists have found that to do therapy with people with Psychopathic Personality Disorder have no positive effect. On the contrary: it can make them more dangerous,  (Thornton, D. and Blud, L., 2007). In therapy they get more tools with which they can manipulate and exploit others, and they often convince the therapist, partner and other people that they understand their bad behaviour, and that they now have changed. That is for the partner and others even more dangerous, because many people believe that everyone has the capability to change, that evreybody is good at the bottom, which obviously is not true! The psychopaths are all mean at the bottom, they cannot feel remorse or bad consciousness, and psychopaths do not think there is any need for them to change as they feel grandiose, even if they say that they want to change.

Orbito Frontal Cortex is the center of love. The ability to love, of empathy, to repect and of selfreflection are one interdependent unity, and does not exist without the presence of all. Thus no psychopaths have the ability of love. empathy,respect or selfreflection, only the ability of pretending it.


Psychopathy and Attachment

Attachment means a good-enough secure bonding between the primal caretakers, mostly first the mother, and her child. The experience of security is the very core of attachment. Attachment is developed from about 3 months to about 10 months in a child’s first year, (Schore, Allan, 2003). Thereafter the attachment bonding must be consolidated during the following about eighth months until the child is about 1 ½ year, to become strong enough and not disrupted. Attachment is dependent of the primary caretaker’s presence both physically and psychologically in such a way so that the child can feel safe and secure. To obtain this security, the child and primary caretaker need a certain time with a certain quality together during these eighteen first months. It is thus about both quality and quantity. To promote the development of attachment, the primal caretaker must thus behave in a predictable and secure way.

The primal caretaker’s emotionally expressive face is the most potent visual stimulus in the baby’s environment. Especially the primal caretaker’s eyes lead the child to engage in intense mutual gaze. “The infant’s gaze, in return, reliably evokes the mother’s gaze, thereby acting as a potent interpersonal channel for the transmission of “reciprocal mutual influences””, (Schore, Allan, 2003). This is called affect synchrony, where the mother tunes and corrects the intensity and duration of her affective stimulation in order to maintain the child’s positive state, and as a result of this matching, both increase their degree of engagement together. Nonverbal affective signals like facial expressions, posture, tone of voice, physiological changes, tempo of movement, gestures and touch is crucial, likewise the primal caretaker’s ability to get “inside” the mind of the child. To obtain this, the primal caretaker must be attuned most of all to the child’s internal state more than to the overt behavior. 

“The key to this is the caregiver’s capacity to monitor and regulate her own affect, especially her negative affect. These regulatory processes are precursors of psychological attachment and its associated emotions,” (Schore, Allan, 2003). 

The primal caregiver’s emotional availability towards the child affects the development of the child’s right hemisphere in many ways. The child’s response to this in return also affects the growth of the primal caregiver’s right hemisphere. During this emotional attunement between the primal caregiver and the child about 40 000 cells of the grey matter in the brain are developed each day in both mother and child in the first year after birth, (Schore, Allan, 2014).We have seen that to develop attachment the child needs a specific interaction with a primal caretaker, which means that the primal caretaker must be one and the same. When attachment is obtained at about 10 months, as we have seen, the child still needs the primal caretaker the next 6 to 8 months to continue the child’s experience of security, and to consolidate the attachment into an attachment bonding. In this period the attachment is very vulnerable for disruption. If the child in this period is exposed to insecurity because of too long absence from the primal caretaker, the attachment can be disrupted, and the development of attachment bonding thereby missed. Because of the child’s vulnerability to disruption of attachment in this period, the primal caretaker must be present and available, and guide the child with care, respect and firmness when the child is frustrated. This leads to the release of the hormone trypthophan in Hypothalamus, and by that to the development of the serotonin nevrons in OFC, and  thus to the ability of empathy. The fulfillment of attachment is thus necessary for the development of empathy.

As we have seen, the development of Orbito Frontal Cortex leads to the ability of empathy and love, and thereby to the ability of attachment. This is also nesessary for the development of the other three nuclei of the Orbito Prefrontal Cortex. The nucleus Orbito Medial Prefrontal Cortex is involved in affective responses of events in the humans’ life, and is central of regulating interpersonal and social behavior, and in the general regulation of emotions, (Cozolino, Louis, 2006). Orbito Medial Prefrontal Cortex also has the function to correct responses as social conditions change. Lack of neurological development in this nucleus can lead to lack of relevant social behavior, and to dysfunction of self-regulation, (Schore, Allan, 2003). As the Lateral Prefrontal Cortex is involved in regulating interpersonal and social behavior, the Medial Prefrontal Cortex is the seat of the ability of social behavior. The nucleus Orbito Medial Prefrontal Cortex is also nvolved in the development of the ability of moral behavior. The Orbito Dorsal Prefrontal Cortex is the seat of the ability to care, closeness, and to grieve.

Failure of attachment can  lead to personality disturbances and disorders. It is the cause of lack of functions in Orbito Frontal Cortex, and by that the cause of lack of empathy, and thus the  cause of development of many personality disorders. But for Psychopathy and Narcissism the lack of attachment is NOT the cause, but lack of good enough borders put up for the child who HAS attachment, as we have seen. Then the attachment  is not going to be consolidated, and the child remains in the notion that he or she is entitled to always get what she/he wants, just like when he/she was a baby before 12 months. It is this unmature and  not consolidated attachment  from 12 to 18 months that are the cause of the grandiosity that is only present in psychopaths and narcissists.

Personality Disorders can be divided into four categories: Psychopathy, Narsissism, Dissocial Personality Disorder, and Antisocial Personality Disorder.

Dissocial Personality Disorder lacks attachment in the first year of life, in contrast to psychopats and narsissists. Different from psychopaths and narsissists there is no grandiosity. The reason for this is that because these children lack attachment when they reach about 10 months, they have a different emotional state at this age to meet their primary caretakers whith when it is put up boundaries. As attachment is a presupposition for the development of empathy, children that lack attacchment can not develop the ability of empathy, even if they get good enough boundaries between 12 and 18 months. Children who lack attachment cannot feel the typt of frustration nesessary for empathy to develop, but they rather feel anger and fear when they get good enough boundaries. They thus produce different transmittersubstances than those with attachment when they get boundaries. This affects the Orbito Frontal Cortex differently, and they develop the Dissocial Personality Disorder.This leads to lack of the ability of empathy, caring, morality and closeness, and thus lack of the ability of self-insight, closeness and love. They also are egoistic persons. The difference between Psychopathy and Dissosial Personality Disorder, is, as mentioned, that psychopaths are grandiose, wheras dissosial people are not, and dissocial persons have the ability to learn sosial skills.

Antisocial Personality Disorder  also develops when the child has not developed attachment in their first year of life. These children have not gotten good enough boundaries between 12 and 18 months, wich means that they are more or less allowed to get what they want. They also lack the ability of empathy, caring and morality, they also are not grandiose, but in constrast to Dissosial Personality Disorder, they have not the ability of social skills. They also lack the ability of self-insight, closeness,attachment and love.

Narcissistic Personality Disorder is functioning just like Psychopathy because of the same prosesses and reasons. Psychopaths and Narsissists have the same personality strukture, and the same symptoms and way of behaviour. This means that they are grandios, lack the ability of empathy, social learning, morality, caring, closeness, attachment, self-insight and love.They can be as evil and cruel! What is then the difference? The difference seems to be that narcissists in some very rare incidents, maybe never, can experience empathy, probably because a nucleus just behind Orbito Prefrontal Cortex, named Gyrus Cinguli, have become very well developed, and thus MAY, PERHAPS, be activated and transmit emotions directly from our sensorgans into conciousness in Cortex. This transmition of emotion(s) directly to Gyrus Cinguli WITHOUT input  first via Orbito Prefrontal Cortex, seems to be very, very rare, and might not happen at all during a whole lifetime.


So lack of attachment is NOT the cause of psychopathy. On the contrary: attachment is the PRESUPPOSITION for the development of psychopathy  -  as well as for empathy. “Sometimes the cruelest killers can come from loving homes,” (Cozolino, Louis, 2006). This can be difficult to understand as many people, also professionals, think that lack of attachment is a presupposition for the development of psychopathy. But it is on the contrary: attachment is a necessity for the possibility of psychopathy to develop, as we have seen. When a securely attached child who has been the center of the world continues to be the center of the world because of lack of socialition and bounderies from about 12 to 18 months of age, and is allowed to decide and rule its primary caretaker to the extend that too little frustration is obtained to consolidate the attachment. The child then remains in the illusion of being the center of the world, and the attachment obtained during the first year of life is disrupted. All the four nuclei of Orbito Prefrontal Cortex fails to develope, and all the corresponding emotional abilities are lacking.The attachment is lost, and empathy cannot develop.Then it becomes understandable that psychopaths behave in such incredible ways! That they may know intellectually what is right and wrong is for them subordinated their grandiosity and egoism.  


Psychopathy is the most dangerous we have to deal with.

You can never trust a psychopath. They can do anything for their own benefit, and many of us don’t want to believe that. Many people don’t want to believe that this is possible even after they have got strong proofs and evidences. They refuse to accept that psychopathy exists. The ideology that “there is something good in every person” can have disastrous consequences for the victims. The diagnosis of psychopathy was even said to be removed from the Diagnostic systems, but it luckily was not, even if the description of the diagnosis is lacking.

To prevent and avoid psychopathy we need to learn what psychopathy is. Then we can more easily learn to discover who is a psychopath and how to deprive them from their power. We must be aware and conscious about the existence of psychopathy, and how crucial it is to be realistic about that many people are fundamentally and genuinely bad.

Psychopaths can be very dangerous, especially for people who believe that everyone is good at the bottom, as just mentioned. They mean it is only a question of finding in to the psychopath’s good core, to break through what they call the shell of defense and fear, by being understandable, patient and good. But there is no shell, no hidden pain or vulnerability, nothing to find inside of warmth and genuine care and empathy. Some peoples’ naivety and credulity can make them particularly vulnerable to become trapped in the psychopaths’ evil net, and be exploited, misused and destroyed. The psychopaths’ seductive abilities can mislead many to believe they have met the most beautiful person in their life, until reality hits.

When we look at how psychopaths are, we understand that the people that they interact with, or have got into their net, can be seriously physically and psychologically hurt and damaged. The psychopaths’ skills to make one think and feel that one is incompetent, psychic dysfunctional, ill, weak and wrong, often lead to many personal tragedies. The tragedies often get worse because family, friends, colleagues and health personnel very often get convinced and seduced by the psychopaths’ charm, gift of speech, lies and twisting of reality. This is especially dangerous when psychopaths manipulate and brainwash children to get them on their side. Then these people often take the side of the psychopath and work against the victim. That can have terrible consequences for the victim, and of course for the children. There are many stories seen about that.

When we become able to recognize and understand how psychopaths function, we can see through their manipulations and lies. We can refuse to let them rule, decide and have power, and withdraw from them, or remove them from teir position. Consciously we can choose to have contact with people that we see have good and human values like genuine kindness, care, truth and respect, and thus prevent the psychopaths to create a destructive society. If we let psychopaths be in power for even a small time, this can be very difficult, and lead to suffering.


Stress in Women

Now, let us turn to the women in our society, and have a look at their situation, as women are far most often the primal caretaker of children. Women are the ones who are in a good position to help their children to develop a healthy, psychic state through the development AND consolidation of attachment leading to empathy, and therefore also to prevent the development of psychopathy.

The Norwegian Labor and Welfare Services, (2013), which we in Norway call NAV, publishes that the total amount of reported sicknesses for men in the first quarter of 2004 was 191 162, and for women 295 476.That is more than 100 000 more. In the first quarter of 2013 it was 200 841 for men, and 324 532 for women. Now the difference has increased to more than 120 000 in difference. The 5th of October 2014 professor in psychology Arnstein Mykletun tells to Norway’s biggest newspaper, Aftenposten, about his study that shows that women have more than 70% higher reported absence from work because of sickness than men. This article has resulted in many explanations and interpretations, but this seems clear:

Women have more pain than men. They have more tensions, muscle aching, headaches, problems with sleeping, depressions, anxieties, and many other illnesses. This is confirmed by The Norwegian Prescription Database from The Norwegian Institute of Public Health, ( 2014). Back in 2008, women used the double amount of anti-depressives, sedatives and sleeping drugs than men. Women also used clearly more painkillers than men. 

When we look at some typical stress related diagnosis, NAV’s statistic ( shows that reported sickness for intestinal disorders in the second quarter of 2005 was for men 10 554 and for women 12 960. The difference is 2 406. In 2014 the numbers for men in the second quarter were 13 150, and for women 17 616. Now the difference has increased to 3 566. 

The psychiatric problems like anxiety and depression within men was in second quarter 2008 measured to be 10 299, and for women 20 567. In 2014 the occurrence had decreased to 8 829 for men, but increased to 33 760 for women.  

How can we explain these differences?

There are investigations that show that women get more easily stressed than men, (, 2013), and there are consensus that stress can lead to many disorders and illnesses. How does stress affect women, and how can stress have an influence on women’s psyche and emotional state? To understand this, let us first have a look at the stress mechanism.


The Stress Mechanism

Stress is a mechanism of survival. When we are in danger, are threatened, or experience fear and anxiety, the body reacts with processes that make us more able and fit to react and act, (Brudevold, Anne, 2008).

This is a basic instinct to help us survive that was formed in the humans 10 000 years ago, and it is still the same. When we were threatened, for example b y a lion, other wild animals, or hostile tribes or enemies, the body immediately reacted to our feeling of fear exactly the same way as it does today. 

Deep in our instinctual brain we have a gland named Amygdala. Amygdala immediately reacts to threats with sending message to the center of the feelings and emotions in the brain, Hypothalamus, which quicker than the light can travel activates the Autonomous Nervous System, ANS. ANS is a part of the nervous system which is not ruled by our will. It consists of two parts with mostly opposite functions, the Parasympathetic and Sympathetic Nervous Systems. The Sympathetic system is activated by fear, insecurity and uncertainty, which leads to the stress response. The stress response leads to releasing the stress hormones adrenalin and cortisol from the adrenals. At the same time there is an inhibition of the Parasympathetic Nervous System, which leads to that many of the body’s processes that are not necessary for fight or flight more or less are put to wait. It refers especially to the digestion system and inhibition of digestion hormones from the Pancreas gland, the inhibition of metabolic hormones from the Thyroid gland, and to the inhibition of the production of some sex hormones and sexual pleasure. 

The stress hormones changes the body processes characteristically. Adrenalin and cortisol gives us a whole range of useful reactions for survival: 

The muscles tighten to prepare for fight or flight.

At the same time the breath is held. Fight or flight is chosen, or freeze is unconciously happening.

Then the bronchus expands and the breathing starts or eventuelly increases so that the blood gets more oxygen.

The heart beats faster and the blood pressure increases, so that the blood flows faster and can ensure a better supply of oxygen and other vital nourishments to the body.

The arteries to inner organs not necessary for fight, flight or freeze constrict to hinder unnecessary blood flow to ensure enough blood to vital organs for survival, for instance to the muscles.

The eye pupils dilate to enable the eyes to register the movements in the surroundings better.

The body secrets more sweat to cool the body down.

The liver releases more carbohydrates, and fatty acids are released from their stores, in order to increase energy.

The blood coagulates more easily in order to stop bleeding faster in case of injury.

Adrenalin also have a positive mental effect on our ability to survive. Adrenalin and cortisol increase our concentration, creativity, and our willingness to take risks we normally would not take.

All these reactions are the same in men and women.

10 000 years ago we could attack, run away, or maybe become concurred. The important point is that the stress situation only lasted for a certain time, and then it stopped! It was on and off! By nature, we got time for restitution. The Parasympathetic Nervous System was reactivated, and brought the body back to its balanced state and function.


What are the Lions that create Stress today?

In our society of today there can be “lions” everywhere, all the time! Many offers, choices and possibilities, so much we want to do, so much we want to try out, or that we feel we have to keep up with: activities, availabilities, and not to miss what seems important and fun. Many feel a pressure on how they shall act, look, behave and speak. All the outer circumstances, the whole range of the modern life, affect us physically and psychologically, and can make us overwhelmed by demands and claims and offers from both inside and outside ourself.


Stress can lead to many Illnesses and Disorders

This means that the stress reactions of today more or less continuously can be activated without the necessary time off for restitution. This can be of a great danger to us, and can lead to many illnesses and disorders, both physical and psychological, that we even may not be aware of are connected to stress. 

As already mentioned, tensions come first. The first thing we do when we are afraid, uncertain or nervous is to constrict in our stomach muscles and restrict our breath. By this, all the muscles in the body more or less get tensed. This can result in sore and aching muscles, first especially in shoulders, neck and arms, headache and back problems. 

Secondly, stress can lead to digestion problems like a LEAKY GUT SYNDROME, LGS, (hyper permeable small intestines), Irritable Bowel Syndrome, IBS, (lack of mucus in the small intestines and/or the stomach), constipation, diarrhea, both constipation and diarrhea, blown up, colic. 

Third, stress can lead to lowered immune system, problems with sleep, increased hart beat, increased blood pressure, paleness, shivering, periodical impotence, reduced sexual urge, muscle cramps, reduced energy or overspill, and problems with blood sugar, to mention a range.

Over time this can lead to diabetes 1 and 2, osteoporosis, heart attack, stroke in the brain, disorder of one’s metabolism, increase in weight, loss in weight, burned out syndrome, and much more!

In addition to all this, stress can lead to psychic reactions like anxiety, depression, dejection, effortlessness and irritability. 

One of the reasons why stress can lead to so many different illnesses, is that cortisol and adrenaline can lead to “holes” in the wall of the small intestine, what I just mentioned as LEAKY GUT, a hyper permeable wall between the small intestines and the blood vessels. The reason of this hyper permeability from stress is that cortisol can damage the cell membrane of the Parietal epithelial cells, and the desmosomes (“bridges”) between them, and that adrenaline can damage the cell membrane of the Main cells, and the tight junctions between them. That allows undigested food, and other unwanted and harmful matters and particles to enter into the bloodstream. These not biological matters can then adhere for example to proteinreceptors, and thus lead to many more disorders and illnesses than just mentioned, like Allergies, Autoimmune Diseases, Fatty Liver, Fibromyalgia, Multiple Sclerosis, Autiisme, Cancer, Parkinson's, Thyroiditis, (minocha, Anil, 2014, Pagano, John,O. A., 2008). To cure these disorders and illnesses therefore also includes the repair of the small intestinal wall, which means to eat food supplements that consist of the amino acids that build up and restores the cell membranes of the epithelial cells in the small intestinal wall, and the connections between them, (the desmosomes and the tight junctions).

There are, of course, also other reasons of a Leaky Gut, and probable even more common. Chemicals and poisons in food and medicin and elsewhere, and bugs and infections of microbes also weaken the wall of the small intestines.


Stress is ruled by Fear

We have seen that statistics show that more women than men are inclined to develop stress. How can we explain that? Then we need to look at what leads to stress.

Stress is ruled by fear, uncertainty, nervousness, and the feeling of insecurity. 

Uncertainty, nervousness and the feeling of insecurity can make us run away with compensating behaviors to keep unpleasant and hurtful feelings away that we don’t tolerate and don’t want.

What we are afraid of can be:

Fear of not being valued.

Fear of not being good enough.

Afraid of doing things the wrong way.

Afraid of getting a bad conscience (it is such an unbearable feeling!).

Afraid of being misunderstood.

Afraid of being perceived as bad and not nice.

Afraid of experiencing oneself as mean, inferior or incompetent.


This is the same for men and women.

But the women’s nature, her biology and physiology, her emotional situation and feelings, are more vulnerable for not being acknowledged than men. 

By “acknowledged” is meant to be approved for what you are, who you are, your values and nature.

To be able to understand why women’s nature is more vulnerable than men’s, let us look more into stress. We know that the stress reaction starts with fear and anxiety, and we have just seen what we can be afraid of in our society of today. The need of being unassailable to avoid to be criticized and to get negative reactions, can lead to a stressful behavior and lifestyle in order to prevent painful feelings of not being valued, not good enough, wrong, having bad conscious, being misunderstood, bad and not nice, mean, inferior and incompetent. 

At the very core of all these fairs lays LOW SELF-ESTEEM.

Underlying stress is fear of experiencing one’s low self-esteem.

By DOING, stress can cover the experience of low self- esteem and low self-reliance by trying to be perfect, have control, please, and to be altruistic. Then the low self-esteem can be put away, “forgotten”, and hidden in the unconscious.

Why do we fear the feeling of being unworthy, no good, and not acknowledged by others? 

Because of the threat to be rejected, expelled and pushed out of the group. 

That means death.

This is the base of our fairs. This is our basic instinct. This is what amygdala is to warn about, all the time from the creation of humans, an up to today.


Do Women have a lower Self-Esteem than Men?

When lack of self-esteem and the threat of death are at the core of stress, and investigations show that women are more disposed of stress than men (, 2013), does that mean that women in our days have a lower self-esteem, and feel more threatened in their core, than men?

To be able to answer that question, we have to look at what is forming self-esteem. 

It is of course many different circumstances that form a human’s self-esteem, like the genes, personalities of the parents, the quality of the upbringing, friends, family, and other surroundings. But the body’s biology and physiology play a major role in all these conditions.  The same is the case with identity. Biology and identity are strongly woven together, and crucial for the creation of self-esteem. A good self- esteem is not possible without the experience of identity, and how stronger the identity, the better the self-esteem can be. A strong identity is created when we are living according to our biology, mind, body and emotions. That means, when biology, mind, body and emotions are in tune and are being respected as an interconnected hole, it forms a secure self-esteem and a deep sense of value.  


Women’s Distinctive Character.

To understand stress and women, it then follows that we need to find out what the distinctive character of women is. 

First of all it is her sexual receptivity, which means her ability to receive, to take in and hold, and to be attached. 

Secondly, it is her ability to care, attend, and to be trustful.

Third, it is the women’s ability to be attached and dedicated to home. 

All these distinctive abilities are deeply rooted in her body and her biology, and are strongly imprinted in her genes, mind and emotions. It is the women's genes, and thereby hormones, that are the reason for her distinctive abilities and character:

Women have about the double of glands producing the hormone oxytocin, and about three times as many nerve receptors for oxytocin, than men. This hormone provides the ability of care and receptivity. Oxytocin also enhances emotional bonding, (Zac, Paul J., 2012). Oxytocin is specifically important in bonding from both the mother to her child and from the child to the mother. When a woman is breast feeding, the release of oxytocin increases, which enhances mother’s maternal behavior and care for her baby, (Bartels, Andreas and Zeki, Semir, 2004, Douglas, Alison J., 2010). This maternal behavior and care for the child consists also of urge for eye contact, cuddling, stroking and to communicate in baby language with the child, (Palm, Linda Folden, 2013).The mother's milk contains oxytocin, which enhance the baby's bondingability.

Not-pregnant women have more than three times as many glands producing the milk hormone prolactin than men, which also counts for maternal behavior. Prolactin is especially central in maternal nest building. The hormone also provides women’s inclination of wanting to have babies, (Zarrow, M. X., Gandelman, R., and Deneberg, V. H., 1971).

Women have much more estrogen than men. Even low estrogen in women is more than in any man, (Nardi, Dario, 2003). This hormone is vital for the women’s attachment and dedication to their home. Dr. Miriam J Law Smith, clinical psychologist, et al., (2012), hold that maternal tendencies are related to physical feminization, and that this effect may, at least in part, reflect the impact of the hormone estrogen.

In addition to the great difference of amount of these hormones in men and women, the placing of these glands and their receptors in the brain is different in men and women. This means that the glands get different types of stimulations in the sexes, which gives a different way of response to the same hormone in men and women.


The Good Girl Syndrome

Have you heard about The Good Girl Syndrome? Women who cannot say no, and always want to be nice, able and good? The Good Girl Syndrome leads to much workings and doings, which The Good Girls often see as their duties. The urge of being Good has its root in an unbalance between women's sexual hormones and their way of life, creating insecurity and low self-esteem. But low self-esteem cannot be worked away, as we have seen, but remains in the mind. More doings are then often needed, and stress is a fact.

The gender hormones are fundamental building blocks in hunans' self-esteem. When the family, friends, colleagues and society are not giving these distinctive characteristics acknowledgement and resonance, and humans are more or less ignored for who they are, not enough valued, considered or recognized for these qualities, they can feel bad, wrong and not good enough. 

Because women are more vulnerable than men due to their sexual hormone constellations, they can more easily feel sad and sorry if they are not respected and are being ignored, than men. 

Stress, as we have seen, leads to the release of the stress hormones adrenalin and cortisol. When the amount of cortisol in the body increases, the amount of oxytocin in the body decreases, (Stoller, Kenneth P., 2012). Increase of cortisol also leads to a disturbance in progesterone producing cells, which result in a decrease of the body’s amount of estrogen, (, 2014). 

When the women’s distinctive character is not respected, emptiness and alienation arise. Emptiness and alienation are fundamental parts of low self-esteem. 

As we have seen, psychological stress always includes low self-esteem, but we are seldom aware of it. By DOING we want to “prove” how good and able we are, and thus move away from the threat and pain of experiencing low self-esteem. 

It is possible to suffer from low self-esteem and develop other reactions and symptoms in addition to stress.This is what The Good Girl Syndrome is about. Being The Good Girl covers up the pain of low self-esteem.


Women give Birth

Women are made to give birth. Already from the conception the mother’s and baby’s bodies start to connect in a biologically unity. Throughout the 9 months of normal pregnancy, great changes take place in the women’s body, as well as in her mental state. Normally almost everything is concerning the coming birth and arrival of the baby. The specific biology of women’s body and mind are in every way created and designed to take care of the newborn, and to bring it up. There is plenty of evidence to suggest that nature has in most cases given the mother special skills and a distinct biological role when it comes to giving birth and to care for her child. Investigations of the feminine gender hormones give prove of that, (Jaak Panksepp, 1998, Susan Hart, 2006, Dahlström, Annica, 2007). 

Of course, there is no doubt that many men are competent and loving caregivers. Some men also prove themselves to be able to take better care of small children than some women are able to do, or willing to do. Therefore it is important to underline that there are variations and overlap between the sexes, as well as within the sexes.

Nevertheless, we see that women biologically, anatomically and emotionally far more often are in a better position to take care of small children. Bonds are also created between mother and baby through mother’s voice, heartbeat and smell during prednancy, as we have seen. This bond is important for giving the child security as a good start for developing attachment.

What is also important is that for women the same bond is essential for her inner self-esteem, security and level of stress, (Schore, Allan, 2008, Cozolino, Louis, 2006). This means that if the woman has to part from her child too early too long, even if the child is very well taken care of otherwise, her body, mind and emotions can react with insecurity and stress.  


Men’s Distinctive Character

Because men have different gender hormones than women, they have a different distinctive character than women. The gender hormones in men create another emotional situation and state of mind than the female gender hormones.

Men have about five times as much testosterone as women. Testosterone creates the characteristics of boldness, exploration and ability to fight for a prey. Testosterone also leads to less naivety, (Bos, Peter A., Terburg, David, and van Honk, Jack, 2010). Androgens are male hormones, but are normally also created in small amounts in women. Androgens create the men’s instinct of wanting to win. The female gender hormone prolactin also creates the instinct of wanting to win, but that is mostly when the woman needs to protect her children. Men have about three times the amount of the gender hormone estradiol than women. Estradiol creates the ability to be extrovert. 

As we have seen, the same types of glands have different positions in the brain in men and women, and thus lead to different types of reactions, (Lasley, Elizabeth Northon and McEwen, Bruce S., 2005).

When we look at what hormones there are more of in men and in women, we see that men by their biology have a greater instinct to be bold, explorative, eager to win, and extrovert than women. Women on their side have by their biology a greater instinct to care, to be receptive, and to be attached and dedicated to home, and have a distinctive character specifically favorable in taking care of children, (Pankseep, Jaak, 1998). 

But the father is also important to their child, and the presence of the father also has impact on the development of the child’s brain, (Schore, Allan, 2014). Whereas the mother and her way of interaction with the child from birth and the first years in the child’s life is important for the development of the child’s right side of the brain, the father’s way of interaction with the child is also important for the child from birth, but in a different way, and is crucial for the development of the child’s left side of the brain. 


To value our Distinct Character

10 000 years ago, the societies were formed in tune with what the nature allowed, and in interplay with the biology and physiology. Today societies are more and more formed without regard to the biology and physiology, and what is natural for us.

If we want to lower the stress reactions in women, women must start to explore, discover and experience their distinct character, their receptivity, caring and holding, and their caring for home. The women can, independent of others, learn by themselves to value and respect who they are as women. Then they can create a good self-esteem, and can show the world around them their pride of womanhood. Because of women’s biological nature, and thus the unique role they can play in caring, attachment, bonding and in bringing up both boys and girls in their first critical years, they have a unique chance to create and transform a society into a society based on worth, respect and good self-esteem. 

Women’s and men’s distinctive character and nature can explain why women are more disposed to stress than men in our Scandinavian society. The human being has a biological supposition to the context in which she and he are living. From that context it raises clear and distinct reactions in the human beings as an answer to the effect of the milieu in which they are living on the body and mind. These effects are naturally formed by the unique and hereditary properties of both men and women. All biological and psychological functions are influenced and affected by the society as a hole. The balance of the gender hormones is dependent of the way we live our life, (Larsen, Arvin, 2001). Health and wellbeing are therefore dependent of that we consciously choose to create a society and a living that are in harmony with our biology, mind and emotions.  

When we look at men’s distinctive character, we have seen that men have a different psychology than women. Their character is more in accordance with the form and expectations of the Scandinavian society of today, a society much based on being extravert and successful in a winning culture. Men can therefore more easily feel valued and develop a good self-esteem than women. Even if a woman is successful based on the same values which are characteristic for men, she all the same often lack self-esteem, and can react with becoming more “perfect”, and thus more stressed and more ill. 

When women realize that these characteristics are more distinct for men, they can relieve themselves of the pressure to perform and behave like them, and build up their self-esteem in their own specific way.  

Exactly the same is the case for men. There are indications that show that it is also difficult to be men in our society. The claim of being tough can often be stronger than what feels right. That is why both men and women need to become conscious about their true character, inner being and worth, and its concequensis.

Because our society is moving away from women’s biology and what creates their identity, what is much less the case for men, women suffer more often from low self-esteem than men. Awareness about what we mean by equality between men and women and how we practice it is therefore of the greatest importance.

The modern society as we know it in Norway and in many other Western countries today, are clearly wanting us to believe that men and women are equal also when it comes to the biological qualifications. The ideology of today that says that the women‘s and men’s biology is secondary, and that they can transcend it into human beings with common abilities and preferences, obviously can be harmful especially to women, and create depression and anxiety.  

Then they risk to become more and more unconscious of their deepest natural truth, and instead compensate with other behavior and skills that the society values more.

When women allow themselves to be Women, and men allow themselves to be Men, instead of adopting the political correct ideology of our society of today, we can all become more satisfied and healthy.

Men and women are alike in some ways, but different in many more ways. Thus we are complementary, and can supplement each other in a beautiful way. Thus men and women can respect and enjoy their uniqueness to the advantage of both men and women, as well as respecting and enjoying their sameness because men and women have the same worth.

Then both men and women can feel secure, respected and valued, and develop their unique identity and a good self-esteem. 

This is at the core of being a satisfied individual, a good parent and a good primal caretaker, and to have the ability to create well-functioning children. 


Children, Primary Caretakers and the Society

Science shows us how crucial and important especially a child’s first 1 ½ year is to secure a normal development in the brain's Orbito Prefrontal Cortex, and by that give our children a good fundament to deal with the challenges of the social and relational life. This knowledge must be our guidance in how we take care of our children especially in this period. This insight has always to be in our minds when we are to take decisions concerning our children: the child and the primal caretaker must be granted enough time together. 

In Norway the ideology of equality between genders has led to that men and women have the same possibilities. To have the same possibilities means for many people, and for most politicians, that men and women equally shall choose study, occupation and work without regarding gender. It often looks like there is not going to exist such a thing as gender differences and preferences. Of course it is of immense value that there no more exists limits for what education and work men and women can chose, but it seems to have been put forward a new paradigm that tells us that men and women are alike to the extend of the more untraditionally the better, and then they can be valued more.

It has been necessary to focus on the fact that many men in the past have been too little present for their children and family, but this is now done in a way that often separates mothers (primal caretakers) for a too long time from their children at a too early age.

Norway has many favorable welfare arrangements for parents. One of them is the parental benefit. The purpose of parental benefit is to ensure income for parents in connection with the birth of a child. The rules are flexible, and can be received in various graduated ways before the child is 3 years of age. The parents can choose between receiving 100% of the basic money coverage, which means 49 weeks leave from work, or choose 80%, which means 59 weeks leave. The basic money coverage is 100 % of the income with a roof of 530 220 Norwegian crowns.

The first 6 weeks after birth are reserved the mother.

Then both parents have been reserved 10 weeks each after birth, which cannot be transferred to the other parent.  26 weeks of parental benefit are additionally of free choice for the mother or father.  

This means that the mother can only take 36 weeks of leave from work with 100% coverage to be 100 % together with her child after birth. As we have seen, the mother is more often the primal caretaker. This means that the mother can be forced back to work long before the child’s development of attachment at around 10 months is finished, and before the consolidation of the attachment bonding and development of empathy has started, if her economic situation his dependent of her income. In some cases the mother can be forced back to work, or choose to work, already from the child is 6 weeks of age.

There  is no doubt that the parental benefit is of great help to parents the first 46 weeks after birth, and is better than it ever has been. What is worrying is that the paternal quota can result in that the mother leaves her child already after 6 weeks to work full time for a shorter or longer time. That can lead to a harmful loss in the development of the child's development. 

It is also worrying that parents let their children start in kindergarten full time at one year. That means great loss of contact with the primal caretaker and the possibility to feel safe and secure as the child has to relate to many unknown people in an unknown place. This can lead to a broken attachment process, and thus to lack of attachment. At one year the child is just about to learn walking, and still has little language to make itself understood, and therefor needs a familiar and secure hand to feel safe and to finish the attachment process. Anxiety and stress can be the result. 

The law grants every child in Norway the right to a place in kindergarten from they are 1 year, but if parents don’t want to send their child to kindergarten, they can choose cash-for-care benefit for the child between 1 and 2 years. The amount of money received for one child is 6000 Norwegian crowns per month for maximum 11 months. If the child is in kindergarten 20 hours or less per week, it qualifies for 50% of the support. 

This is of course of great help for some families who find that to send their children to kindergarten at 1 year of age is too early. For most families, however, this is too little money to allow the mother to stay home from work to take care of their child.

We have learned how crucial and vital the good enough and long enough connection between mother and child is at the beginning of life. By forcing the primal caretaker and her child to separate before the child is 1 ½ years, can damage people and societies fundamentally and deeply.


How can we prevent Psychopathy, promote Empathy and obstruct Stress?

First of all we need to become aware of how attachment is built in our children, and live according to that. Then we need to learn about psychopathy. We need to learn about how it is developed, and how it functions. That can make us more aware and more conscious of how we behave as parents when our children start to get more conscious about their will and desires. The primal caretaker needs to understand the importance of putting up good enough boundaries in a loving way as prevention against the development of psychopathy, and a guaranty for the development of the ability of empathy and optimal function in OPFC. For this to be possible, the primary caretaker already must, as we have seen, have provided attachment by caring for the child in a warm and attuned way from birth.

We are now aware that the cause of psychopathy is the lack of putting up good enough limits and boundaries so that the child can learn that it no longer is the center of the world, but has to take account of others, and treat them with respect and equal value. The frustration caused by the limits and restrictions often creates crying, screaming and anger in the child, and the child shows in many ways that it is displeased, disappointed, and that it dislikes the primary caretaker in such situations. If the primal caretaker is a person with low self-esteem, the chance is strong that he or she cannot tolerate the child’s dissatisfaction, and can too often let the child get its will. This is because a screaming and dissatisfactory child can provoke the feeling of being a bad, worthless and incompetent primal caretaker, which can lead to inner pain and fear of rejection. 

When we have acquired knowledge of how psychopathy is developed, we can more easily detect when we our self, or someone else, are reluctant, unwilling or uncomfortable in putting up good enough boundaries. Then the primal caretaker can more easily ask for help, or we can more easily help the primal caretaker in developing inner strength and self- esteem so that he or she can bring up the child in a good enough way.

To have the inner strength and security, and to be sure of being good enough and confident of one’s values as a primal caretaker, is a presupposition to be able to stand the child’s screaming and dissatisfaction and to keep up the limit and boundary with a caring guidance. 

To prevent psychopathy, promote empathy and obstruct stress, politicians and the society as a whole need to become aware and conscious of the women’s inner, natural qualities, and act in accordance with this insight. This must result in reactions from the politicians so they can promote attitudes and make rules and laws that secure the primal caretakers and their family good and necessary conditions in which they can raise their children to the best for the child, the family, and the society as a whole.



Aftenposten Ruud, Solveig Elsket og omstridt i 15 år. (Loved and disputed in 15 years.) Aftenposten, Oslo, Wednesday 11th of December, (2013). 

Babiak, Paul and Hare, Robert, D. Snakes in Suits. When Psychopaths go to work. Harper Collins Publishers Inc. , New York, (2006).

Bartels, Andreas and Zeki, Semir  The Neural Correlates of Maternal and Romantic Love. NeuroImage, volume 21, Issue 3, march 2004, pages     1155-1166.

Bos, Peter, Terburg, David, van Honk, Jack  Testosterone decreases trust in socially naïve humans. Proc. Natl Acad. Sci. 107, 9991-9995, (2010).

Brudevold, Anne Stress and the little relaxation moment. Org. title: Stress og det lille øyeblikks avspenning, Bazar Forlag, Oslo, (2008).

Brudevold, Anne Psychopaths Among Us. Org. title: Psykopatene blant oss. Anne Brudevold Forlag, Oslo, (2011).

Cozolino, Louis  The Neuroscience og Human Relationship.Attachment and the Developing Brain. W. W. Norton & Company Inc., New York, (2006).

Dahlström, Annica  Könet sitter i hjärnan, (Gender is in the Brain). Corpus Gullers, Göteborg, (2007). Stressende kjønnsforskjeller, (Stressing sex differenses), (2013).

Goa, Yu, Glenn, Andrea, Schug, Robert A., Yang, Yaling, Raine, Adrian
The neurobiology of psychopathy: A neurodevelopmental perspective. Canadian Journal of Psychiatry, 54(12), 813-823. 

Hart, Susan. Betydningen av samhørighet. Om neuroaffektiv udviklingspsykologi, (The importance of solidarity. About neuroaffective developmental psychology). Hans   Reitzels Forlag, København, (2006).

Kiehl, Kent A. et al.  A Cognitive neuroscience perspective on psychopathy: Evidence for paralimbic system dysfunction. Psychiatry Research 142, 107 – 128, (2006).

Lapierre, D., Braun CM., Hodgins S  Ventral frontal deficits in psychopathy: neuropsychological test findings. Neuropsychologica, Feb., 33(2): 139-51, (1995).

Larsen, Alvin Livets hormoner. En bog om psykologien bag de livgivende hormoner, samt deres betydning for helbredet (Life’s hormones. A book on the psychology behind life-giving hormones and their importance to health).  Holistisk Forlag, Danmark, (2001).

Lasley, Elizabeth Norton and McEwen, Bruce S. The End of Sex as We Know It. The Dana Foundation, (2005).

Minocha, Anil. Is It Leaky Gut or Leaky Gut Syndrome? LOGOS Enterprise LLC, Shreveport, LA 71115, USA, (2014).

Nadi, Dario  Hormones, Sex and Personality Type, (2013). Liv Haaker Tierdness of the Adrenal Glands (Org. title: Binyretretthe), (2014)

Palmer, Linda Folden Nursing: It’s More than Breastfeeding, and Every Mother Can Do It, (2013).

Pagano, John O. A., One Cause, Many Ailments. Leaky Gut Syndrome, What it is and How It May Affect Your Health. A.R.E. Press, Virginia Beach, Virginia, (2008).

Panksepp, Jaak  Affective Neuroscience. The Foundation of Human and Animal Emotions. Oxford University Press, New York, (2005).

Raine, Adrian and Yang, Yaling  The Neuroanatomical basis of Psychopathy. A Review of Brain Imaging Finding. In Patrick, Christopfer J., edited: Handbook of Psychopathy, The Guilford Press, New York, (2006).

Robert, Rogers The Functional Architectureog the Frontal Lobes:Implicatons for Research with Psychopathic Offenders. In Patrich, Christopher J., edited: Handbook of Psychopathy, The Guilford Press, New York, (2006).

Schore, Allan Affect regulation and the Repaire of the Self. W.W. Norton & Company, New York, London, (2003).

Schore, Allan Lecture in Oslo, 28.09.2014

Schore, Allan Affektregulering og personlighetsdannelse, (Regulation of affect and creation of personality). In: Susan Hart & Rikke Schwartz  Fra Interaktion til Relation, (From interaction to relation). Hans Reitzels Forlag, København, (2008).

Smith, Miriam J. Law et al. Maternal tendencies in women are associated with estrogen levels and facial femininity, (2011).

Stoller, Kenneth Paul  Cortisol vs. Oxytocin, (2011), Article from the book: How a hormone saved me and what it can do for you. Google seeking: Cortisol vs.oxytocin, (2014).

The Norwegian Institute of Public Health (2013).

The Norwegian Labor and Welfare Service Samfunn, statistikk, sykefravær, (02.11.2014).

Zac, Paul J. The Moral Molecule. Transworld Publishers, London, (2012).

Zarrow, M. X., Gandelman, R. and Deneberg, V. H. Prolactine: Is it an Essential Hormone in Mammals? (2004).