Sex Differences in Anxiety Disorders
Fear and anxiety are a part of life. Whether it be due to an important exam, walking alone at night, or an upcoming job interview, anxiety has its place in life. For many, anxiety is a useful tool that can keep them alert and help them be prepared in stressful or even dangerous situations. However, anxiety can also be a debilitating issue for those with anxiety disorders. According to the Anxiety and Depression Association of America (n.d), anxiety disorders are the most common mental health illness, impacting about 40 million or 18% of adults in the United States. Anxiety disorders have a large and lasting impact on one’s life, although they can affect men and women’s life quite differently, not only in their prevalence, but also in their symptom patterns, comorbidity, and treatment.
Anxiety disorders, defined as a group of disorders that are characterized by fear and anxiety, consist of disorders such as generalized anxiety disorder (GAD), panic disorder (PD), social anxiety disorder (SAD), post traumatic stress disorder (PTSD), and more. As reported by Carmen McLean, Anu Asnaani, Brett Litz, and Stefan Hofmann (2012) one in three women meet the criteria for an anxiety disorder during her lifetime. On the other hand, only 19.2% of men meet the criteria. After taking data from CPES and numerous other national surveys regarding mental health, they were able to calculate that the prevalence rates of PD, agoraphobia, social anxiety disorder, specific phobia, and PTSD were higher in women than in men (McLean, Asnaani, Litz, & Hofmann, 2012). With the exception of SAD, which revealed no gender difference in regards to prevalence, it was found that women are more vulnerable to the majority anxiety disorders.
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Symptoms also manifest differently in women than they do in men. According to Margaret Altemus, Nilofar Sarvaiya, and C. Epperson (2014), women reported substantially differing symptoms and severity for the majority of anxiety disorders. For GAD, which is characterized by constant, nonspecific, and irrational anxiety, it was reported that women more frequently described somatic discomfort than men did. This somatic discomfort included muscle tension, fatigue, and cardiorespiratory, autonomic, and gastrointestinal symptoms. Unlike women, men with GAD reported more strained relationships with their friends and family due to their excessive anxiety (Altemus et al., 2014).
These kinds of differences were also found in other anxiety disorders. For obsessive compulsive disorder (OCD), women were more likely to have cleaning compulsions and obsessions regarding checking and harming others while men with OCD were reported to have more social phobia (Altemus, Sarvaiya, & Epperson, 2016). Katherine Shear, Marylene Cloitre, Daniel Pine, and Jerilyn Ross (2005) from the Anxiety Disorders Association of America (ADAA) found that women with PTSD present symptoms of numbing and avoidance while men tend to display irritability and difficulties with impulse control.
Research on panic disorder also showed a notable difference in symptoms between the sexes. Jalnapurkar, Allen, and Pigott (2018) stated that women suffer more from individual panic symptoms and show significantly higher levels of phobic avoidance when compared to men. Not only that, but women with PD are notably more dependent on family members in fearful situations and have more panic attacks that are triggered by taking public transportation or leaving home alone. Men are more likely to worry about their physical appearance and potential consequences due to having a panic attack (Jalnapurkar, Allen, & Pigott, 2018). They are more often concerned with the social consequences of anxiety while women fear the physical symptoms of panic. One explanation for this difference is that women often receive positive reinforcement when conveying concern about their symptoms, which promotes self focused attention and may lead to more perceived physical discomfort (Altemus et al., 2014).
Furthermore, Eaton et al., (2012) discovered that women with anxiety disorders tend to internalize emotion more than men, often resulting in withdrawal and loneliness. Contrastingly, men frequently externalized emotions, leading to aggressive, coercive, impulsive, and noncompliant behavior. This conclusion coincides with research that states women ruminate more frequently than men and continually focus on their negative emotions and problems instead of taking part in active problem solving.
Comorbidity, the simultaneous occurrence of two or more illnesses or conditions in the same person, also plays a large part in anxiety disorders and their symptoms. Taking results from the National Comorbidity Survey, the National Institute of Mental Health, and the Collaborative Psychiatric Epidemiology Studies, Jalnapurkar et al.(2018) realized that anxiety disorders are often associated with multiple comorbid diagnoses, especially mood disorders such as major depressive disorder (MDD). Each anxiety disorder has differing risks of developing comorbid disorders. For instance, about 90 percent of individuals with GAD have comorbid conditions, with mood disorders, PD, and SAD being the most common among them (Jalnapurkar et al., 2018). Those with SAD have an incredibly high risk of developing dysthymia, bipolar disorder, and MDD. The presence of PD also increase the chance of developing multiple condition such as phobias, GAD, OCD, PTSD, and mood disorders.
Along with symptom higher severity, women also tend to have more comorbid conditions than men. Women with a lifetime diagnosis of an anxiety disorder are more likely than men to be diagnosed with another anxiety disorder, bulimia nervosa, and major depressive disorder (Mclean et al., 2012). For example, panic disorder in women tends to be associated with increased rates of significant comorbidity, such as GAD, agoraphobia, and somatization disorder (Shear et al., 2005). Research has also found that hormone fluctuations in progesterone and estrogen throughout the lifespan during the phases of the menstrual cycle can have a large impact on the course and severity of anxiety disorders in women. Hormones during pregnancy, the postpartum period, and menopause also influence this (Jalnapurkar et al., 2018). Meanwhile, illnesses such as substance use disorders, attention deficit hyperactivity disorder, and intermittent explosive disorder are comorbid conditions that tend to be more present in men.
In regards to the treatment of anxiety disorders, research by Wang et al.,(2005) observed that women had significantly more visits to the ER, urgent care, and doctors than men and non-anxious women. However, men and women missed a similar amount of work during a one month period and were also equally likely to visit a professional for emotional/substance abuse issues. The lower rate of treatment among men can possibly explained by greater perceived stigma and women’s abilities to decipher nonspecific feelings of distress as having a mental health problem (Wang et al., 2005).
Despite women being more likely to seek health care support from professional, they were less likely than men to receive adequate mental health services (Wang et al., 2005). This may be caused by primary care physicians being more willing to treat women. Instead of treating men, primary care physicians often tend to refer men to a specialist (Wang et al., 2005). Because of this, men have a much higher chance of receiving adequate mental health treatment than women do. This may contribute to the large number of women that remain untreated and undiagnosed, which can have unintended consequences on the no only the women themselves but their families and friends as well.
Additionally, women face more barriers to treatment. Because women take on the majority of housework and child rearing responsibilities, they might face difficulties when seeking mental health support or therapy if childcare is not affordable or available to them (Shear et al., 2005). Some anxiety symptoms might not even be recognizable or accepted in women due to specific gender role expectations, which often normalize symptoms of fear, shyness, or worrying. Other factors that become barriers to treatment may include the cost of therapy, the stigma that is associated with a psychiatric diagnosis, a lack of mental health care insurance, and unavailable or inaccessible healthcare services (Shear et al., 2005).
The burden that women face when diagnosed with a anxiety disorder is not just limited to them. With the role of primary caregiver, the costs of untreated and unrecognized anxiety disorders in women can reach far beyond the individual diagnosed, but also to their significant others, children, and extended family in ways that may not happen for men (Shear et al., 2005). Anxiety disorders in any family member can cause family dysfunction and severely hinder one’s life. It can put a definite strain on all relationships and cause stress and worry for everyone involved if they do not have correct mean of coping and communication.
Overall, anxiety disorders have a great influence on one’s life. For each condition, symptoms between the sexes can greatly differ and manifest in various ways. Men tended to be more affected by the social consequences of their disorders while women focus on physical symptoms. Comorbidity also varied according to the illness and the sex of the person. Men had more comorbid conditions such as substance use disorders while women’s comorbid conditions were often other anxiety disorders. Although the majority of disorders are significantly more prevalent in women than in men, women face a lot more barriers in regards to treatment. Despite women seeking more mental health services than men, they were less likely to receive adequate care and the burden that anxiety disorders place on women can have bigger consequences on the lives of those around them.
- Altemus, M., Sarvaiya, N., & Epperson, C. (2014). Review: Sex differences in anxiety and depression clinical perspectives. Frontiers in Neuroendocrinology, 35, 320??“330. https://doi.org/10.1016/j.yfrne.2014.05.004
- Mclean, C. P., Asnaani, A., Litz, B. T., & Hofmann, S. G. (2011). Gender differences in anxiety disorders: Prevalence, course of illness, comorbidity and burden of illness. Journal of Psychiatric Research, (8), 1027. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3135672/
- Wang PS, Lane M, Olfson M, Pincus HA, Wells KB, Kessler RC. (2005) Twelve-month use of mental health services in the united states: Results from the national comorbidity survey replication. Archives of General Psychiatry. Retrieved from https://www.ncbi.nlm.nih.gov/pubmed/15939840
- Jalnapurkar, I., & Allen, M., & Pigott, T. (2018). Sex differences in anxiety disorders: A Review. Retrieved from https://www.researchgate.net/publication/323847924_Sex_Differences_in_Anxiety_Disorders_A_Review
- Shear, M., Cloitre, M., Pine, D., & Ross, J. (2005) Anxiety disorders in women: Setting a research agenda. Anxiety Disorders Association of America. Retrieved from https://adaa.org/sites/default/files/ADAA_Womens_R1.pdf.
- Eaton, N. R., Keyes, K. M., Krueger, R. F., Balsis, S., Skodol, A. E., Markon, K. E., … Hasin, D. S. (2012). An invariant dimensional liability model of gender differences in mental disorder prevalence: Evidence from a national sample. Journal of Abnormal Psychology, 121(1), 282??“288. https://doi-org.libez.lib.georgiasouthern.edu/10.1037/a0024780
- Anxiety and Depression Association of America.(N.d) Facts and statistics. Retrieved from https://adaa.org/about-adaa/press-room/facts-statistics