Mental disorders and gender

Gender is correlated with the prevalence of certain mental disorders

Gender is correlated with the prevalence of certain mental disorders, including depression, anxiety and somatic complaints. For example, women are more likely to be diagnosed with major depression, while men are more likely to be diagnosed with substance abuse and antisocial personality disorder. Men are at risk to suffer from post traumatic stress disorder (PTSD) due to past violent experiences such as accidents, wars and witnessing death, and women are diagnosed with PTSD at higher rates due to experiences with sexual assault, rape and child sexual abuse. Nonbinary or genderqueer identification describes people who do not identify as either male or female. People who identify as nonbinary or gender queer show increased risk for depression, anxiety and post traumatic stress disorder. People who identify as transgender demonstrate increased risk for depression, anxiety, and post traumatic stress disorder. Sigmund Freud postulated that women were more prone to neurosis because they experienced aggression towards the self, which stemmed from developmental issues. Freud's postulation is countered by the idea that societal factors, such as gender roles, may play a major role in the development of mental illness. When considering gender and mental illness, one must look to both biology and social/cultural factors to explain areas in which men and women are more likely to develop different mental illnesses. A patriarchal society, gender roles, personal identity, social media, and exposure to other mental health risk factors have adverse effects on the psychological perceptions of both men and women.

Gender specific risk factors increase the likelihood of getting a particular mental disorder based on one's gender. Some gender specific risk factors that disproportionately affect women are income inequality, low social ranking, unrelenting child care, gender based violence, and socioeconomic disadvantages.

Women experience a higher rate of General Anxiety Disorder (GAD) than men. Women are around 15% more likely to experience comorbidities with GAD than men. Anxiety disorders in women are more likely to be comorbid with other anxiety disorders, bulimia, or depression. Women are two and a half times more likely to experience Panic Disorder (PD) than men, and are also twice as likely to develop specific phobias. Additionally, Social Anxiety Disorder (SAD) occurs among women more frequently than men. Obsessive compulsive Disorder (OCD) is present among both men and women at similar rates, though men tend to have an earlier onset of symptoms. Men are more likely to experience more aggressive, sexual, religious, and social impairments while women are more likely to experience fear of contamination.

Major depressive disorder is twice as common in women compared to men. This increased rate is partially related to women's increased likelihood to experience sexual violence, poverty, and higher workloads. Men are more likely to have depressive symptoms relating to aggression than women. Women are more likely to attempt suicide than men however, more men die from suicide due to the different methods used. The presence of a gender bias results in an increased diagnosis of depression in women than men. and around 8 10% of American fathers experience paternal postpartum depression (PPPD). Postpartum depression is under diagnosed. Factors that contribute to the gender disproportionality of eating disorders are perceptions surrounding "thinness" in relation to success and sexual attractiveness and social pressures from mass media that are largely targeted towards women. Between males and females, the symptoms experienced by those with eating disorders are very similar such as a distorted body image. Contrary to the stereotype of eating disorders' association with females, men also experience eating disorders. However, gender bias, stigma, and shame lead men to be underreported, underdiagnosed, and undertreated for eating disorders. It has been found that clinicians are not well trained and lack sufficient resources to treat men with eating disorders. Children also approach goals differently, which in turn can cause different reactions to stressors such as bullying.

Status enhancement is a main driver of bullying. A bully's gender and the gender of their target can impact whether they are accepted or rejected by a gender group. A study by René Veenstra et al. reported that bullies were more likely to be rejected by peer groups who saw them as a possible threat. The study cited an example of a male elementary school bully who was rejected by his female classmates for targeting a female student, whereas a male bully who only targeted other males was accepted by females but rejected by his male classmates.

The fashion industry and media have been cited as potential factors in the development of eating disorders in adolescents and pre adolescents. Eating disorders have been found to be most common in developed countries and per scholars such as Anne Becker, the introduction of television has prompted an increase of eating disorders in media naïve populations. Females are more likely to have an eating disorder than males and scholars have stated that this has become more common "during the latter half of the twentieth century, during a period when icons of American beauty (Miss America contestants and Playboy centerfolds) have become thinner and women’s magazines have published significantly more articles on methods for weight loss". Other potential reasons for eating disorders among adolescents and pre adolescents can include anxiety, food avoidance emotional disorder, food refusal, selective eating, pervasive refusal, or appetite loss as a result of depression. and that gender has an impact on the avenue an adolescent may use when attempting suicide. Males are known more to use guns in their suicide attempts, whereas females are more likely to cut their wrists or take an overdose of pills. They also reported that females are more likely to attempt suicide than their male counterparts, whereas males are more likely to succeed in their attempts. Studies have shown that social media use among adolescents is associated with poor body image. A study published in the Journal of Early Adolescence found that there is a significantly stronger correlation between self objectified social media use, body surveillance, and body shame among young girls than young boys. The same studied emphasized that adolescence is an important psychological development period; therefore, opinions formed about oneself during this time can have a significant impact on self confidence and self worth. Research has found that women have higher rates of PTSD compared to men. According to epidemiological studies, women are two to three times more likely to develop PTSD than men. The lifetime prevalence of PTSD is about 10 12% in women and 5 6% in men. There are observed differences in the types of symptoms experienced by men and women. These differences are found to be persistent across cultures. Epidemiological studies have found that men are more likely to have PTSD as a result of experiencing combat, war, accidents, nonsexual assaults, natural disaster, and witnessing death or injury. Meanwhile, women are more likely to have PTSD attributed to rape, sexual assault, sexual molestation, and childhood sexual abuse. However, despite the theorized explanation that gender differences were due to different rates of exposure to high impact traumas such as sexual assaults, a meta analysis found that when excluding instances of sexual assault or abuse, women remained at a greater risk for developing PTSD. A history of sexual assault is related to increased rates of depression. For example, studies of survivors of childhood sexual assault found that the rates of childhood sexual assault ranged from 7 19% for women and 3 7% for men. This gender discrepancy in childhood sexual assault contributes to 35% of the gender difference in adult depression. This risk has been associated with an increased risk of developing depression. The United Nations estimates that "35 percent of women worldwide have experienced either physical and/or sexual intimate partner violence or sexual violence by a non partner (not including sexual harassment) at some point in their lives."'''''' There have been numerous studies conducted linking the experience of being a survivor of domestic violence to a number of mental health issues, including post traumatic stress disorder, anxiety, depression, substance dependence, and suicidal attempts. Humphreys and Thiara (2003) assert that the body of existing research evidence shows a direct link between the experience of IPV and higher rates of self harm, depression, and trauma symptoms. As far as males are concerned, it is estimated that 1 in 9 men experience severe IPV. For men as well, domestic violence is correlated with a higher risk of depression and suicidal behavior.

Global estimates published by the World Health Organization indicate that about 1 in 3 (35%) of women worldwide have experienced either physical and/or sexual intimate partner violence or non partner sexual violence in their lifetime. Sexual violence increasingly impact adolescent girls who are subjected to forced sex, rape and sexual assault. Approximately 15 million adolescent girls (aged 15 to 19) worldwide have experienced forced sex (forced sexual intercourse or other sexual acts) at some point in their life. Sexual assault, rape and sexual abuse are likely to impact a women's mental health on a short and long term basis. Many survivors are "mentally marked by this trauma and report flashbacks of their assault, and feelings of shame, isolation, shock, confusion, and guilt." Additionally, survivors of rape or sexual assault are at a higher risk for developing PTSD, with the lifetime prevalence being 50% compared to the average prevalence of 7.8%. Sexual assault is also associated with higher rates of depression, self harm, suicide, and disordered eating.

Social media is highly prevalent and influential among the current generation of adolescents and young adults. Approximately 90% of young adults in the United States have and use a social media platform on a regular basis. In terms of social media use and body image, boys experience social media as a higher positive influence on their body image than girls, who report social media causing more negative effects on their body image. Indeed, social media use has a connection to increased risk for eating disorders in women. Women receive greater amounts of pressure and criticism surrounding their physical appearance, making them more likely to internalize the body ideals that are glorified on social media. Furthermore, Pro anorexia communities are widespread among social media platforms which creates an environment that encourages disordered eating behaviors, and uses primarily photos of young women to spread unhealthy messages promoting thinness. Women are more likely to be involved with pro anorexia communities.

The World Health Organization notes gender differentials in both the diagnosis and treatment of mental illness. Gender bias observed in diagnostic and healthcare systems (including as related to under diagnosis, over diagnosis, and misdiagnosis) is detrimental to the treatment and health of people of all genders. The difference in diagnosis emerges at an early age, with diagnostic rates for children diverging on the basis of gender once children reach school age. For hundred of years in Western Europe, hysteria was seen as an excess of emotion and a lack of self control, that would mostly impact women. The diagnosis was used as a form of social labeling to discourage women from venturing outside of their role, that is a tool to take control over the increasing emancipation of women. Another instance in which such disparities emerged is in the use of lobotomies, popularized in the 1940s to treat a variety of psychiatric diagnoses including insomnia, nervousness, and more. Studies have found that US asylums disproportionately lobotomized women in spite of the fact that men made up the majority of asylum patients.

Implicit bias in medicine also affects the way lesbian, gay, bisexual, and transgender (LGBTQ+) patients are diagnosed by mental health physicians. Due to internalized societal and medical bias, physicians are more likely to diagnose LGBTQ+ patients with anxiety, depression and suicidality.

It has also been observed that mental health professionals may pathologize the behaviors of individuals who do not conform to the practitioner's gender ideals.

SES is a key factor in determining one's opportunities and quality of life. Inequities in wealth and quality of life for women are known to exist both locally and globally. According to a 2015 survey of the U. S. Census Bureau, in the United States, women's poverty rates are higher than men's. Indeed, "more than 1 in 7 women (nearly 18.4 million) lived in poverty in 2014." When it comes to income and earning ability in the United States, women are once again at an economic disadvantage. Indeed, for a same level of education and an equivalent field of occupation, men earn a higher wage than women. Though the pay gap has narrowed over time, according U. S Census Bureau Survey, it was still 21% in 2014. Additionally, pregnancy negatively affects professional and educational opportunities for women since "an unplanned pregnancies can prevent women from finishing their education or sustaining employment (Cawthorne, 2008)".

Increasing evidence tend to show a positive correlation between lower SES and negative mental health outcomes for women. Firstly, "Pregnant women with low SES report significantly more depressive symptoms, which suggests that the third trimester may be more stressful for low income women (Goyal et al., 2010)." Secondly, women are often the primary care taker for their families. As a result, women with insecure job and housing experience higher stress and anxiety since their precarious economic situation places them and their children at higher risk of poverty and violent victimization. Finally, a low socioeconomic status puts women at higher risk of domestic and sexual violence, therefore increasing their exposure to all the mental disorder associated with this trauma. Indeed, "statistics show that poverty increases people's vulnerabilities to sexual exploitation in the workplace, schools, and in prostitution, sex trafficking, and the drug trade and that people with the lowest socioeconomic status are at greater risk for violence"

Research have been made on the effect of biological differences between male and female on the exposure to both Post Traumatic Stress Disorder (PTSD) and Depression.

Biological differences is a proposed mechanism contributing to observed gender differences in PTSD. Dysregulation of the hypothalamic pituitary adrenal (HPA) axis has been proposed for both men and women. The HPA helps to regulate an individual's stress response by changing the amount of stress hormones released into the body, such as cortisol. It is also thought that gender differences in threat appraisal might contribute to observed gender differences in PTSD as well by contributing to HPA dysregulation. Women are reported to be more likely to appraise events as stressful and to report higher perceived distress in response to traumatic events compared to men, potentially leading to an increased dysregulation of the HPA in women than in men. One important challenge for future researchers is navigating fluctuations hormones throughout the menstrual cycle to further isolate the unique effects of estradiol and progesterone on PTSD.

Expanding on the research concerning the HPA and PTSD, one existing hypothesis is that women are more likely than men to have a dysregulated HPA in response to a traumatic event, like in PTSD. This dysregulation may occur as a result of the increased likelihood of women experiencing a traumatic event, as traumatic events have been known to contribute to HPA dysregulation. Studies have found that women tend to respond differently to stressful situations than men. For example, men are more likely than women to react using the fight or flight response. Women, meanwhile, are thought to use emotion focused, defensive, and palliative coping strategies. As well, women are more likely to engage in strategies such as wishful thinking, mental disengagement, and the suppression of traumatic memories. These coping strategies have been found in research to correlate with an increased likelihood of developing PTSD. Women are more likely to blame themselves following a traumatic event than men, which has been found to increase an individual's risk of PTSD. In addition, women have been found to be more sensitive to a loss of social support following a traumatic event than men. A variety of differences in coping mechanisms and use of coping mechanisms may likely play a role in observed gender differences in PTSD. These described differences in coping mechanisms are in line with a preliminary model of sex specific pathways to PTSD. The model, proposed by Christiansen and Elklit, suggests that there are sex differences in the physiological stress response. In this model, variables such as dissociation, social support, and use of emotion focused coping may be involved in the development and maintenance of PTSD in women, whereas physiological arousal, anxiety, avoidant coping, and use of problem focused coping may be more likely to be related to the development and maintenance of PTSD in men. However, this model is only preliminary and further research is needed. For more about gender differences in coping mechanisms, see the Coping (psychology) page.