Depression is pink and alcoholism is blue: all color of mental illnesses

By Ellie Liverani

eli.liverani.ra@gmail.com

There appear to be differences in the incidence of mental illnesses between men and women. For example, women are more likely to be diagnosed with depression, post-traumatic stress disorder (PTSD) and anxiety disorders, while men are more likely to be diagnosed with autism, attention-deficit hyperactivity disorder (ADHD) and substance abuse. Women in general are also more likely to experience mental illnesses than men.

Is the statistic accurate? Is there a clear diagnosis for mental illnesses for each sex? Can this be influenced or even determined by the different social expectations we have for men and women?

There are sex-related differences in how the nervous system responds to external stimuli. This is due to differences in genetic, as well as hormonal exposure. Scientists have studied specific biological causes (such as specific genes and/or biochemical/hormonal changes) to understand the mechanism of mental illnesses.

For example, autism has been associated with testosterone levels, but the data collected so far do not explain the higher incidence of autism in men. Also estrogen seems also to be related to mental illnesses (in both men and women) depending on the concentration. However, the data are still inconclusive.

Identifying mental illness has proven to be challenging and at times the diagnosis is inaccurate in both men and women. For example, antidepressants have often been prescribed to men and women after their 50s, while it was later discovered that their symptoms were a reflection of decreased testosterone or estrogen (for men and women).

Seeking help is still difficult due to the stigma about mental illnesses present in our society. Women are more likely to ask for help, while men are hesitant, probably due to the stereotypical idea that men have to be strong and stoic. This could be a reason why women seem to have a higher incidence of mental illnesses than men.

Men and women can also present different symptoms for the same diseases. For example, in the past, eating disorders were thought to be prevalent in young women, while nowadays they have a comparable prevalence in men. We discovered that not only were men less inclined to ask for help, but it also depended on the fact that men present eating disorders differently than women. While women are likely to pursue thinness, men are pursuing a muscular look. Overall, it was easier to identify them in women. In this specific example, it is interesting to notice that the different symptoms are correlated to the certain beauty standard imposed by our society, so there is a social component in the symptoms of mental illnesses and, as a result, in how they are diagnosed.

This has been noted in other mental illnesses. For instance, anxiety disorder seems to be more prevalent in women than men. But recent studies have shown that men may have different symptoms. While women show “classical symptoms” such as increased heart rate, gastrointestinal issues and weakness, men react to anxiety abusing alcohol or drugs and they are easily angry and frustrated. So anxiety disorders can be diagnosed for substance abuse or irritability.

Age is an important variable, too. For example, it seems that ADHD is more common in men and boys than women. However, more recently women have been diagnosed with ADHD as adults. The discrepancy between men and women disappears with age. Women are more likely to show inattention as the most common symptom while hyperactivity and impulsive-like symptoms are more prevalent in men. Older women have recently been diagnosed with eating disorders also, challenging the idea that they are prevalent in young girls.

Animal studies have been used to understand the genetic or biological changes in mental illness, including sex as a biological variable. Indeed, in animal models, social expectations should not be present. Despite all the improvement, it is still extremely hard to reproduce mental illness in animals. As a result, the conclusions need to be validated in humans.

Overall, more studies are required to understand sex-related differences in mental illnesses. We should be aware that the criteria for diagnosis are constantly changing and still heavily based on cultural stereotypes. This alone makes it hard to identify these illnesses.

For instance, women feel more open to express anxiety and depression, while men are usually more inclined to show anger. Overall, the underlying situation could indeed be the same. So let’s study more and keep an open mind!

 Dr. Liverani is an assistant professor at the NDSU School of Pharmacy.