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Published on: May 2, 2016
by Julia Hogan, LPC for Verily:
It was recently reported that the life expectancy for white American women has declined from 81.2 years to 81.1 years. While that may seem like a statistical blip, researchers say the source behind the drop should give us all pause: Despite improvements in mortality from causes such as heart disease, there has been a significant increase in deaths from causes such as suicide and alcohol-related disease and overdose.
On some level, this isn’t surprising. Women today have a lot of demands put on them. Raise kids, have a career, be a great wife, exercise, volunteer, cook dinner. The list goes on, and while each of these is a worthwhile pursuit, together they can create an overarching sense of overwhelm. How can one person do it all and take care of herself?
Statistics show that women are twice as likely as men to develop Generalized Anxiety Disorder and Panic Disorder and are more likely to be affected by Post Traumatic Stress Disorder than men. On the National Institute for Mental Health anxiety fact page, “being female” is listed as a risk factor for experiencing anxiety. In addition, one study on gender differences and anxiety concluded that anxiety disorders are more “disabling” in women than in men.
Given the higher instance of anxiety disorders in women, perhaps it shouldn’t be controversial that one in four women in the United States is prescribed psychiatric medication compared to only one in seven men. But the reality is that this disparity has raised many questions over the diagnosis and treatment of women and anxiety. Is the rate of diagnosis and medication due to real differences, or is it that because we’re women, doctors are quicker to whip out the prescription pad and send us on our way?
When we look at why, the answer isn’t immediately clear. But there is helpful research available to shed some light on this hot-button issue.
OUR BODIES ARE MORE SENSITIVE TO STRESS
Experiencing stress is a significant trigger for anxiety, and there are several studies that have found that the female body responds to stress differently than the male body. One landmark study conducted at the Children’s Hospital of Philadelphia studied rats (whose brain structures are similar to those of humans) and found that females are more sensitive to even low levels of stress hormones than males and experience more difficulty adapting to high levels of stress.
“This may help to explain why women are twice as vulnerable as men to stress-related disorders,” says study leader Rita J. Valentino, Ph.D., a behavioral neuroscientist at the Children’s Hospital of Philadelphia.
Being more sensitive to stress, even low levels of it, means that we are more likely to experience the effects of stress than our male counterparts in the same environmental situation.
OUR BRAIN CHEMISTRY IS DIFFERENT
In addition to responding to stress differently, women have a different brain chemistry than men. The Anxiety and Depression Association of America explains that the fight-or-flight response is activated faster in women and stays activated for longer periods. It is believed that estrogen and progesterone play a role in this difference, the ADAA says.
Additionally, male brains produce serotonin (a mood-boosting hormone) more quickly than female brains, which may make women more vulnerable to the effects of stress for longer periods than men.
Another study cited by the Wall Street Journal found that women’s brains have a more active region that signals when a mistake has been made. The research suggests that this awareness of making errors can be a biological risk factor for anxiety. Our brain differences mean that we are more aware of stressors in our environment. It makes sense: If we aren’t aware of our surroundings and potential danger (from an evolutionary perspective), then we can’t take care of ourselves and our communities.
WE RESPOND TO STRESS DIFFERENTLY
Research also finds that women respond to stress triggers differently than men do. Susan Nolen-Hoeksema, department chair of psychology at Yale, told the Wall Street Journal that one of the reasons women tend to be more anxious is because they are more attuned to the relationships around them and take responsibility for other people’s happiness. The research also shows that men and women differ in the way that they approach emotions.
Further, a study published in the American Psychological Association’s Journal of Abnormal Psychology found that women who were diagnosed with anxiety disorders were more likely to internalize emotions (which can lead to withdrawal and loneliness), whereas men are more likely to externalize their emotions (which can lead to aggression and impulsivity). This difference between internalizing and externalizing was one factor that accounted for the difference in the prevalence rates of mental disorders between genders.
In my work as a therapist, many of my female patients who are coping with anxiety often struggle to find a balance between caring for themselves and others who are important to them. They are also constantly aware of their time and energy spent at work versus the time and energy spent in their personal life. Often they feel stretched between the many different roles they fill in the lives of those around them. They ask themselves, “Is my boss happy?”; “Are my coworkers happy?”; “Are my children happy?”; “Is my husband happy?” Navigating all these relationships are certainly stressors that could contribute to anxiety.
MEDICATION AFFECTS US DIFFERENTLY
Given this research that men and women are affected by and cope with stress differently, it shouldn’t come as a surprise that medication also affects men and women differently. For example, Scientific American points out that, though the research in this area is relatively new, it has already been found that the lower acidity in women’s stomachs is linked to them experiencing the effects and intensity of anti-anxiety medication and cautions doctors to be mindful of the doses they are prescribing to their female patients.
Research also found that women’s kidneys filter out drug compounds more slowly than men, so they may need to delay their next dose, especially for drugs such as Xanax (a commonly prescribed anti-anxiety medication) and other benzodiazepines.
Similarly, having a higher level of body fat means that drugs such as Xanax remain in a woman’s system for longer, which could contribute to experiencing side effects at lower doses.Psychiatrist Julie Holland wrote for the New York Times that “the new, medicated normal is at odds with women’s dynamic biology; brain and body chemicals are meant to be in flux.”
She goes on to explain that too high of a medication dose can numb the natural emotional calibration, whereas too little may leave a woman feeling like every situation and emotion is a problem needing to be fixed. She advocates using medication when needed while appreciating the emotional sensitivity that makes us human. I’ve had several patients complain that the medication they were prescribed by their doctor left them feeling “numb.” I always encourage my patients who are on medication to remain in constant communication with their prescribing doctor and let them know about any changes they experience.
THE CASE FOR GENDER-FOCUSED CARE
These biological differences between women and men both in how stress and medication affect them calls for gender-focused treatment. If women are experiencing and responding to stress and medication in a biologically different way from men, shouldn’t they receive treatment tailored to their needs? An APA press release cited research that supports gender-focused mental health treatment and suggested that treatment for women could focus on providing skills to cope with rumination and prevent it from escalating into clinically significant symptoms. It also recommends that treatment for men could focus on building skills to reduce impulsivity and aggression.
Other research has found that women find support during stress from strong social relationships. These research findings emphasize the importance of developing treatment methods that take into account the biological traits that are unique to women.
“Women’s emotionality is a sign of health, not disease; it is a source of power,” psychiatrist Julie Holland writes. Like Dr. Holland says, our emotionality that aids us in our valuing of relationships and in our sensitivity to the emotions and needs of others is to be valued and seen as a positive attribute, not a negative one.
WHAT TO MAKE OF IT ALL
What it all boils down to is this: We need to respect the mental and emotional health needs of both males and females. Statistics and our own real-life experiences show that we need to further medical and behavioral health awareness so that we can be honored and cared for as women, period.
When we respect the individuality of others in treatment, the focus becomes what works best for that person. When I work with patients who have anxiety, we discuss whether therapy alone or a combination of medication and therapy is best for them, depending on the severity of their symptoms. I can’t tell you how many times I’ve had the conversation with a patient about the importance of finding the right medication that works for them and with their body chemistry. I remember one patient who was frustrated because the medication that her psychiatrist prescribed her was not working, and she even thought her symptoms were worsening. We discussed how medication affects everyone differently, and, after explaining the side effects to her psychiatrist, she was prescribed a different medication that enabled her to reduce her anxiety and focus on developing coping skills for the future.
Without advocating for individualized treatment, my patient could have grown impatient and dropped out of therapy. Without treating every reaction women have to stress as abnormal—and particularly when their reactions to stress differ from men’s—we can seek out treatment, both medication and therapy, that embraces the uniqueness of each person and helps them achieve their full potential.
Given the levels of anxiety women carry compared to men, some can choose to the way we biologically handle stress as a sign of weakness in our gender. I like to see it as Nature knowing that women have unique strengths.
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