As a mature woman, I see each day the trials and tribulations that women face as they live their lives with courage, humility, passion, and determination. No one sets out to have a mental illness, yet women are facing a time in history where the stressors of daily living exacerbate one’s ability to navigate successfully – in school, a career, relationships, motherhood, etc.
Women are facing a crisis in mental health. While more than 1 in 5 women experience a mental health issue such as depression and anxiety, fewer are diagnosed and treated worldwide because of the social stigma attached to mental illness and the reluctance of women to seek help.
In 2017, 46.6 million adults in the US were being treated for a mental illness, representing nearly 20% of the adult population and women represent almost 50% higher rates of treatment than the percentage of men (NIMH). While we discussed substance abuse in an earlier article, it is important to note that a substance abuse disorder is often co-occurring with a mental health disorder.
Likewise, a study conducted by the US Armed Forces Surveillance Branch found that women service members were diagnosed with anxiety at a rate that was 1.4 times that of their male counterparts, and women were 1.9 times more likely than men to experience depression.
Women and Generalized Anxiety Disorder (GAD)
Women are twice as likely as men to be impacted by GAD. The Anxiety and Depression Society reports that 6.8 million people in the US are affected by GAD. Women are twice as likely to be diagnosed as men as having a panic disorder.
Exposure to violence makes women 3 to 4 times more likely to be affected by depression and women who were exposed to sexual activities as a child or a violent partner as an adult are diagnosed with depression at a higher rate. Ironically the Office of Women’s Health at the US Department of Human Services reports that women wait for an average of four years after the onset of PTSD to seek help! Men seek help in one! African American women are half as likely as Caucasian women to seek help and Latina women are also hesitant to seek help according to a John Hopkins Medical report. Women also report higher incidences of disordered eating as a result of sexual assault.
These women are not alone and are a small microcosm of the complexity of the mental health challenges facing women today.
Many women’s mental health issues such as bipolar disorder affect women differently than men. There are also certain types of disorders that are unique to women. For example, women may experience symptoms of mental disorders when there is a hormonal imbalance such as perinatal depression, premenstrual dysphoric disorder, and perimenopause related to depression. For women, mental health issues often start to appear as children become adolescents, the most common being depression, anxiety, and disordered eating. These can appear alone or alongside other issues like substance abuse.
Depression Is the most common mental health issue in women. Depression is defined as, “a mood disorder which prevents individuals from leading a normal life at work, socially or with family.” Seligman, 1973 referred to depression as the “common cold of psychiatry because of its frequency of diagnosis ).
Some of the most common signs of depression in women include;
- Sleep disturbances, sleeping too much, or struggling to get out of bed.
- Feelings of sadness, helplessness, uselessness, or emptiness.
- Changes in eating habits, Binging, restricting, eating more, or eating less.
- A loss of joy with school, work, family, themselves, etc
- No longer wanting to engage in favorite activities
- Loss of energy.
- Inability to focus or decide.
- Emotional mood swings-rapid speech, going from happy, sad, mad, glad in rapid cycles.
- Thoughts of self-harm, death, or suicide.
- Persistent headaches, nausea, or other physical pain that does not improve with treatment.
- Becoming easily annoyed or frustrated.
A lot of factors come into play that facilitates depression. In young women for example feelings of helplessness, not fitting in, academic issues, weight, being bullied, not being invited to join a club, etc. Also witnessing or experiencing an act of violence such as physical or verbal abuse can contribute to the development of depression in teens.
Experiencing trauma, whether Subjective (ie. being told you are not good enough) or Objective (witnessing a devastating experience, being in a flood, storm, car accident, having a loved one die tragically), can contribute to the development of anxiety and depression. In later years a multitude of factors can principate feelings of depression from hormonal imbalances to the loss of a partner.
Suicide is a brain disease. Suicide attempts can look different among young girls, women, and men. Though more women are likely to attempt suicide, men are more successful in completion largely because of the violent means used. The SAD PERSON SCALE is widely used to access suicidality. It is important that Suicide Ideation is treated seriously and calls to appropriate authorities are to be made if you are worried about a loved one.
The NIMH defines GAD as experiencing excessive worry for most days over a period of six months. Other anxiety disorders include panic disorder, obsessive-compulsive disorder, social anxiety or social phobia, separation anxiety, phobia related disorders such as fear of flying, fear of driving, fear of heights, or fear of specific objects. In young girls or teens, the onslaught of social media, bullying, and the desire to fit in coupled with peer pressure can facilitate the development of GAD.
Some signs of GAD
- Chronic irritability or nervousness.
- Feelings of impending doom.
- Racing heartbeat, hyperventilating, sweating, or trembling.
- Stomach aches or other digestive issues.
Reproductive Issues – Premenstrual Syndrome (PMS)
Due to fluctuations in hormones, most women experience symptoms pre and post-menstrual cycles. PMS can show up differently from woman to woman, yet the most common symptoms include fluctuating emotions, headaches, bloating, and cramps. Symptoms of depression can overlap with feelings of anxiety.
Simply perinatal depression is depression that occurs while a woman is pregnant with a child This s more common in underdeveloped countries yet must be highlighted, nonetheless. Perinatal depression can hinder the growth of the baby and mothers.
This is a subset of perinatal depression and affects some women within one year of giving birth. This is characterized by extreme sadness, anxiety, and tiredness that impact the woman’s ability to care for themselves and their infant. It is felt that this condition does not originate from any action on the mother’s part, yet rather from a combination of physical and emotional factors including hormonal changes during pregnancy and after delivery, a lack of sleep in the weeks and months after the baby’s arrival and the physical pain relate and giving birth are with a tremendous amount of force in the first days or early.
This is rare and usually occurs within the first days or weeks after delivery The signs and symptoms show up suddenly and with a great deal of force including delusions, hallucinations, sleep disturbances, and paranoia. The mother could try and harm the infant and herself.
Other signs of depression related to pregnancy (Miscarriage and Sudden Infant Death (SID)
The loss of a baby from a miscarriage can trigger great sadness as does the death of an infant from sudden infant death syndrome. Both experiences are unique, can be traumatic, and can trigger great loss and grief. It’s important to understand that grief and sadness unto themselves is a normal reaction and does not have to be pathologized. That being said, understanding the fragile ego of the woman who has experienced these types of losses is paramount in helping her navigate in a way that affirms her is tantamount to success.
Hormonal imbalances again occur as a woman enters menopause and her menstrual cycle stops. This can trigger anxiety and depression due to hormonal issues or women facing an existential crisis over the loss of their ability to procreate.
Body Dysmorphia in Women – BDD
The Cleveland Clinic defines this condition as a person’s extreme anxiety about some perceived physical defect. People with body dysmorphia experience low self-esteem and constantly seek reassurances about their appearance and may consider themselves ugly to the point where they seek remedies such as plastic surgery to remove what they may consider physical imperfection.
Bipolar disorder is often characterized by wide mood swings that are more extreme than the normal ups and downs people normally experience in their day-to-day lives. One’s mood swings can greatly affect how one functions throughout the day. Bipolar 1 (hypomania )is viewed as more severe as the mood swings are more severe than bipolar II .in which women tend to experience more depressive episodes than mania.
Borderline personality disorder (BPD)
Perhaps BPD is one of the most perplexing diseases and it affects young women more. Parents report they do not know if they are going or going, they feel like they are walking on “eggshells” as they don’t know who is showing up or what they will do. Parents report being afraid of their daughters and tend to give them much more power than they should have. I remember one mother clearly saying she could not even set a curfew for her 17-year-old as she would yell uncontrollably at her, while another mother was frightened to cancel the credit cards of her 33-year-old for fear she would never speak to her again. Boundaries are often loose or nonexistent. I remember one family calling and sharing they could not There are often erratic changes in mood, behavior, values, symptoms of BPD include quickly exerting into and ending physical and emotional relationships, extreme swings in feeling toward people and activities, and unrealistic skewed sense of oneself and acting in compulsive and dangerous ways. Often people with BPD struggle with self-doubt and fear of abandonment. They can get bored very easily and can be impulsive, engaging in risky behaviors, like unprotected sex and binge eating and they may have a history of intense and unstable relationships.
Factors that can contribute to BPD are a family history of the disorder, childhood traumatic events, and generational dysregulation of family and brain function. Families often are frightened of daughters that show up this way and so learning how to navigate, set and maintain healthy boundaries is important when living or working with someone that has BPD.
Twice as many women than men are affected by eating disorders (20 million versus 10 million according to the National Eating disorder Association. The causes of the illness are not well defined, yet researchers believe there is an interplay between culture (what does culture say about looking good), biology (our genetic makeup), and psychology (one’s emotions ) These disorders are common in women for several reasons. Teen girls and young women are often held to unrealistic magazine cover standards. Social media, movies, magazines, and billboards paint an unrealistic picture of what beauty looks like. Genetics and biochemistry may play a part in the onset of an eating disorder as well. The most common eating disorders involve too much focus on body weight, shape, and food and spurning dangerous eating behaviors. These behaviors include but are not limited to self-induced vomiting, eating restriction, overeating, and the use of laxatives. Disordered eating can significantly impact the body’s ability to get nutrition and can harm the heart, major organs, bones, and teeth, and lead to other diseases.
Among the risk factors for developing disordered eating are:
- Being closely related to someone who has a mental illness and/ or disordered eating.
- Chronic Dieting
- Burning more calories than are being ingested (negative energy balance.
- Being diagnosed with Type 1 insulin-dependent diabetes, including a pattern of missing insulin injections which can cause death.
- Poor body image ‘Being diagnosed with an anxiety disorder.
- Being the victim of bullying or body shaming due to weight.
- Having a tendency toward perfectionism and behavioral inflexibility.
Early Childhood issues
Learning Disabilities- One of the most common conditions diagnosed in children is ADHD. Ironically more boys are diagnosed with ADHD than girls. Because girls exhibit fewer behavioral problems than boys it is sometimes hard to see and they also try to overcompensate for what they can’t do and develop perfectionistic traits. Girls as compared to boys often;
- Appear more withdrawn.
- Struggle with self-esteem and lack confidence.
- Exhibit higher degrees of anxiety.
Both Boys and girls may have;
- Difficulty keeping up with other children in school.
- Difficulty staying focused or paying attention in class.
- Exhibiting verbal aggressiveness, teasing, engaging in name-calling, or aggressiveness.
- Appearing not to listen, follow or track.
ADHD rarely travels alone. ADHD can predispose girls to addictive to impulsive behaviors including bulimia, binge eating disorder, substance abuse, and self-harm. People with ADHD are also more likely to struggle with anxiety and depression. According to Harvard Health, 50 % of children diagnosed with ADHD may also experience dyslexia. Early intervention and treatment are indicated.
Autism, or autism spectrum disorder (ASD), refers to a broad range of conditions characterized by challenges with social skills, repetitive behaviors, speech, and nonverbal communication. According to the Centers for Disease Control, autism affects an estimated 1 in 44 children in the United States today. We know that there is not one autism but many subtypes, most influenced by a combination of genetic and environmental factors. Because autism is a spectrum disorder, each person with autism has a distinct set of strengths and challenges. The ways in which people with autism learn to think and problem-solve can range from highly skilled to severely challenged. Some people with ASD may require significant support in their daily lives, while others may need less support and, in some cases, live entirely independently.
Several factors may influence the development of autism, and it is often accompanied by sensory sensitivities and medical issues such as gastrointestinal (GI) disorders, seizures, or sleep disorders, as well as mental health challenges such as anxiety, depression, and attention issues.
Signs of autism usually appear by age 2 or 3. Some associated development delays can appear even earlier, and often, it can be diagnosed as early as 18 months. Research shows that early intervention leads to positive outcomes later in life for people with autism.
Aging- Grief, Loss
Romance Scams- Gambling – Alzheimer’s Dementia
Aging brings its dilemmas. No longer are women that well-oiled machine, their bodies creak and groan a bit. They have seen much and have experienced loss, loss of careers I, loss of loved ones, and loss of body functions. Their worlds change and while their eyesight changes so too may their brain functions. Words may not easily come to mind, memories fade away. Loneliness may creep in and women can fall prey to obsessive-compulsive behaviors such as shopping, hoarding, and gambling.
Help is Available
Knowledge is often power and as a clinician, educator, and interventionist, teaching folks where and how to get help is paramount. For the public, it’s important for them to know that there are many different kinds of professionals who can diagnose and treat mental disorders. The Mayo Clinic describes the most common types of mental health practitioners and providers:
- Psychiatrists are medical doctors (MDs) or doctors of osteopathy (DOs) with a specialty in mental health. In addition to diagnosing and treating mental illnesses, psychiatrists can write prescriptions and offer counseling via psychotherapy.
- Psychologists typically hold a doctoral degree—Ph.D., Psy.D., or Ed.D. They provide psychological counseling in groups and one-on-one sessions, and while most cannot write prescriptions, many are licensed to do so or work with providers who can prescribe medication.
- Psychiatric mental health nurses are registered nurses with training in mental health. Many are advanced-practice RNs holding advanced degrees (doctorate of nursing practice) or certifications (certified nurse practitioner), and in some states, they can prescribe medication.
- Licensed clinical social workers generally have master’s degrees or doctorates in social work, while licensed professional counselors hold master’s degrees and have relevant clinical training. Both provide counseling and other services, though they cannot prescribe medication.
Women who are looking for a nearby mental health provider are instructed to ask for a referral from their primary care provider or request a list of covered mental health providers from their health insurance company. Many employee assistance programs cover some or all of the cost of mental healthcare.
- The National Alliance for Mental Health (NAMH) provides a help line that is staffed 24/7 by people who can answer questions about mental health symptoms and treatments, help family members, and provide contact information for local mental health resources.
- The Office of Women’s Health’s mental health resources include links to federal agencies that offer information about specific disorders, and to organizations that offer assistance to families and individuals impacted by mental health issues.
People coping with mental health challenges—their own and those of loved ones—cannot be reminded too often that they don’t face those struggles alone. At all hours, an encouraging voice or online chat is just a call or click away.
Listed below are some sources for more information about support groups for everyone and anyone affected by mental health disorders.
- The National Alliance for Mental Health offers a Find Support page that lists the National Suicide Prevention Hotline (800-273-8255) and provides links to state organizations representing the 950-plus NAMH affiliates in the U.S.
- The Depression and Bipolar Support Alliance offers a Find a Support Group web page. It lets you search for a group by ZIP code or by state, and includes contact names, phone numbers, email addresses, and websites of various alliance chapters.
- WebMD’s depression support guide discusses how to create a support group by recruiting family members and friends. It has a link to WebMD’s online depression support group but also emphasizes the importance of receiving psychotherapy and psychological counseling from trained professionals.
One of the most comprehensive collections of useful resources for women’s mental health patients and providers is available through the Massachusetts General Hospital Women’s Mental Health Center. Links to sources for information and helplines are categorized by disorder and include illnesses that occur during and after pregnancy, breastfeeding while taking psychiatric medication, the impact of infertility on mental health, mood disorders, and menopause.
The website of the U.S. Food & Drug Administration (FDA) features a guide to Women’s Health Topics that includes sections on pregnancy, menopause, and safe use of pain medicine and other medications. The FDA’s Take Time to Care program seeks to disseminate free health education information to women through health care organizations and professionals, community nonprofits, schools, and local government agencies. Organizations wishing to participate can learn more about the program on the FDA’s Invitation to Collaborate page.
The HHS website at MentalHealth.gov features an extensive list of local organizations that provide mental health support services, several of which are particularly geared to meet the mental health needs of women. For example, many local branches of the YWCA USA offer women expert advice on mental health issues and how to receive professional help.
Tips for women’s mental health
Much of maintaining good mental health entails developing the skills to cope with the ups and downs of everyday life. The Office of Women’s Health’s Good Mental Health web page features tips and suggestions that teach women of all ages the important coping skills that can prevent small problems from becoming big ones. These are among the helpful tips offered by the service:
- Improve your mood by exercising regularly. Aerobic exercise releases endorphins, which are chemicals that help alleviate stress and promote calmness. Regular physical exercise also helps improve sleep habits and quality and may also reduce the symptoms of anxiety and depression.
- Eat a balanced diet. Consuming healthy foods has been found to improve people’s mood in addition to improving their physical health. In particular, avoid sugary foods, which can lead to tiredness and irritability when blood sugar levels drop. Researchers recommend that alcohol and coffee be consumed in moderation. Also, certain vitamins and minerals—such as selenium, omega-3 fatty acids, folate, vitamin B12, calcium, iron, and zinc—appear to alleviate the symptoms of depression.
- Find a job you enjoy. Often, a woman’s mental health issues can be exacerbated by her employment. A change of job can give such women a renewed sense of purpose and alleviate some of the effects of their illness. However, it can be difficult for women who suffer from mental illness to rejoin the workforce or switch jobs. Many states and mental health services offer vocational rehabilitation services, employment support, and free employment and job counseling services.
The HelpGuide from HelpGuide.org International offers six strategies intended to promote mental health by boosting contentment and happiness. The first is to invest in face-to-face relationships with people you trust in a friendly, engaging, and nonjudgmental manner. Other tips include staying physically active; identifying and avoiding (when possible) the stressors in your life; eating foods that are good for your brain (low in sugar, high in “healthy” fats); sleeping well, and finding a purpose in life.
Women’s Mental Health: Knowledge Is Power
Often, the first and most important step on the road to mental health is acknowledging the need to take action. For women, taking that first step can be particularly challenging due to the societal pressures women feel to be the strong, nurturing caregiver for their families, friends, and communities. The health care industry is continuing to discover the unique needs of women affected by mental illness in terms of treatment options and support services.
Armed with accurate, up-to-date information on the most effective strategies for overcoming mental health challenges, women can be more empowered to reclaim the fulfilling, enjoyable, and purposeful lives they so richly deserve.
- World Health organization- The top 10 Issues for womens help
- American Psychiatric Association, “Mental Health Disparities: Women’s Mental Health”
- American Psychiatric Association, Women’s Mental Health
- Cambridge University Press, “A Handbook for the Study of Mental Health: Gender and Mental Health: Do Men and Women Have Different Types and Amounts of Problems?”The Conversation, “Biology Is Partly to Blame for Higher Rates of Mental Illness in Women — the Rest Is Social”
- Everyday Health, “State of Women’s Wellness 2017” Forbes, “These Female Founders Are Addressing a Majorly Neglected Area of Women’s Mental Health with This App” International Association for Women’s Mental Health JAMA Network, “Women’s Mental Health and Well-being 5 Years After Receiving or Being Denied an Abortion: A Prospective, Longitudinal Cohort Study”
- Joan Lunden, “Differences in Men and Women’s Mental Health”Journal of Psychiatry and Neuroscience, “Why Is Depression More Prevalent in Women?”
- The Lancet Psychiatry, Women’s Mental Health
- Mental Health America, “Depression in Women”
- Prevention, “4 Mental Health Issues that Are More Common in Women”Psychology Today, “Women and Mental Illness: Why Are Mental Health Issues More Common Among Women?”
- Stigma-Free Society, Women’s Peer Support GroupTheravive, “What Is Mental Health Stigma?”
- Thrive Global, “A Women’s Mental Health Support Group: Going Beyond and Changing Society”
- University of California San Diego Health, “Postpartum Depression, Postpartum Anxiety, and Other Women’s Reproductive Mental Health Issues”