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In some men, anxiety can manifest in less recognized ways

Velizar Nikiforov, M.A., LCPC
• November 07, 2019

Anxiety disorders are one of the most common mental health issues, estimated to affect close to 20% of Americans in a given year. But not everyone is affected equally — research consistently shows the number of women diagnosed with anxiety disorders is about double that of men.1,2 Researchers have yet to definitively determine the causes of this discrepancy, but anecdotal evidence and clinical experience suggests that some men respond to anxiety in ways that can cause it to be misinterpreted or else missed entirely.

In everyday life, anxiety helps us respond to emergencies, focus and prepare for challenges, and activates the fight-or-flight system when needed. We can thank anxiety when we swerve out of the way of an unexpected obstacle on the road or when we are motivated to prepare and rehearse a big presentation. It is when anxiety is overactive that problems emerge: the fight-or-flight response kicks in excessively, and every situation where an outcome is uncertain gets flagged as an emergency. In an effort to keeps us safe and reduce uncertainty, anxiety leads us to worry, avoid activities and situations or seek safety and reassurance. These are commonly recognized symptoms of anxiety. In some men, however, anxiety can manifest in less obvious ways:

Anger & aggression

For men who have been socialized to conceal emotions and never show weakness or fear, anger may be the only “acceptable” emotion. When anxious, the expression of their fight-or-flight system may tend towards “fight.” In confronting a worrisome situation, an anxious man might use aggression or anger in an effort to ensure safety and avoid a feared outcome. This might be effective in the short term, causing others to comply, but in the long term, this kind of reaction can damage relationships, affect well-being or impact work performance.

Alcohol & substance use

Men who perceive anxiety as a form of weakness may not have many tools available to release anxiety. Forms of self-care and relaxation (mindfulness, yoga, massage or confiding in others) might not seems as acceptable as having a drink. Alcohol (and other drugs) are an effective way to temper anxiety in the short term, and habitual use might be a mask for anxiety.

Excessive work

In cases where anxiety is related to work, an inability to step away, excessive checking of email and long hours can be an attempt to cope with what anxiety is flagging as potential catastrophes. This kind of response is not exclusive to men, but for some men it might be compounded by an excessive focus on status and social comparison. The social acceptability of this kind of behavior can lead it to be missed as a sign of distress.

To be sure, expressions of emotion, including anxiety, vary widely within genders, and the categories of gender itself encompass a spectrum of expressions, including cis and trans men and women and non-binary individuals. Nevertheless, some of these expressions might be seen more frequently in male-identified individuals.

Fortunately, effective treatment for anxiety is available. Cognitive behavior therapy (CBT) is the most broadly studied treatment for anxiety, with research evidence consistently supporting its effectiveness.3,4,5 It is an active, problem-solving approach that does not involve delving into the past or the kind of lengthy introspection that some men may resist. In many cases, treatment is short term, consisting of between 12 and 20 sessions. The therapy is focused on teaching skills and coping strategies that can help with life-long management of anxiety.  

The goal-oriented, active nature of CBT may be appealing for men considering treatment. Nevertheless, the same sociocultural factors that account for differences in the presentation of anxiety can also lead to some men having difficulty recognizing it as an issue and seeking help. To help a resistant man consider treatment, experts recommend:

  • Focusing on your own concern for his quality of life — letting him know you are worried about him
  • Avoid diagnostic labels or even the word “anxiety”
  • Present therapy as a short-term, skill-building exercise that may improve resilience, performance and quality of life
  • Remain compassionate and recognize that gendered expectations are compounding the problem

For more information on anxiety treatment, contact The Family Institute’s Cognitive Behavioral Therapy team.

Additional Reading

Velizar Nikiforov, M.A., LCPC

Coordinator, Cognitive Behavioral Therapies Program

Mr. Nikiforov is a staff therapist at the Family Institute. He specializes in working with individuals experiencing problems with anxiety, worry, obsessive compulsive disorder or depression using cognitive-behavioral therapy (CBT), an evidence-based treatment that research supports as the most effective approach for these issues.

References & Citations

1 Stein, Dan J, and Vythilingum, B. (Eds.). (2015) Anxiety Disorders and Gender. Cham: Springer International.
2 Remes, O., Brayne, C., van der Linde, R., Lafortune, L. (2016) A systematic review of reviews on the prevalence of anxiety disorders in adult populations, Brain and Behavior, 6(7).
3 Kaczkurkin, A. N., & Foa, E. B. (2015). Cognitive-behavioral therapy for anxiety disorders: an update on the empirical evidence. Dialogues in clinical neuroscience, 17(3), 337–346.
4 Otte C. (2011). Cognitive behavioral therapy in anxiety disorders: current state of the evidence. Dialogues in clinical neuroscience, 13(4), 413–421.
5 Hofmann, Stefan & Asnaani, Anu & Vonk, Imke & Sawyer, Alice & Fang, Angela. (2012). The Efficacy of cognitive behavioral therapy: a review of meta-analyses. Cognitive therapy and research, 36. 427-440.