Understanding Mental Health Over a Woman’s Lifetime

Many mental health conditions impact women differently at different stages in life: It’s about time we talked about it

June 13, 2021

One of the most pressing issues in health care today is mental health. Unique issues related to the mental health of girls and women are of particular importance.

Understanding women’s mental health is a twofold approach. There are mental health issues that only appear in women. There are also mental health issues in all genders that impact women differently.

A better lens to examine women’s mental health is by looking at it across their life spans.

This article is focused on the biological differences between men and women and the variances in mental health between the two. We understand that not all gender identity fits into one of these two categories. This article does not exclude the validity of those who identify with other genders.

Keep Reading to Learn

  • Why—and how—mental health can impact women differently than men
  • How mental health conditions change—and which appear—over the life span of a woman
  • The causes, effects, and treatment of women-only mental health conditions

The Role of Sex and Gender in Mental Health

Sex and gender differences play a major role in mental health and mental illness. Though there are biological differences between men and women that may impact mental health, there are also societal differences between men and women that can influence the development of mental health issues.

Often gender determines degrees of power when it comes to men and women. There are still societal barriers that women face when it comes to social and economic determinants of mental health, such as susceptibility and exposure to mental health risks as well as social considerations.

Research has shown significant differences between genders when it comes to the development of common mental health disorders, with some disorders being more prevalent in women.

It is important to keep all these differences in mind when taking a closer look at how mental health issues may appear in women throughout their lives. The earlier mental health issues are detected, the faster they can be addressed.

Mental Health in Early Childhood: ADHD

One of the most common mental health issues that children are diagnosed with is attention-deficit/hyperactivity disorder (ADHD).

ADHD is noted for symptoms related to attention dysregulation, impulsivity, and sometimes hyperactivity. Challenges in executive functioning are a core feature of ADHD. These challenges include problems with time management, organization, decision-making, working memory, planning, emotional regulation, and prioritization.

According to information published by the Centers for Disease Control and Prevention (CDC), boys are more than twice as likely to receive a diagnosis of ADHD as girls.

This diagnosis rate isn’t necessarily because boys are more likely to develop ADHD than girls. This stark contrast is more likely because ADHD symptoms may present differently in girls, making it harder to identify this disorder.

Research has shown that boys with ADHD tend to have symptoms that are easier for others to see. For example, they tend to run around more often, behave more inappropriately, act physically aggressive, and be more outgoing.

Girls, on the other hand, tend to have symptoms that are harder to see. For example, they may have trouble paying attention in some situations or have low self-esteem. Furthermore, because girls are more verbally than physically aggressive when compared to boys, it is often harder to identify girls who have ADHD.

Because girls often display fewer behavioral problems compared to boys with ADHD, it can be harder to notice their symptoms. As a result, the difficulties that girls struggle with when it comes to ADHD are often overlooked. This can lead to severe problems down the road.

Though girls often exhibit different symptoms when it comes to ADHD, research has shown that undiagnosed or misdiagnosed ADHD can harm a girl’s self-esteem. Girls with ADHD often don’t externalize their frustrations and usually focus on work. As a result, this can increase their risk of developing eating disorders, depression, and anxiety.

Girls with ADHD often overcompensate. They may adopt a stance of perfectionism. This is due in part to shame around their executive function challenges. Often this leads to an under-identification and sometimes a dismissal of an ADHD diagnosis based simply on the outcome (e.g., good grades).

Furthermore, girls who have undiagnosed ADHD are prone to developing problems in social settings, at school, and even in their personal relationships.

Girls often develop symptoms that are not closely associated with ADHD because many of the symptoms of ADHD that people think about are more common in boys. Some of the most common symptoms of ADHD in girls include:

  • Appearing more withdrawn
  • Struggling with low confidence and low self-esteem
  • Exhibiting higher degrees of anxiety
  • Difficulty keeping up with their schoolwork and peers in the classroom
  • Difficulty paying attention during class
  • Exhibiting verbal aggressiveness and engaging in teasing or name-calling
  • Appearing not to listen from time to time

ADHD rarely travels alone. Having ADHD can predispose girls to addictive or impulsive behavior, including bulimia, binge eating disorder, substance misuse, and self-harm. People with ADHD are more likely to also struggle with anxiety or depression.

Of kids with ADHD, 50-60% have a learning disability or difference, such as dyslexia or a non-verbal learning disability. It is very important to treat the ADHD, since not doing so will undermine the treatment of any co-occurring condition.

The treatment of ADHD in boys and girls is relatively similar. Instead of focusing on differences between boys and girls when it comes to treatment, doctors tend to consider individual differences because everyone responds differently to therapy and medication.

Usually, the best treatment for ADHD is a combination of therapy and medication. Not every symptom of ADHD is controllable with medication alone.

It is critical to focus on identifying children—particularly, girls—with ADHD as quickly as possible. Like with many mental health conditions, the faster these symptoms are recognized, the faster they can be treated.

What You Need to Know About ADHD

2 kids play ball outside

Dr. Roberto Olivardia explains what ADHD is (and isn’t), offers tips and tricks to make the condition more manageable, shares his experiences of living with ADHD, and answers audience questions about the condition both in kids and adults.

2 kids play ball outside

During Adolescence: Depression, Anxiety, and Eating Disorders

Mental health issues often start to appear as children become adolescents, the most common being conditions such as depression, anxiety, and eating disorders. While these conditions may occur alone, they often appear alongside one another.

Depression in Young Women

The most common mental health issue in women is depression. Research has shown that twice as many women experience depression during their lives as men.

Because of its prevalence, it’s important to understand its symptoms, diagnosis, and treatment. Some of the most common signs of depression in women include:

  • Significant changes in sleep habits, such as sleeping more often or not at all
  • Major changes in eating habits, such as eating more often or not at all
  • A total loss of enjoyment in activities that used to bring pleasure
  • Emotional lability (rapid mood swings), moving quickly from happiness to anger and sadness
  • Thoughts of suicide, self-harm, or attempts of self-harm or suicide

There are a lot of factors that play a role in the development of depression in teenagers, particularly teenage girls. Weight issues, problems with friends, long-term bullying, and academic problems can make it more likely for a teenage girl to struggle with depression.

Also, witnessing or experiencing an act of violence, such as physical or sexual abuse, can contribute to the development of depression in teens.

It is important to diagnose and treat depression as quickly as possible. Typically, treatment of depression is a combination of therapy and medication.

Antidepressants may be used to treat depression in women and teens. In some cases, individuals may benefit from inpatient therapy. Every case of depression is as unique as the person diagnosed, so it’s important to discuss all options with a care team.

Suicide attempts can look different in women and girls compared to men. Though women are more likely to attempt suicide, men are more likely to be successful, largely based on the violent methods often used by men in their attempts.

When it comes to the treatment of depression, regardless of gender, continuity of care is important for sustained results.

Anxiety in Young Women

Anxiety is another common mental health disorder in adolescent girls and young women. According to the American Psychiatric Association, women are twice as likely as men to experience generalized anxiety disorder or panic disorder.

Anxiety is often characterized by feeling tense or worried. People with anxiety disorders usually have recurring, intrusive thoughts or worries, which may lead them to avoid certain situations.

There are multiple reasons why teenage girls might develop anxiety.

Pressure

Today, teenagers are under a tremendous amount of pressure to perform not only in the classroom but also outside of the classroom. This high bar can contribute to the development of anxiety disorders.

Physical and Biological Changes

Hormone fluctuations can contribute to the development of anxiety. Because hormone production can ebb and flow, this can impact brain chemistry, leading to the development of anxiety. Testosterone has been found to help with easing symptoms of anxiety, and girls and women have much less testosterone than men. Also, the frontal lobes of teenagers are still developing, which can contribute to the onset of anxiety.

Presence of Other Mental Health Conditions

Anxiety often occurs hand in hand with other mental health conditions, including substance misuse and depression.

Anxiety can manifest differently in boys and girls, and symptoms in girls may not be as obvious.

Some of the most common ways that anxiety may appear in teenage girls include:

  • Feeling physically ill, like an upset stomach, nausea, or frequent headaches
  • Worrying about things that are outside of their control
  • Poor sleeping habits, including sleeping too much or too little
  • Pointing to vague symptoms to stay home from school

Anxiety can be treated in a few ways, including medication, therapy, or a combination of the two. Caring for anxiety includes continued management of the condition to keep it from interfering with or disrupting daily activities.

Eating Disorders: Commonly Found in Teen Girls and Young Women

Eating disorders can be devastating. While eating disorders can develop in anyone at any time, they are more common in teenage girls and young women than they are in men.

A majority of people diagnosed with anorexia or bulimia and close to two-thirds of individuals with binge eating disorder are female. Women are also more likely to have an eating disorder at some point in their life.

These disorders are more common in women for several reasons. Teen girls and young women are held to unrealistic beauty standards. Social media, movies, and billboards paint an unrealistic picture of what beauty looks like. Genetics and biochemistry may play a part in the onset of eating disorders as well.

The most common eating disorders involve too much focus on body weight, shape, and food, which spurns 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.

Some of the common physical and behavioral signs of eating disorders include:

  • Sudden changes in mood
  • Exercising excessively
  • Extreme amounts of weight loss in a short amount of time
  • Very involved food rituals
  • The degradation of teeth and fingernails due to constant exposure to stomach acid
  • An unhealthy obsession with body image, weight, and calorie counting
  • The development of very thin hair, usually referred to as lanugo
  • Feeling cold all the time due to changes in internal temperature regulation

In many cases, teenage girls who are diagnosed with an eating disorder spend time in inpatient therapy to ensure these issues are treated completely. Recovery typically is not linear, as stress and anxiety can aggravate symptoms of an eating disorder—but eating disorders are treatable.

Reproductive-Related Mental Health Issues in Women

Genetics, biochemistry, and naturally fluctuating hormones during reproductive years can contribute to the onset of mental health issues that may only appear in women. Some of these conditions include:

Premenstrual Syndrome (PMS)

Thanks to fluctuations in hormones, most women experience symptoms during the week before their period. In many situations, this is referred to as PMS.

Though PMS can show up differently from person to person, the most common symptoms include fluctuating emotions, headaches, and bloating. In particular, women who have been diagnosed with depression or anxiety may experience symptoms of PMS that are worse than women who do not have depression or anxiety.

Importantly, the symptoms of depression and anxiety can overlap with PMS. It might even get worse before or during menstruation. Women should see their primary care doctor regularly if they would like to address PMS. In some situations, medications used to control periods, such as birth control, can help treat the symptoms of PMS as well.

Premenstrual Dysphoric Disorder (PMDD)

If PMS symptoms are extreme, women may be diagnosed with premenstrual dysphoric disorder. This is a condition that is similar to PMS. However, the symptoms are significantly worse.

PMDD may have worse physical symptoms than PMS’ cramps, tenderness, and bloating, but its biggest difference lies in its emotional impacts. This can include extreme mood swings, tension, irritability, and severe depression.

In many situations, the symptoms of PMDD might be so severe that they harm a woman’s everyday life. PMDD may impact not only personal relationships but professional relationships as well.

In women who are diagnosed with depression or anxiety, PMDD is more common. Women with PMDD should coordinate with their primary care clinician as well as mental health specialist to make sure they understand the treatment options that are available to them. Like PMS, the symptoms of PMDD will get worse around the time of menstruation.

Watch Now!

Dr. Laura Payne helps us understand why menstrual pain should be a part of mental health care

Postpartum Depression

When a woman gives birth, it is normal to have some degree of emotional letdown afterward from hormonal fluctuations. This is often referred to as postpartum blues or baby blues.

If symptoms of postpartum blues continue to persist for more than two weeks, the mother is usually diagnosed with postpartum depression. Some of the most common symptoms include mood swings, anxiety, crying fits, appetite problems, trouble sleeping, and feelings of being overwhelmed.

These symptoms may continue to get worse and could include difficulty bonding with a child and overwhelming loss of energy, reduced interest in the child, and feelings of hopelessness. Some women may even feel guilty. It is important for women experiencing these symptoms to get treatment as quickly as possible.

Postpartum Psychosis

A rare condition that can show up in women who have recently given birth is called postpartum psychosis. This is a rare condition that usually shows up during the first days or weeks after delivery.

The signs and symptoms tend to show up suddenly and with a tremendous amount of force. The most common symptoms of postpartum psychosis include confusion, disorientation, hallucinations, sleep disturbances, and paranoia. The mother could even attempt to harm the child.

Postpartum psychosis should be treated quickly by trained mental health professionals.

Menopause

Toward the end of a woman’s reproductive years, her hormones start to shift. In some cases, if a woman is prone to depression or anxiety, this change in hormone levels may reignite symptoms of mental health conditions around the time of menopause.

Often midlife has other stressors associated with aging or caring for both children and parents. These stressors can exacerbate even mild mental health symptoms, but any changes in mood or behaviors should be addressed with a medical professional.

Variations in Mental Health Conditions in Females

Other mental health conditions can impact women differently based on physical, genetic, and psychosocial factors.

Substance Use Disorders

Substance use disorders can drastically impact someone’s mental and physical health as well as relationships with colleagues, family members, and friends. Even though not everyone who uses alcohol or drugs will become addicted, some people will.

Though more men struggle with addiction to drugs or alcohol, women are more susceptible to progressing faster from using an addictive substance to being dependent. Women tend to find it harder to quit using substances and are more susceptible to relapsing than men.

Women who struggle with substance addiction may be feeling overwhelmed with parts of their life that should be addressed. These additional stressors could be childcare, eldercare, or other personal obligations.

Though substance use issues are closely tied to adulthood, alcohol use disorder can start early in life. A lot of girls tend to start drinking during their teenage years, which can also be harmful to the development of the brain.

Binge drinking is also on the rise in adult women. One survey showed that 13% of women who drink will consume more than seven drinks in a week or one per day. Although this is not necessarily a sign of alcoholism, women who consume four or more drinks in a given day are more likely to develop alcohol use disorder.

Borderline Personality Disorder

Borderline personality disorder (BPD) impacts millions of people in the United States. Once thought to predominantly affect women, current research shows that BPD affects men and women about equally. This myth can lead to BPD being overdiagnosed in women and underdiagnosed in men.

BPD is known for symptoms of instability in behavior, mood, self-worth, and relationships. Often people living with BPD struggle with self-doubt and self-image. They may also have an intense fear of abandonment that is closely tied to their view of their self-worth.

If someone is struggling with BPD, their intense feelings of anger, depression, and anxiety may only last a day—or sometimes mere hours. They may get bored very easily and can be impulsive, engaging in risky behaviors, like unprotected sex and binge eating.

The self-identity of a person with BPD may vary widely over time, which can impact their goals, jobs, friendships, and relationships. As some with BPD view themselves as unworthy, misunderstood, or empty, they may also have a history of intense or unstable relationships.

There is no singular cause of BPD, though scientists believe it is a combination of genetics, environmental factors (like experiencing trauma during childhood), and brain function. It can be difficult to diagnose and treat. Many with BPD also have additional conditions, like anxiety disorders, PTSD, depression, or eating disorders.

If it’s suspected that a person has borderline personality disorder, it’s important to seek help. A health care provider can help navigate signs and symptoms and provide a medical exam and a psychological evaluation to get the help needed.

Bipolar Disorder

Formerly called manic-depressive illness, bipolar disorder is a serious mental health issue that causes people to fluctuate rapidly between episodes of mania (or euphoria) and depression. Pregnancy, the menstrual cycle, and menopause can all impact the frequency and severity of this cycle.

Women and men are equally likely to develop bipolar I disorder. However, women are more likely to develop bipolar II disorder, meaning they may experience more rapid cycling between mania and depression.

Women with bipolar disorder are more likely than men with bipolar disorder to develop other physical and mental health issues. These may include substance use disorders, depression, thyroid disease, obesity, and migraines.

If a woman has bipolar disorder, she is more likely to experience severe depression after giving birth. Importantly, they are at a higher risk of developing postpartum psychosis.

If it’s suspected that a woman is dealing with bipolar disorder, it’s important to receive a diagnosis and treatment as quickly and as early as possible. The earlier this condition is diagnosed the sooner care can be implemented.

Women’s Mental Health at McLean

Patient and clinician talk outside

McLean’s Division of Women’s Mental Health aims to innovate and improve mental health care for all women and girls throughout their lives.

Patient and clinician talk outside

Older Adulthood: Dementia

Alzheimer’s disease is the most common form of dementia. According to the American Alzheimer’s Association, nearly two-thirds of Americans living with Alzheimer’s disease are women.

This condition is more common in individuals who are 65 years of age or older. As life expectancy continues to increase, particularly in women, Alzheimer’s disease will likely become more common.

Symptoms of Alzheimer’s disease may include forgetting the names and faces of loved ones and an inability to manage executive functions, such as tallying finances. Some people with Alzheimer’s disease have expressed difficulty performing day-to-day activities, like household chores and getting dressed.

To make matters worse, two-thirds of those caring for a loved one living with Alzheimer’s disease are also women. It is not uncommon for many caregivers to experience burnout. The stress of caring for others can contribute to poor mental health and the onset of conditions such as depression and anxiety.

Though there are no medications that can cure Alzheimer’s, it is possible to slow the progression of symptoms with the right treatment plan. Women and their loved ones need to be attentive to the onset of these symptoms. Early diagnosis can make a significant difference in quality of life as they get older.

Looking to the Future

While mental health care has grown exponentially, there is still work to be done when examining mental health by gender. The differences in women’s mental health conditions, if taken seriously, can improve the quality of life of millions of women around the world.

Destigmatizing women’s mental health starts with us. By looking after ourselves and those we care about, as well as having a voice in conversations about mental health, we can help shape future research, treatment decisions, and societal views when it comes to mental health issues.

If you or a loved one needs help managing their mental health, McLean is here to help. Contact us today at 617.855.3141 to learn more about treatment options.

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