I was diagnosed with anorexia nervosa in my sophomore year of high school. I was always the bigger one of my friends and my boyfriend at the time would always tell me he liked the fact that I was chubby. I would see all the stick-skinny models and actresses on TV and feel completely disgusted with myself. At one point during my fight with anorexia, I weighed about 35 pounds less than what was healthy for my height and I was very sick. It is so scary to look in a mirror and see fat when you are actually skin and bones. It ruined my relationship with so many loved ones and I still don’t have regular menstrual cycles. (Stephanie, college junior, age 20) It happened one Saturday night [at] a Greek restaurant … Suddenly I began to feel as if the walls were edging in. My palms grew damp, my heart drummed, my stomach churned. I had only one thought: If you don’t get out of this restaurant immediately, you are going to faint or die. I mumbled that I didn’t feel well and raced for the door … I began to avoid restaurants, but then my panic [appeared] in other venues … My world shrank to a thin corridor of safe places. (Anndee Hochman, 2004, pp. 99–100)
verall, rates of mental illness are almost identical for women and men. There are, however, striking gender differences in the prevalence of
specific mental disorders. Women have higher rates of eating disorders, depression, and anxiety disorders. Men are more likely to have impulse-control, antisocial, and substance abuse disorders (Becker et al., 2010; Office on Women’s Health, 2009a; Rondon, 2010; Russo, 2010). In this chapter, we focus not only on pathology but also on mental health and the factors that promote it. We begin the chapter by looking at two key factors that are associated with good mental health: social support and optimism. We then explore mental health in childhood and adolescence, followed by a discussion of eating disorders and substance abuse.
Next, we explore anxiety disorders, depression, and suicide. We then discuss mental health issues of sexual minority women and of older women. We close with a look at the diagnosis and treatment of psychological disorders.
FACTORS PROMOTING MENTAL HEALTH Social Support
A substantial body of research indicates that both receiving and giving social support play an important role in maintaining good physical and mental health and helping people cope with stressful life events (Brown et al., 2008; Cornwell & Waite, 2009; Golden et al., 2009; McLaughlin et al., 2011; Mechakra-Tahiri et al., 2009; S. Taylor, 2010; Thomas, 2010). This association is especially strong for females. For example, girls are more likely than boys to seek social support following stressful events, and this support appears to play a more protective role for girls than for boys (Eschenbeck et al., 2007; Jackson & Warren, 2000; Rose & Rudolph, 2006). Similarly, studies have found that women who feel more loved and supported by their friends, relatives, and children are at less risk for major depression. Among men, however, level of social support is less strongly related to the risk of depression (Wareham et al., 2007).
TEND AND BEFRIEND. Women also use social support as a coping aid more readily than men do. Shelley Taylor (2000, 2010) and her colleagues have proposed that women often respond to stress by tending to themselves and their children and by forming ties with others (the “tend and befriend” response). Men, in contrast, are more likely to show aggression or escape. This so-called fight or flight response was proposed by psychologists 60 years ago to explain how both men and women react to stress. That view, however, was heavily based on studies of males (Goode, 2000) and was just assumed to apply to females (yet another example of the “male as normative”). But Taylor and her colleagues found many studies that supported their model. For example, Rena Repetti’s research (cited in Taylor et al., 2000) showed that mothers returning home after a stressful day at the office were more caring and nurturant toward their children, while stressed fathers were more likely to withdraw from their families or incite conflict. What stimulates these different behaviors in females and males? Taylor and her colleagues suggest that hormonal differences are partly responsible, but they and others are quick to reject the idea that gender stereotypes are biologically hard-wired. Alice Eagly (cited in Goode, 2000), for example, points out that the gender difference could be a result of cultural conditioning that prepares females from an early age for the role of caregiver and nurturer.