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Anxiety - rattling the 'masculinity' cage amongst men

Anxiety disorders are ranked as the sixth largest contributor to life-long health concerns worldwide with an estimated 3.6% (264 million) of the global population living with anxiety.
It affects nearly 1 in 5 adults in the U.S (1), and in South Africa, the South African Stress and Health (SASH) study, which investigated the lifetime prevalence of common mental disorders, anxiety disorders were found to be the most prevalent class of lifetime mental disorders at 15.8% (2).
On average, one in eight men will have depression and one in five men will experience anxiety at some stage of their lives (3).
And even though statistic points towards women being twice as likely to suffer from anxiety disorders, the reason might be more social than scientific.
Dr Ian Westmore, member of the South African Society of Psychiatrists (SASOP) says the stigma associated with anxiety disorders considers the condition as ‘unmanly’ and a sign of weakness. He says that “this is the very reason men are less likely to talk about their anxiety, and instead drown their anxiety with poor coping behaviours, increasing their risk of the anxiety or depression to go unrecognised and untreated.”
Dr Westmore says men are far less likely to seek support, as is more common with women who more eagerly speak-out and seek help, due to the ‘macho male stereotype’ in society expecting men to ‘man up’ and adopt the ‘boys don’t cry’ mentality.
“It’s this attitude of men portrayed as being brave and fearless that leads to men considering themselves in a negative light if they suffer from anxiety. And for this very reason, they see it as putting themselves in a vulnerable position when seeking help."
Dr Westmore emphasises that it’s a given that everyone will feel anxious from time to time and not every anxious episode should be seen as a disorder.
“It’s OK to worry about things and life’s many challenges. The difference is when that very worry is difficult to control or shake long past a certain experience or event and it starts interfering with your day-to-day activities or changes the way that you used to approach life such as going out with your friends, being productive at work, taking part in team sport, bantering with colleagues, and so forth. It severely affects relationships in that the coping mechanisms applied more often affects those close through alcohol, abusive behaviour, and frequently depression."  
“Society expects a lot from men. They’re expected to be seen as confident, in control, the decision makers and the decisive voice of reason and rational. They are many times portrayed as the rock with a steady hand and mind in times of trouble or uncertainty. They are stereotyped as the provider, protector, being dependable, confident, and fearless.”
“However, these very traits that society has labeled men with, could lead men to feeling inadequate and emasculated. It’s not realistic to expect men to be the stronger sex that always lives by society’s motto of ‘what makes a man’ and to simply find a way to ‘pull yourself together’.”
Dr Westmore says, if left untreated, anxiety presents itself in many forms.
“Men who don’t speak out, find inappropriate coping strategies that might very well dull the anxiety temporarily but could develop into a dependency that eventually spins out of control, aggravating the anxiety disorder.”
“Abuse, gambling, drugs (including alcohol), and reckless behaviour are some of the confidence gaining and coping mechanisms embraced by men. However, since they enable men to avoid their anxieties instead of facing them, the very coping mechanisms could aggravate the disorder.”
“Anxiety can trigger anger in men with violence, outbursts, bullying, abusiveness, and explosive quick temper bursts as a result. Irritability and being edgy, touchy, cranky or impatient, becomes the norm reaction to everyday small and large frustrations. In addition, anxiety drives avoidance which in turn constricts lives. The result is a sense of an empty life that turns to depression with feelings of hopelessness and helplessness.”
Dr Westmore says a range of factors can contribute to, or even trigger the development of an anxiety disorder. These could be a genetic predisposition, as well as physical factors such as an imbalance of hormones and chemical messengers in the brain. But it can also be environmental factors such as excessive stress in a relationship, job, school or financial predicaments, and traumatic life events. Medical factors could lead to an anxiety disorder such as side effects of medication, symptoms or stress relating to an illness.
What are the tell-tale signs?
“Anxiety is more than just a bit of stress, sweaty palms and a sense of butterflies in the stomach. The symptoms are far more severe and include continuous feelings of worry, fear and impending doom that are so severe they interfere with your ability to work, live a healthy life, maintain relationships and ability to sleep.” Dr Westmore points out the following signs:
- Pounding or racing heart
- Excessive sweating
- Muscle tension or aches
- Restlessness or agitation
- Dizziness or vertigo
- Shortness of breath or sensation of choking
- Insomnia
- Panic attacks
- Fatigue
- Nausea, diarrhea or irritable bowel syndrome
- Constant worry about what could go wrong
Perceiving situations and events as threatening when they are not
- Indecisiveness and fear of making the wrong decision
- Difficulty concentrating
- Feelings of dread
- Concentration problems
- Avoidance
- Catastrophic thinking
- Irritability and edginess
- Nightmares or intrusive thoughts in which traumatic scenes are replayed in the mind
- Mood swings
- Being overly vigilant towards danger
- Absentmindedness
- Fear of losing control
In addition, persistent sadness, apathy or loss of hope or suicidal thoughts could show that the anxiety has morphed into a depression, a common condition seen together with anxiety disorders.
Dr Westmore says it’s important to share your symptoms with someone you trust. Start with a family member or friend but always find your way to a health care professional who would be able to help you manage the symptoms. He says that treatments include cognitive behavioural therapy, counseling and in some instances, medication depending on the type of anxiety present.
“It’s important to note that you need to develop your own action plan that includes lifestyle changes which is as much part of the recovery process as seeking medical attention. Engage in regular exercise to release your anxious energy and happy endorphins, get enough sleep, socialise with supportive friends and family, manage stress through meditation, music or art, follow a healthy diet, cut down on alcohol and avoid drugs and other stimulants.”
1.    McLean, C. P., Asnaani, A., Litz, B. T., & Hofmann, S. G. (2011). Gender differences in anxiety disorders: prevalence, course of illness, comorbidity and burden of illness. Journal of psychiatric research, 45(8), 1027–1035. doi:10.1016/j.jpsychires.2011.03.006
2.    Herman, A. A., Stein, D. J., Seedat, S., Heeringa, S. G., Moomal, H., & Williams, D. R. (2009). The South African Stress and Health (SASH) study: 12-month and lifetime prevalence of common mental disorders. South African medical journal = Suid-Afrikaanse tydskrif vir geneeskunde, 99(5 Pt 2), 339–344
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