Psychological differences between women and men

Abstract

The psychological differences between men and women are evident in the varying prevalence, diagnosis, and expression of mental health disorders. This paper explores the underlying factors contributing to these differences, focusing on biological, hormonal, and sociocultural influences. Although neuroanatomical differences between male and female brains are minimal, hormonal fluctuations, particularly in women, play a significant role in shaping mental health outcomes. These fluctuations are especially impactful during key reproductive life stages such as puberty, pregnancy, and menopause, increasing vulnerability to mood and anxiety disorders.

Sociocultural factors, including gender roles, early socialization, and societal expectations, further exacerbate psychological differences between men and women. Women are more likely to experience internalizing disorders such as anxiety and depression, while men tend to externalize stress through behaviors like substance abuse. Gender stereotypes and life experiences shape these coping strategies, contributing to distinct patterns of distress and help-seeking behaviors.

The findings emphasize the importance of gender-sensitive approaches in both research and clinical practice. By considering the unique biological, psychological, and social experiences of men and women, more effective mental health interventions can be developed. This paper calls for a paradigm shift in mental health care, advocating for tailored treatments that address the specific needs of each gender.

Abstract

Las diferencias psicológicas entre hombres y mujeres son evidentes en la variación de la prevalencia, el diagnóstico y la expresión de los trastornos de salud mental. Este estudio examina los factores subyacentes que contribuyen a estas diferencias, centrándose en influencias biológicas, hormonales y socioculturales. Aunque las diferencias neuroanatómicas entre los cerebros masculinos y femeninos son mínimas, las fluctuaciones hormonales, particularmente en las mujeres, juegan un papel importante en la configuración de los resultados de salud mental. Estas fluctuaciones son especialmente relevantes durante las etapas reproductivas clave, como la pubertad, el embarazo y la menopausia, aumentando la vulnerabilidad a los trastornos del estado de ánimo y la ansiedad.

Los factores socioculturales, incluidas las normas de género, la socialización temprana y las expectativas sociales, exacerban aún más las diferencias psicológicas entre hombres y mujeres. Las mujeres son más propensas a sufrir trastornos internalizantes, como la ansiedad y la depresión, mientras que los hombres tienden a externalizar el estrés a través de comportamientos como el abuso de sustancias. Los estereotipos de género y las experiencias de vida moldean estas estrategias de afrontamiento, contribuyendo a patrones diferenciados de angustia y conductas de búsqueda de ayuda.

Los hallazgos subrayan la importancia de enfoques sensibles al género tanto en la investigación como en la práctica clínica. Al considerar las experiencias biológicas, psicológicas y sociales únicas de hombres y mujeres, se pueden desarrollar intervenciones de salud mental más efectivas. Este estudio aboga por un cambio de paradigma en el cuidado de la salud mental, promoviendo tratamientos personalizados que aborden las necesidades específicas de cada género.

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Psychological differences between women and men

It is well known that there are differences in the prevalence, diagnosis, and comorbidity of mental health issues between men and women. However, these differences are not clearly established, and their origins remain uncertain. For example, are there differences in how men and women experience and express symptoms, seek help, and respond to psychological distress? Could these differences be influenced by gender stereotypes, social roles, or societal expectations? Do healthcare professionals treat men and women differently, perhaps in the assessment and importance given to their symptoms or the level of care provided? Are there variations in diagnosis or therapeutic approaches based on gender? Furthermore, are specific risk factors and vulnerabilities for mental health being adequately explored for both men and women?

Neuroanatomical and Functional Differences Between Sexes: Implications for Mental Health

Understanding the evolutionary origins of sex differences can provide valuable insights into the distinct ways men and women experience disease, helping to tailor medical interventions accordingly. These differences in psychiatric disorders may stem from inherent variations in brain function and behavior across species, including humans and rodents. For instance, females typically exhibit heightened sensitivity and responsiveness to potential threats, resulting in stronger stress responses and defensive behaviors. This tendency is thought to be evolutionarily advantageous, as it aligns with the greater reproductive and parental responsibilities of mammalian females. This evolutionary trait of risk aversion in females may help explain why women are more prone to psychiatric disorders related to stress, such as anxiety disorders, phobias, depressive disorders, PTSD (Choleris, Farida Sohrabji, & Frick, 2018).

From a neuroscience perspective, anatomical differences between men and women have been analyzed using neuroimaging techniques. Many studies have examined differences in the volumes of major subcortical brain structures, adjusted for overall brain size. Most claims about "sexual dimorphism" have not been reliably replicated, and the two structures consistently found to differ (the putamen and amygdala, which are slightly larger in men) show a volume difference of only 1 to 3%. Similarly, no significant differences have been found in cortical structures. In summary, MRI studies conducted over the past two decades have not found evidence of a universal difference in the volumes of specific cortical regions. It is possible that male and female brains change their structure and functions due to different experiences and exposures to various social environments. Thus, the sex/gender-related anatomical and functional differences in the brain observed so far may also be modulated by experience, rather than solely by sex-related genetic influences. Genetic, hormonal, and social influences may interact in currently unknown ways in shaping the brain and behavior (Eliot, Ahmed, Khan, & Patel, 2021; Jäncke, 2018). Considering all these factors is crucial for understanding the differences in the prevalence and expression of mental health challenges and for offering more specific treatments.

Hormonal and other biological factors

The increased incidence of depression in women begins primarily at puberty and diminishes somewhat in the years following menopause, though there is often a notable perimenopausal spike. This pattern may be linked to the hormonal changes that affect neurotransmitter systems throughout a woman’s life. The surge in estrogen during puberty alters neurotransmitter sensitivity, while the constant fluctuations of estrogen and progesterone during the reproductive years continuously modify these systems. Premenstrual syndromes might result from these changes. Pregnancy and childbirth cause dramatic hormonal shifts and significant suppression of the HPA axis, potentially increasing depression risk. As estrogen levels decline and pituitary LH and FSH levels rise during menopause, the loss of estrogen and progesterone regulatory effects may contribute to the development of mood disorders in susceptible women (Steiner, Dunn, & Born, 2003). Data suggest that women face an increased risk of developing anxiety disorders during key reproductive life events, including menarche, menstruation, pregnancy, childbirth, and menopause. Collectively, these epidemiological findings imply that gonadal hormones may play a role in the onset of psychiatric disorders in women (Soares & Zitek, 2008). 

Even though no significant anatomical differences have been found between men and women, other factors affect functionality. A recent study led by neuroscientists Elizabeth Rizor and Viktoriya Babenko from the University of California discovered that hormonal fluctuations during the menstrual cycle influence the volumes of gray and white matter in women's brains. By utilizing neuroimaging and hormonal analysis, the team examined 30 menstruating women and found that elevated levels of luteinizing hormone and estradiol just before ovulation led to changes in white matter, promoting faster information transfer. Furthermore, higher progesterone levels were linked to changes in cerebrospinal fluid volume and an increase in gray matter (Rizor, Babenko, Dundon, 2024).

Li and colleagues suggested that women might be more susceptible to anxiety and depression disorders due to the greater fluctuations of hormones such as estradiol and progesterone throughout the month and over the course of their lives. These hormonal changes can affect neurotransmitters and neurosteroids and influence cognition and behavioral processes, contributing to the gender gap in these disorders (Li, Browny, & Graham, 2017). 

In other disorders, such as schizophrenia, the potential effect of the hypothalamic-pituitary-gonadal axis is also being studied. An increased incidence has been observed during periods of low estradiol concentrations in these cases. Many women with schizophrenia, even in the untreated prodromal phase, experience estradiol deficiency and gonadal dysfunction, which might have put them at increased risk and could be due to stress-induced hyperprolactinemia (Riecher-Rössler, 2016). In relation to panic disorder, the potential worsening of symptoms during the premenstrual phase has been investigated for several decades. Studies report a worsening of symptoms in women during this stage of the cycle, with a significant increase in the frequency of panic attacks (Kaspi, Otto, Pollack, Eppinger, & Rosenbaum, 1994). Concerning generalized social anxiety disorder (gSAD), symptoms were observed to be more intense during the premenstrual period, diminished during pregnancy, and then reverted to pre-pregnancy levels in the postpartum period. These findings suggest that certain women with gSAD may be especially sensitive to changes in reproductive hormones (Van Veen, Jonker, Van Vliet, & Zitman, 2009). 

The evidence supports that hormonal changes occurring throughout the life cycle and menstrual cycle impact mental health. It is essential to consider these factors when designing mental health treatments and to evaluate their interaction with other social and cultural variables.

Sociocultural factors and gender stereotypes

Gaviria Arbeláez (200) summarizes the major risk factors and socioeconomic, cultural, and gender differences related to the disparities observed between men and women. Gender differences in early socialization have been well-documented, with parents and educators often having different expectations for boys and girls. This can lead to women becoming more anxious and concerned about others' evaluations, while boys may develop a stronger sense of mastery and independence. These differences can affect self-esteem and vulnerability to depression, with women often engaging in rumination when feeling sad, whereas men may use distraction. 

Traumatic life events also play a crucial role. Women generally experience more stressful life events than men and may be more sensitive to their effects. Adolescents, particularly girls, report more negative life events related to family and peer relationships. There is a significant link between life stressors and depressive symptoms in adolescent girls, who are more vulnerable to depression from family conflicts and maternal depression compared to their male peers. Additionally, a history of sexual abuse is much more common among women and is a stronger risk factor for depression than for other psychiatric disorders (Gaviria Arbeláez, 2009).

Women’s life experiences differ significantly from men’s due to their roles across personal, professional, and social spheres, including economic and political power imbalances. They often juggle multiple roles, such as childbearing and child-rearing, and frequently manage both household and work responsibilities. Marriage was once viewed as a risk factor for depression in women, but it is now considered less protective for women than for men. While a supportive marriage can reduce the risk of depression for both genders, married women still experience higher rates of depression compared to men (Wu & DeMaris, 1996). The results of a study based on data from the Finnish Regional Health and Welfare Survey show that 11.0% of women experience more psychological distress compared to 8.8% of men. Interestingly, a significant interaction with gender was found in only two variables: psychological distress was associated with work absorption at the expense of family for women and with mental strain at work for men (Viertiö, Kiviruusu, Piirtola, Kaprio, Korhonen, Marttunen, & Suvisaari, 2021). 

Socioeconomic status is a key factor linked to higher depression rates among women. Women disproportionately bear the global burden of poverty, which adversely affects their physical and mental health. In single-parent households, where mothers are typically the primary caregivers, family income tends to be lower due to the significant wage gap between men and women. Additionally, both employment and parenting status can influence women’s depression risk. A fulfilling job can lower depression risk, especially if the woman chooses to work rather than feeling compelled by economic pressures. The risk is heightened if she works outside the home and struggles to find reliable childcare (Gaviria Arbeláez, 2009).

Finally, gender roles are also linked to cultural beauty standards. Cultural pressures to adhere to the socially accepted ideal of being "slim but shapely," along with media influence on body image, can significantly impact women's mental health (Grogan, 2021).

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Differences in the diagnosis and expression of mental disorders

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Besides differences in prevalence, coping strategies, symptoms and help seeking are different in women and men. 

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Not all symptoms are equally relevant or cause the same level of distress for men and women. Research shows that women who engage in less positive reframing experience higher levels of depressive symptoms compared to those who use more positive reframing. This difference is notable even when compared to men, regardless of their reframing practices. Additionally, women who tend to self-blame report higher levels of trait anxiety, a pattern not observed in men. These gender differences in coping strategies and their links to depression and anxiety highlight distinct clinical presentations of these conditions between men and women (Kelly, Tyrka, Price, & Carpenter, 2008). 

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Ruminations, uncontrollable negative thoughts, associated with depression, anxiety and negative mood are more frequent in women (Ando, Geromini, Ales, Zenaro, 2020). Anger rumination was independently associated with externalizing psychopathology in women and was inversely associated with internalizing psychopathology in men. This highlights the clinical importance of ruminative thought processes and suggests that anger and depressive content may have differential relevance for understanding internalizing and externalizing psychopathology (du Pont, Rhee, Corley, Hewitt, & Friedman, 2018). 

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Leaving disorders aside, in relation to well-being, there are also differences between protective factors for men and women. Although women reported experiencing both positive and negative emotions with greater frequency and intensity compared to men. A consistent finding is that women score higher than men in positive relationships with others. Across various cultures, women have been found to score lower than men in self-acceptance and autonomy, while men score higher in these areas. Women, however, tend to score higher than men in personal growth and positive relationships with others. While the impact of job status on well-being was found to be stronger in men than in women, our study indicates that job status affects the well-being of both genders. Specifically, Spanish women who are homemakers or have manual occupations experience lower well-being compared to those in higher job levels. Additionally, masculinity was positively associated with all dimensions of well-being. Although femininity also had positive associations with most well-being dimensions (except autonomy), its impact was less pronounced compared to masculinity, with the exception of positive relationships with others (Matud, López-Curbelo, & Fortes, 2019). 

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A recent study has shown that women were significantly more likely than men to want to use prescription medication as a way to cope with stress and men were less inclined than women to seek help for psychological issues. Men significantly preferred group support over women, a preference possibly influenced by women’s relative aversion to group settings compared to other forms of therapy. The study revealed that both men and women commonly used talking with friends as a coping strategy. However, men and women might approach these conversations differently; for instance, men might discuss sports or other topics in addition to their feelings. The key factors influencing help-seeking were found to be self-awareness of the problem for women and a desire for anonymity for men (Liddon, Kingerlee, & Barry, 2018).

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Research indicates that women gain more from supportive networks but are also more susceptible to the negative effects of inadequate or conflict-laden relationships. This highlights the importance of having diverse, high-quality relationships and minimizing conflicts to improve women’s health. Addressing these needs through tailored interventions for women could be crucial in enhancing their overall well-being (Shin & Park, 2023).

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Neglecting to explore the differing causal pathways and treatment responses between women and men not only undermines scientific validity but also hinders the provision of gender-sensitive treatments. There is an urgent need for a paradigm shift in both practice and research. It is crucial that psychiatric training, research, and clinical practice more thoroughly incorporate sex and gender considerations. To accurately discern true gender differences and understand causal pathways, it is essential to conduct longitudinal studies on population-based, representative cohorts of patients. Selected populations and cross-sectional studies do not provide sufficient insights. Therefore, more interdisciplinary and multilevel research is needed to investigate both biological sex and psychosocial gender factors. Furthermore, there should be a focus on understanding gender differences in illness behavior, coping strategies, help-seeking behavior, and treatment adherence. This includes exploring sex-specific aspects of psychopharmacology, hormonal therapies, and the development of gender-sensitive psychotherapy (Oram, Khalifeh, & Howard, 2017; Riecher-Rössler, 2016).

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References

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