Navigating Gender Differences in Anxiety: A Holistic Approach for Women in Recovery

When people think of anxiety, they often think of social anxiety and in some cases generalized anxiety disorder (GAD) as well. Yet, several types of anxiety disorders may be overlooked by the general public, such as panic disorder (PD). According to the National Institute of Mental Health (NIMH), in a given year an estimated 2.7% of U.S. adults experience PD, and 4.7% experience the disorder at some point in their lives. Moreover, women have a higher prevalence of PD with 3.8% experiencing it compared to 1.6% of men. Despite the higher prevalence of PD in females and the pervasiveness of internalizing disorders like anxiety in women, gender differences in anxiety are often overlooked.

At New Creation Recovery, we recognize the role gender differences play in how women experience challenges with mental health and addiction. Thus, we understand how important having a mental institution near me is to address the impact of anxiety disorders like PD on women. When left unaddressed, mental health disorders can lead to impairments in functioning in every part of your life. Unaddressed gender differences can further complicate your well-being and your ability to recover. As a result, we are committed to offering Christian based recovery programs that provide a personalized and whole-person approach to healing. With a holistic and spiritual approach to care, we can address the impact and specific needs of women with PD for lifelong recovery.

Yet, you may wonder: What is PD? Is PD the same or related to panic attacks? What makes PD different from social anxiety disorder (SAD) and GAD? How can gender differences complicate your challenges with PD? Expanding your awareness of PD can help you understand the importance of gender differences in the symptoms and course of the disorder.

What Is Panic Disorder?

As the NIMH notes, PD is a type of anxiety disorder characterized by frequent and unexpected panic attacks. Moreover, as MedlinePlus states, panic attacks are sudden waves of intense fear, discomfort, or a sense of losing control. The psychological signs and symptoms of PD can expand to also include:

• An overwhelming fear of death
• A sense of impending doom
• Intense and persistent worry about when another panic attack will happen
• Fear and/or avoidance of situations and places where a panic attack has happened

In addition to psychological symptoms, panic attacks come with distressing physical symptoms too. The physical symptoms of a panic attack can include:

• Heart palpitations
• Chest pain
• Shortness of breath
• Dizziness or weakness
• Upset stomach
• Nausea
• Sweating
• Trembling and or chills
• Tingling or hand numbness

Panic attacks are distinctive as they occur when there is no danger or clear trigger for your distress. Episodes often seem to appear out of the blue without a recognizable fear or stressors. However, it is important to note that experiencing a panic attack is not synonymous with PD. 

You can experience a panic attack without developing PD. Many people may experience one or two panic attacks at some point in their life. A variety of experiences can contribute to an isolated panic attack, such as prolonged stress and overconsuming coffee. On the other hand, PD may develop from certain risk factors:

• Genetics: Having a close biological relative with PD can increase your risk
• Brain biology and chemistry: Differences in processing lead to false alarms where your survival instincts happen too frequently, are overactive, or both
• Environment stress: Witnessing or experiencing stressful events
• Chronic stress: Repeating and/or prolonged stress and/or a temperament that is more sensitive to stress and negative emotions
• Physical and/or psychological trauma: Exposure to physical, sexual, and emotional abuse and neglect in childhood and or adulthood
• Substance misuse and abuse: Can lead to changes in brain functioning 

Furthermore, frequent panic attacks can turn into PD and occur several times a day or a few times a year. Regardless of the frequency of PD, its seemingly unpredictable nature can wreak havoc on your well-being. The overwhelming fear of another attack happening at any time and anywhere can disrupt your life. You end up making significant changes to your life to avoid another attack. 

The changes you make to avoid another panic attack impair your ability to function in your daily life. Moreover, the lack of control you feel over your mind, body, and life can put you at risk for other disorders like depression and substance use disorder (SUD). The challenges of PD symptoms and other co-occurring disorders highlight the need to understand how gender differences impact symptoms. With more knowledge of gender differences, you can understand the impact PD has on women.

Understanding Gender Differences in Panic Disorder

Gender differences in different disorders like PD can impact the way you experience your disorder. According to the International Journal of Psychophysiology, there are gender differences in the prevalence, course, and symptoms of anxiety disorders in women. Not only are women twice as likely to experience PD, but the course and symptom expression can be more detrimental. Listed below are some of the gender differences in symptom expression and disorder course for women:

• Increased respiration-related difficulties during a panic attack
  • Difficulty breathing, dizziness, feeling smothered
• More prone to chronic and severe forms of PD and other anxiety disorders
  • Impairment of functioning in daily life
• Greater prevalence of agoraphobic avoidance behavior
• Higher rate of co-occurrence with other anxiety disorders

Yet, what causes these gender differences in the course and symptoms of anxiety disorders? There are a variety of factors that may contribute to higher rates of anxiety in women compared to men. Many of the sex and gender differences experienced in anxiety disorders in women include biological, psychosocial, and other cultural factors:

• Heightened sensitivity to the unpredictability of potential threats
  • Women experience increased startle potentiation in anticipation of predictable and unpredictable threats
  • There are gender differences in brain activation and function that involve a neural network that spans multiple brain regions
    • Anxiety is typically triggered by the uncertainty and unpredictability of a threat
      • A lack of certainty and inability to predict a threat can lead to avoidance, defensive preparedness, and hypervigilance
    • Predictability of a threat is an important factor in the symptoms and course of PD, which is characterized by periods of intense fear and anxious apprehension
      • Correlates with heightened sensitivity and startle to unpredictable threats in PD
        • Greater severity of panic symptoms
• Other gender differences in brain chemistry
  • Estrogen and progesterone increase the activation of the fight-or-flight response and length of activation in women compared to men
  • As a neurotransmitter, serotonin can also play a role in responsiveness to stress and anxiety
    • Female brains may not be able to process serotonin as quickly as male brains
    • Women are more sensitive to low levels of the hormone corticotropin-releasing factor
      • This hormone typically helps organize stress responses
      • Greater hormonal sensitivity increases women’s risk for stress-related disorders
• Hormonal gender differences and changes
  • Differences in endogenous hormones contribute to greater sensitivity to threat
    • The primarily male hormone testosterone can reduce the effect of the startle response in women
    • Puberty is characterized by acute changes in hormones, physiology, and behavior that can impact threat sensitivity
      • Females going through puberty may experience increased threat-potentiated startle response and unpredictable threat during this developmental period
• Greater exposure to anxiety-inducing experiences
  • Girls and women are more likely to experience interpersonal trauma in childhood and adulthood
• Gender roles and societal and cultural expectations
  • Through socialization, girls are more often encouraged to express fear and worry
  • Girls are also more often socialized toward dependence, fearfulness, passivity, and obedience
  • Through socialization, boys are often encouraged to suppress feelings of fear and insecurity
  • In socialization, boys are also more often socialized toward strength, bravery, preparing for action, problem-solving, achieving goals, and success
  • Boys and men are less likely to report experiencing anxiety symptoms because it conflicts with traditional Western masculinity norms
    • Expressing difficulties with anxiety is perceived as a weakness 
• Women are often expected to wear and maintain multiple hats as primary caregivers, teachers, and employees while running the everyday tasks and errands of a household
• Intersecting factors that contribute to gender differences in experiencing anxiety disorders
  • Females tend to experience more harmful factors related to gender roles, social and economic situations, discrimination, and other life experiences

The countless factors related to sex and gender showcase the significance of gender differences in anxiety disorders. However, gender differences are often overlooked in the diagnosis, prognosis, and treatment of anxiety disorders like PD for women. Thus, greater insight into how gender differences in PD and other anxiety disorders impact the well-being of women will further showcase the need for gender-specific care in treatment.

Impact of Gender Differences on the Well-Being of Women

When gender differences in mental health are left unaddressed, women are harmed. As noted in “Gender and Health” from the World Health Organization (WHO), there are countless gender-related barriers to physical and mental healthcare for girls and women. Through gender norms, roles, and relations, coupled with gender inequality and inequity, well-being can be impaired. Listed below are some of the ways gender differences in anxiety disorders and other health concerns can impede women’s well-being:

• Impairs ability to function at work
  • Frequent missed days at work can increase work and financial insecurity
• Higher prevalence of health, emotional, and substance use issues
• More likely to experience high levels of comorbidity with other mental health conditions
  • Other anxiety disorders
  • Depressive disorders
  • Eating disorders
• A higher risk of suicidal ideation
• Pregnant women with PD are at a greater risk for adverse birth outcomes
  • May experience higher rates of preterm births 
  • A greater number of small-for-their-gestational-age babies
• Increases risk for physical health issues
  • Cardiovascular issues
  • Barlow syndrome – a type of heart valve disease
  • High blood pressure
  • Respiratory issues
  • Irritable bowel syndrome
  • Gastrointestinal issues

As noted in the list, gender-specific risk factors in anxiety disorders like PD can also increase the risk of SUD. In an effort to alleviate or suppress the overwhelming distress of PD, you may seek to self-medicate with substances. Your misuse of substances can also increase your risk of developing psychological disorders like PD. The increased use, misuse, and abuse of substances like alcohol and nicotine can cause additional complications to your wellness. Some of the complications that come with co-occurring PD and SUD include:

• Worsens anxiety symptoms
• Increases the frequency and severity of panic attacks
• Stimulants like cocaine, amphetamines, and marijuana can trigger panic attacks
• Withdrawal symptoms from substances like alcohol and benzodiazepines can mimic anxiety symptoms and/or lead to a panic attack
  • Unassisted detox can lead to sudden and unpredictable symptoms that cause physical and psychological distress and harm
    • Can increase your risk of relapse
    • Overwhelming craving and withdrawal symptoms can lead to overdose and fatal overdose
    • Exasperate other mental health conditions
    • Can lead to health complications and worsen chronic health conditions
• Further impaired functioning for typical daily tasks and errands, work, school, and relationships

The complications of PD and SUD, especially detoxing alone, highlight the need for treatment and support.

Gender Differences and the Value of Talk Therapy in Treatment

There are several different treatment options that can support women in addressing PD. Specifically, psychotherapy, also known as talk therapy, and/or medication is effective in treating PD. As noted in the Cochrane Reviews, some of the therapeutic interventions used to treat PD with or without agoraphobia include:

• Psychoeducation (PE): Combines elements of cognitive-behavioral therapy (CBT), group therapy, and education
  • Provides information and knowledge to you and your loved ones about your disorder
  • Supports building opportunities for you and your family to work in collaboration with clinicians for better health outcomes
• Supportive psychotherapy (SP): Focuses on providing emotional support, encouragement, and validation related to present life difficulties
  • Works to maintain, restore, or improve self-esteem
  • Improve adaptive skills
• Physiological therapies (PT): Approaches to therapy that involve a physical training element to address the physiological symptoms of PD and other anxiety disorders
  • Breathing retraining
  • Relaxation techniques
    • Progressive muscle relaxation (PMR) reduces tension and supports bodily balance to decrease responses to panic-inducing stressors
• Psychodynamic therapies (PD): A set of therapies that use different therapeutic strategies to reveal, interpret, and resolve conflicts
  • Works to understand how subconscious thoughts, feelings, and memories impact current behaviors
  • Support building adaptive coping skills through deeper insight and self-awareness
• Behavior therapy (BT): Focuses on a gradual increase in exposure to body sensations that accompany panic and/or situations perceived as a threat
  • Works to reduce apprehensive reactions to the somatic symptoms of PD
• Cognitive therapy (CT): The main component focuses on cognitive restructuring for negative thinking patterns
  • Supports you in learning how to identify and modify irrational or maladaptive thoughts through various strategies
    • Socratic questioning
    • Guided imagery
• CBT: The main components of the therapy use interventions like psychoeducation, PMR, cognitive restructuring, and in vivo exposure
• Other therapies: Approaches originating from CBT that focus on the function of cognition
  • Therapies can include mindfulness‐based cognitive therapy, acceptance and commitment therapy, compassionate mind training, extended behavioral activation, metacognitive therapy, and schema therapy
  • Supports you in developing more adaptive emotional responses to stressful situations
  • A mindfulness and acceptance approach helps you observe your symptoms without overthinking or judging them

Out of the listed therapies, CBT is most often used to treat PD. CBT is an effective evidence-based talk therapy because it focuses on changing thinking, behavior, and reactions. Through CBT, you can learn how to change the way you think, behave, and react to your feelings before and during a panic attack. 

With a deeper awareness of your negative thoughts, you can foster healthier thoughts and feelings with adaptive coping strategies. Further, the therapeutic interventions that will be the most beneficial for you are more effective through a gender-specific lens. Through a gender-specific lens, treatment options can be tailored to address your unique experiences and needs to recover.

Fostering Healing With Gender-Specific Care at New Creation Recovery

At New Creation Recovery, we recognize the need for gender-specific care and dual diagnosis to support healing women with PD. Unaddressed PD and other anxiety disorders can be detrimental to functioning and your ability to recover. In addition, PD and co-occurring SUD can impede your ability to lead a fulfilling life. 

Therefore, we recognize the need to treat gender differences in PD to support whole-person healing. Through our Christian based drug rehab for women, we are committed to providing tailored gender-sensitive and responsive recovery. With a holistic and spiritual approach, you can heal in mind, body, and soul to thrive in your life.

Women are twice as likely to experience anxiety disorders like PD. The prevalence of PD in women can stem from a variety of biological, psychosocial, cultural, and environmental factors. However, gender differences in PD and other disorders are often overlooked in how they impact the well-being of women. Sex and gender differences like hormonal differences, gender socialization, and greater exposure to trauma can increase the risk of anxiety disorders and unhealthy coping strategies like substance misuse. Yet, with increased self-awareness and gender-specific care, you can dismantle negative thoughts and foster adaptive coping skills. At New Creation Recovery, we are committed to providing gender-sensitive and responsive treatment to address your specific recovery needs. Call us at (877) 868-5730 today.