Men and Anxiety

Before that first panic attack at age 34, Bruno Feldeisen lived a charmed life in New York. A celebrated chef who had won awards and competitions, with a throng of friends, he felt invincible. But one summer day 16 years ago, something inside him snapped. “The light dimmed, my vision got narrow, I couldn’t breathe,” he said. “I thought I was having a heart attack.”

Bruno Feldeisen pastry chef

It wasn’t his heart that was ailing, it was his mind. A French national, Feldeisen had left his native country years earlier in pursuit of the American dream. In fact, he had escaped. From a young age, Feldeisen had suffered horrific abuse from his drug-addicted mother.

While Feldeisen had learned to suppress his trauma, the past caught had up with him. Even though the cardiologist reassured him his heart was fine, Feldeisen couldn’t stop worrying about his health. “My mind was totally focused on the symptoms in my body—a tight chest, a little dizziness. Every small symptom would trigger a panic attack,” he said. As he spent entire days scanning his body for illness, his old life melted away. He stopped going out in public because restaurants made his back spasm and busy streets caused hyperventilation. He quit his job, drifted, and eventually went bankrupt. “I didn’t enjoy life anymore,” he said.

Stories like Feldeisen’s are uncommon, likely because men have half the reported rate of anxiety disorders as women, according Dr. Neil Rector, Research Director in the Thomson Anxiety Disorder Centre at Toronto’s Sunnybrook Hospital. Data from the Anxiety Disorders Association of Canada show that one in four Canadians will have at least one anxiety disorder during their lifetime, which translates to one in six men, all of whom may suffer the same crippling consequences as Feldeisen: they can lose their jobs and damage their relationships, said Dr. Rector.

Are Men & Women Wired for Anxiety Differently?

The reasons why fewer men appear to suffer from anxiety are many, but biology does play a role. “For men, the male hormone testosterone protects against anxiety,” Dr. Mohamed Kabbaj, Professor of Biomedical Sciences and Neurosciences at Florida State University said. Testosterone boosts the action of GABA and increases serotonin, two brain chemicals (neurotransmitters) that are found to be low in anxious people. Testosterone also reduces the activity of the amygdala, the site of the “fight-or-flight” reaction and an area that is working overtime in some anxiety states. Additionally, it diminishes fear and anxiety by dampening the activity of the circuit linking the bed nucleus of the stria terminalis with the amygdala. Finally, testosterone modulates the release of the hormone cortisol, in response to stress.

How Does Anxiety Affect Men?

Men with anxiety feel something many women don’t—shame. “If you’re male and have been socialized to be active and controlling, anxiety is (perceived) as a sign of weakness,” said Dr. Rector. Men with anxiety berate themselves, saying “I’m vulnerable, I’m failing.” Their embarrassment prevents them from reaching out for help. This means that by the time they do get a consult, their condition is more severe than that seen in women.

Feldeisen berated himself for his perceived weakness. “I was ashamed and disappointed in myself,” he says. “I was not a masculine man (anymore).” He was reluctant to seek help because he feared appearing vulnerable. “If a man says ‘I have a mental illness’, that’s equal to craziness,” he said. He tried biofeedback half-heartedly, would go a few times, then stopped.

How do Men Cope with Anxiety?

Many men with anxiety express similar feelings as Feldeisen. Instead of seeking help, 30% of men with anxiety turn to substances as a way to cope with their symptoms, said Dr. Jeffery Wardell, post-doctoral fellow at the Centre for Addiction and Mental Health in Toronto. Men’s greater impulsivity also accounts for their higher reliance on substances. Further, men hold stronger positive beliefs about alcohol (the number one substance of abuse), than women. By contrast, anxious women are more likely to turn to friends than substances. As well, women limit their consumption of substances because society judges this behavior more harshly in females than in their male counterparts. Men who trust that alcohol will relieve their tension are more likely than women to act on this assumption when feeling stressed (including anxiety states).

“People suffering from anxiety take substances in an effort to self-medicate,” said Dr. George Koob, Director of the US-based National Institute on Alcohol Abuse and Alcoholism. Substances co-opt the brain’s natural reward system. Deep inside the brain, the mesolimbic dopamine reward system is activated by pleasurable stimuli including food and sex, producing a rush of feel-good brain chemicals, said Dr. Koob. The ingestion of substances including alcohol, opioids, marijuana, and nicotine produces identical pleasure effects. When endorphins (the chemicals responsible for the “runner’s high”) are released by natural stimuli or by substances, they bind to the same receptors as morphine, dulling emotional pain and calming the mind. It is this type of relaxation that people with anxiety are seeking when they turn to substances.

Feldeisen turned to alcohol to manage his symptoms. After the first panic attack, he began taking two full glasses of wine at dinner. “It put me out of my misery, made me a little numb,” he said. He hastens to add that he didn’t become an alcoholic.

Detecting Anxiety

While many men are reluctant to admit their anxiety, making it difficult for loved ones to find out what’s going on, there are some tell-tale clues, said Dr. Martin Antony, Professor and Chair in the Department of Psychology at Ryerson University in Toronto. “If the man in your life starts to avoid things he used to enjoy or becomes irritable, these can be signs of an anxiety disorder. Anger is more acceptable for some men than anxiety.” Additionally, it’s not uncommon for men suffering from anxiety to also experience depression. Other signs include trouble concentrating, difficulty sleeping and loss of interest in sex.

While men who do see a clinician are usually dragged in by their partners, it’s important not to push, according to Dr. Maureen Whittal, a psychologist in private practice in BC. “Instead, reassure him that his condition is extremely common,” she said. “Tell him ‘It doesn’t have to be this hard’. Find him a family doctor when he’s ready, and you can offer to accompany him. Suggest you treat the visit as an experiment, and don’t ask for a commitment to treatment,” she said.

Feldeisen didn’t have a partner to motivate him into getting help but he does have a son. He was five years old at the time. “I told myself enough is enough,” he said. “We need to fix this. My son needs me to be the best person I can be.” He used the Anxiety BC website to find a counselor trained in cognitive behavior therapy (CBT). He succeeded. “My therapist is one of the best in Canada,” he said.

Hope for the Future

“There is hope for other men suffering from anxiety,” says Dr. Rector. CBT, which addresses distorted thinking patterns, is the first-line intervention for all anxiety disorders. It works 60-70% of the time, for both men and women. “Some patients can also be treated with medication, while more severe cases may require both counseling and pills,” he said.

Today, Feldeisen is thriving and his panic attacks have vanished. He receives recognition as a chef and importantly, he’s a “super dad” to his now eight-year-old son. And he’s finally achieved something that has eluded him all his life—serenity. “I don’t go to bed with worries. I wake up in the morning with a sense of peace,” he said.

Feldeisen believes there’s hope for other men suffering from anxiety. “You don’t need to be ashamed of the life you’re living—by seeking treatment, you could fully live the life you want.”