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Why Do So Many Women Have Anxiety Disorders? A Hormone Hypothesis

(Stuart Anthony/Flickr)

(Stuart Anthony/Flickr)

Why do so many women suffer from anxiety? Is it something inherent in being female, are we more attuned to our moods? Or is that breath-clenching feeling of impending doom hard-wired?

According to the National Institute of Mental Health, women are 60 percent more likely than men to experience an anxiety disorder over their lifetime. (Obviously, men are not immune: taken together, anxiety disorders are among the most common mental health conditions — they affect about 40 million men and women age 18 and older, or about 18 percent of the U.S. population.)

Mohammed Milad is an associate professor of psychiatry at Harvard Medical School and director of the Behavioral Neuroscience Program at Massachusetts General Hospital. He studies the complex interplay of gender, fear and anxiety. More specifically, he’s looking at how hormones, notably estrogen, might play a role in the fear response and our ability to extinguish fear and anxiety.

I spoke with him about his work. Here, edited, is some of our conversation:

RZ: OK, can you just clearly explain the difference between fear and anxiety? Sometimes it’s a fine line indeed.

MM: I was thinking about taking my kids camping over the summer, and I was reading about bears and potential bear encounters, and considerations for taking cover and putting your food this distance away from your camping site, etc. Anxiety is when you’re camping and you have that heightened awareness — hyper-vigilance  — that’s anxiety, it’s sustained, it’s continuous, but it’s not at the point where it makes you run or look for cover. Fear is when you see the bear; fear is intense, it’s immediate, it’s right there in front of you.

RZ: Thanks for that. But I’m curious, how did you start studying how men and women are different when it comes to fear and anxiety?

MM: When I was in grad school we used to host kids from middle and elementary school…showing our lab to them, showing them the rats, and one kid, maybe 10, 12 years old, asked, are they male or female rats and I said they’re all male rats, and he asked, why, what about the female rats? And I didn’t know the answer, so I went to my mentor and asked, why don’t we study the females? And the answer, simply put, was they’re complicated.

RZ: So the female rats were just too complicated. I get that. But considering far more women than men suffer from anxiety disorders, the fact that you were studying only male rats wasn’t such a great approach, was it?

MM: No, so I think that’s not an acceptable answer now.

RZ: In your experiments on rats and humans, you and your team use Pavlovian conditioning, as in Pavlov’s dogs, who were famously conditioned into drooling every time they heard a bell because they associated that sound with food. So, in these studies you repeatedly showed a blue light on a screen to men and women who would then receive a mild shock, until they came to expect — and fear — a shock every time they saw the blue light. Then, you stopped giving shocks when the blue light came on, to teach the subjects not to fear it. That’s “fear extinction.” And the next day, the men and women were tested to see if they still had a fear response to the blue light.

The results in these studies were all over the place, but most of the variance in fear response was among women in the experiment, right? The men were much more consistent. Why might that be?

MM: That’s what got me into beginning to think about hormones, because what could account for that other than maybe some women that we’re bringing in to the lab were at a particular phase of their menstrual cycle? And when we did that study we found that women who came in when their estrogen is elevated, they had their [fear] extinction capacity much better, in other words, they were able to control their fear, or express much less fear, compared to the women that came in in the early phase of their cycle… when they had low estrogen.

RZ: So just to be clear, high estrogen was linked to better control of fear, and low estrogen meant more potent and longer lasting fear?

MM: Right. Continue reading

Why To Exercise Today: There Won’t Be A Conflicting Study Tomorrow


You can hear a new crescendo these days in the familiar chorus of annoyance about scientific studies that tell you one thing one day, and something else the next. In The New York Times today, columnist Gail Collins writes:

Sometimes you really do want to tell the medical profession to just make up its mind.

We got word this week that estrogen therapy, which was bad, is good again. Possibly. In some cases.

This was not quite as confusing as the news last year that calcium supplements, which used to be very good, are now possibly bad. Although maybe not. And the jury’s still out.

Or the recent federal study that suggested women be told to stop checking their breasts for lumps. Or the recommendations on when to get a mammogram, which seem to fluctuate between every five years and every five minutes.

We certainly want everyone to keep doing studies. But it’s very difficult to be a civilian in the world of science.

It’s true, undeniably true, that many health findings prompt a frustrating pendulum swing between contradictory conclusions. But I’d like to point out that certain findings are so robust that the pendulum never swings. One is the harm of smoking. I’ll never forget sitting in on an MIT biology class taught by cancer research rock star Bob Weinberg, and hearing him tell students: If you take away one thing from this class, don’t smoke.

The multitudinous findings on the healthful effects of exercise also never waver, they just accumulate. CBS’s Andy Rooney likes to claim that since so many studies are contradictory, he gets to eat ice cream and drink bourbon. Well, okay. But sadly for those of us looking for an excuse to skip a workout, there’s no such confusion to give us an out.

Coping: Breast Cancer Doctor Diagnosed With Breast Cancer

Dr. Marisa Weiss is a breast oncologist who was recently diagnosed with breast cancer

Listen to this amazing interview on Fresh Air with Dr. Marisa Weiss a well-known breast oncologist and founder of a web site for women with breast cancer, breastcancer.org who was herself diagnosed with breast cancer in April.

One of the most inspiring aspects of the piece is how Dr. Weiss has transformed her life to improve her health and prognosis, and more specifically, to steer clear of excessive estrogen in her diet and environment, which can trigger an increase in cancer cell production. She’s lost weight, doesn’t eat foods with added hormones and pesticides, drinks less and stays away from people who smoke. She explains:

The breast cancer genes only explain 5 to 10 percent of breast cancer cases today and those are ancient, stable abnormalities. They haven’t changed. But what has changed over the years … are changes in our outside environment and our body’s inside environment. So in terms of the inside environment, with obesity making extra inside hormones that can influence breast cell growth, it also triggers more insulin growth factor. More women are drinking alcohol. More women have not stopped smoking. They’ve started but they haven’t stopped as quickly as men have. We lead very stressful lives. We don’t sleep enough. We run ourselves ragged.”