Don’t be Afraid to Say ‘I Have Anxiety’

The other day, I was having dinner with some girlfriends when one of them opened up about experiencing anxiety episodes over the past few months. She was really embarrassed, confused and crying.

As our conversation deepened, 3 of the 4 people at the table revealed they have been coping with anxiety for a long time. I was one of them. I sat there thinking: how is it possible that I have known these people for my entire life and yet we’ve never mentioned that we suffer from this condition?

Everyone can feel anxious from time to time – it’s a natural reaction of the body and the brain to certain situations or events. But an anxiety disorder is something else.

Have you ever felt as though you spend every single minute of every single day worrying over the slightest thing? Have you ever felt as though your heart is bursting out of your chest? Do you tend to catastrophize every situation in your life? Do you have irrational fears? If you said yes to at least two of those questions then…congratulations! You may have an anxiety disorder.

You must be thinking, congratulations? I’m miserable!

But I congratulate you because recognizing and admitting you are struggling with a mental health issue is the first step towards dealing with it and feeling better.

We need to start acknowledging anxiety for what it is so we can eliminate the stigma around it. 

Anxiety disorder is the most common mental health condition in Mexico, affecting 14.3% of the population. To put that into context, there are more people living with anxiety in our country than there are people living with diabetes, yet we rarely hear about those in mental distress. Having an anxiety disorder can be debilitating and crippling at the best of times – add people calling you crazy or helpless and society judging you and things can become much worse.

Since feeling anxious is common, anxiety isn’t often thought of as a mental health issue. I believe that this is where the problem originates. Anxiety is real and in Mexico it is still underestimated. Did you know May is Mental Health Awareness Month, and 14 – 20 May is Mental Health Awareness Week? If not, it’s not your fault: too often mental health is put on the back burner and seen as less important than physical health.

If you’ve experienced anxiety and wondered why it happens, anxiety disorders develop from a complex set of risk factors including genetics, brain chemistry, personality, and life events. There are several types of anxiety disorders, including Social Phobia, Generalized Anxiety Disorder (GAD), Panic Disorder, Obsessive-Compulsive Disorder (OCD), Post Traumatic Stress Disorder (PTSD), and many others.

Anxiety disorders are highly treatable, yet only 36.9% of those suffering receive treatment. If you are suffering, don’t be afraid to seek help or counseling. You may think you are alone and that no one will understand what you’re going through, but by opening up to people close to you and receiving the treatment you deserve, we will all be one step closer to breaking the stigma around anxiety. If you sense that someone close to you might be suffering, approach them in a way that makes it feel safe for them to open up to you.

It might sound like a cliché but it really is true: you are not alone. Speak up. 

Girls are Facing a Mental Health Crisis

According to the World Health Organization (WHO), around 80,000 people die by suicide every year. This means that one person dies by suicide every 40 seconds.

Suicide is “the second leading cause of death among 15 to 29 year olds globally,” and is not limited to developed countries: “78% of suicides occurred in low- and middle-income countries in 2015.Depression is “the leading cause of disability worldwide, and is a major contributor to the overall global burden of disease.

What these shocking numbers reveal is that while there are many serious global health issues that demand attention, mental health must not be left behind, and this is especially true when considering the current state of girls’ mental health.

In The State of the World Population 2016, UNFPA portrayed a worrying picture of girls’ mental health, stating that suicide is the “second leading cause of death for adolescent girls between ages 10 and 19.” In the United States, according to the Centers for Disease Control and Prevention, suicide rates among teenage girls reached a 40-year high in 2015.

In the United Kingdom, data on child and adolescent mental health from the National Health Service has revealed significant differences between genders. For example, “more than two-thirds of antidepressants prescribed to teenagers are for girls,” 90% of children admitted to hospital due to eating disorders are girls, and hospitalizations due to self-harm involving girls “have quadrupled since 2005.

The reasons for this global trend of worsening mental health conditions among girls are complex. A common cause given for such a dire situation is the negative effects of social media, especially in relation to body image issues. Though research has documented a link between social media and girls’ body image issues, this does not tell the whole story of why girls’ mental health is in crisis.

There are also serious issues of sexual harassment and abuse, domestic violence, and poverty faced by girls worldwide which have significant impacts on mental health. Research has found, for example, an increase of children living in poverty in the UK, and poverty has been found to be a risk factor for worsening mental health.

Not only are girls suffering from the most common mental disorders of depression and anxiety, but research has also found an increase in post-traumatic stress disorder in this demographic. And while links between suicide and a history of mental illness have been established, the WHO has highlighted the critical issue of high suicide rates among “vulnerable groups who experience discrimination,” such as LGBT and indigenous peoples, refugees, and migrants – and girls are included in all of these categories.

To address this crisis, organizations such as Girls Inc. are raising awareness of the importance of mental health for girls. Similarly, the International Bipolar Foundation has created a Mental Health Awareness Patch in partnership with girl scouting organizations that can be earned by Girl Scouts in all ranks to provide them with an opportunity to learn about mental health, how it’s portrayed in the media, and how to be involved in anti-stigma campaigns.

And if social media can be harmful to girls’ mental health, it can also be a source of help. For example, the Sad Girls Club is an online community for girls – particularly of color – dealing with mental health challenges. It was founded by Elyse Fox, who experienced depression herself, and officially launched in February 2017. The club goes beyond an online community, however, as it also holds real-life meetings.

The fact that mental health has been added to the UN Sustainable Development Goals under goal 3 is a good example of mental health being placed at the heart of the global agenda. The mental health of girls around the world today is without a doubt a complex and multi-faced issue. It requires an approach that takes into consideration the intersection of issues that have brewed this crisis, such as the role of social media in girls’ lives, poverty, and violence.

If we truly believe that ‘the future is female,’ then our girls’ mental health must be made a priority.

On the Importance of Mental Health to Women’s Health

Until recently, the main images that would show up in my head when I thought of ‘women’s health’ would be gynaecological exams, menstrual cramps and pregnancy. I didn’t think, for example, of premenstrual dysphoric disorder (PMDD) or of postpartum depression. Mental health wasn’t something I automatically associated with women’s health – that is, until I began to struggle with debilitating mental health issues myself. Those issues negatively affected my overall wellbeing and disrupted my whole life.

Mental health issues occur in both sexes, but in my experience as a woman with mental health issues, and reading stories of other women like me, I believe that gender plays a major role in the way mental health issues are experienced by individuals. Stigma around mental health is, unfortunately, still rampant among both men and women, and social constructs of men being physically and mentally ‘stronger’ than women – the ‘fragile sex’ – can deeply hurt those of all genders. However, one thing I’ve noticed is that for women in particular, these social constructs can put their experiences at risk of being belittled as simply a “woman’s issue” instead of a legitimate health issue – an obstacle I’ve come up against myself time and time again. 

Many symptoms of anxiety and depression throughout my life have been ‘blamed’ on my sex: my short temper and irritability as a teenager – common symptoms of depression among teens – were “just PMS”, and my depressive moods were “just hormones”. I kept silent about the anxiety I’d been dealing with for over 16 years for fear of being seen as “weak” (weaker than already being a woman, that is) or as a “drama queen”.

Women who struggle with PMDD, for example, can suffer for years without having their disorder diagnosed and their condition taken seriously as something more than ‘just’ pre-menstrual syndrome. Women who suffer with addictive disorders also struggle as they are less likely than men to seek help for alcohol dependence.

Other facts confirm just how much mental health can affect women’s overall health, such as the fact that suicide is the second-leading cause of death among teenage girls worldwide, and that women are more at risk of developing anxiety and depressive disorders than men. And although biology (what psychology refers to as “nature”) may have something to do with women’s predisposition to mental health issues, the environment women are raised and live in (“nurture”) can also play an important role. Environmental triggers range from a constant fear of falling victim to sexual harassment and assault to the negative impacts of social media on girls’ and women’s views of their bodies and their sexuality.

Despite having struggled with mental health issues at some level since childhood, it has only been in the last year that I began to see and validate those issues as serious and deserving of help. In therapy, I have been working through dealing with long-held feelings of guilt I have associated with my anxiety and depression. One of the reasons for this, I believe, is that growing up I wanted to overcompensate for being ‘fragile’: I wanted to be seen and treated as ‘strong’ and to be respected by others just as my male counterparts were. Perhaps I believed that admitting, especially publicly, that I struggled with anxiety and depression would give others even more ammunition to see me and treat me as fragile and less-than. Today, I’m in the process of accepting my mental health issues – I take medication, go to therapy, and have seen doctors and psychiatrists.

For the first time in my life, I’m beginning to see these issues not as weaknesses, but as the medical conditions they really are. I’m beginning to see that if anything, dealing with them for most of my life has made me a stronger, not weaker, woman.

Mental health should become as common as pregnancy and menstrual cramps in conversations about women’s health – there can be no women’s health without mental health. In these conversation, though, it’s important to acknowledge that although women can have a greater biological predisposition to mental health issues, this fact says absolutely nothing about the character and the strength of women. Our biology can contribute to the high incidence of anxiety and depression among our sex, but by no means does it limit our capabilities or our right to have our health issues taken seriously by medical professionals and the people in our lives.

Taking Premenstrual Dysphoric Disorder Seriously

Premenstrual syndrome, better known as PMS, is nearly a universal experience for women; the most common symptoms include bloating, fatigue, headaches, and mood swings. As annoying and bothersome as these symptoms can be, most women are able to endure this monthly disturbance without any major issues.

But PMS can turn into a debilitating and even life-threatening disorder that is unfortunately not nearly as well-known as it should be – premenstrual dysphoric disorder (PMDD), a disorder recognized by both the American Psychiatric Association and the World Health OrganizationThe symptoms of PMDD are similar to those of PMS, but much more severe, and also include loss of interest in daily activities, difficulty concentrating, irritability, sudden mood swings, and severe anxiety and/or depression which can even lead up to suicidal thoughts and/or attempts.

Several women have shared the struggle of living with PMDD with the BBC – they talk of experiencing bursts of anger, suicidal thoughts, and even being sanctioned to psychiatric hospitals. With treatment, however, the women shared that they are able to live happy and fulfilling lives despite PMDD.

Lack of awareness of PMDD is likely the main obstacle for treatment (I myself only heard of it for the first time around a year ago). A survey commissioned by the Society for Women’s Health Research revealed that 45% of respondents never talked about PMS with their doctors, and worse yet: 24% of respondents who claimed having severe PMS symptoms were unaware of PMDD, and feared that their doctors would not take their complaints seriously.

To diagnose PMDD, as there is no specific test, a doctor must first eliminate other possible causes for the symptoms. The doctor will want to rule out thyroid disorder, anxiety and mood disorders, and chronic fatigue syndrome, for example, as these disorders can cause similar symptoms to PMDD. To be considered PMDD, the symptoms must show up during the week or two before a woman gets her menstrual period, and then subside shortly after the period is over.

Treatment options vary, from hormonal treatment with birth control pills, to taking the class of antidepressants called SSRIs (selective serotonin reuptake inhibitors). Since PMDD only shows up around the time before a menstrual period, it may take a few cycles for treatment to take effect, but with adequate treatment and support, it’s possible to live well with PMDD.

Women’s health, especially surrounding menstruation, remains a taboo and stigmatized topic, even in developed countries. We need a major culture change to start taking women-specific health issues as seriously as heart issues, for example. I believe this change must start with us, women, in breaking the shame and stigma that may live within ourselves. How many times have we been ashamed of our own periods and PMS symptoms? I know I have. It begins with us to be proud of our biology, to know our bodies, talk openly about it, take our symptoms seriously, seek medical help, fight for the treatment we deserve, and encourage other women to do same.

If you think you may have PMDD, please reach out for help, especially if you’ve been experiencing suicidal thoughts. Talk to a trusted family member of friend and seek medical help as soon as possible. If you have PMDD, we welcome you to share your experience with us, so we can break the stigma together!