There is an old saying in psychology circles that “women go to mental hospitals and men go to prison.” This saying suggests that men act out their distress while women internalize it. And although more women are being seen for sex and porn addiction, men are still the majority. A traditional view might attribute such gender differences in the sex addict population to higher sex drive among men, but a study recently published by JAMA online seems to shed a great deal of light on the externalizing behavior in men.
The study sought to investigate the long accepted gender gap in which women are 70% more likely than men to experience depression in their lifetimes. Health policy researchers from the University of Michigan and Vanderbilt University hypothesized that the symptoms of depression in women and men might be different. In their study they devised a “male symptom scale” as well as a “gender inclusive (gender neutral) depression scale” to measure not only the commonly thought of symptoms of sadness, hopelessness etc. but also the symptoms likely to be exhibited in men such as anger attacks, aggression, risk-taking, hyperactivity and substance abuse.
The researchers and others are in effect suggesting a revision in the diagnostic criteria for depression. An LA Times (8/28/13) report on the study states the following insight:
“While women may not feel shame in acknowledging their sadness and sagging self-esteem, mental health experts find that depressed men often respond to such feelings with actions that look like their opposite: They bluster and bully. They throw themselves into harms way. They numb themselves with sex, drugs and endless workdays.”
If we accept that using a mood altering substance or behavior including compulsive sexual acting out are attempts to escape negative emotional states, then the greater prevalence of sexual addiction that has been seen in men can be seen in part as their way of externalizing the negative emotions such as those associated with a depressive state.
The fact that men are reportedly many times more likely to commit suicide than women supports the notion that men take external action in response to mood disturbance or disorder more often than women, not that they experience it less than women do.
This is new territory in terms of the diagnosis and treatment of depression and emotional distress generally as well as its relationship to addiction. Both the male patient and the public at large may have an easier time seeing men who are risk takers, rule breakers and addicts as being just “bad” guys or as lacking some kind of moral compass or internal control.
But the prevailing thinking in the addiction field supports the idea that drug addictions, including compulsive sexual behavior, are an attempt to self-soothe or self-stimulate in such a way as to cope with intolerable emotions. Externalizing addictive behavior like sexual acting out logically must have a relationship to the internal distress.
Addicts are seeking relief, and many recovering sex addicts in treatment admit to chronic or acute depression, isolation and self hate. In my experience many male sex addicts have found the use of psychotropic medications such as SSRIs to be an invaluable support during treatment and recovery. This is only one study but I hope that it will lead to further research and possibly a change in the way we see the manifestations of depression.