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Men view traditional symptoms of depression as more severe than other types of symptoms

A study has found men view traditional symptoms of depression as more severe than other types of symptoms, and men with traditional depressive symptoms are perceived as more feminine and less masculine. This has major implications for stigma and help-seeking.

Basically, “traditional” symptoms are more internalizing ones such as crying, sadness, and withdrawal, and “non-traditional” ones are more externalizing ones such as anger and self-medication.

In the study, respondents were presented one of four vignettes about a man experiencing different types of depression symptoms. They were asked if the character was depressed and their perceptions of him. In the vignettes in which the man wasn’t experiencing traditional symptoms or exhibited behaviors such as increased anger, self-medicating such as increased drinking and similar behaviors, he was perceived as more masculine, while men with more traditional symptoms like crying or withdrawal from normal behaviors and routines were viewed as more feminine.

“In situations where we had those nontraditional symptoms or a ‘rub dirt on it and walk it off’ kind of attitude, they were perceived as less depressed and more masculine,” Cole said. “There was just something about those external behaviors that help men save face. This is concerning because these nontraditional signs of depression were deemed less severe and more socially acceptable for men to exhibit. One potential implication of this is that men won’t recognize their own experiences of depression or that their symptoms warrant help-seeking.”

The findings showed that respondents who experience gender role conflict and self-stigmatizing views were less likely to seek treatment

It seems like the assumption here is that this is all in the man’s head, but I would wonder how much of a role other people are playing in this. It would be very unsurprising to me to find that men with these outlooks have many more people in their lives socially enforcing these rules.

For those who are confuse about “traditional depressive symptoms” vs “non-traditional depressive symptoms”, the article appears to articulate it this way:

In the vignettes in which the man wasn’t experiencing traditional symptoms or exhibited behaviors such as increased anger, self-medicating such as increased drinking and similar behaviors, he was perceived as more masculine, while men with more traditional symptoms like crying or withdrawal from normal behaviors and routines were viewed as more feminine.

So, in my understanding, this breaks it down to

Traditional (viewed as feminine and more severe depression):


Withdrawal from normal behaviors

Non-Traditional (viewed as masculine and less severe depression):

Increased anger

“Self-medicating” with alcohol



excessive spending

excessive eating

All come to mind

If you are depressed seek help. It’s important to know that none of these activities make you a bad person. And if you slip you slip; it happens. Don’t let shame keep you from trying again.

Don’t think “Well, I fucked up again, I guess it doesn’t really matter. I guess I’m just fucked up. Who cares?”

I’ve been there. But believe me, you can be better. Some days you’ll feel like you’ve turned a corner and none of that shit will bother you ever again. Then the next day you’ll wish you were dead and fall back into it. That’s ok.

Just try to work on yourself. Find an alternative activity. Attend a meeting. Try helping someone. Anything is something. Hopefully, over time, the number of “good days” before you have another “bad day” will get longer.

But you need to know: You aren’t broken. You are human. Your faults are what make you beautiful and make you into a person that can help people. Here is a quote I ponder a lot:

The wound is the place where the light enters you.

— Rumi

The term “traditional” in the article seem to be based on gender stereotypes. I have been diagnosed and treated for depression for many years. I have fit all of the descriptions at some point or another. However, I would agree that the men that I have talked with about depression express anger more readily than overt sadness. What l would like all people, regardless of gender, to understand is this.

One of the most difficult things that a person can do was look a themselves with an objective, caring eye. Through this, I came to understand that gender roles were/are imposed on us throughout our lives. When I was in high school if you came into the boys locker room and were crying because your girlfriend broke up with you, there would be little sympathy.

If you acted out in anger, striking out and using foul language to express your pain, you would have more support. These are lessons men can learn from other men, media and peers. What I came to find was that bravery, courage and accountability are not gender specific. They are human traits that cross over gender. The ability to connect with your feelings, embrace them and understand them is a Warriors Act. It requires commitment, perseverance in the face of pain and a desire to become the best person you can

Moreover, this is from the perspective of diagnostic criteria of depression disorders. It’s so that when a mental health or medical provider evaluates someone, their “traditional” illness script of depression doesn’t disqualify the “non-traditional” presentation described here for men with more masculine presentations of depression.

Additionally, the characteristics described as “non-traditional” are already in the depression criteria, but we consider these parts of an atypical depression. When you have 5 out of 9 total symptoms possible to diagnose depression, there’s 126 possible combinations (not including the permutation of more than 5 symptoms, which is more common). Now increased anger and lashing out are two different behavioral domains. Increased agitation is one thing, impulse control is another.

There’s a lot of difficulty in nuancing whether impulse control is affected by increased substance use, or if there’s an underlying substance use disorder that lowers impulse control, or if the depressive (or other) disorder is itself lowering impulse control. Agitation is also a pretty ubiquitous symptom in mental disorders.

Also, I think one has to go about dissecting intent, action, and result when it comes to parsing out how your behaviors work from a brain standpoint. It sounds like you have a lot of insight into what you need to stay or get healthy, but you don’t necessarily have the motivation to do it. That’s more indicative of depression, in which people have a partial to complete loss of motivation (in other words, it’s difficult for our wants to align with our needs).

Impulse control likely has something to do with it, but more in the sense that overall cognition is affected in depression. Loss of impulse control would be when you have no mental insight/sensation/”voice in your head” telling you that what you’re about to do is dangerous for yourself or others (i.e. deciding to punch someone due to agitation, buying something even though you don’t have the money/budget, saying whatever comes into your mind without thinking about how it will be perceived). Depression tends to come with a lot of guilt that we aren’t able to reason with, and this tends to counteract any increased impulsivity that may underlie a depressive disorder (in the case of guilt over food selection or work tardiness, those are harder things to analyze).

This is why doctors/therapists are really concerned putting someone on a new drug, like an SSRI, because there’s an interval in which the full benefit of the drug is not fully realized until after you’ve experienced some quick improvements, primarily in motivation and reduced guilt.

This significantly increases someone’s risk for suicide attempt/completion, since a lot of what prevents suicide at baseline in depression is the loss of motivation and increased guilt (perhaps the one positive element you can say about this combination of symptoms, without intending to minimize how disabling they are). I say all of this with an asterisk since depression, like all mental disorders, are vary heterogeneous and diverse, as are the environmental factors that each person may experience.

There are people who likely have enough motivation without acute treatment who would attempt suicide before getting to see a doctor, in addition to many other factors I will not be covering in my current TED Talk.

All of this is to say, seek help if symptoms worsen, and reach out to your doctor therapist if you’re experiencing suicidal thoughts. People usually pull through those thoughts given enough time with treatment.

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