‍Submodule 2: Mental health conditions 

Aim: To provide additional information from submodule 1 regarding the rise of mental health conditions in men.

Key definitions

There are a number of similar terms that are sometimes used interchangeably. We have clarified them here:

Mental health: a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community¹. 

Mental disorder: a clinically significant disturbance in an individual’s cognition, emotional regulation, or behaviour². 

Mental health condition: a broader mental health term, encompassing mental disorders, psychosocial disabilities and other mental states linked with distress, impaired functioning and self-harm².

Severe mental illness: psychological problems that are often so debilitating that their ability to engage in functional and occupational activities is severely impaired³. This can often include schizophrenia and bipolar disorder.

It is also worth noting that different health organisations group categorise mental health disorders slightly differently. In this module, we will use the World Health Organisation’s International Classification of Diseases (ICD), as used in the NHS.

Overview

According to the World Health Organisation, mental health is a basic human right, and defined as a state of mental well-being that enables people to cope with the stresses of life, realize their abilities, learn well and work well, and contribute to their community¹. Mental health is not however, simply an absence of a mental disorder, with mental health existing on a continuum¹. However, sadly, every single day, men across the country are not in a state of mental well-being, and suffer from a number of mental health conditions. Often, without awareness.

Mental disorders are whereby an individual experiences a clinically significant disturbance in cognition, emotional regulation, or behaviour². This often includes stress and impaired functioning. Mental health conditions can include both mental and physical symptoms, and changes in behaviour.

Importantly, mental health disorders can be treated. But, men are less likely than females to receive mental health treatment⁴. The first step in being able to help and support men, is understanding what these conditions are, how prevalent they are, and what are the typical signs and symptoms we should be aware of, both in ourselves, and in friends, family and others around us. 

Below, we provide an overview of some of the most common mental health conditions in males, including both the clinical definitions alongside more commonly used terms, to allow you to best understand the landscape of men’s mental health, and use this resource in your clinical practice.

Prevalence and conditions

In general, the prevalence of mental health disorders has been rising since the early 1990s, with development of the first diagnostic criteria for mental health disorders in the late 1970s⁵. Mental health disorders can be considered as present, having been experienced within some recent period (e.g. in the last week or year), or across a person’s lifetime. MDs are one of the top ten leading causes of health burden worldwide⁶.

Common mental disorders (CMD)

Frequently used in the medical literature is the term common mental disorder, which is an umbrella term including depression, anxiety, panic disorders, phobias, and obsessive-compulsive disorder (OCD), and post-traumatic stress disorder (PTSD)⁷. Common mental disorders lead to significant emotional distress and impairment in daily functioning⁸.

Globally, 1 in 5 adults have experienced a common mental disorder in the last 12 months, and nearly 30% in their lifetime⁵. The prevalence of common mental disorders in men in England has risen since the early 1990s⁹. 12.5% of all men (1 in every 8) in England currently has a common mental disorder¹⁰.

Mood Disorders

Mood disorders are defined by specific types of mood episodes and their pattern over time¹¹. Mood disorders include depression and bipolar disorder, but can also be substance-induced. 280 million people worldwide live with depression, and 40 million with bipolar disorder².

Depression (Major depressive disorder)

Depression is characterised by severe and persistent lows in mood (such as feelings of sadness, irritability, or emptiness) or a loss of enjoyment. Unlike the normal feelings of sadness that we all experience at times, these feelings are much more intense, and persist. This occurs alongside other cognitive, behavioural, or neurovegetative symptoms. Combined, these significantly affect an individual’s ability to function¹².  Depression is one of the leading causes of disability worldwide. 

Annual prevalence of depression in adults from high income countries at 5.5%¹³. Depression is nearly twice as likely for females than males¹⁴, with nearly 3% of males experiencing a depressive episode⁸. 

Seasonal affective disorder (SAD)

SAD is a type of depression that comes and goes across the year. It is often known as ‘winter depression’, and is more apparent in the colder and darker months¹⁵. This can particularly affect men in the UK with long work hours and short daylight in winter. However, for some people, symptoms can be stronger during summer months.

Anxiety or fear-related disorders

Anxiety or fear-related disorders are closely related, with fear involving a reaction to perceived immediate threats in the present, whereas anxiety relates to perceived potential threats in the future¹⁶. These include Generalised anxiety disorder, panic disorder, social anxiety disorder, and phobias. Over 300 million people worldwide live with an anxiety disorder². 

Anxiety (Generalised Anxiety Disorder (GAD))

Generalised anxiety disorder, or anxiety, is a long-term condition characterised by excessive worrying about everyday topics, often around family, health, money, school or work, that are out of proportion with the likely risk¹⁷. Symptoms of anxiety persist for several months on more days than not, which can include restlessness, nervousness, poor concentration, irritability, disturbed sleep. These symptoms cause significant distress, and impair daily (including social and occupational) functioning¹⁷. 

The prevalence of anxiety has increased in the last 30 years, around 5% of males in England reporting GAD in the past week⁸. GAD is twice as likely in females than males¹⁷. 

GAD and depression tend to co-occur. People with GAD are likely to experience depression in their lifetime^17–19. 

Panic disorder and panic attacks

Panic attacks are discrete episodes of sudden intense fear or anxiety, usually lasting for a few minutes, alongside symptoms including heart palpitations, a racing heartbeat, sweating, trembling, shortness of breath, chest pains, dizziness/lightheadedness, tingling in fingers or lips, and even fear of imminent death^20,21. Panic disorder is where there are repeated panic attacks which are unexpected and not a result of a specific stimulus (e.g. alcohol) or situation²⁰. Around 0.3% of men in England suffer from panic disorder⁸. Panic disorder is twice as likely to develop in females than males, but there appear to be no difference in clinical features or symptoms²⁰.

Obsessive-compulsive or related disorders

In obsessive-compulsive or related disorders are characterised by unwanted, intrusive and unpleasant thoughts and preoccupations (obsessions)²², and repeated behaviours or mental acts that the person feels must be performed as a result of the obsession, to relieve the unwanted and unpleasant feelings about the obsessive thoughts (compulsions)²³. However, the compulsions only provide short-term relief before the obsession returns. Disorders include obsessive-compulsive disorder (OCD) and body dysmorphia.

Obsessive-compulsive disorder (OCD) 

Around 1-1.5% of men in England suffer from obsessive-compulsive disorder⁸. Reports suggest OCD affects males and females equally²³, with males more likely to develop OCD during childhood and adolescence, and females more likely in adulthood²².

Body dysmorphia

In Body dysmorphia, or Body dysmorphic disorder (BDD), individuals become highly worried about their body, or aspects of it. Often, these bodily aspects are unnoticeable or barely noticeable to others²⁴. Body dysmorphia is not vanity or self-obsession, individuals experience significant upset from the obsession. 

Body dysmorphia appears to affect males and females at similar rates. However, males are more likely to experience co-occurring preoccupations with the appearance of their overall physique (i.e., muscle dysmorphia) and genitalia, whereas females are more likely to also have an eating disorder. Muscle dysmorphia, or ‘bigorexia’, is characterised by preoccupations with and attempts to achieve a highly muscular physique, due to a self-perceived lack of size and muscularity²⁵. The actual number of individuals living with muscle dysmorphia is unclear, but is higher in individuals participating in weightlifting or bodybuilding compared with the general populatioN²⁶. A crude estimate suggested 1 in 10 men in gyms may have muscle dysmorphia²⁶.

Stress-related disorders 

Several disorders exist that are specifically associated with stress, the most common of which is Post traumatic stress disorder (PTSD).

Post traumatic stress disorder (PTSD)

Post traumatic stress disorder is a relatively common mental disorder that can affect men at any age. It develops following exposure to a single highly traumatic event, or a series of highly traumatic events²⁷. The traumatic event could be a life-threatening incident, assault, abuse, natural disasters or war/conflict^8,27. 

Post traumatic stress disorder is generally more common amongst females²⁷, with around 3.7% of men have Post traumatic stress disorder in England⁸. Military services personnel are nearly twice as likely to report probably Post traumatic stress disorder, at 6.2%²⁸. The potential for development of Post traumatic stress disorder is high, given that around a third of men in England have experienced at least one major traumatic event at some stage in their life, similar to women⁸. PTSD diagnoses appear to peak in men at the age of 45-54⁸.

Feeding or eating disorders

Eating disorders are characterised by persistently abnormal eating or eating-related behaviours, that are not the result of another health condition²⁹. When people have an Eating disorder, food is used to cope with feelings and other difficult circumstances³⁰.  There is often a preoccupation with food, and noticeable concerns around body weight and size²⁹. Eating disorders include Anorexia nervosa, Bulimia Nervosa and Binge eating disorder. Eating disorders most commonly develop in adolescents and younger adults, but they can develop at any age³⁰.

Around 14 million people have experienced an eating disorder worldwide², with an estimated lifetime prevalence ranging from 0.6-2.4% in young men³¹. in the UK, it is estimated that 25% of all eating disorders are diagnosed in men³². Between 2015 and 2021, there was a 128% rise in hospital admissions for eating disorders in boys and young men³³.

Anorexia nervosa

Anorexia nervosa is where there is restrictive eating, and other behaviours to prevent weight gain (e.g. excessive exercise, self-induced vomiting). Anorexia nervosa is characterised by a low body weight relative to height, and concerns around body image and weight gain³⁴. 

Whilst Anorexia nervosa is far more common in females, evidence suggests that diagnosis and incidence of AN in males is increasing³⁴, with as many as 25% of those diagnosed being male³⁵.

Bulimia Nervosa and Binge eating disorder are disorders relating to binge eating. Binge eating is defined as a distinct period of uncontrolled eating, leading to an abnormally large amount of food intake in a short space of time³⁶. 

Binge eating disorder

Binge eating disorder is characterised by repeated and frequent binge eating episodes (at least once per week for several months)³⁷. During the episode, the individual feels unable to stop eating, or limit the type of food or quantity eaten³⁷.  Binge eating episodes are not regularly followed by compensatory behaviours to prevent weight gain.

People of any age can develop Binge eating disorder, but it typically develops in the 20s or older³⁸. Whilst more common in females³⁷, 0.3% of all men will experience BED at some point in their life³⁹, and is more commonly identified in male adults than adolescents⁴⁰, and often associated with obesity³⁹. 

Bulimia Nervosa

In Bulimia nervosa, there are frequent, recurring episodes of binge eating (at least once per week for several months) that are then followed by compensatory behaviours to prevent weight gain, such as self-induced vomiting, laxative abuse or excessive exercise³⁶. Males are more likely to use excessive exercise or anabolic steroids as compensatory behaviours, whereas females are more likely to use purging behaviours³⁶.

Around 0.1% of males have Bulimia nervosa⁴⁰. But, rates have tripled in recent decades⁴¹,  and males are less likely to seek treatment than females³⁶.

Substance use and addictive behaviour disorders

Substance use disorders 

Substance use disorders can result from single or repeated use of substances with psychoactive properties⁴². With a Substance use disorder, individuals can become preoccupied with the substance, with a feeling of need or dependence. As a result, individuals develop a tolerance and continue to use the substance, despite knowledge of its harms⁴³. Substances with this effect can include alcohol, opioids, cocaine, caffeine, nicotine and also certain medications⁴². 

Substance dependence in England is higher in males across all ages, than females harms^43,44. Men are more likely than women to drink hazardous quantities of alcohol in England, with around 30% of men aged 16-64 drinking at hazardous levels or above⁴⁴. Amongst men, alcohol use and abuse is a leading cause of premature death and illness among men⁴⁵, and three times more likely than women to become alcohol dependent⁴⁶. Men also show the highest rates of drug dependence, averaging 4.3% compared with 1.9% of women. Nearly 12% of men aged 16-24, and 6.6% of men aged 25-34 report signs of dependence on illicit drugs⁴³. 

Addictive behaviour disorders

Addictive behaviour disorders result from repeated rewarding behaviours outside of the use of dependence-producing substances, such as gambling or gaming addictions⁴⁷. This leads to distress or interference with personal functioning.

Males appear to be more likely to be affected by both Gambling disorder and Gaming disorder than females, with twice as many males being diagnosed with Gambling disorder than females. In adolescence, 80% of diagnoses are in males, potentially reflecting males starting gambling at a younger age^48,49. 

Other disorders

ADHD

ADHD is a type of neurodevelopmental disorder, and characterised by a persistent pattern (at least 6 months) of inattention and/or hyperactivity-impulsivity that has a direct negative impact on academic, occupational, or social function⁵⁰. Males are more likely to display hyperactivity and impulsivity, particularly when younger. Females are more likely to display inattentive symptoms⁵⁰.

The global prevalence of ADHD in children is around 5%, and in adults around 2.5%⁵¹, but is more common in males than females⁵⁰. In the UK, it is estimated that roughly three times more males are diagnosed with ADHD than females⁵². 

There are also other mental/behavioural/neurodevelopmental health conditions to be aware of, including: Schizophrenia, Catatonia, Dissociative disorders, Elimination disorders, Bodily distress/experience disorders, Impulse control disorders (e.g. pyromania), Disruptive behaviour/dissocial disorders, Personality disorders, Paraphilic disorders, Factitious disorders, Neurocognitive disorders (e.g. Dementia), Pregnancy/childbirth related disorders⁵³. Closely related are also sleep-wake related disorders, such as insomnia (difficulty going to sleep or staying asleep), hypersomnolence (excessive daytime sleepiness), which can be associated with a mental disorder⁵⁴. 

Common mental health condition symptoms

Common symptoms in mental health include feelings of stress, anxiety, fear and panic, low mood and sadness, loneliness, grief and anger⁵⁵. 

For all of us, life can be difficult at certain times. As a result, we can all feel emotions such as stress, anxiety low mood, fear, or anger. For example, it is completely normal to feel anxious before an exam or interview⁵⁶. However, it is paramount to not mistake clinically significant mental health conditions as simply ‘feeling a bit down’, telling people to ‘just get over it’, or worst of all, to ‘man up’.  As outlined by the NHS, depression is not trivial⁵⁷. It is a serious illness with clinically characterised symptoms. Yet sadly, many men are told to “snap out” of it, or “pull yourself together”⁵⁷.

This is particularly important around some cultural attitudes and stereotypes around being a man, which will be discussed in a later submodule.

We will discuss breaking the status quo and taboo around men’s mental health, and cover these symptoms in more detail in a later submodule.

Self-harm: the impact of mental health conditions 

Self-harm is any intentional act of committing self-injury or self-poisoning⁵⁸. At the extreme scale, self-harm can include suicide. Sadly, rates of self-harm are on the rise. Over 6% of the population report having ever self-harmed in the UK, and nearly 10% of 16-34 year-old men⁵⁹. Self-harm rates are on the rise for older men in England, particularly those aged 60-74⁶⁰. 

Suicide

Suicide is defined as “death caused by self-directed injurious behaviour with intent to die as a result of the behaviour”⁶¹, and a suicide attempt is a “non-fatal, self-directed, potentially injurious behaviour with intent to die as a result of the behaviour”⁶¹. A suicide attempt does not have to necessarily result in any injury⁶¹. Suicidal thoughts are defined as having thoughts about take one’s own life.

Whilst not a mental disorder in itself, suicide, suicide attempts and suicidal thoughts are all closely linked with and a consequence of mental disorders, in particular, depression and substance (alcohol) use disorders^62,63. Mental health disorders are important risk factors for self-harm and suicide⁶⁴. For example in men, suicide is nearly 8 times more likely with depression, and nearly 5 times more likely with anxiety⁶⁴.

Globally, over 700,000 people die from suicide each year, and is the leading cause of death in 15-29 year olds⁶². Many more attempt suicide, and even more have suicidal thoughts. In the US, there are nearly twice as many suicides as homicides, and the suicide rate is 4 times higher in males than females⁶¹. In England and Wales, suicide rates are three times higher for men than women - 75% of all suicides males⁶⁵.

This means that over 4,300 men diet each year from suicide⁶⁵, and equates to around 1 in every 20 men has attempted suicide. Suicide is the leading cause of death for mean aged 20-34 in England and Wales⁶⁶. Since the 1980s, suicide rates have been declining, but the suicide rate for males is progressively worsening and now at their highest levels since 1999 and 1994⁶⁵.

More broadly, there have been increased reports of self-harming across all male age groups since 2007⁸. But, this may also be down to greater awareness of self-harming.

Useful links:

• NHS Adult Psychiatric Morbidity Survey
• ICD-11
• NICE CKS

References

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