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TEXTBOOK OF MEN’S

MENTAL HEALTH

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Washington, DC

London, England

TEXTBOOK OF MEN’S

MENTAL HEALTH

Edited by

JON E. GRANT, M.D., M.P.H., J.D.

MARC N. POTENZA, M.D., PH.D.

Note: The authors have worked to ensure that all information in this book is

accurate at the time of publication and consistent with general psychiatric and

medical standards, and that information concerning drug dosages, schedules,

and routes of administration is accurate at the time of publication and consis￾tent with standards set by the U.S. Food and Drug Administration and the gen￾eral medical community. As medical research and practice continue to advance,

however, therapeutic standards may change. Moreover, specific situations may

require a specific therapeutic response not included in this book. For these rea￾sons and because human and mechanical errors sometimes occur, we recom￾mend that readers follow the advice of physicians directly involved in their care

or the care of a member of their family.

Books published by American Psychiatric Publishing, Inc., represent the views

and opinions of the individual authors and do not necessarily represent the pol￾icies and opinions of APPI or the American Psychiatric Association.

All patient names in this book are fictional. To protect confidentiality, these

cases are composites of several people’s stories, and case details have been

changed to protect patients.

Copyright © 2007 American Psychiatric Publishing, Inc.

ALL RIGHTS RESERVED

Manufactured in the United States of America on acid-free paper

10 09 08 07 06 5 4 3 2 1

First Edition

Typeset in Palatino and Futura Condensed.

American Psychiatric Publishing, Inc.

1000 Wilson Boulevard

Arlington, VA 22209–3901

www.appi.org

Library of Congress Cataloging-in-Publication Data

Textbook of men’s mental health / edited by Jon E. Grant, Marc N. Potenza.—

1st ed.

p. ; cm.

Includes bibliographical references and index.

ISBN 1-58562-215-X (hardcover : alk. paper)

1. Men—Mental health. 2. Men—Psychology. I. Grant, Jon E.

II. Potenza, Marc N., 1965– . III. Title: Men's mental health.

[DNLM: 1. Men—psychology. 2. Mental Health. 3. Mental Disorders.

4. Sex Factors. WA 305 T3558 2006]

RC451.4.M45T49 2006

616.89'0081—dc22

2006014699

British Library Cataloguing in Publication Data

A CIP record is available from the British Library.

CONTENTS

Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix

Introduction. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii

I

Boys and Men at Different Life Stages

1 Childhood: Normal Development and Psychopathology . . . . . . . . . . . . . . . .3

Eric L. Scott, Ph.D.

Ann M. Lagges, Ph.D.

2 Adolescence: Neurodevelopment and Behavioral Impulsivity . . . . . . . . . . .23

Craig A. Erickson, M.D.

R. Andrew Chambers, M.D.

3 Older Men. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .47

Rani Desai, Ph.D.

II

Psychiatric Disorders in Men: Assessment and Treatment

4 Anxiety Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .69

Carlos Blanco, M.D., Ph.D.

Oriana Vesga López, M.D.

5 Depression . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93

Yael Levin, B.A.

Gerard Sanacora, M.D., Ph.D.

6 Substance Use Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119

N. Will Shead, M.Sc.

David C. Hodgins, Ph.D.

7 Antisocial Personality Disorder, Conduct Disorder, and Psychopathy. . . . . . 143

Donald W. Black, M.D.

8 Sexual Health and Problems: Erectile Dysfunction,

Premature Ejaculation, and Male Orgasmic Disorder. . . . . . . . . . . . . . . . . 171

David L. Rowland, Ph.D.

9 Impulse Control Disorders . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205

Jon E. Grant, M.D., M.P.H., J.D.

Marc N. Potenza, M.D., Ph.D.

10 Posttraumatic Stress Disorder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233

Dolores Vojvoda, M.D.

Steven Southwick, M.D.

III

Sociocultural Issues for Men

11 Fathering and the Mental Health of Men . . . . . . . . . . . . . . . . . . . . . . . . . 259

Thomas J. McMahon, Ph.D.

Aaron Z. Spector, M.S.N., A.P.N.

12 Men, Marriage, and Divorce . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283

Scott Haltzman, M.D.

Ned Holstein, M.D., M.S.

Sherry B. Moss, M.A.

13 Body Image and Muscularity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307

Roberto Olivardia, Ph.D.

14 Aggression, Violence, and Domestic Abuse . . . . . . . . . . . . . . . . . . . . . . . . 325

Caroline J. Easton, Ph.D.

Tara M. Neavins, Ph.D.

Dolores L. Mandel, L.C.S.W.

15 Culture, Ethnicity, Race, and Men’s Mental Health. . . . . . . . . . . . . . . . . . . 343

Declan T. Barry, Ph.D.

16 Mental Health of Gay Men . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .363

Michael King, M.D., Ph.D., F.R.C.P., F.R.C.G.P.,

F.R.C.Psych.

17 Overcoming Stigma and Barriers to Mental Health Treatment . . . . . . . . . .389

Deborah A. Perlick, Ph.D.

Lauren N. Manning, B.A.

Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .419

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ix

CONTRIBUTORS

DECLAN T. BARRY, PH.D.

Associate Research Scientist, Yale University School of Medicine, New

Haven, Connecticut

DONALD W. BLACK, M.D.

Professor of Psychiatry, Department of Psychiatry, The University of Iowa

Roy J. and Lucille A. Carver College of Medicine, Iowa City, Iowa

CARLOS BLANCO, M.D., PH.D.

Assistant Clinical Professor of Psychiatry, New York State Psychiatric In￾stitute at Columbia University Medical Center, New York, New York

R. ANDREW CHAMBERS, M.D.

Director, Laboratory for Translational Neuroscience of Dual Diagnosis

Disorders, Institute of Psychiatric Research, Department of Psychiatry,

Indiana University School of Medicine, Indianapolis, Indiana

RANI DESAI, PH.D.

Associate Professor of Psychiatry and Epidemiology and Public Health,

Yale University School of Medicine, West Haven, Connecticut

CAROLINE J. EASTON, PH.D.

Assistant Professor of Psychiatry, Director of Forensic Drug Diversion,

and Director of Substance Abuse and Domestic Violence Services, Divi￾sion of Substance Abuse, Department of Psychiatry, Yale University

School of Medicine, New Haven, Connecticut

CRAIG A. ERICKSON, M.D.

Chief Resident in Psychiatry and Fellow in Child Psychiatry, Depart￾ment of Psychiatry, Indiana University School of Medicine, Indianapo￾lis, Indiana

JON E. GRANT, M.D., M.P.H., J.D.

Associate Professor of Psychiatry, University of Minnesota Medical

Center, Minneapolis, Minnesota

x TEXTBOOK OF MEN’S MENTAL HEALTH

SCOTT HALTZMAN, M.D.

Clinical Assistant Professor of Psychiatry and Human Behavior, Brown

Medical School, Providence, Rhode Island

DAVID C. HODGINS, PH.D.

Professor of Psychology, Department of Psychology, University of Cal￾gary, Alberta, Canada

NED HOLSTEIN, M.D., M.S.

Clinical Assistant Professor, Department of Community and Environ￾mental Medicine, Mount Sinai School of Medicine, New York, New

York

MICHAEL KING, M.D., PH.D., F.R.C.P., F.R.C.G.P., F.R.C.PSYCH.

Professor of Primary Care Psychiatry, Department of Mental Health Sci￾ences, Royal Free and University College Medical School, London, En￾gland

ANN M. LAGGES, PH.D.

Assistant Professor of Clinical Psychology in Clinical Psychiatry, Co￾chief, Mood Disorders Clinic, Riley Child and Adolescent Psychiatry

Clinic, Riley Hospital for Children, Indiana University School of Medi￾cine, Indianapolis, Indiana

YAEL LEVIN, B.A.

Research Assistant, Yale Depression Research Program and Depart￾ment of Psychiatry, Yale University School of Medicine, New Haven,

Connecticut

ORIANA VESGA LÓPEZ, M.D.

Assistant Clinical Professor of Psychiatry, New York State Psychiatric

Institute at Columbia University Medical Center, New York, New York

DOLORES L. MANDEL, L.C.S.W.

Program Coordinator of Drug Diversion, Forensic Drug Diversion, and

Director of Substance Abuse and Domestic Violence Services, Division

of Substance Abuse, Department of Psychiatry, Yale University School

of Medicine, New Haven, Connecticut

Contributors xi

LAUREN N. MANNING, B.A.

Research Assistant, Northeast Program Evaluation Center, West Haven

Veterans Affairs Medical Center and Department of Psychiatry, Yale

University School of Medicine, New Haven, Connecticut

THOMAS J. MCMAHON, PH.D.

Associate Professor, Yale University School of Medicine, Department of

Psychiatry and Child Study Center, West Haven Mental Health Clinic,

West Haven, Connecticut

SHERRY B. MOSS, M.A.

Lecturer in Psychiatry, Harvard Medical School, Boston, Massachusetts

TARA M. NEAVINS, PH.D.

National Institute on Drug Abuse Postdoctoral Fellow, Forensic Drug Di￾version, and Substance Abuse and Domestic Violence Services, Division

of Substance Abuse, Department of Psychiatry, Yale University School of

Medicine, New Haven, Connecticut

ROBERTO OLIVARDIA, PH.D.

Clinical Instructor of Psychology, Department of Psychiatry, Harvard

Medical School, Belmont, Massachusetts

DEBORAH A. PERLICK, PH.D.

Associate Professor of Psychiatry, Mount Sinai School of Medicine, New

York, New York

MARC N. POTENZA, M.D., PH.D.

Associate Professor of Psychiatry, Yale University School of Medicine,

New Haven, Connecticut

DAVID L. ROWLAND, PH.D.

Professor, Department of Psychology, Valparaiso University, Valparaiso,

Indiana

GERARD SANACORA, M.D., PH.D.

Director, Yale Depression Research Program and Associate Professor of

Psychiatry, Yale University School of Medicine, New Haven, Connecticut

xii TEXTBOOK OF MEN’S MENTAL HEALTH

ERIC L. SCOTT, PH.D.

Assistant Professor of Clinical Psychology in Clinical Psychiatry, Co￾chief, OCD/Tic/Anxiety Disorders Clinic, Riley Child and Adolescent

Psychiatry Clinic, Riley Hospital for Children, Indiana University School

of Medicine, Indianapolis, Indiana

N. WILL SHEAD, M.SC.

Doctoral Student, Department of Psychology, University of Calgary, Al￾berta, Canada

STEVEN SOUTHWICK, M.D.

Professor of Psychiatry, Department of Psychiatry, Yale University School

of Medicine, New Haven, Connecticut

AARON Z. SPECTOR, M.S.N., A.P.N.

Graduate Student, Yale University School of Nursing, Psychiatric and

Mental Health Nursing Specialty Program, New Haven, Connecticut

DOLORES VOJVODA, M.D.

Assistant Professor of Psychiatry, Department of Psychiatry, Yale Uni￾versity School of Medicine, New Haven, Connecticut

xiii

INTRODUCTION

Since the late 1990s, the volume of research on gender issues in mental

health has grown significantly. One important point that the gender lit￾erature has demonstrated, in addition to clarifying how women’s health

differs from that of men’s, is how little we actually know about men’s

mental health concerns. Although the great body of research in mental

health has historically been based on men, until recently the research has

largely failed to address how male gender integrally influences the clin￾ical presentation and treatment of various disorders. Thus this volume

reflects an exciting moment in the history of men’s mental health. Re￾search on women’s health has highlighted the important premise that

diagnosis, etiology, prevention, and treatment efforts should carefully

consider how men and women differ as well as how they are similar.

This volume builds on this premise by presenting the latest research on

what mental health care professionals should know about men’s psychi￾atric issues.

Although many clinicians encounter men with mental health issues,

many have never considered the unique issues faced by men at various

stages in life or how men present differently with certain disorders. In ad￾dition, clinicians may be relatively unaware of how treatment responses

in men differ from those in women. Thus, a primary aim of this book is to

document salient aspects of men’s mental health throughout the life

span, the clinical presentation and treatment of various psychiatric disor￾ders frequently observed in men, and sociocultural topics of particular

relevance to men.

The first part of this text highlights three important stages in men’s

lives. Scott and Lagges (Chapter 1, “Childhood: Normal Development

and Psychopathology”) and Erickson and Chambers (Chapter 2, “Adoles￾cence: Neurodevelopment and Behavioral Impulsivity”) provide compre￾hensive descriptions of normal childhood and adolescent development,

respectively, and highlight the major developmental issues encountered

by boys and how boys differ from girls in their developmental trajectories.

At the other end of the age spectrum, Desai (Chapter 3, “Older Men”) de￾scribes the biopsychosocial changes that occur as men age.

xiv TEXTBOOK OF MEN’S MENTAL HEALTH

A primary aim of this book is to provide clinicians with information

on how men differ from and are similar to women with respect to clin￾ical presentation and treatment of psychiatric disorders. As such, the

second part of this text addresses areas of clinical care in which men

present unique clinical issues. Disorders that are more prevalent in men

are examined by Shead and Hodgins in Chapter 6, “Substance Use Dis￾orders,” and by Black in Chapter 7, “Antisocial Personality Disorder,

Conduct Disorder, and Psychopathy.” These chapters provide a com￾prehensive understanding of these various disorders as well as treat￾ment approaches. Although the treatment of men’s sexual functioning

has made tremendous advances since 2000, few mental health clinicians

address this important topic. To enhance the overall care of male pa￾tients, Rowland has provided an invaluable chapter on male sexual

functioning (Chapter 8, “Sexual Health and Problems: Erectile Dysfunc￾tion, Premature Ejaculation, and Male Orgasmic Disorder”).

Certain psychiatric disorders are seen less frequently in men. There￾fore, when men present with these disorders, clinicians often assume

that the presentation and treatment will be similar to what is seen and

used in women. Disorders less commonly seen in men but with impor￾tant clinical and treatment differences are explored by Blanco and López

in Chapter 4, “Anxiety Disorders,” by Levin and Sanacora in Chapter 5,

“Depression,” and by Vojvoda and Southwick in Chapter 10, “Posttrau￾matic Stress Disorder.” Finally, in Chapter 9, “Impulse Control Disor￾ders,” we address certain disorders that are seen more frequently in men

(pathological gambling, compulsive sexual behavior) and other disor￾ders that are less commonly encountered (trichotillomania, kleptoma￾nia, compulsive buying).

The last section of the book, Part III, focuses on several sociocultural

issues of particular salience to men. McMahon and Spector discuss the in￾fluence of fathers on the family and the impact of fathering on children’s

mental health in Chapter 11, “Fathering and the Mental Health of Men.”

Haltzman and colleagues examine how men think about and behave in

intimate relationships in Chapter 12, “Men, Marriage, and Divorce.”

Body image, a problem long associated with women, has become a seri￾ous and underrecognized health issue for many men. Olivardia discusses

the clinical presentation of and treatment options for male eating disor￾ders, muscle dysmorphia, and steroid abuse in Chapter 13, “Body Image

and Muscularity.” Easton and colleagues address the complex issues un￾derlying male aggression and violence and how various interventions of￾fer hope for this public health problem in Chapter 14, “Aggression,

Violence, and Domestic Abuse.” Mental health issues appear to be intrin￾sically linked to issues of culture and ethnicity in men. In Chapter 15,