A silhouette of a young boy and girl behind a group of people.
CommentaryMental Health

Boys are suffering too. Here’s how we miss that.

Apr 11, 2024
Lisa Damour

In February 2023, the media picked up and ran with the findings of an alarming CDC report centered on girls’ mental health in 2021. In the depths of the pandemic, 57% of teenage girls described themselves as sad and hopeless, compared to 29% of boys. Girls also reported that they were twice as likely as boys to have considered, or even attempted, suicide.   

But largely absent from the media coverage was another critical and well-established finding, namely that adolescent boys are about three to four times more likely than adolescent girls to actually die by suicide, as the figure below shows: 

Clearly, many boys are in tremendous emotional pain. But this is not being detected in surveys like the CDC’s Youth Risk Behavior Survey (YRBS), which is where the 2021 data are drawn from. This is just one example of a more general challenge. There are good reasons to believe that the current approach to measuring mental health does a better job gauging emotional distress in girls than it does in boys. This bias occurs for three reasons:

1. Large-scale surveys often miss externalizing symptoms

One of the cardinal rules in adolescent psychology is that distressed girls tend to internalize – to collapse in on themselves and suffer from anxiety and depression – while distressed boys tend to externalize – to act out or get themselves in trouble. (These patterns are almost entirely the result of socialization: we teach girls not to visit their misery on others, and we discourage boys from expressing feelings of vulnerability.)  

The Youth Risk Behavior Survey (YRBS) asks about feelings of sadness or hopelessness – mood states that girls are far more likely than boys to report. It does not, however, ask about feelings of irritability or anger, the moods often associated with emotional pain in boys.  

Large-scale, annual surveys like the YRBS are a vital source of information about how adolescents are faring. Accordingly, they should ask teens about both internalizing and externalizing symptoms, as other validated self-report surveys do, in order to offer a fuller picture of mental health across all genders, and among boys in particular.

2. Well-known phenomena are more likely to be observed

Social scientists have long recognized an observational bias known as the “streetlight effect.” The term comes from an old joke: 

Late at night, a police officer finds a drunk man crawling around on his hands and knees under a streetlight. The drunk man tells the officer he’s looking for his wallet. When the officer asks if he’s sure this is where he dropped the wallet, the man replies that he thinks he more likely dropped it across the street. “Then why are you looking over here?” the befuddled officer asks. “Because the light’s better here”, explains the drunk man.²

This observational bias crops up in assessments of adolescent distress. We tend to spend our energy on phenomena for which we have a well-established research literature: depression, anxiety, anorexia, bulimia, self-harm, and problematic social media use. All of these occur more frequently in girls. We are not as inclined to search in less well-illuminated areas, such as exposure to violent pornography, problematic gaming, or compulsive online gambling, which may tell us more about the distress being felt by adolescent boys.  

To give one troubling example, recent evidence points to a sharp increase in eating disorders in boys characterized by an obsession with gaining muscle while losing fat. Our predisposed attention to traditional forms of eating disorders, from which girls are more likely to suffer, may account for the related recent finding that eating-disordered boys arrive at the hospital more medically compromised than girls. 

In short, noticing emotional pain in boys requires being willing to search beyond the usual places when looking for evidence of their distress.

3. The way some boys show distress may be off-putting

Parents and educators now routinely ask me how they should respond to the growing interest of many boys in the broadly offensive ideology of internet influencer and self-proclaimed misogynist Andrew Tate. I always find myself navigating a double reaction in these conversations. Personally, I am appalled to think that some boys are letting themselves be taken in by this material. Professionally, I know from nearly thirty years of clinical practice that no kid who feels good about himself becomes drawn to hateful worldviews. 

For most of us, it’s easier to feel compassion for those who suffer from anxiety or depression than to summon sympathy for those who hole up in dark corners of the internet, compulsively gamble or play video games, act out, or spout hate. Further, the externalizing symptoms which boys are more likely to exhibit are often addressed with nothing beyond a disciplinary response, especially for boys of color.   

But if we are going to do right by our boys, we need to see past the negativity on the surface to recognize underlying distress that deserves our compassion and help. People who feel whole and worthy don’t build themselves up by degrading or hurting others, and those who have healthy strategies for managing life’s inevitable challenges don’t need to soothe themselves by getting lost in pornography, video games, or gambling.  

Occasionally, a well-meaning concern is raised that focusing attention on the suffering of boys comes at the cost of caring for girls. I don’t think this concern is merited. For one thing, this need not be a zero-sum game; our hearts and minds are expansive enough that we can be concerned about all teenagers at once. For another, if roughly half the population’s mental health is under-regarded and consequently under-addressed, that’s bad for everyone. We are doing a better job of noticing the emotional distress of our teen girls. It is time to pay the same attention to our teen boys. 

Dr. Lisa Damour, author, podcaster and psychologist.
Lisa Damour
Dr. Lisa Damour is the author of three New York Times best sellers: Untangled, Under Pressure, and The Emotional Lives of Teenagers, which have been translated into twenty-three languages. She co-hosts the Ask Lisa podcast, works in collaboration with UNICEF, and is recognized as a thought leader by the American Psychological Association. Dr. Damour is a regular contributor to The New York Times and CBS News and the creator of Untangling 10to20, a digital library of premium content to support teens and those who care for them. Dr. Damour serves as a Senior Advisor to the Schubert Center for Child Studies at Case Western Reserve University and has written numerous academic papers, chapters, and books related to education and child development.