Depression is a disorder that affects millions of Americans each year, but diagnosing it isn’t the same for everyone.
According to the Mayo Clinic, it is commonly diagnosed using a set of criteria laid out in the American Psychiatric Association’s Diagnostic and Statistical Manual of Mental Disorders, often referred to as the DSM.
While these criteria have saved lives and improved many people’s mental health, they also have their limits.
“Historically, we use something like the DSM to diagnose — that’s kind of the holy grail when you’re talking about behavioral health,” said Lauren Carson, founder and executive director of Black Girls Smile, a nonprofit organization whose mission is to support the mental health of Black young women. But she said the text is predominantly written by older white men, and the data that forms the basis of its diagnostic criteria comes largely from studies on white men, too.
“A lot of the information that we receive when it comes to diagnosing … doesn’t always fit these marginalized demographic groups,” Carson said.
Many are working to make the mental health field more racially and ethnically inclusive, and the industry has made strides in recent years, but it has a ways to go.
Studies have shown that marginalized groups like Black people are at higher risk of depression. A new study gives some insight into what that looks like ― and how depression in Black women doesn’t always present in the “traditional” ways.
Self-critical symptoms are more common in Black women with depression.
In a paper published last month in the journal Nursing Research, researchers at New York University and Columbia University found that Black women are more likely to report self-criticism, self-blame, trouble sleeping, an inability to experience pleasure and irritability than the more widely recognized symptoms of depression like feeling sad or hopeless.
Meghan Watson, the founder and clinical director of Bloom Psychology and Wellness in Toronto, said in her work she’s seen depression present as some of the symptoms the study reported — self-criticism, self-blame — in addition to other behaviors that are not associated with depression, like people-pleasing.
“I think a lot of the reasons I attribute [people-pleasing] to depression is that from my understanding in talking to Black women regularly, it’s not emotionally safe to simply be sad or hopeless, which are some of the hallmark symptoms of depression,” Watson said.
She added that stereotypes of the “strong and resilient” Black woman may also keep Black people from leaning into sadness or anything that could be seen as “weak.”
Physical symptoms like a low libido were also reported.
Participants in the study, which tracked data in 227 Black women, also reported somatic symptoms, meaning physical symptoms such as a lower sex drive. Carson agreed with this finding based on her work with patients.
“We are more likely as Black women and girls to experience what’s called psychosomatic symptoms, so manifesting stress, anxiety or trauma in our bodies,” Carson said.
She noted that Black women with mental health conditions like depression or anxiety report higher rates of headaches, migraines, muscle tension, backaches and gastrointestinal issues.
Carson added that when many Black women go to the doctor for headaches or gastrointestinal issues, providers often immediately look to treat those symptoms rather than getting a full understanding of the person’s stress or anxiety levels. This leads to misdiagnosis or underdiagnosis in many people in the Black community, she said.
Nicole Perez, the study’s lead author and a psychiatric-mental health nurse practitioner and postdoctoral associate at NYU Rory Meyers College of Nursing, acknowledged this, too.
“Based on our findings, it’s possible that health care providers may miss depression symptoms in Black women, resulting in underdiagnosis and undertreatment,” Perez said in an NYU press release.
Symptoms won’t look the same from person to person, though.
Due to the large number of ways people can experience depression, it’s worth noting that not all Black women will experience these exact symptoms.
Additionally, the people who participated in the study were generally younger Black women with lower levels of depression — so depression may look different in older Black people or those with more severe depression.
“Depression is a very nuanced disorder. … There are over 1,500 different permutations of how depression can ultimately show up in someone,” Watson said. “You may have two people that have totally different symptoms that don’t overlap with each other — that’s not even factoring in culture, ethnicity, race and how that can impact the way that depression shows up generationally, intergenerationally, culturally, emotionally. So it’s validating to see research showing just the depth of that nuance.”
Additional signs of depression include loss of appetite, feeling sad, getting frustrated easily, and loss of interest in things you used to enjoy, according to the Cleveland Clinic.
If you feel you are exhibiting these symptoms, seek professional help.
Both Watson and Carson stressed the importance of getting mental health support if you think you are suffering from any of these symptoms.
“If you can, if you have the resources, if you have the ability, seek out providers who look like you,” Watson said. “Work with therapists who exist in an intersectional identity — maybe they’re Black, maybe they’re Black and queer, maybe they’re faith-based.”
Carson added that pastoral counseling is another good option for those looking to go the spiritual route in their treatment.
Finding a therapist who directly understands your experience and beliefs can help create a sense of safety and, in turn, help you open up to your therapist, Watson said.
If you’re not sure where to start, try a simple Google search with terms that match your criteria along with the name of the area where you live ― like “therapists in Boston.” You also can use Psychology Today’s nationwide database to find a provider in your area, search the Black Emotional and Mental Health Collective’s online wellness resource for a therapist, or try an online therapy provider.
Or lean on your community.
“A lot of us turn to community first, whether that’s friends, family, co-workers, the church … and there is strength in that,” Carson said.
When leaning on your community, it’s important to seek out people who are supportive and noncritical, she noted. So, if you have a sibling who gives you advice like “just deal with it,” they’re not someone you should turn to in this situation.
Carson explained that leaning on community doesn’t just mean having people to confide in. Instead, you can ask your community to support you in physical ways too — like asking someone to help with a task on your to-do list.
Watson also stressed the importance of community for folks suffering from depression. “Anything that brings you closer to social connectedness, because depression is an incredibly isolating experience and it pushes us into the shadows of society and within ourselves.”
But Carson cautioned that while community is important as part of your treatment plan ― it’s not the whole thing. If you’re able, getting professional help is also important.
There are providers who are well-versed in the signs of depression in Black people who are ready to help you feel better.
“You’re not alone,” Watson said. “It’s isolating to feel like you are underwater and sad and overwhelmed, but you’re not alone.”