The Relationship Between Help-Seeking Attitudes and Masculine Norms Among Monozygotic Male-Twins Discordant for Sexual Orientation

Abstract

Objective

In general, heterosexual men are less favorable to asking for help compared to women and gay men. This can be problematic if a man avoids professional help when he is experiencing significant psychological distress. Yet, it is unclear to what degree such attitudes among men are due to innate differences or social environments. Studying twins provides one avenue for teasing apart these relationships.

Methods

We recruited 38 pairs of monozygotic male-twins (M_Age 35.87; SD = 9.52) raised together and who were discordant for sexual orientation. They completed a measure of psychological distress (Symptom–Checklist–90–Revised), positive attitudes towards psychological help-seeking behavior, and emphasis with fulfilling traditional masculine norms.

Results

Contrary to predictions, the heterosexual twins expressed more symptoms of specific distress—Hostility (r = .30), Paranoid Ideation (r = .26), and Psychoticism (r = .24)—compared to their gay co-twins. As predicted, heterosexual men were less favorable to seeking help (r = .25) and expressed greater emphasis on masculine norms (r = .26) compared to their co-twins. Within each group of men, unique aspects of masculine norms were significantly related to attitudes towards psychological help-seeking behavior.

Conclusion

The findings lend credence to the hypothesis that social environments influence attitudes and behaviors that are stereotypically masculine and potentially detrimental to men’s health.

Men would rather drive around aimlessly than ask for help when they are lost. Although this is a gross stereotype, the notion that men should be self-sufficient and able to solve their own problems is a dominant ideal within traditional views of masculinity (O’Neil, 2010). At an extreme end, however, men who rigidly adhere to such ideals may end up hurting themselves if they avoid seeking help when they need it (Boman & Walker, 2010).

Of particular interest is men’s help-seeking behavior when they are experiencing psychological distress. For many men raised in the United States, their sense of self is tied to dated views of masculinity consisting of being competitive, controlling one’s emotions, and avoiding vulnerability (O’Neil, 2010). Yet, men will encounter distressing situations during different phases of life, and scholars have argued that the socialization of men inhibits them from seeking help during such periods (Brooks, 2010). That is, the idea of exhibiting feelings characterized as feminine (e.g., helplessness and hopelessness) and the idea of needing help violate traditional tenets of masculinity (Levant, Wimer, & Williams, 2011).

Studies have found that men who place greater emphasis on such norms are more negative about seeking help compared to those who place less emphasis (e.g., McCusker & Galupo, 2011). Yet, these results may not generalize to all men. For instance, gay men do not endorse as many masculine norms compared to heterosexual men (Lippa, 2008). No report has directly compared help-seeking attitudes among heterosexual and gay men. However, the higher prevalence of gay men using mental health services compared to heterosexual men (Cochran, Sullivan, & Mays, 2003) suggests that gay men may be more open to the idea of seeking help.

An alternative explanation could be that gay men experience more psychological problems and hence need to seek help more often. Population-based studies have found that gay men report more symptoms of psychological distress compared to heterosexual men (Cochran et al., 2003). The few studies that have compared male twins discordant for sexual orientation are limited because some defined being gay as having had at least one sexual contact with a man. For instance,Herrell et al. (1999) used data collected in 1988 on veterans of the Vietnam War: Among the 103 pairs, twins who had had sex with a man at least once were more likely to report a history of suicidal behavior compared to their co-twins who had never had sex with a man.

Thus, we were interested in seeing if monozygotic (MZ or “identical”) male twins discordant for sexual orientation (i.e., one identifies as gay and the other as heterosexual) differed in their help-seeking attitudes. The use of MZ twins raised together can minimize unsystematic variability due to genetics. That is, MZ twins share the same genetic code, and they develop with markedly similar characteristics. For instance, the personalities of MZ twins are significantly more similar to each other compared to other relatives (e.g., siblings and parents), even among MZ twins that were raised apart (Bouchard & McGue, 2003). Consequently, studying MZ twins who have different sexual orientations may hint at how unique cultural experiences can influence attitudes and behaviors while minimizing differences due to biology.

Based on the previous reports on masculine roles and help-seeking attitudes, we hypothesized that the heterosexual men would score higher on a measure of masculine norms and lower on a measure of help-seeking attitudes compared to their gay co-twins. We further hypothesized that the gay men would report more symptoms of distress compared to their heterosexual co-twins given the reports on the higher incidence of mental disorders among gay men. Finally, we sought to examine if similar aspects of masculine norms were significantly related to help-seeking attitudes among the heterosexual and gay twins.

Method

Participants

The data for this report was collected as part of an on-going study on the genetic basis for sexual orientation. A total of 38 MZ twin-pairs raised together (M_Age = 35.87; SD = 9.52; Mdn = 36.00) and who were discordant for sexual orientation (Kinsey, Pomeroy, & Martin, 1948/1975) were included in this analysis. Approximately 32:1,000 live births in the U.S. are twins with 30% being MZ twins, and males constituting about half of all live births (Martin et al., 2010). Furthermore, the low incidence of same-sex attraction in males (approximately 3%; Laumann et al., 1994) coupled with a discordance rate of approximately 68% for a non-heterosexual orientation among twins (Kendler et al., 2000) makes this a highly unique sample.

The twins were recruited via community events, advertisements, and press releases. All were U.S. citizens residing in the U.S. For the gay men, the average number of years since identifying as gay was 15.92 (SD = 9.33; Mdn = 15.50). The majority of the sample was White (Non-Latino; 89.5%), with 5.3% identifying as Hispanic/Latino, and 5.3% as African American. Further demographic information can be found in the online supplemental materials.

Measures

The following measures were presented in spiral order. Scale reliabilities in parentheses are for the gay men and heterosexual men, respectively.

Psychological distress

The Symptom Checklist–90–Revised (SCL–90–R; Derogatis, 1994) was used to assess primary symptoms of psychological distress. Using a five-point scale (0 = not at all; 4 = quite a bit), participants indicated the degree to which they had been bothered by 90 different symptoms during the past seven days. Nine common psychiatric syndromes are assessed by the SCL–90–R: somatization (α = .51, .85), obsessive-compulsive (α = .84, .89), interpersonal sensitivity (α = .78, .84), depression (α = .79, .88), anxiety (α = .79, .88), hostility (α = .64, .90), phobic anxiety (α = .86, .56), paranoid ideation (α = .49, .80), and psychoticism (α = .57, .83). In addition, three global indices provide an overall measure of the intensity of different aspects of psychological distress. The Global Severity Index (α = .93, .97) reflects the current intensity of the overall reported distress. The Positive Symptom Distress Index reflects the intensity of distress for the specific symptoms endorsed while the Positive Symptom Total merely reflects the total number of the 90 symptoms endorsed regardless of the intensity.

Attitude towards help seeking

A shortened version of the Attitudes towards Seeking Professional Psychological Help (Fischer & Farina, 1995) was used to determine how open the participants were to seeking help for problems they may be experiencing (α = .84, .86). Using a four-point scale (0 = disagree, 3 = agree), participants responded to 10 different items (e.g., “I would want to get psychological help if I were worried or upset for a long period of time”).

Masculine Norms

We used the 37-item Gender Role Conflict Scale (O’Neil, Helms, Gable, David, & Wrightsman, 1986) to assess the degree to which the men emphasized adherence to traditional masculine norms. The 13-item Success, Power, and Competition subscale (α = .89, .89) assesses one’s emphasizes on personal achievement and competitiveness (e.g., “I worry about failing and how it affects my doing well as a man.”). The 10-item Restrictive Emotionality subscale (α = .92, .89) assesses one’s discomfort with emotional self-disclosure and with emotional expression by others (e.g., “I do not like to show my emotions to other people.”). The 8-item Restrictive Affectionate Behavior Between Men subscale (α = .71, .78) measures discomfort with emotional affection with other men (e.g., “Hugging men is difficult for me.”). The 6-item Conflict Between Work & Family Relations subscale (α = .89, .83) measures distress due to trying to balance demands from work/school and family/leisure life (e.g., “My career, job, or school affects the quality of my leisure or family life.”). Respondents used a 6-point scale (1 = strongly disagree; 6 = strongly agree).

Results

We first screened for missing data points. Mean substitution was used to correct the seven omissions found (Dodeen, 2003). Given the small sample size and that univariate distributions significantly deviated from normality, we employed non-parametric statistical tests.

Group Comparisons

Our first aim was to compare the scores within each twin pair using Wilcoxon Signed-Rank Test. For each test pair, we entered the gay twin’s score first and the heterosexual co-twin’s score second. Table 1 presents the quartiles for the ranked order of the paired differences with negative values meaning that the heterosexual twin scored higher and positive values meaning that the gay twin scored higher. Further descriptive statistics are in the online supplemental materials. Table 1 also present effect-size estimates for the pairwise comparisons as Pearson’s r given that it is more easily understood by a wider audience (Field, 2009).

Table 1.

Quartiles for Paired Differences

	Paired Differencea			Wilcoxon Signed Rank Test
	Q1	Mdn	Q3	z	p	r
SCL-90-R Dimensions
Somatization	−0.50	0.00	0.25	−1.13	.259	.13
Obsessive-Compulsive	−0.83	−0.20	0.30	−1.66	.096	.19
Interpersonal Sensitivity	−0.55	−0.11	0.22	−1.49	.138	.17
Depression	−0.51	−0.04	0.33	−0.65	.516	.07
Anxiety	−0.40	−0.05	0.23	−1.13	.257	.13
Hostility	−0.54	−0.16	0.00	−2.60	.009	.30
Phobic Anxiety	−0.14	0.00	0.00	−0.46	.643	.05
Paranoid Ideation	−0.66	−0.17	0.04	−2.25	.025	.26
Psychoticism	−0.43	−0.10	0.10	−2.06	.040	.24
SCL-90-R Indices
Global Severity	−0.42	−0.17	0.19	−1.86	.062	.21
Positive Symptom Distress	−0.25	0.06	0.31	−0.38	.701	−.04
Positive Symptom Total	−23.50	−9.25	11.25	−1.93	.054	.22
Positive Help-Seeking Attitude	−2.25	1.50	7.25	−2.21	.027	−.25
GRCS Total Score	−29.25	−9.00	5.75	−2.29	.022	.26
Success, Power & Competition	−8.25	1.00	8.50	−0.10	.922	−.01
Restricted Emotions	−12.25	−2.00	7.25	−0.74	.460	.08
Restricted Affection	−13.25	−7.00	−1.75	−4.51	.000	.52
Work/School Emphasis	−7.25	−2.50	4.25	−0.74	.460	.08

Note. Each heterosexual twin’s score was subtracted from his gay co-twin’s score; Mdn = the middle value of the 38 paired differences for each measure. r = effect-size estimate; negative r value = gay twins tended to score higher on the measure; positive r value = heterosexual twins tended to score higher on the measure.

^aNegative value = Heterosexual twin scored higher; Positive value = Gay twin scored higher.

When comparing symptoms of psychological distress, the heterosexual twins scored significantly higher on three dimensions—Hostility (Mdn = 0.34), Paranoid Ideation (Mdn = 0.42), and Psychoticism (Mdn = 0.26)—compared to their gay co-twin (Mdn = 0.26, 0.34, and 0.11, respectively). As a group, the gay twins did not score significantly higher than their heterosexual co-twins on any of the SCL–90–R dimensions or indices.

At the same time, the heterosexual twins (Mdn = 19.50) were less open to the idea of seeking professional psychological help compared to the gay co-twins (Mdn = 22.00). Looking more closely at the raw scores, 24 of the heterosexual twins scored lower than their gay co-twins whereas 12 of the heterosexual twins scored higher than their gay co-twins.

The final set of comparisons was on the scores assessing emphasis of traditional masculine roles. Overall, the heterosexual twins (Mdn = 121.50) reported greater emphasis with masculine roles compared to the gay co-twins (Mdn = 114.00). More specifically, heterosexual twins (Mdn = 24.00) were more uncomfortable being emotionally affectionate with other men compared to their gay co-twins (Mdn = 16.50).

Masculine Norms and Help-Seeking

Our final aim was to examine the relationship between attitudes toward help-seeking and emphasis with specific masculine roles. Table 2 presents the Spearman’s correlation coefficients for the two groups. Among the heterosexual twins, only discomfort with being emotionally affectionate with other men was significantly related with help seeking attitudes (r_S = −.34, p = .036). On the other hand, the degree to which the gay men emphasized being powerful and successful (r_S = −.32, p = .050) and the degree to which they restricted their emotional expression (r_S = −.33, p = .041) were significantly related to help seeking attitudes. Consequently, for this group of men, different factors associated with masculine roles were related to how open the gay men and the heterosexual men were to seeking help.

Table 2.

Spearman’s Correlations for Positive Attitudes Towards Help-Seeking by Group

	Whole Sample N = 76		Gay n = 38		Heterosexual n = 38
	rS	p	rS	p	rS	p
GRCS Total Score	−.26	.023	−.37	.024	−.11	.500
Success, Power, & Competition	−.10	.407	−.32	.050	.13	.445
Restricted Emotions	−.28	.014	−.33	.041	−.23	.169
Restricted Affection	−.30	.008	−.15	.371	−.34	.036
Work/School Emphasis	−.12	.320	−.18	.269	−.06	.706

Discussion

This study supports past research linking the endorsement of traditional masculine norms and negative attitudes towards help-seeking. However, our findings extend the research by sampling a rare population of twins. The most surprising result—and counter to our hypotheses—was that the heterosexual men endorsed more symptoms of distress, especially related to hostility, paranoid ideation, and psychoticism compared to their gay co-twins.

In considering why this finding differed from past research comparing non-twin heterosexual and gay men, one possibility is that we used a different measure than that used in larger population-based studies. For instance,Cochran et al. (2003) used a questionnaire designed to diagnose specific mental disorders whereas we used a measure focused on a broad range of symptoms. Another possible explanation is that these specific SCL–90–R dimensions relate to interpersonal interactions (e.g., anger) and uneasiness around others. Perhaps the nature of our study primed the heterosexual twins to feel self-conscious given that the overall study is aimed at understanding what contributes to the discordance of their sexual orientation.

Unfortunately, even though the heterosexual twins were reporting greater distress compared to their gay co-twins, they were less open to the idea of seeking help. As with past studies, aspects of masculine norms were significantly related to help seeking attitudes among the heterosexual twins—specifically the degree to which they were uncomfortable being emotionally affectionate or vulnerable with other men. This specific aspect of masculinity also differed between the co-twins, which was unsurprising. It is unclear if making heterosexual men more comfortable being vulnerable with other men would make them feel more positive about seeking psychological help. Yet, the fact that the co-twins significantly differed hints at environmental pressures causing the difference given they share the same genetic code. Heterosexual men may, therefore, be more vulnerable to the negative aspects of masculine norms (e.g., men should handle problems on their own) that can ultimately harm their well-being.

As for the gay men, the degree to which they emphasized success and were uncomfortable with being emotionally expressive were significantly and negatively related to positive attitudes towards seeking help. Consequently, gay men may be more susceptible to specific gender norms that dictate the need for men to be powerful to prove themselves to others and the ideas that men should not show “weak” emotions compared to heterosexual men.

Some limitations should be kept in mind. First, although we recruited a highly unique sample, this was a sample of convenience that was pre-dominantly White (non-Latino). Furthermore, the small number and the unique characteristics of our men limits generalizability. Second, reliability alphas for the gay men were low for several indices; while it is unclear how much of an impediment these were given the constructs being assessed (Schmitt, 1996), our results may be influenced by measurement error. Third, there may still be biological factors contributing to the differences observed. That is, some of the mechanisms and biological events that contribute to gay men’s sexual attraction may also affect personality and behavioral traits associated with attitudes regarding help seeking.

Notwithstanding these limitations, our findings further hint at how environmental and cultural variables may influence attitudes and behaviors that are stereotypically masculine. Future studies can continue to compare the variance of gender-role and help-seeking attitudes among other types of relatives (e.g., fraternal twins and father–son dyads) and among MZ twins concordant for sexual orientation to further elucidate the role of biology and the environment.

Masculinity in and of itself is not a bad thing. Rather, it is the rigid adherence to such norms—which heterosexual men may be more prone to do compared to gay men—that can be detrimental to men’s health. Whether it is refusing to stop and ask for directions or avoiding psychological help when in pain, the quality of men’s lives would improve if they can overcome the dated ideal that they must always be able to solve their own problems.