Worldwide, women are twice as likely as men to have an anxiety disorder. At least, that’s the official word.

But anxiety isn’t objective—a white-coated lab tech can’t look down a microscope and diagnose it. Instead, to get the two-to-one ratio, science has relied on self-report—who’s willing to tell researchers about symptoms, who shows up to therapy clinics and psychiatry waiting rooms, who stands up and proclaims, “I am anxious.”

And those things—seeking treatment, saying “Yes, I have anxiety,” even the willingness to label our fears and insecurities as “anxiety”—are pushed and pulled by social forces like stigma, gender norms, and what it means to be a woman or a man. Therefore, as a clinical psychologist and anxiety specialist, I’d be willing to bet the canyon between the numbers of men and women who report having anxiety is more like a crack in the sidewalk.

Why might men with anxiety be flying under the radar? While the science is still emerging on the biology of anxiety in men and women, I think the difference has a lot to do with how anxiety manifests.

Anxiety can present in a classic way, of course: worry, tension, fretting. But it also comes in a rainbow of other flavors. Anxiety is a slippery shape-shifter—when you try to stuff it down, it just re-emerges in a different form.

And while there is no such thing as “men’s anxiety” or “women’s anxiety,” what happens in a society where, for men, fear is still stigmatized? Where boys are still told to suck it up when they’re nervous or afraid? Where it’s okay to feel bravado or rage, but not fear? What are the red herrings that, for men, may actually signal anxiety? These are the most common:

Alcohol Misuse

While women are more likely to turn to their friends for support when they’re worried, men more often turn to a friend-in-a-bottle. It’s true that alcohol “works,” at least short term. For instance, one study found that for every drink, social anxiety declined by four percent. But long-term, alcohol enables men to avoid their anxieties instead of facing them, which just makes things worse. It’s like trying to hold a beach ball underwater—it works for a while, but eventually it pops back up as a force to be reckoned with.

Anger

Everyone has heard of the stress response of fight or flight. Flight is what comes to mind when we think of anxiety: cowering in the corner, hiding in the bathroom, or making a beeline for...anywhere but here. But then there’s fight. When feeling threatened, rather than making a break for it, men may be more likely to come out swinging. Anxiety can trigger the full range of anger, from the flash of an explosive outburst to the slow burn of constant frustration.

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Irritability

Grumpy, grouchy, touchy, on edge: Whatever you call it, it’s irritability, and it’s a little-known hallmark of anxiety. When your nerves are already frazzled, it’s no surprise that your office-mate’s overly-loud breathing or the driver who drills his high beams into your retinas on a country road makes some guys channel their inner grumpy old man.

Depression

In the anxiety specialty clinic where I work, I see many men who have worried themselves into a depression. Anxiety drives avoidance, which in turn constricts their lives. For instance, men who have panic attacks may avoid activities that stress their bodies, like working out. Those who fear judgment will avoid dating or turn down their buddies’ invitations to go out. Men may try to control their anxiety by becoming more rigid, but living in a constant state of “if you want it done right you have to do it yourself” leaves little time for life’s joys. Over time, avoiding life leaves life empty, which in turn is depressing. And feeling unable to turn anxiety around or a sense that things will never get better leaves many men feeling hopeless and helpless—the two pillars of depression.

All in all, how anxiety manifests in men and women can differ, but anxiety itself is equal opportunity. For both men and women, anxiety has the same tenets: anxiety is vague (“What if something bad happens?”), out of proportion to the actual risk or threat (“If I don’t land a good summer internship my entire career is doomed”), and tells us we’re going to suck at whatever life throws at us (“I’ll just wait until there are no footsteps in the hallway before I leave my apartment so I don’t have to make awkward small talk with the neighbor.”)

But what else is equal opportunity? The fact that anxiety is changeable. It is indeed worrisome and stressful to be human, but it is also hopeful. No matter how your anxiety manifests, reach out. No matter your gender, anxiety doesn’t have to run your life.

Ellen Hendriksen is a clinical psychologist at Boston University's Center for Anxiety and Related Disorders (CARD) and the host of the Savvy Psychologist podcast.