I was just reading an edited volume on the issue of gender and PTSD (appropriately enough, titled “Gender and PTSD” (Kimmerling, Ouimette, & Wolfe, 2002)). It’s an excellent book, and one of the most systematic reviews of the literature surrounding a truly interesting issue in PTSD research that I’m aware of. The basic issue is this: internationally and consistently across studies, men are shown to be exposed to significantly more traumatic events than women. Despite this, women are much more likely to have PTSD.
In their day-to-day lives, men are much more likely to be the victims of violence. In the U.S., various studies (reported in Norris, Foster, & Weisshaar 2002 – the first chapter of Gender and PTSD) have found rates of exposure to trauma ranging from 61%-81% in men, and 54%-74% in women. Women’s exposure rates are consistently lower than men’s. Despite this, the lifetime prevalence of PTSD is consistently about twice as high in women as in men. Studies have found rates around 10-11% in women, and 5-6% in men. So there is an interesting disconnect in the data. Even with the fact that men are more likely to experience traumatic events, women are overall more likely to show PTSD.
What explains this? This is a large and active field of research, so there is as of yet no single accepted answer. There are a couple of ideas that have been studied, however. One possibility is that men experience more trauma, but women experience kinds of trauma that are more psychologically distressing. It is certainly the case that experiences of trauma differ. Men are much more likely to experience combat, physical assault, and car accidents than women, while women are more likely to experience sexual assault than men. It is entirely possible that this difference explains a great deal of the effect. However, it does not explain all of it – a study that specifically looked at rates of conditional risk (the likelihood of experiencing PTSD after a traumatic event) found that women’s rates of conditional risk were higher for every category of traumatic event with the exception of rape, where conditional risk was about equal between women and men. This suggests that something else is happening that leads to the gender differences found.
Another explanation is biological. The second chapter of Gender and PTSD, by Rasmussen & Friedman, discusses the (extremely limited) literature looking at the physiology of PTSD in men and women. There has not been much work done in this area, but the existing research does suggest that there are some physiological differences in stress response both between women and men and within women across the menstrual cycle. In several specific ways, women have been found to show responses to stressors more similar to people with PTSD, when compared to men. For example, some studies have found that women and female animals release less Neuropeptide Y in response to stressors than males do. A reduced NPY response is one physiological response associated with PTSD. This research is developing, and may serve as an important perspective in the question of gender and PTSD. However, as it stands it is not a complete answer to the question.
A third explanation is more social/cognitive. The psychological experience of a traumatic event is a critical mediator of long-term distress. Those people who experience more distress are much more likely to have long-term problems. In part, this is a physiological issue: more reactivity means more experience of distress. But in part, it’s also a reflection of the individual’s beliefs and interpretation of the event. If someone feels that a traumatic event was strongly negative, and blames themselves, then they will probably show more long-term distress. There is evidence that women are much more likely to view the world as threatening, and also to blame themselves following traumatic events (discussed in chapter 3 of the Gender and PTSD book, by Tolin & Foa). This also dovetails neatly with cross-cultural research showing that cultures which have strict gender roles that discourage men from expressing emotion show stronger differences between men and women in PTSD than those which are more equal in gender expression. It may be that in these cultures, women are allowed or even encouraged to focus on their negative emotional reaction to traumatic events in a way that men are not. This, in turn, leads to differences in their interpretation of the event and to more significant long-term distress.
In many ways, any question about sex or gender differences is another version of the age-old nature versus nurture debate. Those who would emphasize biological differences as the cause of these differences emphasize the “nature” part, while those who point to culture emphasize the “nurture.” Most likely, this research, like almost all the research into this question, will resolve eventually not into the question of which approach is right, but instead how the “nature” variables interact with the “nurture” context to produce behavior. At the current state of the research, though, this remains an interesting puzzle for researchers – and a challenge for women exposed to traumatic events across the world.
I was just reading an edited volume on the issue of gender and PTSD (appropriately enough, titled “Gender and PTSD” (Kimmerling, Ouimette, & Wolfe 2002). It’s an excellent book, and one of the most systematic reviews of the literature surrounding a really interesting issue in PTSD research that I’m aware of. The basic issue is this: internationally and consistently, men are exposed to significantly more traumatic events than women. In their day-to-day lives, men are much more likely to be the victims of violence. In the U.S., various studies (reported in Norris, Foster, & Weisshaar 2002 – the first chapter of Gender and PTSD) have found rates of exposure to trauma ranging from 61%-81% in men, and 54%-74% in women. Women’s exposure rates are consistently lower than men’s. Despite this, the lifetime prevalence of PTSD is consistently about twice as high in women as in men. Studies have found rates around 10-11% in women, and 5-6% in men. So there is an interesting disconnect in the data. Even with the fact that men are more likely to experience traumatic events, women are overall more likely to show PTSD.
What explains this? This is a large and active field of research, so there is as of yet no single accepted answer. There are a couple of ideas that have been studied, however. One possibility is that men experience more trauma, but women experience kinds of trauma that are more psychologically distressing. It is certainly the case that experiences of trauma differ. Men are much more likely to experience combat, physical assault, and car accidents than women, while women are more likely to experience sexual assault than men. It is entirely possible that this difference explains a great deal of the effect. However, it does not explain all of it – a study that specifically looked at rates of conditional risk (the likelihood of experiencing PTSD after a traumatic event) found that women’s rates of conditional risk were higher for every category of traumatic event with the exception of rape, where conditional risk was about equal between women and men. This suggests that something else is happening that leads to the gender differences found.
Another explanation is biological. The second chapter of Gender and PTSD, by Rasmussen & Friedman, discusses the (extremely limited) literature looking at the physiology of PTSD in men and women. There has not been much work done in this area, but the existing research does suggest that there are some physiological differences in stress response both between women and men and within women across the menstrual cycle. In several specific ways, women have been found to show responses to stressors more similar to people with PTSD, when compared to men. For example, some studies have found that women and female animals release less Neuropeptide Y in response to stressors than males do. A reduced NPY response is one physiological response associated with PTSD. This research is developing, and may serve as an important perspective in the question of gender and PTSD. However, as it stands it is not a complete answer to the question.
A third explanation is more social/cognitive. The psychological experience of a traumatic event is a critical mediator of long-term distress. Those people who experience more distress are much more likely to have long-term problems. In part, this is a physiological issue: more reactivity means more experience of distress. But in part, it’s also a reflection of the individual’s beliefs and interpretation of the event. If someone feels that a traumatic event was strongly negative, and blames themselves, then they will probably show more long-term distress. There is evidence that women are much more likely to view the world as threatening, and also to blame themselves following traumatic events (discussed in chapter 3 of the Gender and PTSD book, by Tolin & Foa). This also dovetails neatly with cross-cultural research showing that cultures which have strict gender roles that discourage men from expressing emotion show stronger differences between men and women in PTSD than those which are more equal in gender expression. It may be that in these cultures, women are allowed or even encouraged to focus on their negative emotional reaction to traumatic events in a way that men are not. This, in turn, leads to differences in their interpretation of the event and to more significant long-term distress.
In many ways, any question about sex or gender differences is another version of the age-old nature versus nurture debate. Those who would emphasize biological differences as the cause of these differences emphasize the “nature” part, while those who point to culture emphasize the “nurture.” Most likely, this research, like almost all the research into this question, will resolve eventually not into the question of which approach is right, but instead how the “nature” variables interact with the “nurture” context to produce behavior. At the current state of the research, though, this remains an interesting puzzle for researchers – and a challenge for women exposed to traumatic events across the world.
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