“It terrifies me, the fragility of these moments in our lives.”
Monday, 14 November 2016
Research on Women, Trauma and PTSD
This fact sheet reviews research on women's experiences of trauma and posttraumatic stress disorder (PTSD), with a focus on gender-based similarities and differences.
Most early research on trauma and PTSD focused on male samples (1). The majority of these studies examined factors related to how male combat Veterans responded to war-related trauma. Around the same time, researchers who studied women's experiences of sexual assault identified a syndrome that was similar to that experienced by combat-exposed men (1). This recognition led to an increase in research on women's experiences of traumatic events and risk for PTSD (2,3). Since this time, a great deal has been learned about trauma and PTSD in women, including their risk for exposure and PTSD prevalence, factors that increase or decrease risk for PTSD, symptom expression and comorbid conditions, and to a lesser extent, gender-specific PTSD treatment outcomes (4).
Risk of trauma exposure
Findings from the National Comorbidity Survey Replication (5) indicate that about half of all women in the U.S. will be exposed to at least one traumatic event in their lifetime. While women are somewhat less likely to experience traumatic events overall (6-8), research findings indicate that they are more vulnerable to sexual assault and childhood sexual abuse than men (9). Results based on the CDC National Intimate Partner and Sexual Violence Survey conducted in 2010 indicate that nearly 1 in 5 women (18.3%) in the United States have been raped at some time in their lives (10).
Outcomes of trauma exposure
Women's experiences of trauma have been linked to a variety of negative mental health consequences, including especially PTSD (4). Estimates from community studies suggest that women experience PTSD at two to three times the rate that men do (4). U.S. prevalence estimates of lifetime PTSD from the National Comorbidity Survey Replication are 9.7% for women and 3.6% for men (5).
Gender difference in susceptibility to PTSD appear to be at least partially related to the fact that women are more likely to experience sexual assault, as this experience carries one of the highest risks for PTSD (9). However, this does not entirely account for the gender difference in PTSD, as findings indicate that women are at greater risk for developing PTSD than men even when they are exposed to similar types of trauma (9). A number of explanations have been proposed to account for this gender difference (4,11). For example, it has also been suggested that women may be more susceptible to mental health consequences because they are more like to experience trauma within established relationships or their traumatic exposures are more chronic than those experienced by men (e.g. ongoing interpersonal violence within a marriage). Another interesting hypothesis suggests that women's gendered social roles (e.g., wife, mother, or caretaker) may compound the negative impact of trauma exposure, as women could experience additional role strain when traumatic experiences or stress reactions interfere with their ability to fulfill these roles.
All of these explanations posit potential moderators of the relationship between trauma exposure and posttraumatic sequelae, consistent with the perspective that the gender difference in risk for PTSD may be larger or smaller depending on specific contextual factors (4). In this regard, it is interesting to note that recent research has revealed few differences between women's and men's risk for PTSD following combat-related stress exposure (12,13), suggesting one context in which gender differences may be less salient.
Risk factors for PTSD following trauma exposure
Previous studies have identified a number of psychosocial factors that increase risk for PTSD following trauma exposure in both women and men (14,15), including:
Pre-existing mental health problems (e.g., depression or anxiety disorder)
Family history of mental health problems
Experiencing additional life stressors
Availability of posttrauma social support
Though few studies have yet to explore whether these risk factors are equally relevant for both women and men, there is at least some evidence that social support may be a more powerful resilience factor for women compared to men (12). Additional research is needed to better understand the extent to which these, and other contextual factors, influence women's, as well as men's risk for PTSD.
Expression of PTSD and Comorbidity
Findings generally indicate that PTSD is experienced similarly for women and men. For example, a recent study (16) found that female and male OEF/OIF Veterans were about equally likely to report a variety of different symptoms of PTSD on a widely used self-report measure of PTSD, the PTSD Checklist (PCL). Another study that examined differences in the latent structure of PTSD as a function of both gender and trauma type, also failed to identify substantial gender differences (17).
Although women and men may experience PTSD similarly, the broader literature indicates that women are more likely to report co-occurring internalizing disorders like anxiety and depression and men are more likely to reporting externalizing disorders, like substance abuse (9,18). Thus, it is likely that these differences would also be observed among individuals with PTSD. Consistent with this perspective, there is some evidence that women with PTSD are more likely to have comorbid mood and anxiety disorders and less likely to have comorbid substance use disorders (SUDs) compared with men (19). While findings indicate that PTSD is also associated with adverse changes in physical health status, little evidence is yet available regarding unique effects of PTSD on physical health for women (20). One study that did address this question found similar relationships between PTSD and physical symptoms for women and men (21).
Treatment Seeking and Treatment Effectiveness
There are a variety of effective treatments for PTSD, including both cognitive behavioral therapy and pharmacotherapy (22). Overall, findings indicate that women are somewhat more likely to seek PTSD treatment than men (23). However, because women and men often experience different kinds of trauma, evaluating whether there are gender differences in the effectiveness of PTSD treatment can be a challenge. While there is some evidence that women and men may respond similarly well to PTSD treatment (24), additional research is needed to draw more definitive conclusions regarding gender differences in treatment outcomes.
Summary and future directions
As this review of the literature reveals, we now know a great deal about women's experiences of trauma and PTSD. In general, research indicate that women experience fewer traumatic events compared with men, though the kinds of traumatic events they experience are typically associated with higher risk for PTSD. While women are more likely than men to develop PTSD, research generally suggests more gender similarities than differences in the way that women and men experience PTSD. Finally, while there is some research suggesting that women and men may respond equally well to treatment, additional research is needed to better understand gender differences in PTSD treatment.
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