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Women and Posttraumatic Stress

 

Does posttraumatic stress disorder (PTSD) differ for men and women? June is PTSD Awareness Month, and women’s sometimes different response to trauma warrants a closer look. A national survey reported that more than half of all women experience at least one trauma at some point during their lives. Some statistical models predict that 7.8% of individuals in the United States will experience PTSD, with women (10.4%) predicted as twice as likely as men (5%) to develop the disorder. This greater prevalence of PTSD among women raises the question: How are women’s experiences of trauma different from those of men?

PTSD develops in the aftermath of trauma. However, while 51% of women and 60% of men presumably experience a traumatic event during the course of a year, only 3.6% are identified as having PTSD. This highlights the fact that experiencing trauma does not necessarily lead to PTSD. The DSM-IV-TR (the diagnostic manual used by the American Psychiatric Association) defines the necessary conditions for a diagnosis of PTSD. The individual must experience or witness a traumatic event and respond with intense fear, helplessness, or horror. In addition, the traumatic event is re-experienced through intrusive images, memories, dreams, or “flashbacks” where the trauma seems as if it is recurring. Individuals with PTSD develop “arousal symptoms” where they feel on alert, irritable, and vigilant to sources of danger. They may have difficulty sleeping or concentrating and startle easily. Symptoms of avoidance and numbing also develop and are manifested through avoiding events, people, or places that are reminders of the trauma, a loss of interest in previously meaningful activities, a constricted emotional response to others, or an inability to remember significant aspects of the traumatic event.

Identifying those unique factors that contribute to the development of PTSD is essential, since this understanding may eventually aid in its prevention. Researchers have found that women at higher risk for developing PTSD have experienced one or more of the following: they were sexually assaulted, experienced a trauma that was life-threatening or severe, sustained injury during the incident, had a past history of mental health problems, encountered additional stressful experiences after the traumatic event, or lacked adequate social support. While the traumatic event itself may not have been preventable, some of these other factors could be addressed, such as reducing stress after the incident or offering social support. Recently, Kerry Ressler of Emory University identified pituitary adenylate cyclase-activating polypeptide (PACAP) as a hormone that may be related to susceptibility to PTSD. In one study of women who had experienced significant trauma, those with high blood levels of PACAP had PTSD symptom scores five times higher than women with lower PACAP levels. This finding points to biochemical factors that may contribute to the development of PTSD and could eventually lead to improved treatment and prevention.

Women may be more likely than men to manifest certain PTSD symptoms. They more frequently show symptoms of anxiety, startle easily, avoid situations that evoke memories of the traumatic event, and may become numb to their emotions. Women are less likely than men to feel angry or have difficulty controlling their anger. In fact, many women blame themselves for the trauma, which can worsen their symptoms. Almost half of all women with PTSD become depressed, and many develop social anxiety and fearfulness related to situations that remind them of the event. Some women use alcohol or drugs, although drug and alcohol abuse is also commonly seen among men with PTSD symptoms.

One positive research finding is that women are more likely to seek help after trauma and may respond better to therapy than men. Women may be more open in general to expressing feelings and to seeking support when needed. Various specialized treatments for PTSD have been used in addition to traditional psychotherapy. These include cognitive-behavioral therapy, eye movement desensitization and reprocessing (EMDR), exposure therapy, and the use of medications that can be combined with psychotherapy. Support groups focused on trauma recovery can be helpful if led by experienced group therapists. Family and couples therapy can engage family members to offer support and understand the impact of the trauma. Most importantly, while emerging from trauma takes time and patience, women who progress through the process of recovery eventually develop respect for their own strength and resilience.

Related articles:
Surviving Sexual Assault
Self-Compassion after Trauma
From Victim to Survivor to Thriver

© Copyright 2012 by Gail Post, PhD, therapist in Jenkintown, PA. All Rights Reserved.

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Comments
  • Val B May 31st, 2012 at 4:58 PM #1

    Regardless of whether or not comparable numbers of men and women exhibit PTSD symptoms, it is important to know the different ways this disorder ca manifest itself in patients of a different sex.
    You would reason that women experience this with more anxiety and less anger, as this is typically how we go through life to begin with.
    But knowing the different things to look for may better aid clinicians when they are seeking treatments that will be effective for their patients.

  • Reagan June 1st, 2012 at 11:06 AM #2

    Honestly, I always thought that PTSD was something only experienced by mainly men, and I kinda had it in my mindset that it was for soldiers and veterans and stuff and not just everyday people like you and me.

    I can definitely see how women would experience the symptoms of PTSD way differently from men, just because women tend to process pretty much everything differently than men do.

    While anger would be treated one way, and you would give those patients one way to manhage that anger, it is a whole different ballgame when you are dealing with more anxiety and depression.

    I realize that this could be different aspects to PTSD, but the treatment is not always going to fit under the same unbrella.

  • Gal Post June 1st, 2012 at 5:01 PM #3

    It really is interesting how differently women and men respond in so many situations. So it is not surprising that women’s reactions to trauma can be so different

  • Gwyn June 1st, 2012 at 5:13 PM #4

    Reagan: Oh, trust me. I was never in combat in any armed forces. But being raped twice will give you exaggerated startle from here to eternity. I know.

  • cheyenne June 2nd, 2012 at 11:57 AM #5

    Do you really think that PTSD is a disorder that eventually could be prevented? I mean, I think that maybe there could be some more effective treatments, but it is hard to imagine that it could be something that would be prevented. You never know who is going to experience it or when it would start in some people, so what could you possibly do that would prevent it from occuring?

  • Gail Post June 3rd, 2012 at 12:42 PM #6

    Cheyenne,

    I think the research suggests that although trauma cannot be prevented, some people may be more susceptible to develop PTSD when faced with a traumatic situation. If more understanding of these factors can be identified, perhaps some preventative measures can be developed. Again, this would not prevent the trauma, but could possibly prevent the PTSD symptoms from developing in response to the trauma.

  • dean June 4th, 2012 at 4:22 AM #7

    I watched my dad struggle with ptsd for a long time before anyone got him the help that he needed.

    I think about how much time of his life that he lost, that we as a whole family lost, because he had such horrible mood swings, or that’s what we thought that it was at the time.

    How the VA never quite got it that this was what was going on with him is kind of astonishing. It took my mom going out on her own and doing the leg work before she figured out that this was something that was treatable at least.

  • kaye Fitzpatrick June 4th, 2012 at 5:10 PM #8

    Women and PTSD has been strangely avoided for too long now. If you think about all of the abusive situations that many women have found themselves in over the years you would think that there would have been more attention paid to it before now.

  • Vesen O June 5th, 2012 at 12:12 PM #9

    I was diagnosed with PTSD and at the same time menopause when my significant other e mailed me a breakup after 3 years. He had taken my things to Nigeria to work for an oil company. Then he found a 22 year old Nigerian that was 35 years younger than himself he was a white man There was no discussion and I never got my things back. I guess he hurt my confidence and my ability to protect myself at such a vulnerable time. All of the events still haunt me from time to time. He stooped for a prostitute. He told me it was all my fault

  • Deb July 2nd, 2012 at 9:17 PM #10

    I truly think this is something that I have suffered, I thought it was depression, I was virtually suicidal nearly 5 years a go, due to abuse, I no now, that It has been due to my partner having a Narcissus Personality Disorder, it caved my world in when we experienced a few set backs as you do in life, I couldn’t of ever imagined what was in store and how bad it would get……But I am strong, a survivor, and got through it alone, took time, but I’m still here more than ever, I know I didn’t make myself depressed, something else happened that I couldn’t explain at the time, knocked me to the ground, hit me like a ton of lead & I was in shock & this lead to me fighting not to take my own life I was so in disbelief. I have recently read about PTSD, and it answered a lot of questions, it seems, I had the major case of it, and i now wonder how I survived, II haven’t been diagnosed, but, I think i have suffered this and it’s so frightening & a terrible experience I’ll never forget, get over yes, but never forget. I don’t know what I have inside that drives me, but I thank god it’s there, it saved my life. I don’t think it’s a reality to think this can ever be truly prevented, people cause this, through unbalanced states of minds, emotional dysfunction and unless you get rid of all the unbalanced, emotional dysfunctional people of today, the cycle is going to be one of repeat, severe or not so severe, it is surely, therefore unstoppable as such. But, prevention, is surely better than cure, pity we didn’t have the minds to see the extent of what needs preventing and curing decades ago, but that is the art of listening and learning, and public awareness on these issues, more mind awareness and giving the people of tomorrow the tools to help the people of tomorrow. Tell all, to open their hearts, show emotion, be sad when you feel sad, be happy when you are happy, grieve, feel all anger & stand strong in a positive way so others can learn, you can learn and it is an ongoing infectious disease,within itself, that needs no cure…..that is the answer….that is the Cure, therefore xxx

  • Nicole May 2nd, 2013 at 7:45 AM #11

    Hi Gail,

    Very interesting article, thank you.

    As a fellow therapist who works with people with PTSD, I thought you might like to know about yoga nidra. The Sanskrit words translate to mean yogic sleep, but it isn’t really sleep, it is the activation of a theta wave brain state, which puts people in a liminal place between waking and sleep. Not only is this extremely relaxing, since it stimulates the parasympathetic nervous system, but it also increases vagal tone, making folks more resilient to future emotional assaults.

    This ancient yogic mediation practice has come to the West via people like Richard Miller, Ph.D. Dr. Miller is using it at Walter Reed Medical Center with veterans. (Here’s a link to more info on that work: irest.us/projects/veterans.)

    The best way to sample an excellent yoga nidra practice for free is to go to iTunes.
    Access “podcasts” on the menu bar.
    Type in “Elsies Yoga,” and click on episode #62.
    The first 15 minutes she’s chatting with a fan, but the next hour is one of the best yoga nidra meditations available.
    Naturally, one would never use yoga nidra while operating heavy machinery.

    Nicole S. Urdang, M.S., NCC, DHM

  • Gail Post May 3rd, 2013 at 5:53 PM #12

    Nicole,

    Thanks for your input.

    Gail

  • Laurie W. PhD June 10th, 2013 at 2:53 PM #13

    This is for all and especially Gail. In order for PTSD to not become a “catch all” diagnosis, you need to be clear about the criteria from DSM-IV-TR.

  • Laurie W. PhD June 10th, 2013 at 2:57 PM #14

    I meant to say for all. I thought it would be useful for Dr. Post to include all the criteria in her article so that readers realize there are many factors involved.

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