Women and PTSD – Controversy over Sex Differences in Prevalence (Part II)

Girl with head in hands

Attempts to Explain Gender Differences


Whenever there is a need to establish explanations for a phenomenon, studies geared at looking at biological facts seem to increase in number.


Study Focusing on Stress Hormone


In 2011, Irish et al. attempted to identify sex-related differences in psychobiological factors that might mediate the development of post-traumatic stress disorder (PTSD). They looked chiefly at the body’s two primary stress pathways, the sympathetic-adrenal-molecular (SAM) pathway and the hypothalamic-adrenal-axis (HPA), to understand differences in the production of cortisol, which is also known as the “stress hormone.” However, they concluded that it is still too early to determine a real association between biological traits or behaviors that differ according to sex (gender) and the development of PTSD. Furthermore, they suggested that, currently, it might not be useful to look at objective physiological responses to trauma in order to understand PTSD; instead, looking at subjective emotional and cognitive responses to trauma may prove more helpful for explaining sex-related differences.


Cognitive Appraisal of Potentially Threatening Events


Last May, The Journal of Abnormal Psychology published a study that mentioned cognitive models. These models focus on the role an individual’s emotional and cognitive appraisal plays in evaluating the threat of a potentially threatening event (PTE), as well as his/her subsequent ability to cope with such a threat. A greater perceived threat is known to predict a greater PTSD risk; therefore, initial reactions to trauma mediate the relationship between gender and subsequent PTSD. With this premise in mind, researchers have determined that women are more likely than men to view comparable events as threatening and that females pick up on threat signals more rapidly than men.


Emotional Appraisal of Potentially Threatening Events


Alongside this cognitive process of appraisal, an emotional appraisal also takes place. Women are more likely to report higher perceived emotional distress in terms of a loss of personal control during and following the PTE as well as a sense of fewer available alternative coping strategies. Subsequently, greater emotional distress produces a higher risk of peritraumatic dissociation. This is a state of limited or distorted awareness during and immediately after the PTE that produces distorted personal perception. Although peritraumatic dissociation can serve to regulate aversive affects as the PTE is experienced, it is often identified as a significant risk factor for the development of PTSD or its related symptoms. In fact, peritraumatic dissociation seems to have a greater predictive capacity for the development of PTSD than other factors like prior trauma or prior adjustment. Ultimately, what this line of study is suggesting is that women’s cognitive appraisals lead them to experience a PTE as threatening more often than men. This cognitive process fuels their more intense emotional responses that lead to peritraumatic dissociation, which can be understood as a reason for the higher prevalence of PTSD among women.




Could the gender disparities found by the researchers simply reflect natural biological differences, in that women in general are not as large or strong as men, are aware of their limitations, and historically have had to be more guarded? Does their innate set of maternal traits make them more wary, cautious, or quick to identify threats than men? What do you think this line of research can tell us about trauma, stress, and the associated gender differences?




Irish, L. A., Fischer, B., Fallon, W., Spoonster, E., Sledjeski, E. M. & Delahanty, D. L. (2011). Gender differences in PTSD symptoms: an exploration of peritraumatic mechanisms. Journal of anxiety disorders, 25, 209-216.


Kumpula, M. J., Orcutt, H. K., Bardeen, J. R., Bardee, J. R. & Varkovitzky, R. L. (2011)  Peritraumatic dissociation and experiential avoidance as prospective predictors of posttraumatic stress symptoms. Journal of abnormal psychology, Advance online publication. doi: 10.1037/a0023927



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