Trauma and Violence: Are Women the Weaker Sex?

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Posttraumatic stress disorder

Psychological sequelae of trauma are varied and include anxiety disorders, substance abuse disorders, and mood disorders.2 Exposure to childhood trauma, in addition to serving as a risk factor for development of problems following exposure to later trauma, has also been indicated in the etiology of some personality disorders. Posttraumatic stress disorder (PTSD) is unique among psychiatric classifications in that it requires exposure to a traumatic event and a subsequent emotional response of

Epidemiological aspects

Despite the high rates of exposure to traumatic events, research indicates that PTSD occurs in relatively low numbers of people exposed. Studies examining the prevalence of lifetime history of PTSD in the general US population report rates of 2% to 14%.2, 5, 6 Multiple epidemiological studies have found that women are more likely to develop PTSD than men.2, 3, 7, 8 This is despite the fact that men report significantly more exposure to potentially traumatic events, with the exception of

Interpersonal trauma

A common suggestion for this discrepancy focuses on the types of trauma commonly experienced by women versus men. Men are more likely to experience most categories of potentially traumatic event including nonsexual assault, accidents, combat, and witnessing death or injury, and no significant sex differences exist for nonsexual childhood physical abuse and neglect.9, 13 Women, however, are more likely to experience intimate partner violence (IPV) and sexual assault during childhood and

Trauma type and PTSD

It is therefore plausible to speculate that higher rates of PTSD among women could be accounted for by the types of traumas that women are likely to experience, as some types of trauma have been found to lead to PTSD more commonly than others. Specifically, events that involve interpersonal violence precipitate PTSD more often than disasters or motor vehicle accidents. For example, in one study, 55% of rape victims developed PTSD compared with only 7.5% of those involved in a serious accident.2

Cognitive mediation and PTSD

The broad picture of higher rates of PTSD in those who experience interpersonal trauma may indicate a key factor that cannot be examined using even advanced methods of statistical analysis, which cannot take the role of cognitive mediation into account. Given that development of PTSD requires an interpretation of an event as threatening and horrifying and of an inability to control it,1 there is clearly a role for interpretation. Perhaps, therefore, one missing ingredient in the type of

Emotional reactivity and PTSD

Another seemingly likely alternative explanation is that socialized gender characteristics influence response to traumatic events such that they contribute not only to risk and resilience but also to specific symptom presentation. At the most basic level, there is a body of research that suggests that men and women tend to differ in terms of emotional reactivity.23, 24 Although this difference is sometimes not substantiated by research, it has been suggested that the absence of findings can be

Gender-biased presentations

Consideration of these findings raises important questions on the various possible psychological outcomes following trauma. Specifically, it highlights the perspective that the emotional responses to trauma that may be responsible for resilience versus risk to specific posttraumatic sequelae are associated with gender. Other evidence for gender-related differences in emotional responses exist in the literature. For example, it has been shown that immediately following sexual assault, men

Gender bias in personality disorders

The role of childhood trauma in the development of personality disorders is another area of literature that offers some support for differential responsiveness in males versus females. Although it is a vast oversimplification of etiological factors to view personality disorders as simply trauma spectrum disorders, there is a growing body of literature examining the high prevalence rate of childhood abuse among those who are subsequently diagnosed with certain personality disorders.38, 39, 40, 41

The role of trauma in ASPD and BPD

Etiological factors for these 2 disorders are unquestionably complex and involve an interaction with biological and genetic vulnerabilities.50 However, the literature has consistently found comparatively high rates of childhood abuse among those who are diagnosed with either ASPD or BPD. There is, in particular, a large literature that reports high levels of childhood trauma (particularly relationship trauma) among individuals with BPD. Studies have found rates of CSA in this population ranging

Summary

Although the literature consistently shows that women are significantly more likely than men to develop PTSD, the possible explanations for this are seemingly more complex. Certainly PTSD is most likely to develop following sexual trauma, an event that is much more likely to occur for females than males, and this can unquestionably contribute to some of the skewed gender prevalence in the community. However, it does not seem that the sex difference in PTSD prevalence can be completely

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