Why Do Women Have More PTSD Diagnoses Than Men?

Here's a fact that may surprise you: according to an influential 2006 study covering 25 years of research, women are twice as likely to be diagnosed with post-traumatic stress disorder (PTSD) as men. This goes against the grain of popular assumption for several reasons, the main one being that the majority of public attention around PTSD is focused on war veterans (and deservedly so: one study found that 38.3 out of every 100,000 veterans committed suicide every year, with PTSD a likely cause), who are predominantly male. But PTSD is more widely spread among the general populace than it seems; as an anxiety disorder, up to 8 percent of the American population suffer from it, with one out of every nine women likely to develop it. What's going on? Are women genetically probe to developing the condition? Are we more likely to experience serious trauma? Or is there a strange combination of factors creating the gender divide in PTSD?

To understand this issue properly, you first need to understand what exactly PTSD is. It's not a blanket response to trauma; rather, PTSD is developed in response to a severely life-threatening event, like a natural disaster, sexual assault, car accident or robbery. While extreme traumas of various kinds are unfortunately quite common, PTSD isn't; whether people develop PTSD in response to trauma appears to depend on many factors, including genetics, co-existing health conditions, support afterwards, the presence of other traumas, the type of trauma experienced (the Anxiety & Depression Association of America records that 67 percent of people exposed to mass violence develop PTSD, a very high percentage), and numerous other factors. In that mix, it appears, is gender; and we're only gradually beginning to understand why. This issue is coming more to the forefront of the discussion (New Scientist has published a feature on research this week), but one thing seems to be emerging: it's not just that women are fundamentally worse at dealing with problems. It's a lot more complicated than that.

1. We're More Likely To Experience Sexual Assault

One theory put forward to explain at least part of the gender gap in PTSD diagnoses is the fact that women are far more likely than men to experience sexual or domestic assault over the course of their lives — an experience which is correlated to a high incidence of PTSD afterwards. The National Center for PTSD, run by the Department of Veteran Affairs, lays out some pretty shocking statistics: while women are "somewhat less likely to experience traumatic events overall" than men, their increased likelihood of experiencing sexual assault (18.3 percent of the US female population have experienced it) raises their PTSD likelihood substantially. They're also more vulnerable to childhood sexual assault, a highly traumatic event, than men. The link between sexual assault and PTSD is a very strong one; RAINN reports that 94 percent of women who have been raped experience PTSD symptoms in the following two weeks.

Sexual assault by itself isn't the only possible mediating factor when it comes to gender violence, either. As Rose Eveleth points out in her look at female PTSD for VICE, women are more likely to be victims of long-term campaigns of mental or physical abuse than men, as well as "one-time attacks".

2. We May Be Biochemically More Vulnerable

The interplay of nature and nurture when it comes to susceptibility for PTSD can be a tricky subject — after all, women have had to endure centuries of false allegations that we're emotionally weak and prone to keeling over when slightly upset, and we don't want to reinforce those notions. But, intriguingly, new bodies of research are showing that there may be certain genetic factors in women that predispose them to PTSD diagnoses, which have nothing to do with stereotypes about "weak" women, and give new hope for targeted treatment.

We already learned, due to twin studies, that PTSD is "moderately" controlled by genes. But a landmark set of studies in the 2010s found that high levels of the stress hormone pituitary adenylate cyclase-activating polypeptide (PACAP) were found in the blood of women with PTSD, but not men. Biochemically, female PTSD is different from the PTSD experienced by men. The actual cause of the PACAP levels, though, is where it gets really interesting. It turns out that there's a specific gene linked to PACAP, and that it's responsive to estrogen levels. In some women, the gene has a variation that means it seems to "amp up" its response, and having that variation means a much higher likelihood of developing PTSD after trauma. Basically, as Science magazine said at the time, "estrogen, the primary female sex hormone, may amplify the effects of stress." In those of us who've got the gene variant, being a woman seems to leave us more vulnerable to PTSD diagnoses.

3. Our Societal Roles Encourage Lack Of Self-Care & A Feeling Of Responsibility For Trauma

Alongside biological and criminal motivations for PTSD differences, there's likely a societal element in play, as well. Women, as the treatment program Recovery Ranch points out, are more likely to assume a sense of responsibility or guilt for their own trauma, and to be more prone to depression and anxiety in general, something I've discussed elsewhere. The tendency to find fault with themselves and ruminate on events, the program suggests, "can make it harder for them to avoid cycling into other disordered emotional responses to trauma."

There's also the fact that emotional self-care can be less available to women. This goes against the societal stereotype of women as "innately caring," but there's actually a gender difference in the ways in which PTSD shows symptoms in women and men: scientist Lisa Jaycox explained to Washington Monthly that "women often tend to blame themselves for their anxiety, spiraling into depression and social isolation; men are more likely to turn to substance abuse, or commit acts of violence." The tendency of women to go "inward" rather than externalizing symptoms of distress can exacerbate the problem of gender roles: without showing their difficulties, women are expected to remain capable caregivers to others (wives, mothers and daughters), fulfilling their "gendered social roles" without due attention to their condition. Unsurprisingly, having to keep acting like a normal mother if you're severely traumatized likely doesn't help with the development of PTSD.

4. We May Have A Stronger Conditioned Response To Fear

There's a very interesting sub-section of human psychology studies called "fear conditioning." In it, scientists show people (or animals) images, sounds or other stimuli while also having them experience something negative, like a minor electric shock. Over time, people will become "conditioned" to fear the sight of the stimulus, even if they're not actually being hurt any more. A fascinating fear conditioning study was done in 2013 on women and men with PTSD, and it found something interesting: within the study, women showed stronger physical fear responses to the thing they were being conditioned to loathe than the men.

The research scientists weren't really sure what this meant, though they came up with two suggestions: One is that women might just be more responsive to fear in general; the other is that women who already have PTSD develop massive increases in their reaction to fear. The brains of normal women and men have been shown to respond a bit differently to fear conditioning, so it might be a gender difference; but we're just not sure yet.

5. Women Of Color May Be Particularly Vulnerable Due To Racism

It's been suggested that women of color might be more vulnerable to PTSD than white women, because of the impacts of racism. A survey found that 9.1 percent of African-Americans had PTSD, compared to 6.8 percent of white Americans, indicating that there's a definite racial component; and it's been suggested that the many micro-aggressions and overt acts of racist discrimination that POC deal with on a daily basis create such an environment of stress that PTSD occurrence becomes more likely. There hasn't been a lot of research, though Dr. Monnica Williams of the University of Louisville’s Center for Mental Health Disparities is at the forefront of new studies; she explained to Psychology Today that "Chronic fear of [racist] experiences may lead to constant vigilance or even paranoia, which over time may result in traumatization or contribute to PTSD when a more stressful event occurs later."

It's clear that whatever creates PTSD's higher incidence among women can't be traced to a single effect; it's an interplay of genetics, societal expectation, stress and other vulnerabilities. But either way, let's all agree it is awful.

Images: Pexels, Giphy