PTSD and Gender

PTSD and Gender


Both women and men are at risk of enduring unfathomable trauma, but it’s important to emphasize gender differences here, with the hopes that they can ultimately be a much-needed catalyst for improved preventative measures, diagnosis, and treatment.

In 2006, Tolin and Foa reviewed the results of about 25 studies, and indicated that women are approximately 2x as likely to meet criteria for PTSD than men, and also approximately 4x as likely to have more chronic iterations of PTSD.

The question that is begged is, what might account for the higher rates of diagnosis in women?

  • Women are NO more likely to experience trauma in general, but ARE more likely to experience certain types of trauma, including sexual abuse and assault. These types of trauma are associated with greater risk for PTSD.
  • When compared with male trauma survivors, women tend to react with self-blame, belief that their incompetence lead to trauma, and coping skills that are maladaptive such as mental disengagement and suppression of traumatic memories. This seemingly gender-specific expression of emotional distress post-trauma might explain greater rates of PTSD in women.
  • Increased baselines of anxiety and depression might put women at greater risk for developing PTSD. Most studies assess participants after trauma has occurred, without taking into account base rates of premorbid psychological distress. This limitation can inflate the risk of PTSD.
  • Women are more likely than men to experience multiple traumas across their lifespan and the cumulative effects of repeated traumas likely increase their risk of developing PTSD.

Research directed toward specific details regarding gender differences and veterans is still scarce.  It is incumbent upon any clinician, who is screening for PTSD and related difficulties, to be sensitive to this difference.

Female Veterans and PTSD

Women veterans are particularly at risk of being involved in different types of traumatic incidences. There are reports of being sexually (rape) and physically assaulted during military duty, as well as experiencing “duty-related” trauma as part of their military exposure (i.e., warzone exposure).

Also, it is not uncommon to hear that many women in the military have suffered preliminary trauma that might predispose them to the development of full-blown PTSD following a subsequent traumatic exposure.

Recently, research indicated that screening positive for PTSD is associated with a range of self-reported health problems and functional impairments specifically among female VA patients. These include fibromyalgia, stroke, irritable bowel syndrome, chronic pelvic pain, and obesity. In some studies, women reported poor health-related quality of life (HRQoL) relative to both male veterans and non-veteran women. Veteran women with PTSD have significantly more somatic distress, co-morbid medical conditions, psychiatric difficulty, and substance abuse rates than non-veteran women.

Female Veterans and PTSD + Chronic Pain

Women veterans specifically diagnosed with PTSD usually have significantly higher rates of pain and overall poorer health than women in the general population. There is not a lot known about the context of “military culture” that might have implications for women’s health behaviors. Yet, veteran women’s increased prevalence of chronic pain is probably because their pain is compounded upon by extreme conditions that are not experienced by civilian women. The ability to manage chronic pain is probably egregiously limited within military context, such that pain is probably maintained or progressively worsens with little relief.

When chronic pain cannot be readily explained as the direct consequence of tissue damage, some people treating veteran women are apt to think, “It is all in the head.” Although at greater risk for experiencing PTSD and co-morbid pain, women veterans are usually under-diagnosed and also under-use mental health services. A reason cited is that even in our progressed society, women in this position continue to be stigmatized.


I want to take a moment to mention the obvious: both PTSD and Chronic Pain sufferers are often stigmatized. They are relegated to the “outskirts” of the community, and become “liminal” creatures. I see time and again that those who experience either trauma and/or pain are perceived as victims of their own devices rather than just as sufferers.

Fibromyalgia is a common diagnosis given to women post-deployment. As such, women are stereotyped as somatisizers and told that their pain is elicited from the mental construct called the psyche, and not the brain. This concept of somatization implies that pain symptoms are exaggerated or feigned and ultimately within the control of the sufferer.

A variety of social and medical critics view chronic pain in women as a post-modern illness sharing a lineage with nineteenth-century pseudo-maladies like hysteria. These illnesses, they contend, originate in vulnerable human psyches. Central to these suspicions is the seemingly unshakable belief that chronic pain is a psychosomatic disorder, with the implication that the sufferer’s pain is not medically “real.” Within this conceptual framework is the archetype of the traumatized woman who experiences her trauma symptoms in her body. I urge women to take a stand against stereotyping and to pursue quality treatment despite critics who might make it seem unwarranted.

As always…this is a stigma-free, nonjudgmental, open community.  Your comments regarding intellectual, theoretical, and, of course personal accounts of trauma are cared for here.  We’d love to hear from you.

To Thriving,

Jennifer Wolkin, PhD

Trauma and PTSD

Trauma and PTSD

June: PTSD Awareness Month

This is the first of a series of posts that I’ve written on the topic of trauma and PTSD, especially for the month of June! I officially started this series last year, but I’m committed to revising it, adding to it, and updating it annually.

Trauma is one of the most sensitive issues I will ever speak about. In my writing, I want to make information as accurate and accessible as always, but to go to the nth degree to create a sensitivity and respect of all those who have been affected by trauma of any kind. I write this with the utmost respect for those who have and continue to suffer. My hope is that by creating awareness, I can increase health-care utilization and that more people are able to reach out for help.


As a clinical health and neuropsychologist, I am witness to those suffering from trauma on a daily basis. Trauma is a broad term, and according to the American Psychological Association (APA), it is an emotional response to a terrible event. Unfortunately, the said terrible event can constitute a plethora of possibilities, including combat, rape, natural disasters and assaults. There are other potentially traumatic events, and though less talked about, are no less palpable. These can include illness, intra-psychic identity struggles and others’ responses to these struggles, divorce, and constant relocation as a child. Ultimately, any event might be considered traumatic if you have experienced and/or witnessed a threat to your life, a threat to your body, and/or moral integrity and/or witnessed or experienced a close encounter with violence or death.

Usually, when we are faced with danger, we go into fight or flight mode during which our bodies release hormones to help us act faster, to either fight or take flight. Trauma inhibits this very normal and evolutionary response to impending danger. What trauma does is render someone helpless; instead of reacting to trauma with a natural response, we are paralyzed, a sense of control is lost, and we lose any ability to do anything to be relieved from the circumstance.

Symptoms of PTSD:

Those experiencing PTSD often experience a negative change in one’s beliefs, including the way one thinks about oneself and others.  Difficulty trusting someone, and guilt and or shame are often felt as well.

PTSD is most powerfully notable with the experience of three prominent symptoms, which include Re-Experiencing the event, Avoiding any reminders or feeling emotionally numb, and Hyper-arousal, which consists of a sensitive startle response. I am going to parse out each further.

In terms of Re-Experiencing, many people who experience PTSD relive the trauma after the threat has passed.  The reliving feels as if the event was occurring at present as either or both nightmares or flashbacks.  The trauma literally takes hold of someone’s life because it intrudes and fixates itself, and decreases someone’s ability to function day by day.

Many people who experience trauma actually feel compelled to re-experience the event, either literally or figuratively in order to “fix” the original outcome.  As trauma is distinct in its feeling of utter helplessness, it is understandable that many want to reenact the trauma in order to take control and restore a sense of self-efficacy.  This is very precarious, however, and creates a lot of suffering.

Avoidance/Numbing corresponds to a state of indifference, emotional detachment and passivity.  Most people diagnosed with PTSD most blatantly restrict their lives by purposeful and conscious avoidance of any situation that would appear to elicit any reaction other than a sense of safety and security. Some actually dissociate from reality without conscious choice.  When people cannot purposefully detach, or dissociate, they often look toward drugs and alcohol to numb the pain.  So, to reiterate, those with PTSD go on to live a narrowed life because they avoid experience and shy away from new opportunities.

With regard to Hyper-arousal, many people with PTSD will react in such a way that they enter a state of permanent alertness.  They are on guard at all times as if the danger will return at any point.  This heightened state of arousal is induced really around the clock, like swimming in a constant pool of physiological stimulation.  Many people startle to both factors associated with the trauma, as well as unpredictable stimuli (a door bell ringing for example).

In addition to the expressions of symptoms as described above, PTSD causes a huge deal of distress and severely limits functioning on social, personal, and occupational levels.

At the heart of PTSD is an exquisite attempt for the sufferers to try and find balance in their life.  This is often reflected in the cyclical expression of re-experiencing and avoiding. There is a great attempt of the trauma sufferer to both deny the events of the past and at the same time proclaim their experience “out loud”; sometimes one will feel numb to the point of detachment and dissociation, and sometimes relive the event as if it was occurring at present.  Neither symptom allows for the true integration of the traumatic event.  Therefore this pattern is ultimately self-perpetuated.

Symptoms of PTSD can last from months to even years. Symptoms are sometimes experienced consistently, and sometimes an acute flare-up is experienced upon coming into contact with a precipitating reminder (i.e, anniversary of specific event). Regardless of the manifestations and progression of the difficulties, it is important to recognize that not all post-traumatic experiences fit neatly into a labeled disorder with established criteria.  Being told you do not suffer from PTSD does not mean is that you are not suffering or experiencing many emotions and or physical changes.

Fear, anxiety, depression, anger and disconnection are all plausible feelings generated by unfathomable circumstances. 

Early intervention might help stave off whatever you are experiencing from progressing for the worse.  Being labeled or not labeled does not take away from the suffering.  You do NOT need to be diagnosed with PTSD to receive the best treatment for what you are experiencing.


My next post will discuss PTSD and Gender.  Spoiler Alert: Women are approximately 2x as likely to meet criteria for PTSD than men, and also approximately 4x as likely to have more chronic iterations of PTSD!

As always…this is a stigma-free, nonjudgmental, open community.  Your comments regarding intellectual, theoretical, and of course personal accounts of trauma are cared for here.  We’d love to hear from you.

To Thriving,

Jennifer Wolkin, PhD