The topic of women and sexual trauma has certainly been in the news lately, provoking a great deal of emotion and outrage. Much trauma research focuses on male combat veterans, yet women actually have double the rate of post-traumatic stress disorder (PTSD) as men!
While combat veterans have high rates of PTSD and suicide and deserve our attention, so do women sexual assault and abuse survivors. This article will review the symptoms of PTSD, its prevalence in women and men, and factors that may contribute to sex differences in PTSD risk, including the types of traumas that women experience, differences in brain processing, coping, and societal reactions.
What are the symptoms of post-traumatic stress disorder?
To be diagnosed with PTSD, a survivor needs to have the following symptoms present for at least one month and severe enough to interfere with day to day functioning:
Re-experiencing symptoms. These involve reacting as if the trauma is still present, including having nightmares, flashbacks, or frightening thoughts (1 needed)
Avoidance symptoms. These are attempts to avoid being reminded of the trauma, such as staying away from people, places, or things that are similar to aspects of the trauma, or avoiding and shutting out thoughts and feelings related to the trauma (1 needed)
Arousal and reactivity symptoms. These are signs of excess anxiety or anger and physiological arousal, including having angry outbursts, feeling “on edge,” being hyper-vigilant for threat, or having difficulty sleeping (2 needed)
Cognition and mood symptoms. These are memory impairments or negative thoughts, feelings, or judgments relating to the event; these include feeling excessive guilt, blaming yourself unreasonably, having difficulty remembering aspects of the event, seeing yourself or the world negatively, or not finding interest or pleasure in regular activities (2 needed).
It is normal to experience some of these symptoms right after an event like a rape or a serious car accident—but if symptoms last for more than a month, then you may have PTSD and should seek mental health evaluation and treatment. Sometimes, PTSD symptoms can be triggered months or years after the actual event.
What are the rates of PTSD in women and men?
The lifetime prevalence of PTSD is 5 to 6 percent in men and 10 to 12 percent in women. This means that women have almost double the rate of PTSD as men. Women’s PTSD also tends to last longer (four years versus one year, on average). Women are more at risk for chronic PTSD than men. What factors could account for this difference?
Do women experience more traumas than men?
One suggestion for the higher rate of PTSD is that women experience more traumatic events than men. In fact, research shows the opposite is true. Women report about a third less traumas than men. This means women are at higher risk of PTSD even though they experience fewer traumatic life events than men, on average. This is surprising and suggests there may be something about the type of trauma or women's reactivity that puts them at higher risk.
Do types of trauma differ between women and men?
Research shows that men and women do indeed experience different traumas.
Men are more likely to experience:
- combat trauma
- natural disasters
- disasters caused by humans
Women experience more incidents of:
- sexual abuse
- domestic violence
- sexual assault
Sexual traumas are prevalent and particularly toxic to mental health. Sexual abuse typically begins at a young age, when the brain is still growing, leading to a lasting impact on emotion regulation and fear response.
About one out of every six women has experienced attempted or completed sexual assault or rape in her lifetime. Victims of sexual trauma are more likely to be diagnosed with PTSD than victims of nonsexual trauma. While you might be able to stay away from combat, there is a psychological and relationship cost to staying away from sexual activity or being a reluctant participant (in the context of a committed relationship).
The #MeToo movement has highlighted the fact that women in many different career settings experience high rates of ongoing sexual harassment by bosses and colleagues. These experiences of exploitation, besides acting as chronic stressors, may trigger emotions associated with past trauma in women who have been raped and abused. Similarly, events in the news, especially those involving unfair treatment or sexual exploitation of women, can trigger strong reactions in the many women who have experienced sexual abuse or assault.
What makes sexual trauma so traumatic?
When I see survivors of sexual trauma in my practice, they often exhibit high levels of fear and vigilance, shame, and self-blame. Sexual traumas carry a stigma and make women feel ashamed even when there is no valid reason to feel this way. Lawyers representing perpetrators often attack the victim's character, lifestyle, and reputation in attempts to get their clients acquitted.
Many women who have been traumatized turn to alcohol or drugs to block out feelings associated with the trauma and thereby make themselves vulnerable to further sexual exploitation or coercion. They may report body hatred or dissatisfaction or exhibit eating disorders. Many victims of sexual trauma have trust issues, which can get in the way of healthy relationships as an adult. Some may isolate themselves or become avoidant of romantic relationships.
Women abused as children or teens report feeling too scared or ashamed to tell an adult. Some are not believed or told to “get over it." It is difficult to describe the level of violation and loss of sense of a healthy self that sexual abuse and sexual assault can cause to women and men. This is compounded when our society responds with dismissal, minimization, or disbelief.
What other factors might account for the different rates of PTSD?
Women are more susceptible than men to other types of mental health issues like anxiety disorders or depression. These may be the result of sexual assault or abuse, but can also be caused by other factors like genetic vulnerability to depression or high anxious temperament.
However, societal attitudes, gender roles, and income inequalities also affect mental health and mood. Women earn less than men for the same jobs. Many women work in jobs or live in households where they have less power and control over their lives than men. This is especially the case in traditional cultures. Professor Norris and her colleagues studied gender differences in PTSD across cultures and found that the increased risk of PTSD symptoms in women was magnified in more traditional cultures.
Do men and women have different brain responses to trauma?
Although more research needs to be done, it is possible that women’s brains react differently to fear-arousing or threatening stimuli than men’s brains. In experimental studies, women showed more activation of the right amygdala, right rostral anterior cingulate cortex (ACC), and dorsal ACC than men when they were exposed to fearful stimuli. The right side of the brain is associated with emotionality in general and negative emotions in particular. These same brain areas are involved in the stress response and also in mind-body awareness and emotional reactivity.
Another study using physiological measures showed that women acquired fear more easily than men when exposed to fearful stimuli.
Do men and women cope with stress differently?
Men and women may cope differently with stress. There is some evidence that women are more likely than men to exhibit a “tend and befriend” response to stress. They may react to stress by crying for help, turning to others for social support, or care-taking. Men show more angry and avoidant or problem-solving responses when they are stressed. Because women’s responses are more linked to their social network and availability of support, they may be more vulnerable to PTSD symptoms when they feel lonely or rejected or when social support is not available.
Women tend to show more of an emotional and ruminative response to stress, whereas men are more likely to engage in problem-solving. Ruminating about your stressors can make their impact worse if it stops you from taking action, or if the situation is not controllable.
In general, women seem to report stronger emotional reactions to major life events (like death or divorce). Women are also more affected by stressors impacting people close to them, like their parents, friends, partners, or children. These coping factors may contribute to women’s higher rate of PTSD, but more research needs to be done. Women who have been raped or sexually assaulted are also likely to blame themselves more and see themselves more negatively, which can exacerbate their reactions to the trauma.
Research shows that women have higher rates of PTSD than men, despite a lower rate of trauma experience. Women’s greater exposure to sexual trauma, sexual coercion, and intimate partner violence likely plays a role, as well as biological, environmental, and coping factors. When families, social groups, government bodies, news media, or organizations disbelieve, disrespect, or minimize girls' and women's experiences of sexual trauma, this can cause a great deal of harm to mental health.
Tolin, D. F., & Foa, E. B. (2006). Sex differences in trauma and posttraumatic stress disorder: A quantitative review of 25 years of research. Psychological Bulletin, 132, 959-992. doi: 10.1037/0033-2909.132.6.959
Inslicht SS, Metzler TJ, Garcia NM, et al. Sex differences in fear conditioning in posttraumatic stress disorder. J Psychiatr Res. 2013;47:64–71. [PMC free article] [PubMed]I
Olff, M. (2017). Sex and gender differences in post-traumatic stress disorder: an update. European Journal of Psychotraumatology, 8(sup4), 1351204. http://doi.org/10.1080/20008198.2017.1351204
Norris, F.H., Perilla, J.L., Ibañez, G.E. et al. Sex differences in symptoms of traumatic stress: Does culture play a role? J Trauma Stress (2001) 14: 7. https://doi.org/10.1023/A:1007851413867