Women and PTSD
The historical narrative of post-traumatic stress disorder (PTSD), has predominantly associated the disorder with males and the military. However, after modern and extensive studies on gender differences in PTSD, it has been acknowledged that women are found to be two to three times more likely than men to develop PTSD during their lifetimes, with a lifetime prevalence of 10-12% in women and 5-6% in men. Consequently, this raises the question of why women exhibit higher susceptibility to PTSD. Perhaps it is the nature of traumas, playing a role in explaining such contrast - as men and women appear to encounter different types of traumatic stress at various stages of their lives (Olff et al., 2007; van der Meer et al., 2017).
Firstly, research shows that women are disproportionately affected by sexual violence and rape, often at younger ages - adding to the negative impacts of the trauma (Downey & Crummy, 2021). The disparity in access to social and economic resources, compounded by differences in coping strategies between men and women, may be exacerbated by societal and cultural norms. This disparity can potentially contribute to women’s tendency to internalize the trauma they experience more deeply (Gavranidou & Rosner, 2003).
Could other factors, such as a perceived imbalance of physical strength between the average man and women, lead to feelings of vulnerability in women and heightened perceptions of threat? Women are on average weaker and may therefore perceive an incident as a threat to life when it involves someone physically stronger than them (Olff et al., 2007; van der Meer et al., 2017).
Interestingly, women tend to experience increased levels of peritraumatic dissociation and gender-specific acute psychobiological responses to trauma. This could be due to both biological and psychosocial factors and potentially exacerbate the increasing susceptibility to PTSD and even hinder its recovery (Olff et al., 2007; van der Meer et al., 2017). Understanding why women are at a greater risk of PTSD needs to be explored to understand better whether the gender contrast observed is due to psychosocial issues or whether biological factors, such as hormones or family genetics be also at play. (Olff et al., 2007; van der Meer et al., 2017; Yehuda, 1999).
Beyond what has been discussed, gender variations in PTSD could relate to the type or perception of trauma experienced. Interestingly, Women appear to be more susceptible to PTSD following disasters, accidents, loss, and non-malignant diseases, however, the gender differences were less pronounced in cases of violence and chronic diseases (Ditlevsen & Elklit, 2012). Symptom severity in females has been noted to be higher. These could be due to a combination of pre-, peri-, and post-traumatic risk factors, such as past traumas, pre-existing mental health conditions, self-harm, peritraumatic dissociation, and lack of social and medical support – again all being more prevalent in females (Christiansen & Hansen, 2015) and associated with increased risk of PTSD. One study highlighted that the most significant gender discrepancies were observed in symptoms associated with re-experiencing, anxiousness, and dysphoric arousal (Birkeland et al., 2017).
Exploring the complexities of female hormones may be of importance due to the correlation between ovarian hormone levels and PTSD. Notably, a decline in concentration of estrogen is associated with heightened symptoms of PTSD (Glover et al., 2012).
Could hormonal profile at the time of the trauma, play a part in the development of the disorder?
Estradiol may play a pivotal role in both the susceptibility to and treatment of PTSD among women. Higher estradiol levels could enhance the ability to extinguish traumatic memories, potentially reducing the likelihood of PTSD development following a traumatic event. This hormonal influence suggests a natural variance in PTSD risk and could inform personalized treatment timing, leveraging periods of increased estradiol to bolster the effectiveness of therapeutic interventions like exposure therapy (Milad et al., 2010).
Gender-specific responses to treatment, however, indicated that women tend to benefit more, particularly from non-pharmacological therapies, when compared to men (Eftekhari et al., 2013; Shiner et al., 2019; Tiet et al., 2015; Voelkel et al., 2015). A meta-analysis (Wade et al., 2016).
But what does this all mean in the context of the emerging studies and licensing applications for psychedelic treatments in alleviating symptoms of PTSD?
For instance, should treatments be aligned with the menstrual cycle to optimize therapeutic outcomes? Hormones affect our mindset significantly, and therefore logically factor into our psychedelic experience and healing power.
Another consideration is that much of the evidence for psychedelic treatments for PTSD has been drawn mainly from the military, with a predominantly male population. Do these methods and results translate over to women? Does healing from PTSD following combat look the same as healing from other traumas? There is certainly a difference in outcomes for conventional PTSD treatments (Murphy & Smith, 2018).
It’s not just how and when these treatments are given but also, by who. Sadly reports of practitioners in trials of psychedelics for PTSD, engage in inappropriate sexual conduct with vulnerable patients, where re-traumatising could occur. Safeguarding women in treatments like this is of the utmost importance.
Psychedelics have shown considerable promise in the treatment of PTSD, where current treatments certainly fall short. However, a better understanding of the nuances of gender when it comes to PTSD risk, development, and treatment is clearly needed. Understanding better how women’s biology and hormones play a part in female PTSD is important. Women could be affected by PTSD in a different way and may need healing in another way; therefore, we need women-focused studies for any new treatments and consideration of women’s biology and the need for safety in the use of psychedelic treatments for PTSD.
References
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Ditlevsen, D. N., & Elklit, A. (2012). Gender, trauma type, and PTSD prevalence: a re-analysis of 18 nordic convenience samples. Ann Gen Psychiatry, 11(1), 26. https://doi.org/10.1186/1744-859x-11-26
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