Gender- and sex-based contributors to sex differences in PTSD
Open accessAbstract
Purpose of review Sex differences in PTSD are well-established with a 2:1 sex ratio favouring women. Less well-established is the basis of such differences. The purpose of this review is to explore recent research examining potential gender- and sex-based contributors to sex differences in PTSD.Recent findings We identified 19 studies published since 2015. Masculinity is inconclusively associated with PTSD, but masculine ideals and masculine gender role stress are positively associated with PTSD. Among the sex-related factors, testosterone, oestradiol, progesterone, and ALLO/5α-progesterone ratio are believed to be involved in the development of PTSD. These factors likely affect PTSD risk directly and through epigenetic mechanisms. Findings suggest that gender and sex have multiple ways of affecting PTSD, including gender roles, genetic predisposition, and hormonal influences. These factors work together to put women at a particular risk of developing PTSD. By conducting more research, we may improve prediction, prevention, and treatment of PTSD.
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The sex differences in anxiety, depression, and PTSD in the sample mirror the often replicated finding of similar sex differences in the general population.
“These observations in relation to anxiety, depression, and PTSD mirror the often replicated finding of similar sex differences in the general population (Christiansen & Berke, 2020; Farhane-Medina et al., 2022; Tolin & Foa, 2006).”
From An examination of psychological distress and moral injury in journalists exposed to online harassment (2025) · cites this paper as Christiansen & Berke, 2020
The Introduction (page not provided) says that sex differences in PTSD are well established and that PTSD prevalence in women is approximately twice that in men. The paper does not establish the claimed general-population pattern for anxiety and depression; its discussion of those conditions does not report comparable prevalence differences. (LLM, conf=0.86)
Experimental — accuracy not yet measuredWhereas sexual assault often causes multiple problems with intimacy, sexuality, and self-worth in both men and women, male victims may, in addition, subsequently struggle with what they perceive to be a threat to their masculinity.
“Another example referred to earlier: whereas sexual assault often causes multiple problems with intimacy, sexuality, and self-worth in both men and women, male victims may, in addition, subsequently struggle with what they perceive to be a threat to their masculinity (120).”
From Where Sex Meets Gender: How Sex and Gender Come Together to Cause Sex Differences in Mental Illness (2022) · cites this paper as [120]
The section on masculinity reports that men exposed to military sexual assault sometimes perceived their masculine identity as threatened. It does not address the claimed problems with intimacy, sexuality, and self-worth in both men and women, and its evidence for the masculinity point is limited to a military sample. Page numbers are unavailable in our copy. (LLM, conf=0.87)
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Self-citation
- Authors
- Christiansen, D. M., & Berke, E. T.
- Affiliations
- University of Southern Denmark (DK)
- Corresponding author
- Christiansen, Dorte M.
- Venue
- Current Psychiatry Reports
- Published
- 2020-03-03
- Volume
- 22
- Issue
- 4
- Pages
- 19-19
- ISSN
- 1523-3812 (ISSN-L)
- 1535-1645
- OpenAlex
- W3009204937
- Cited by
- 270
- References
- 50
- Citations by year
- 2026: 35 · 2025: 55 · 2024: 54 · 2023: 45 · 2022: 50 · 2021: 27 · 2020: 4
- FWCI
- 2.49
- Type
- journal article
- Language
- en
- Open access
- Licence
- Locations
- Current Psychiatry Reports (publishedVersion)
- PubMed (publishedVersion)
- University of Southern Denmark Research Portal (University of Southern Denmark) (submittedVersion, other-oa)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Gender Studies › Gender, Security, and Conflict
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Keywords
- post-traumatic stress disorder, sex differences, gender differences, masculinity, masculine gender role stress, testosterone, estradiol, progesterone, epigenetics, genetic susceptibility
- MeSH terms
- Gender Identity, Humans, Sex Characteristics, Sex Factors, Gonadal Steroid Hormones, Stress Disorders, Post-Traumatic, Sex Distribution, Epigenesis, Genetic
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