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Gender differences in posttraumatic stress disorder.
Abstract
One of the most consistent findings in the epidemiology of posttraumatic stress disorder (PTSD) is the higher risk of this disorder in women. Explanations reviewed within a psychobiological model of PTSD suggest that women's higher PTSD risk may be due to the type of trauma they experience, their younger age at the time of trauma exposure, their stronger perceptions of threat and loss of control, higher levels of peri-traumatic dissociation, insufficient social support resources, and greater use of alcohol to manage trauma-related symptoms like intrusive memories and dissociation, as well as gender-specific acute psychobiological reactions to trauma. This review demonstrates the need for additional research of the gender differences in posttraumatic stress. Recommendations are made for clinical practice.
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“Research has consistently shown that men and women exhibit different patterns of media consumption and varying emotional responses to distressing (media) content [196,197].”
From Impact of Media-Induced Uncertainty on Mental Health: Narrative-Based Perspective. (2025) · cites this paper as [197]
In the citing paper
“Men may experience higher levels of anger and frustration when exposed to content that challenges their values or sense of control [197].”
From Impact of Media-Induced Uncertainty on Mental Health: Narrative-Based Perspective. (2025) · cites this paper as [197]
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“A consistent pattern in PTSD research is that females are twice as likely to develop PTSD as males 76 .”
From Post‐traumatic stress disorder: a state‐of‐the‐art review of evidence and challenges (2019) · cites this paper as [76]
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“The current sample was composed of approximately 75% women, which is representative of the PTSD sex ratio in the general population (Olff et al., 2007), and the processes examined in the current study did not differ as a function of gender, further extending generalizability of the findings.”
ResultNygaard, E., & Heir, T. (2012) · Health and Quality of Life Outcomes · doi:10.1186/1477-7525-10-76 · Cited by 56
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Self-citationPsychometric properties of the Norwegian Impact of Event Scale-Revised in a non-clinical sample
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“It has been suggested that higher perceptions of threat or control loss in women than in men may contribute to their higher prevalence rate of post-traumatic stress symptoms (26).”
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“A less impaired cognitive bias might allow the maltreated individual to develop good relationships with others, which is a protective factor in itself (e.g. Suzuki et al., 2015; Collishwa et al., 2007; Surguladze et al., 2004; for a review see Olff et al., 2007).”
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Adverse Childhood Experiences and Building Resilience With the JoyPop App: Evaluation Study
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“Investigating the relationship between sex, adversity, and intervention response is important because there may be several potential sex differences, including rates of childhood adversity [81], neuroendocrine and brain responses to stress and trauma [82,83], susceptibility to certain psychological responses to advers…”
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Gender and Age Differences in Trauma and PTSD Among Dutch Treatment-Seeking Police Officers
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“, 1995) and tend to use more emotionally driven and avoidant coping styles than men (Matud, 2004; Olff et al., 2007).”
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“They may also be more sensitive to perceive a situation as threatening and stressful, and experience more psychological and biological responses to trauma [36].”
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“In short, it has been proposed that gender differences in PTSD susceptibility may be due to biological differences, including differential hormonal reactivity on the hypothalamic-pituitary-adrenal axis (Rasmusson et al., 2001; Olff et al., 2007), a system in which the hippocampus is extensively involved (Buchanan et a…”
BackgroundInfluentialSex differences in post-traumatic stress disorder risk: autonomic control and inflammation
Fonkoue, I. T., Michopoulos, V., & Park, J. (2020) · Clinical Autonomic Research · doi:10.1007/s10286-020-00729-7 · Cited by 53
Post-Traumatic Stress Disorder
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Are Gender Differences in DSM-5 PTSD Symptomatology Explained by Sexual Trauma?
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“This study finds more severe stress responses and higher PTSD rates among women than men, consistent with previous research (Christiansen & Elklit, 2012; Kessler, Chiu, Demler, Merikangas, & Walters, 2005; Olff et al., 2007; Tolin & Foa, 2006).”
ResultGuo, J., He, H., Fu, M., Han, Z., Qu, Z., Wang, X., & Guan, L. (2017) · Psychiatry Research · doi:10.1016/j.psychres.2017.04.022 · Cited by 51
“dissociation, as well as gender-specific acute psychobiological reactions to trauma (Gavranidou and Rosner, 2003; Olff et al., 2007).”
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“population suggests that women are twice as likely as men to develop this condition in their lifetime.(44) Being a woman also increases the risk of developing depression and anxiety.”
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“…psychopathologies, such as major depression, generalized anxiety disorder and PTSD, affect approximately twice as many women than men (Bekker & van Mens-Verhulst, 2007; Kessler et al., 2005; Linzer et al., 1996; Olff et al., 2007; Stein et al., 2000; Tolin & Foa, 2006; Vesga-Lopez et al., 2008).”
BackgroundHruska, B. J., Irish, L. A., Pacella‐LaBarbara, M. L., Sledjeski, E. M., & Delahanty, D. L. (2014) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2014.06.009 · Cited by 49
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“These results support the notion that women in general show greater psychopathological reactions to trauma (Olff et al., 2007).”
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“Dissociation appears to be linked to a suppression of activity in the sympathetic nervous system and the HPA axis (Olff et al., 2007).”
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BackgroundThe differential effects of PTSD, MDD, and dissociation on CRP in trauma-exposed women
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“…the other hand are more likely to experience physical and sexual assault (Langeland & Olff, 2024; Norris et al., 2002; Olff, 2017; Olff et al., 2007; Tolin & Foa, 2008) and to be exposed at a younger age, all of which are associated with a higher conditional risk of PTSD (e.g. Olff et al., 2007).”
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Symptoms of Posttraumatic Stress Disorder Among Urban Residents
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BackgroundNewlyweds’ optimistic forecasts of their marriage: For better or for worse?
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“Biologically based explanations of these differences have been offered (i.e. Castanho et al., 2014; Olff et al., 2007; Rasmusson & Friedman, 2002), as well as those pertaining to socio-demographic factors (i.e. Klose & Jacobi, 2004), response bias and various psychological mechanisms (i.e.…”
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“Our finding that female sex independently increases the risk for the development of psychopathology is in line with evidence from twometa-analyses (Olff et al., 2007; Tolin and Foa, 2006).”
ResultFemale psychopharmacology matters! Towards a sex-specific psychopharmacology
Bolea-Alamanac, B. M., Bailey, S., Lovick, T. A., Scheele, D., & Valentino, R. J. (2018) · Journal of Psychopharmacology · doi:10.1177/0269881117747578 · Cited by 46
“Recently, it has also been suggested that estrogen status may increase risk for PTSD in some women, in part through its epigenetic regulation of the HDAC4 gene, which encodes histone deacetylase 4 and is involved in longterm memory formation (Maddox et al., 2017).”
BackgroundInfluentialReliability and validity of the Japanese version of the Peritraumatic Distress Inventory
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“The result is also consistent with a recent review indicating that women seem more likely than men to report acute emotional responses [21].”
ResultPACAP-PAC1R modulates fear extinction via the ventromedial hypothalamus
Velasco, E. R., Florido, A., Flores, Á., Senabre, E., Gomez‐Gómez, À., Torres, A., Roca, A., Norrholm, S. D., Newman, E. L., Das, P., et al. (2022) · Nature Communications · doi:10.1038/s41467-022-31442-w · Cited by 44
“We also detected a reduction of PACAP+ signal in the dorsal CA3 of IMO females (t(6)= 2.”
BackgroundPosttraumatic Stress Reactions in Parents of Children Esophageal Atresia
Gouëz, M. L., Álvarez, L., Rousseau, V., Hubert, P., Abadie, V., Lapillonne, A., & Kermorvant‐Duchemin, E. (2016) · PLoS ONE · doi:10.1371/journal.pone.0150760 · Cited by 45
“This difference in the pattern of the trauma response may be due to the mother’s stronger perceptions of threat and loss of control and to a gender-specific psychobiological reaction to trauma [21,22].”
BackgroundPosttraumatic Growth in Trauma Recollections of 9/11 Survivors: A Narrative Approach
Dekel, S., Hankin, I. T., Pratt, J. A., Hackler, D. R., & Lanman, O. N. (2016) · Journal of Loss and Trauma · doi:10.1080/15325024.2015.1108791 · Cited by 43
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Psychosocial predictors of chronic Post-Traumatic Stress Disorder in Sri Lankan tsunami survivors
Lommen, M. J. J., Sanders, A. J. M. L., Buck, N. M. L., & Arntz, A. R. (2008) · Behaviour Research and Therapy · doi:10.1016/j.brat.2008.10.009 · Cited by 40
Sex differences in trauma exposure and symptomatology in trauma-affected refugees
Mundy, S. S., Foss, S. L. W., Poulsen, S., Hjorthøj, C., & Carlsson, J. (2020) · Psychiatry Research · doi:10.1016/j.psychres.2020.113445 · Cited by 43
The Trauma Recovery and Empowerment Model: A Quasi-Experimental Effectiveness Study
Fallot, R. D., McHugo, G. J., Harris, M., & Xie, H. (2011) · Journal of Dual Diagnosis · doi:10.1080/15504263.2011.566056 · Cited by 46
“Recent reviews have confirmed that PTSD is more likely to develop in women than men ( Olff, Langeland, Draijer, & Gersons, 2007 ), along with the complications of related comorbidity.”
BackgroundLau, J. T. F., Yeung, N. C. Y., Yu, N. X., Zhang, J., Mak, W. W. S., Lui, W. W. S., & Zhang, J. (2012) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2012.06.007 · Cited by 42
“Some reviews show that women are at higher risk than men in developing PTSD [41,42].”
BackgroundRowe, H. J., Sperlich, M. I., Cameron, H., & Seng, J. S. (2014) · Journal of Obstetric, Gynecologic & Neonatal Nursing · doi:10.1111/1552-6909.12312 · Cited by 42
Skogstad, L., Tøien, K., Hem, E., Ranhoff, A. H., Sandvik, L., & Ekeberg, Ø. (2012) · Injury · doi:10.1016/j.injury.2012.10.001 · Cited by 44
Gandubert, C., Scali, J., Ancelin, M., Carrière, I., Dupuy, A., Bagnolini, G., Ritchie, K. A., Sebanne, M., Martrille, L., Baccino, É., et al. (2016) · Neurobiology of Stress · doi:10.1016/j.ynstr.2016.02.002 · Cited by 44
“age, sex, as well as type and/or severity of the traumatic events which may result in a lower dissociation score in that study (Olff et al., 2007; Wittmann et al., 2006).”
BackgroundThe role of cortisol in PTSD among women exposed to a trauma-related stressor
Stoppelbein, L., Greening, L., & Fite, P. J. (2011) · Journal of Anxiety Disorders · doi:10.1016/j.janxdis.2011.12.004 · Cited by 47
“Although women are twice as likely as men to be diagnosed with PTSD (Kessler et al., 1995; Olff et al., 2007), research with men Stoppelbein et al.”
BackgroundPerception of the Threat of Terrorism
Cohen‐Louck, K. (2016) · Journal of Interpersonal Violence · doi:10.1177/0886260516646091 · Cited by 46
Gender Differences in PTSD: Susceptibility and Resilience
Hu, J., Feng, B., Zhu, Y., Wang, W., Xie, J., & Zheng, X. (2017) · InTech eBooks · doi:10.5772/65287 · Cited by 47
“Coping style for dealing with trauma has been proven to play a critical role in PTSD development [83].”
BackgroundSex-dependent mental illnesses and mitochondria
Shimamoto, A., & Rappeneau, V. (2017) · Schizophrenia Research · doi:10.1016/j.schres.2017.02.025 · Cited by 42
“Women are also more likely than men to suffer from many stress-related disorders, including generalized anxiety and post-traumatic stress disorders (PTSD) (Kessler et al., 1995; Olff et al., 2007; Wittchen and Hoyer, 2001).”
BackgroundInfluentialJongedijk, R. A., Eising, D. D., van der Aa, N., Kleber, R. J., & Boelen, P. A. (2020) · Journal of Affective Disorders · doi:10.1016/j.jad.2020.01.077 · Cited by 42
Increased recruitment of cognitive control in the presence of traumatic stimuli in complex PTSD
Herzog, J. I., Niedtfeld, I., Rausch, S., Thome, J., Mueller-Engelmann, M., Steil, R., Priebe, K., Bohus, M., & Schmahl, C. (2019) · European Archives of Psychiatry and Clinical Neuroscience · doi:10.1007/s00406-017-0822-x · Cited by 40
Jenkins, E. J., Wang, E., & Turner, L. (2009) · American Journal of Orthopsychiatry · doi:10.1037/a0016659 · Cited by 40
Krauseneck, T., Padberg, F., Roozendaal, B., Grathwohl, M., Weis, F. C., Hauer, D., Kaufmann, I., Schmoeckel, M., & Schelling, G. (2009) · Psychological Medicine · doi:10.1017/s0033291709990614 · Cited by 40
“…females are known to remember emotionally relevant information better than males, have a well-documented higher risk for PTSD (Tolin & Foa, 2006 ; Olff et al. 2007), and sexspecific effects of BBs on emotional memory have been described in preclinical studies (Cahill & van Stegeren, 2003), we…”
BackgroundGender differences in psychiatric and medical comorbidity with post-traumatic stress disorder
Husky, M. M., Mazure, C. M., & Kovess–Masféty, V. (2018) · Comprehensive Psychiatry · doi:10.1016/j.comppsych.2018.04.007 · Cited by 40
Prolonged grief among traumatically bereaved relatives exposed and not exposed to a tsunami
Johannesson, K. B., Lundin, T., Hultman, C. M., Fröjd, T., & Michel, P. (2011) · Journal of Traumatic Stress · doi:10.1002/jts.20668 · Cited by 40
Guay, S., Goncalves, J., & Jarvis, J. (2015) · Aggression and Violent Behavior · doi:10.1016/j.avb.2015.07.013 · Cited by 39
Post-traumatic Stress Disorder and 20-Year Physical Activity Trends Among Women
Winning, A., Gilsanz, P., Koenen, K. C., Roberts, A. L., Chen, Q., Sumner, J. A., Rimm, E. B., Maria Glymour, M., & Kubzansky, L. D. (2017) · American Journal of Preventive Medicine · doi:10.1016/j.amepre.2017.01.040 · Cited by 45
“activities associated with the trauma; (2) lost interest in important/enjoyable activities; (3) felt isolated/distant from others; (4) found it hard to have love/affection for others; (5) had a sense of foreshortened future; (6) had sleep difficulties; or (7) became jumpy/easily startled.”
BackgroundBrooks, R., Silove, D. M., Steel, Z., Steel, C., & Rees, S. J. (2011) · Journal of Affective Disorders · doi:10.1016/j.jad.2010.12.020 · Cited by 38
Oxytocin improves compassion toward women among patients with PTSD
Palgi, S., Klein, E., & Shamay‐Tsoory, S. (2015) · Psychoneuroendocrinology · doi:10.1016/j.psyneuen.2015.11.008 · Cited by 42
Information Processing in Posttraumatic Stress Disorder
Ehlers, A., Ehring, T. W., & Kleim, B. (2012) · Oxford University Press eBooks · doi:10.1093/oxfordhb/9780195399066.013.0014 · Cited by 40
A new perspective on PTSD symptoms after traumatic vs stressful life events and the role of gender
van den Berg, L. J. M., Tollenaar, M. S., Spinhoven, P., Penninx, B. W. J. H., & Elzinga, B. M. (2017) · European Journal of Psychotraumatology · doi:10.1080/20008198.2017.1380470 · Cited by 42
“…report higher levels of perceived life threat after traumatic A1 events which is predictive of posttraumatic distress (Irish et al., 2011) and might be associated with lower levels of perceived control in women compared to men after A1 events (e.g. Mak, Blewitt, & Heaven, 2004; Olff et al., 2007).”
BackgroundKoch, S. B. J., van Ast, V. A., Kaldewaij, R., Hashemi, M. M., Zhang, W., Klumpers, F., & Roelofs, K. (2021) · Neuropsychopharmacology · doi:10.1038/s41386-020-00947-7 · Cited by 38
Vitriol, V. G., Cancino, A., Weil, K., Salgado, C., Asenjo, M. A., & Potthoff, S. (2014) · Depression Research and Treatment · doi:10.1155/2014/608671 · Cited by 41
“It is very important to consider sex differences in the neurobiological findings associated with childhood trauma [43].”
BackgroundLoey, N. E. E. V., van Son, M. J. M., van der Heijden, P. G. M., & Ellis, I. M. (2008) · Burns · doi:10.1016/j.burns.2008.01.012 · Cited by 38
“Our results were consistent with earlier findings that acknowledged the relationship between female gender and PTSD [25], external attribution of responsibility and PTSD [5,6] and with studies that demonstrated a relationship between anger and PTSD [2,26].”
BackgroundResultNorris, A. E., & Aroian, K. J. (2008) · Psychiatry Research · doi:10.1016/j.psychres.2007.09.005 · Cited by 43
Unique relations between counterfactual thinking and DSM–5 PTSD symptom clusters.
Mitchell, M. A., Contractor, A. A., Dranger, P., & Shea, M. T. (2015) · Psychological Trauma Theory Research Practice and Policy · doi:10.1037/tra0000089 · Cited by 42
Agyapong, V. I. O., Juhás, M., Omege, J., Denga, E., Nwaka, B., Akinjise, I., Corbett, S. E., Brown, M. R. G., Chue, P. S., Li, X., et al. (2019) · International Journal of Mental Health and Addiction · doi:10.1007/s11469-019-00096-z · Cited by 45
Metadata
- Authors
- Olff, M., Langeland, W., Draijer, N., & Gersons, B. P. R.
- Affiliations
- Amsterdam UMC Location University of Amsterdam (NL)
- Vrije Universiteit Amsterdam (NL)
- Venue
- Psychological Bulletin
- Published
- 2007
- Volume
- 133
- Issue
- 2
- Pages
- 183-204
- ISSN
- 0033-2909 (ISSN-L)
- 1939-1455
- OpenAlex
- W2072944527
- Semantic Scholar
- cb3fabbf50ff1505b95b8ac8786ada0903601aae
- Cited by
- 1,058
- References
- 259
- Citations by year
- 2026: 30 · 2025: 48 · 2024: 59 · 2023: 67 · 2022: 78 · 2021: 56 · 2020: 106 · 2019: 47 · 2018: 46 · 2017: 66 · 2016: 66 · 2015: 64 · 2014: 58 · 2013: 57 · 2012: 50
- FWCI
- 41.82
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Psychological Bulletin (publishedVersion)
- PubMed (publishedVersion)
- Pure Amsterdam UMC (publishedVersion)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Topics
- Social Sciences › Psychology › Clinical Psychology › Posttraumatic Stress Disorder Research
- Social Sciences › Psychology › Clinical Psychology › Child Abuse and Trauma
- Social Sciences › Psychology › Clinical Psychology › Psychoanalysis and Psychopathology Research
- Keywords
- post-traumatic stress disorder, gender differences, women, trauma exposure, threat perception, loss of control, social support, alcohol consumption, intrusive memories, psychobiological model, clinical practice
- MeSH terms
- Adaptation, Psychological, Age Factors, Cognition, Culture, Female, Humans, Hydrocortisone, Hypothalamo-Hypophyseal System, Life Change Events, Male, Oxytocin, Pituitary-Adrenal System, Sex Factors, Social Support, Stress Disorders, Post-Traumatic
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