PTSD was first seen and recognised in male veterans. However, subsequent studies have shown that women are generally at greater risk of developing PTSD. It has been suggested that different degrees and types of exposure are the reason for this gender difference in the development of PTSD. However, a 2006 meta-analysis has shown this hypothesis to be false. Differences in trauma types can only partially explain the gender differences in PTSD prevalence, so other variables contribute more to an understanding of this trend.
Women generally have a different psychiatric symptom expression than men. You will typically see higher levels of anxiety and depression in women, and in men you will often see higher levels of aggressive behaviour, drug and alcohol abuse and behavioural problems. This knowledge of symptom expression, as well as numerous other findings on gender differences, suggests that women are more vulnerable to the development of PTSD because their response to traumatic events often involves factors that predispose them to PTSD. Such factors are likely to include perceptions of danger, perceptions of hostility, feelings of isolation and loneliness, depersonalisation and self-blame.
The Danish Center of Psychotraumatology has studied gender differences in relation to PTSD in a number of different contexts. You can read more about this on this page.
Gender differences in PTSD as the main topic. Gender is an important variable in most of our studies.
Murphy, S., Elklit, A., Chen, Y. Y., Ghazali, S. R., & Shevlin, M. (2018). Sex Differences in PTSD Symptoms: A Differential Item Functioning Approach. Psychological Trauma: Theory, Research, Practice, and Policy. Doi: 10.1037/tra0000355
Christiansen, D. M. (2017). Mediation and moderation effects of sex and gender in PTSD. Department of Psychology and Behavioural Sciences, Aarhus University.
Christiansen, D. M. (2017). Sex and gender differences in trauma victims presenting for treatment. In M. J. Legato (red.), Principles of gender-specific medicine: Gender in the Genomic Era (3. udg., s. 497-511). Academic Press. Doi: 10.1016/B978-0-12-803506-1.00043-7
Murphy, S. & Elklit, A. (2017). Gender Differences in PTSD Symptoms: A Differential Item Functioning Approach. Psychological Trauma: Theory, Research, Practice, and Policy, 10(3), 263-385. Doi: 10.1037/tra0000355
Christiansen, D. M., & Hansen, M. (2015) Accounting for sex differences in PTSD: A multi-variable mediation model. European Journal of Psychotraumatology, 6. Doi: 10.3402/ejpt.v6.26068
Ditlevsen, D. N. & Elklit, A.(2012) Gender, Trauma Type and PTSD Prevalence: A Re-analysis of 18 Nordic Convenience Samples. Annals of General Psychiatry, 11(26). Doi: 10.1186/1744-859X-11-26
Christiansen, D. & Elklit, A.(2011) Sex differences in PTSD. In E. Ovuga (Ed.): Post Traumatic Stress Disorders in a Global Context. (pp 113-142). ISBN 978-953-307-825-0. Rijeka, Croatia: Intech.
Spindler, H., Elklit, A. & Christiansen, D. (2010). Risk factors for post-traumatic stress disorder following a technological disaster in a residential area: A note on the origin of gender differences in post-traumatic stress disorder. Gender Medicine, 7(2), 156-165.
Ditlevsen, D. N. & Elklit, A.(2010) The Combined Effect of Gender and Age on Post-tramatic Stress Disorder: Do Men and Women Show Differences in the Lifespan Distribution of PTSD? Annals of General Psychiatry, 9(32). Doi: 10.1186/1744-859X-9-32.
Approximately twice as many women as men develop PTSD after suffering a serious accident. We believe that a large part of the explanation for these gender differences can be found in men's and women's acute reactions to the accident. This includes psychological, physiological and endocrinological (hormonal) reactions. Understanding these factors may therefore be crucial to improving early identification, prevention and treatment of PTSD and other trauma-related disorders among accident victims.
The current project is a prospective pilot study of patients who have been involved in a traffic accident or similar serious accident. The focus area of the study can be divided into three parts:
1. The interplay between acute physiological, endocrinological and psychological responses to major accidents.
2. The influence of these acute reactions on the development of PTSD symptoms 3 and 6 months later.
3. Gender differences in the two items above, with a special focus on how both biological and socio-cultural gender-related factors affect trauma reactions.
The study will be the first of its kind to examine the complex interplay between the physical and psychological aspects of both gender and trauma response from multiple angles, which are often examined separately. The absence of similar previous research is also the reason why the current study is being conducted as a pilot study as the first part of a research project that is expected to be conducted on a larger scale.
Ditlevsen, D. N. & Elklit, A. (2010). The Combined Effect of Gender and Age on Posttramatic Stress Disorder: Do Men and Women Show Differences in the Lifespan Distribution of PTSD? Annals of General Psychiatry, 9:32. Doi:10.1186/1744-859X-9-32.
Charak, R., Armour, C., Elklit, A., Angmo, D., Elhai, J. D. & Koot, H. M.: (2014). Factor Structure of PTSD and Relationship with Gender in Trauma Survivors from India. European Journal of Psychotraumatology, 5:25547. Doi: 10.3402/ejpt.v5.25547.
Ditlevsen, D. N. & Elklit, A. (2012). Gender, Trauma Type and PTSD Prevalence: A Re-analysis of 18 Nordic Convenience Samples. Annals of General Psychiatry, 11:26. Doi:10.1186/1744-859X-11-26
Murphy, S., Elklit, A., Chen, Y.Y., Ghazali, S.R., & Shevlin, M. (2018). Gender Differences in PTSD Symptoms: A Differential Item Functioning Approach. Psychological Trauma: Theory, Research, Practice, and Policy, 10(3) pp. 263-385. Doi: 10.1037/tra0000355
Donbaek, D. F. & Elklit, A. (2015). Gender-specific predictors of Posttraumatic Stress Disorder in Adolescence: The role of problematic substance use and interpersonal relationships. Journal of Child and Adolescent Trauma, 8, 161-172. Doi: 10.1007/s40653-015-0040-5
Ghazali, S. R., Elklit, A., Sultan, M. A., Balang, R. V., & Chen, Y. Y.(2016): Lifetime trauma exposure, gender and DSM-V PTSD symptoms among adolescents in Malaysia. Traumatology, 23(3), 235-239. Doi: 10.1037/trm0000088
Background: Studies indicate that differences in trait anxiety and trauma-related distress may mediate the gender differences observed in posttraumatic stress disorder (PTSD). Objective: We examined the contributions of gender, trait anxiety, and trauma-related distress to the development of PTSD after an industrial disaster. Methods: Three months after a massive explosion in a fireworks factory in Kolding, Denmark, in November 2004, residents in the surrounding area were asked to complete the Harvard Trauma Questionnaire, the General Health Questionnaire, and a questionaire designed for the present study. Using multivariable logistic regression with PTSD as the dependent variable, we examined 4 explanatory models: (1) gender; (2) gender and trait anxiety; (3) gender, trait anxiety, and perceived danger; and (4) gender, trait anxiety, perceived danger, perceived hostility, feeling isolated, depersonalization, and behavioral self-blame. Results: Fifty-one percent (N = 516; 265 women and 251 men) of the area residents participated in the study. The female-to-male ratio of PTSD was 2.4:1. Women experienced significantly more trait anxiety (P < 0.001), feelings of isolation (P < 0.005), and behavioral self-blame (P = 0.018), and less perceived danger (P = 0.034) than did men. In multivariable logistic regression analysis, gender alone predicted 3.7% of the variance in PTSD status (odds ratio [OR] = 2.40; 95% CI, 1.35-4.27; P < 0.005); however, in all other models, gender was not significant. The final model comprised trait anxiety (OR = 1.20; 95% CI, 1.11-1.30; P < 0.001), perceived danger (OR = 4.62; 95% Cl, 2.24-9.50; P < 0.001), perceived hostility (OR = 5.21; 95% CI, 1.93-14.09; P < 0.001), feeling isolated (OR = 3.34; 95% CI, 1.55-7.16; P < 0.002), depersonalization (OR = 2.49; 95% CI, 1.42-4.37; P < 0.001), and behavioral self-blame (OR = 0.46; 95% CI, 0.24-0.86; P = 0.015), explaining 48.9% of the variance in PTSD severity. Conclusion: This cross-sectional study found that gender was no longer associated with PTSD status when trait anxiety, perceived danger and hostility, feeling isolated, depersonalization, and behavioral selfblame were taken into account.
Spindler, H., Elklit, A. & Christiansen, D. (2010). Risk factors for post-traumatic stress disorder following a technological disaster in a residential area: A note on the origin of gender differences in post-traumatic stress disorder. Gender Medicine, 7(2), 156-165. Doi: 10.1016/j.genm.2010.04.001
Objective: There is increasing evidence to suggest that anxiety is related more strongly to chronic pain experience in men relative to women. The aim of the present study was to examine for the first time gender-specific associations between anxiety and chronic pain experience in men and women exposed to whiplash trauma.
Results: Anxiety was found to be positively related to the level of general disability to a significantly stronger magnitude in men compared with women. A trend difference in correlation magnitude was also found between men and women when comparing anxiety with pain frequency, with the magnitude of correlation being higher in men.
Discussion: The stronger association between anxiety and symptoms of whiplash trauma in men compared with women may be due to gender differences in the attribution of anxiety-related autonomic arousal as symptoms of whiplash injury. Alternatively, anxiety may differentially affect the willingness of men and women to report pain and other health indices. Anxiety is an important factor in understanding gender differences in whiplash-related symptoms such as chronic pain and disability, and requires further investigation.
Elklit, A. & Jones, A. (2006).The Association between Anxiety and Chronic Pain After Whiplash Injury: Gender-specific Effects. Clinical Journal of Pain, 22 (5), 487-490. Doi: 10.1097/01.ajp.0000208247.18251.bb
This study examined the relationship between alcohol misuse and different types of childhood maltreatment in a sample of young adults while controlling for posttraumatic stress disorder (PTSD) symptoms and current mental disorders. This study further examined if these associations were different for males and females.
Three types of child maltreatment were assessed; emotional abuse (N =263), sexual abuse (N=59), and multiple abuse (N=64) alongside a non-abused (N=2595) control group. Findings indicated the three maltreatment groups were all related to alcohol misuse. Maltreated women in particular had a 16-to-25-fold increased risk of alcohol misuse. For males these associations were attenuated with odds ratios (OR) ranging between 3 and 5 for emotional and multiple abuse groups. PTSD symptoms were associated with alcohol misuse for both genders, whilst current mental health disorder was non-significant for both males and females.
A significant relationship was found between the child maltreatment and alcohol misuse. This relationship was significantly stronger for maltreated women, which identifies a gap in the literature. High associations between maltreatment and alcohol misuse in females may suggest alcohol is used as a coping strategy following childhood maltreatment.
Cronin, S., Murphy, S. & Elklit, A. (2016). Investigating the Relationship between Childhood Maltreatment and Alcohol Misuse in a sample of Danish young adults: Exploring Gender Differences. Nordic Studies on Alcohol and Drugs, 33, 287-298. Doi: https://doi.org/10.1515/nsad-2016-0022
Christiansen, D. M., Martino, M. L., Elklit, A. & Freda, M. F. (2022). Sex differences in the outcome of expressive writing in parents of children with leukaemia. Clinical Psychology in Europe, 4(1), e5533. Doi: 10.23668/psycharchives.5191
Jones, A. & Elklit, A. (2007). The Association between Gender, Coping, and Whiplash Related Symptoms in Sufferers of Whiplash Associated Disorder. Scandinavian Journal of Psychology,48 (1), 75-80. Doi: 10.1111/j.1467-9450.2006.00543.x