What Does Sex Have to Do with It? The Role of Sex As a Biological Variable in the Development of Posttraumatic Stress Disorder

Overview

Journal Curr Psychiatry Rep

Publisher Current Science

Specialty Psychiatry

Date 2018 May 20

PMID 29777319

Citations 25

Authors

Sara L Kornfield

Liisa Hantsoo

C Neill Epperson

Affiliations

Soon will be listed here.

Abstract

Purpose Of Review: This review highlights the neurobiological aspects of sex differences in posttraumatic stress disorder (PTSD), specifically focusing on the physiological responses to trauma and presents evidence supporting hormone and neurosteroid/peptide differences from both preclinical and clinical research.

Recent Findings: While others have suggested that trauma type or acute emotional reaction are responsible for women's disproportionate risk to PTSD, neither of these explanations fully accounts for the sex differences in PTSD. Sex differences in brain neurocircuitry, anatomy, and neurobiological processes, such as those involved in learning and memory, are discussed as they have been implicated in risk and resilience for the development of PTSD. Gonadal and stress hormones have been found to modulate sex differences in the neurocircuitry and neurochemistry underlying fear learning and extinction. Preclinical research has not consistently controlled for hormonal and reproductive status of rodents nor have clinical studies consistently examined these factors as potential moderators of risk for PTSD. Sex as a biological variable (SABV) should be considered, in addition to the endocrine and reproductive status of participants, in all stress physiology and PTSD research.

Citing Articles

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The severity of perceived stress associated with community violence exposure and its role in future posttraumatic stress: findings from a longitudinal study of U.S. adolescents.

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Sex and Gender Differences in Co-Occurring Alcohol Use Disorder and PTSD.

Saraiya T, Back S, Jarnecke A, Blakey S, Bauer A, Brown D Curr Addict Rep. 2024; 10(4):617-627.

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References

Bryant R . Acute stress reactions: can biological responses predict posttraumatic stress disorder?. CNS Spectr. 2004; 8(9):668-74. DOI: 10.1017/s1092852900008853. View

Bryant R, Creamer M, ODonnell M, Silove D, McFarlane A . A multisite study of initial respiration rate and heart rate as predictors of posttraumatic stress disorder. J Clin Psychiatry. 2008; 69(11):1694-701. DOI: 10.4088/jcp.v69n1104. View

Puralewski R, Vasilakis G, Seney M . Sex-related factors influence expression of mood-related genes in the basolateral amygdala differentially depending on age and stress exposure. Biol Sex Differ. 2016; 7:50. PMC: 5027117. DOI: 10.1186/s13293-016-0106-6. View

Zeidan M, Igoe S, Linnman C, Vitalo A, Levine J, Klibanski A . Estradiol modulates medial prefrontal cortex and amygdala activity during fear extinction in women and female rats. Biol Psychiatry. 2011; 70(10):920-7. PMC: 3197763. DOI: 10.1016/j.biopsych.2011.05.016. View

Breslau N, Davis G, Andreski P, Peterson E, Schultz L . Sex differences in posttraumatic stress disorder. Arch Gen Psychiatry. 1997; 54(11):1044-8. DOI: 10.1001/archpsyc.1997.01830230082012. View

Ferree N, Cahill L . Post-event spontaneous intrusive recollections and strength of memory for emotional events in men and women. Conscious Cogn. 2009; 18(1):126-34. PMC: 2691747. DOI: 10.1016/j.concog.2008.11.008. View

Shansky R, Woolley C . Considering Sex as a Biological Variable Will Be Valuable for Neuroscience Research. J Neurosci. 2016; 36(47):11817-11822. PMC: 5125240. DOI: 10.1523/JNEUROSCI.1390-16.2016. View

Gordon J, Girdler S, Meltzer-Brody S, Stika C, Thurston R, Clark C . Ovarian hormone fluctuation, neurosteroids, and HPA axis dysregulation in perimenopausal depression: a novel heuristic model. Am J Psychiatry. 2015; 172(3):227-36. PMC: 4513660. DOI: 10.1176/appi.ajp.2014.14070918. View

Howard O, Carr G, Hill T, Valentino R, Lucki I . Differential blockade of CRF-evoked behaviors by depletion of norepinephrine and serotonin in rats. Psychopharmacology (Berl). 2008; 199(4):569-82. PMC: 2744742. DOI: 10.1007/s00213-008-1179-7. View

10.

Michopoulos V, Rothbaum A, Corwin E, Bradley B, Ressler K, Jovanovic T . Psychophysiology and posttraumatic stress disorder symptom profile in pregnant African-American women with trauma exposure. Arch Womens Ment Health. 2014; 18(4):639-48. PMC: 4609532. DOI: 10.1007/s00737-014-0467-y. View

11.

Schumacher M, Mattern C, Ghoumari A, Oudinet J, Liere P, Labombarda F . Revisiting the roles of progesterone and allopregnanolone in the nervous system: resurgence of the progesterone receptors. Prog Neurobiol. 2013; 113:6-39. DOI: 10.1016/j.pneurobio.2013.09.004. View

12.

Li S, Graham B . Why are women so vulnerable to anxiety, trauma-related and stress-related disorders? The potential role of sex hormones. Lancet Psychiatry. 2016; 4(1):73-82. DOI: 10.1016/S2215-0366(16)30358-3. View

13.

Soni M, Curran V, Kamboj S . Identification of a narrow post-ovulatory window of vulnerability to distressing involuntary memories in healthy women. Neurobiol Learn Mem. 2013; 104:32-8. DOI: 10.1016/j.nlm.2013.04.003. View

14.

Zorumski C, Paul S, Izumi Y, Covey D, Mennerick S . Neurosteroids, stress and depression: potential therapeutic opportunities. Neurosci Biobehav Rev. 2012; 37(1):109-22. PMC: 3591791. DOI: 10.1016/j.neubiorev.2012.10.005. View

15.

Inslicht S, Metzler T, Garcia N, Pineles S, Milad M, Orr S . Sex differences in fear conditioning in posttraumatic stress disorder. J Psychiatr Res. 2012; 47(1):64-71. PMC: 3806498. DOI: 10.1016/j.jpsychires.2012.08.027. View

16.

Dumas J, Albert K, Naylor M, Sites C, Benkelfat C, Newhouse P . The effects of age and estrogen on stress responsivity in older women. Am J Geriatr Psychiatry. 2012; 20(9):734-43. PMC: 3428432. DOI: 10.1097/JGP.0b013e31825c0a14. View

17.

Clohessy S, Ehlers A . PTSD symptoms, response to intrusive memories and coping in ambulance service workers. Br J Clin Psychol. 1999; 38(3):251-65. DOI: 10.1348/014466599162836. View

18.

Epperson C, Haga K, Mason G, Sellers E, Gueorguieva R, Zhang W . Cortical gamma-aminobutyric acid levels across the menstrual cycle in healthy women and those with premenstrual dysphoric disorder: a proton magnetic resonance spectroscopy study. Arch Gen Psychiatry. 2002; 59(9):851-8. DOI: 10.1001/archpsyc.59.9.851. View

19.

Glover E, Jovanovic T, Mercer K, Kerley K, Bradley B, Ressler K . Estrogen levels are associated with extinction deficits in women with posttraumatic stress disorder. Biol Psychiatry. 2012; 72(1):19-24. PMC: 3675159. DOI: 10.1016/j.biopsych.2012.02.031. View

20.

Kessler R, Chiu W, Demler O, Merikangas K, Walters E . Prevalence, severity, and comorbidity of 12-month DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005; 62(6):617-27. PMC: 2847357. DOI: 10.1001/archpsyc.62.6.617. View