Haunted by memories

Women’s vulnerability to PTSD is probably due to a combination of biological, psychological and social factors. Men and women respond to even normal stress in fundamentally different ways that may have evolved as part of ancient gender roles.

According to Ulf Lundberg, a psychologist who studies gender and hormones at Stockholm University, women feel more stress than men in situations involving a threat to a loved one. In a study of parents taking a sick child to the hospital, mothers had higher acute levels of two stress hormones, epinephrine and cortisol, than fathers.

Lundberg also cites Shelley Taylor, a social neuroscientist at University of California, Los Angeles who studies the “tend and befriend” response that women mobilize in threatening times. Stress responses involving the hormone oxytocin, known for its roles especially in social bonding and maternal behaviors, may help explain why women tend to reach out to other members of the community in an effort to protect themselves and their children during a threat, in contrast to the “fight or flight” response often exhibited by males.

These hormonal responses resulting from females’ strong social ties to group members could be why PTSD is more likely to strike women who witness the suffering of a friend or family member. And this could represent a large subset of the population of PTSD victims. According to a 1996 study led by psychiatrist Naomi Breslau, one-third of PTSD cases in a sample taken from Detroit residents were a result of experiencing the sudden, unexpected death of a loved one.

Cortisol is one hormone that could be a player in women with PTSD. Jessica Gill, a National Institutes of Health fellow who studies PTSD in women, recently led a study that showed that women who suffered from PTSD had chronically lower levels of the hormone in the morning than women without PTSD. Cortisol is an important part of both stress and immune responses, but having less of it over long periods could damage emotional and physical well-being. Women with PTSD seem to have lower cortisol levels than men with PTSD, according to Gill. “I think there is something different in the body” of men and women with PTSD, she says.

Lundberg also notes than women are more likely than men to experience the stress of an event after it has passed. On the job, women bring their stress responses home with them for the weekend more than men do. “Men seem to respond to what they are actually exposed to in an acute situation,” says Lundberg. “Women seem to respond not only to what they are exposed to, but also what they expect will happen, and also afterwards.” This might have helped women protect their offspring from danger many thousands of years ago. Today, it could be related to their continued suffering after traumatic events.

Women’s social role may help explain why they are more predisposed to developing PTSD than men, but it is also an asset than can protect them after traumatic events. Studies of both soldiers and civilians have found that lack of social support is a much more important risk factor for depression and PTSD in women than in men. It’s a reality that Beverly Smith knows all too well.

After her treatment for cervical cancer, Smith was struggling to adhere to a strict regimen of hormone treatments, which had side effects that made her lose her sex drive. As a result, the person she knew should have been one of her strongest supports in life, her husband, instead made it even more of a nightmare. “He just made fun of me and teased me about the medicine and the hormones,” she remembers. When she wasn’t interested in intercourse, he “bought me a four-inch [thick] book on how to give blowjobs.” Smith has relied on the support of friends and family during and after her treatment, but the effects of her now ex-husband’s behavior still weigh on her mind. “I think if I would have had a husband [who] would just have been helpful, it would have been at least fifty percent better,” she says. “He was so focused on the sex problems.”