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

• Published in: Current psychiatry reports Vol. 20; no. 6; p. 39
• Main Authors: Kornfield, Sara L., Hantsoo, Liisa, Epperson, C. Neill
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-06-2018; Springer Nature B.V
• Subjects: Gender differences; Medicine; Medicine & Public Health; Neurobiology; Post traumatic stress disorder; Psychiatry; Section Editors; Sex and Gender Issues in Behavioral Health (CN Epperson and L Hantsoo; Topical Collection on Sex and Gender Issues in Behavioral Health; Sex as a biological variable (SABV); Gonadal hormones; Neurocircuitry; Posttraumatic stress disorder (PTSD); Neurobiology; Stress physiology
• ISSN: 1523-3812; 1535-1645
• DOI: 10.1007/s11920-018-0907-x

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.
Summary
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.