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

  • Sex and Gender Issues in Behavioral Health (CN Epperson and L Hantsoo, Section Editors)
  • Published:
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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.

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.

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Acknowledgements

The editors would like to thank Dr. Susan Kornstein for taking the time to review this article.

Funding

Kornfield: NIMH K23MH102360; Hantsoo: NIMH K23MH107831, Brain & Behavior Research Foundation NARSAD Young Investigator Award; Epperson: NIMH and Office of Research on Women’s Health P50MH099910, NICHD K12HD085848.

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Authors and Affiliations

  1. Department of Psychiatry, Perelman School of Medicine at the University of Pennsylvania, 3535 Market Street, Room 3005, Philadelphia, PA, 19104, USA

    Sara L. Kornfield, Liisa Hantsoo & C. Neill Epperson

  2. Department of Obstetrics and Gynecology, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA

    C. Neill Epperson

  3. Penn PROMOTES Research on Sex and Gender in Health, University of Pennsylvania, Philadelphia, PA, USA

    C. Neill Epperson

Authors
  1. Sara L. Kornfield
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  2. Liisa Hantsoo
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  3. C. Neill Epperson
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Corresponding author

Correspondence to Sara L. Kornfield.

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Conflict of Interest

Sara L. Kornfield declares no potential conflicts of interest.

Liisa Hantsoo and C. Neill Epperson are section editors for Current Psychiatry Reports.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

Additional information

This article is part of the Topical Collection on Sex and Gender Issues in Behavioral Health

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Kornfield, S.L., Hantsoo, L. & Epperson, C.N. What Does Sex Have to Do with It? The Role of Sex as a Biological Variable in the Development of Posttraumatic Stress Disorder. Curr Psychiatry Rep 20, 39 (2018). https://doi.org/10.1007/s11920-018-0907-x

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  • DOI: https://doi.org/10.1007/s11920-018-0907-x

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