Gender differences in posttraumatic stress disorder.

One of the most consistent findings in the epidemiology of posttraumatic stress disorder (PTSD) is the higher risk of this disorder in women. Explanations reviewed within a psychobiological model of PTSD suggest that women's higher PTSD risk may be due to the type of trauma they experience, their younger age at the time of trauma exposure, their stronger perceptions of threat and loss of control, higher levels of peri-traumatic dissociation, insufficient social support resources, and greater use of alcohol to manage trauma-related symptoms like intrusive memories and dissociation, as well as gender-specific acute psychobiological reactions to trauma. This review demonstrates the need for additional research of the gender differences in posttraumatic stress. Recommendations are made for clinical practice.

[1]  C. Brewin,et al.  Neuropsychology of PTSD : biological, cognitive, and clinical perspectives , 2005 .

[2]  K. Brady,et al.  Alcohol dependence and posttraumatic stress disorder: differences in clinical presentation and response to cognitive-behavioral therapy by order of onset. , 2005, Journal of substance abuse treatment.

[3]  C. Classen,et al.  Predictors of posttraumatic stress symptoms among survivors of the Oakland/Berkeley, Calif., firestorm. , 1994, The American journal of psychiatry.

[4]  S. Spaccarelli,et al.  Stress, appraisal, and coping in child sexual abuse: a theoretical and empirical review. , 1994, Psychological bulletin.

[5]  C. Carter-Snell,et al.  Stress disorders and gender: implications for theory and research. , 2003, The Canadian journal of nursing research = Revue canadienne de recherche en sciences infirmieres.

[6]  C. A. Morgan,et al.  The Neuroendocrinology of Posttraumatic Stress Disorder: New Directions , 2003, CNS Spectrums.

[7]  D. Clark,et al.  Identifying anxiety disorders in adolescents hospitalized for alcohol abuse or dependence. , 1995, Psychiatric services.

[8]  C. Spitzer,et al.  Gender Differences in Dissociation , 2003, Psychopathology.

[9]  Biological responses to stressors and the role of personality. , 2003, Life sciences.

[10]  A. Baum,et al.  Urinary Catecholamines and Cortisol in Recent-Onset Posttraumatic Stress Disorder After Motor Vehicle Accidents , 2000, Psychosomatic medicine.

[11]  N. Orentreich,et al.  Age changes and sex differences in serum dehydroepiandrosterone sulfate concentrations throughout adulthood. , 1984, The Journal of clinical endocrinology and metabolism.

[12]  Z. Solomon,et al.  Posttraumatic stress disorder : a lifespan developmental perspective , 1999 .

[13]  P. Heaven,et al.  Gender and personality influences in adolescent threat and challenge appraisals and depressive symptoms , 2004 .

[14]  B. Kudielka,et al.  Sex differences in HPA axis responses to stress: a review , 2005, Biological Psychology.

[15]  K. Matthews,et al.  Sex differences in lipid, lipoprotein, cardiovascular, and neuroendocrine responses to acute stress. , 1988, Psychophysiology.

[16]  B. Kolk,et al.  The psychobiology of posttraumatic stress disorder. , 1997, The Journal of clinical psychiatry.

[17]  G. Knežević,et al.  Coping strategies in civilians during air attacks , 2003, Social Psychiatry and Psychiatric Epidemiology.

[18]  F H Norris,et al.  Epidemiology of trauma: frequency and impact of different potentially traumatic events on different demographic groups. , 1992, Journal of consulting and clinical psychology.

[19]  M. Laudenslager The psychobiology of loss: Lessons from humans and nonhuman primates. , 1988 .

[20]  J. Mann,et al.  Age effects on cortisol levels in depressed patients with and without comorbid post-traumatic stress disorder, and healthy volunteers. , 2004, Journal of affective disorders.

[21]  L. George,et al.  Sex differences in coping and perceptions of life events. , 1983, Journal of geriatric psychiatry.

[22]  Steven M. Southwick,et al.  Increased pituitary and adrenal reactivity in premenopausal women with posttraumatic stress disorder , 2001, Biological Psychiatry.

[23]  Marylene Cloitre,et al.  Enhanced cellular immune response in women with PTSD related to childhood abuse. , 2003, The American journal of psychiatry.

[24]  R. Famularo,et al.  Propranolol treatment for childhood posttraumatic stress disorder, acute type. A pilot study. , 1988, American journal of diseases of children.

[25]  J. Haines,et al.  Psychophysiological and Psychological Correlates of Dissociation in a Case of Dissociative Identity Disorder , 2003 .

[26]  A. Baum,et al.  Acute and chronic distress and posttraumatic stress disorder as a function of responsibility for serious motor vehicle accidents. , 1997, Journal of consulting and clinical psychology.

[27]  W. Brink,et al.  Gender and the relationship between childhood trauma dissociation and alcohol dependence , 2005 .

[28]  M. Livanou,et al.  TRAUMATIC STRESS RESPONSES IN TREATMENT-SEEKING EARTHQUAKE SURVIVORS IN TURKEY , 2002, The Journal of nervous and mental disease.

[29]  Bremner Jd Acute and Chronic Responses to Psychological Trauma: Where Do We Go From Here? , 1999 .

[30]  B. McEwen Protective and damaging effects of stress mediators. , 1998, The New England journal of medicine.

[31]  D. Clark,et al.  A prospective investigation of the role of cognitive factors in persistent posttraumatic stress disorder (PTSD) after physical or sexual assault. , 2001, Behaviour research and therapy.

[32]  V. Helgeson,et al.  Sex Differences in Coping Behavior: A Meta-Analytic Review and an Examination of Relative Coping , 2002 .

[33]  I. Baguley,et al.  Coping style and post-traumatic stress disorder following severe traumatic brain injury. , 2000, Brain injury.

[34]  K. Brady,et al.  Gender differences in individuals with comorbid alcohol dependence and post-traumatic stress disorder. , 2003, The American journal on addictions.

[35]  M. Flinn,et al.  Male-female differences in effects of parental absence on glucocorticoid stress response , 1996, Human nature.

[36]  M. Fredrikson,et al.  Trauma exposure and post‐traumatic stress disorder in the general population , 2005, Acta psychiatrica Scandinavica.

[37]  G. L. Sapp,et al.  Stress, Locus of Control, and Achievement of High School Seniors , 1988, Psychological reports.

[38]  Stephan Eliez,et al.  Attenuation of frontal asymmetry in pediatric posttraumatic stress disorder , 2001, Biological Psychiatry.

[39]  N. Breslau,et al.  Sex differences in posttraumatic stress disorder. , 1997, Archives of general psychiatry.

[40]  S. Southwick,et al.  Decreased benzodiazepine receptor binding in prefrontal cortex in combat-related posttraumatic stress disorder. , 2000, The American journal of psychiatry.

[41]  A. Ehlers,et al.  Psychological predictors of chronic posttraumatic stress disorder after motor vehicle accidents. , 1998, Journal of abnormal psychology.

[42]  F. Norris,et al.  60,000 Disaster Victims Speak: Part I. An Empirical Review of the Empirical Literature, 1981—2001 , 2002, Psychiatry.

[43]  B. Rothbaum,et al.  Behavioral/cognitive conceptualizations of post-traumatic stress disorder , 1989 .

[44]  Miranda Olff,et al.  The time dimension in stress responses: relevance for survival and health , 1999, Psychiatry Research.

[45]  D. Charney,et al.  Psychobiological mechanisms of resilience and vulnerability: implications for successful adaptation to extreme stress. , 2004, The American journal of psychiatry.

[46]  R. Kessler,et al.  Risk factors for DSM-III-R posttraumatic stress disorder: findings from the National Comorbidity Survey. , 1998, American journal of epidemiology.

[47]  D. Clark,et al.  Cognitive factors involved in the onset and maintenance of posttraumatic stress disorder (PTSD) after physical or sexual assault. , 1999, Behaviour research and therapy.

[48]  I. Neumann Involvement of the brain oxytocin system in stress coping: interactions with the hypothalamo-pituitary-adrenal axis. , 2002, Progress in brain research.

[49]  A. Ehlers,et al.  PTSD symptoms, response to intrusive memories and coping in ambulance service workers. , 1999, The British journal of clinical psychology.

[50]  Elizabeth A. Young,et al.  Saliva cortisol in posttraumatic stress disorder: a community epidemiologic study , 2004, Biological Psychiatry.

[51]  A C McFarlane,et al.  Post-traumatic stress disorder: findings from the Australian National Survey of Mental Health and Well-being , 2001, Psychological Medicine.

[52]  J. Reitsma,et al.  Cortisol and post-traumatic stress disorder in adults , 2007, British Journal of Psychiatry.

[53]  P. Ouimette,et al.  Gender and PTSD. , 2002 .

[54]  J. Ptacek,et al.  Gender, appraisal, and coping : a longitudinal analysis , 1992 .

[55]  O. Wolf,et al.  HPA axis and memory. , 2003, Best practice & research. Clinical endocrinology & metabolism.

[56]  W. van den Brink,et al.  Trauma and dissociation in treatment-seeking alcoholics: towards a resolution of inconsistent findings. , 2002, Comprehensive psychiatry.

[57]  C. A. Morgan,et al.  Role of norepinephrine in the pathophysiology and treatment of posttraumatic stress disorder , 1999, Biological Psychiatry.

[58]  R. Bryant Acute Stress Reactions: Can Biological Responses Predict Posttraumatic Stress Disorder? , 2003, CNS Spectrums.

[59]  John D E Gabrieli,et al.  Sex differences in the neural basis of emotional memories , 2002, Proceedings of the National Academy of Sciences of the United States of America.

[60]  T. Newton,et al.  Gender and psychophysiology of PTSD. , 2002 .

[61]  S. Southwick,et al.  Gender differences in the associations between posttraumatic stress symptoms and problematic substance use in psychiatric inpatient adolescents. , 2000, The Journal of nervous and mental disease.

[62]  B. Kudielka,et al.  Impact of gender, menstrual cycle phase, and oral contraceptives on the activity of the hypothalamus-pituitary-adrenal axis. , 1999, Psychosomatic medicine.

[63]  A. Cleare,et al.  Levels of DHEA and DHEAS and responses to CRH stimulation and hydrocortisone treatment in chronic fatigue syndrome , 2004, Psychoneuroendocrinology.

[64]  Bruce S. McEwen,et al.  The relationship between stress induced cortisol levels and memory differs between men and women , 2001, Psychoneuroendocrinology.

[65]  Willie Langeland,et al.  Traumatische Erlebnisse in der Kindheit und psychiatrische Komorbidität bei erwachsenen manlichen Alkoholkranken: Empirische Untersuchungsergebnisse und ihre klinische Bedeutung , 2004 .

[66]  S. D. de Boer,et al.  Coping styles in animals: current status in behavior and stress-physiology , 1999, Neuroscience & Biobehavioral Reviews.

[67]  D. Stein,et al.  Gender differences in the prevalence of childhood sexual abuse and in the development of pediatric PTSD , 2004, Archives of Women’s Mental Health.

[68]  Bonnie L. Green,et al.  Trauma and health : physical health consequences of exposure to extreme stress , 2004 .

[69]  R. Kessler,et al.  Past-year use of outpatient services for psychiatric problems in the National Comorbidity Survey. , 1999, The American journal of psychiatry.

[70]  U. Nater,et al.  Psychological determinants of the cortisol stress response: the role of anticipatory cognitive appraisal , 2005, Psychoneuroendocrinology.

[71]  Y. Yamamoto,et al.  Neonatal manipulation of oxytocin affects expression of estrogen receptor alpha , 2006, Neuroscience.

[72]  J. Raz,et al.  Neuroendocrine and Psychophysiologic Responses in PTSD: A Symptom Provocation Study , 1999, Neuropsychopharmacology.

[73]  Fran H. Norris,et al.  Sex Differences in Symptoms of Posttraumatic Stress: Does Culture Play a Role? , 2001 .

[74]  S. Pollak,et al.  Early experience in humans is associated with changes in neuropeptides critical for regulating social behavior. , 2005, Proceedings of the National Academy of Sciences of the United States of America.

[75]  B. McEwen Stress and hippocampal plasticity. , 1999, Annual review of neuroscience.

[76]  Tanja Michael,et al.  Posttraumatic stress disorder following assault: the role of cognitive processing, trauma memory, and appraisals. , 2003, Journal of consulting and clinical psychology.

[77]  G. Bonanno Loss, trauma, and human resilience: have we underestimated the human capacity to thrive after extremely aversive events? , 2008, The American psychologist.

[78]  D. Weiss,et al.  Characteristics of emergency services personnel related to peritraumatic dissociation during critical incident exposure. , 1996, The American journal of psychiatry.

[79]  K. Light,et al.  More frequent partner hugs and higher oxytocin levels are linked to lower blood pressure and heart rate in premenopausal women , 2005, Biological Psychology.

[80]  A. Ehlers,et al.  Dysfunctional meaning of posttraumatic intrusions in chronic PTSD. , 2000, Behaviour research and therapy.

[81]  J. Mahalik,et al.  Men's Gender Role Conflict and Use of Psychological Defenses , 1998 .

[82]  W. van den Brink,et al.  Psychiatric comorbidity in treatment-seeking alcoholics: the role of childhood trauma and perceived parental dysfunction. , 2004, Alcoholism, clinical and experimental research.

[83]  D. Delahanty,et al.  Initial posttraumatic urinary cortisol levels predict subsequent PTSD symptoms in motor vehicle accident victims , 2000, Biological Psychiatry.

[84]  M. P. Matud,et al.  Gender differences in stress and coping styles , 2004 .

[85]  M. Stein,et al.  Full and partial posttraumatic stress disorder: findings from a community survey. , 1997, The American journal of psychiatry.

[86]  E. Carlson,et al.  Basal and dexamethasone suppressed salivary cortisol concentrations in a community sample of patients with posttraumatic stress disorder , 2004, Biological Psychiatry.

[87]  E. D. de Kloet,et al.  Early vs. late maternal deprivation differentially alters the endocrine and hypothalamic responses to stress. , 1998, Brain research. Developmental brain research.

[88]  K. Lesch,et al.  Sexual dichotomy of an interaction between early adversity and the serotonin transporter gene promoter variant in rhesus macaques. , 2004, Proceedings of the National Academy of Sciences of the United States of America.

[89]  Glenn N Saxe,et al.  Pathways to PTSD, part II: Sexually abused children. , 2005, The American journal of psychiatry.

[90]  D. Watson,et al.  Gender, age, and cultural differences in the Defense Style Questionnaire-40. , 1998, Journal of clinical psychology.

[91]  H. Ursin,et al.  Psychobiology of coping and defence strategies. , 1993, Neuropsychobiology.

[92]  D. Clark,et al.  A cognitive model of posttraumatic stress disorder. , 2000, Behaviour research and therapy.

[93]  P. Resick,et al.  Objective assessment of peritraumatic dissociation: psychophysiological indicators. , 1997, The American journal of psychiatry.

[94]  Martin H. Teicher,et al.  Developmental neurobiology of childhood stress and trauma. , 2002, The Psychiatric clinics of North America.

[95]  J. A. D. Silva,et al.  Sex Hormones and Glucocorticoids: Interactions with the Immune System , 1999 .

[96]  K. Anderson,et al.  Gender differences in reported stress response to the loma prieta earthquake , 1994 .

[97]  L. H. Pelton,et al.  Child abuse and neglect: the myth of classlessness. , 1978, The American journal of orthopsychiatry.

[98]  C. Marmar,et al.  Immediate treatment with propranolol decreases posttraumatic stress disorder two months after trauma , 2003, Biological Psychiatry.

[99]  William J. Doyle,et al.  State and trait affect as predictors of salivary cortisol in healthy adults , 2005, Psychoneuroendocrinology.

[100]  J. Rodin,et al.  Modulation of human natural killer cell activity by exposure to uncontrollable stress , 1992, Brain, Behavior, and Immunity.

[101]  L. Biener,et al.  Gender and Stress , 1987 .

[102]  A. Shalev,et al.  Gender Differences in Responses to Traumatic Events: A Prospective Study , 2002, Journal of traumatic stress.

[103]  Larry Cahill,et al.  His brain, her brain. , 2005, Scientific American.

[104]  C. Stratakis,et al.  Neuroendocrinology and Pathophysiology of the Stress System , 1995, Annals of the New York Academy of Sciences.

[105]  S. Orr,et al.  Evidence for Diminished P3 Amplitudes in PTSD a , 1997, Annals of the New York Academy of Sciences.

[106]  I. Jones,et al.  Cell‐mediated immunity in combat veterans with post‐traumatic stress disorder , 1993, The Medical journal of Australia.

[107]  R. Dienstbier,et al.  Arousal and physiological toughness: implications for mental and physical health. , 1989, Psychological review.

[108]  S. Maccari,et al.  Long-term behavioural alterations in female rats after a single intense footshock followed by situational reminders , 2005, Psychoneuroendocrinology.

[109]  H. Wittchen,et al.  Traumatic events and post‐traumatic stress disorder in the community: prevalence,risk factors and comorbidity , 2000, Acta psychiatrica Scandinavica.

[110]  Suzanne M. Miller,et al.  Sex differences in cognitive coping with stress. , 1987 .

[111]  R. Kessler,et al.  Vulnerability to assaultive violence: further specification of the sex difference in post-traumatic stress disorder , 1999, Psychological Medicine.

[112]  Holger Ursin,et al.  Coping and Health , 1980 .

[113]  B. McEwen The neurobiology and neuroendocrinology of stress. Implications for post-traumatic stress disorder from a basic science perspective. , 2002, The Psychiatric clinics of North America.

[114]  Terry L. Schell,et al.  All symptoms are not created equal: the prominent role of hyperarousal in the natural course of posttraumatic psychological distress. , 2004, Journal of abnormal psychology.

[115]  E. Emory,et al.  Sex differences in neonatal stress reactivity. , 1995, Child development.

[116]  Alan Booth,et al.  Testosterone, cortisol, and women's competition. , 2002 .

[117]  Ravi S. Menon,et al.  Brain activation during script-driven imagery induced dissociative responses in PTSD: a functional magnetic resonance imaging investigation , 2002, Biological Psychiatry.

[118]  Michael Davis,et al.  Central Oxytocin, Vasopressin, and Corticotropin-Releasing Factor Receptor Densities in the Basal Forebrain Predict Isolation Potentiated Startle in Rats , 2005, The Journal of Neuroscience.

[119]  S. Orr,et al.  A prospective study of heart rate response following trauma and the subsequent development of posttraumatic stress disorder. , 1998, Archives of general psychiatry.

[120]  M. L. Macklin,et al.  Emotion- and intrusion-based reasoning in Vietnam veterans with and without chronic posttraumatic stress disorder. , 2001, Behaviour research and therapy.

[121]  K. Kario,et al.  Disasters and the heart: a review of the effects of earthquake-induced stress on cardiovascular disease. , 2003, Hypertension research : official journal of the Japanese Society of Hypertension.

[122]  S. Segerstrom,et al.  Psychological stress and the human immune system: a meta-analytic study of 30 years of inquiry. , 2004, Psychological bulletin.

[123]  J. Henry,et al.  Stress, Health, and the Social Environment: A Sociobiologic Approach to Medicine , 1977 .

[124]  R. Weiss,et al.  The link between substance abuse and posttraumatic stress disorder in women. A research review. , 1997, The American journal on addictions.

[125]  S. Dickerson,et al.  Acute stressors and cortisol responses: a theoretical integration and synthesis of laboratory research. , 2004, Psychological bulletin.

[126]  M. Frankenhaeuser Psychobiological Aspects of Life Stress , 1980 .

[127]  M. Meaney,et al.  Naturally Occurring Differences in Maternal Care are Associated with the Expression of Oxytocin and Vasopressin (V1a) Receptors: Gender Differences , 2002, Journal of neuroendocrinology.

[128]  S. Galea,et al.  Gender, Social Support, and Posttraumatic Stress in Postwar Kosovo , 2004, The Journal of nervous and mental disease.

[129]  Frederik Barkhof,et al.  Noradrenaline mediates amygdala activation in men and women during encoding of emotional material , 2005, NeuroImage.

[130]  L. Schmitt,et al.  Mécanismes de défense et prédiction des états de stress post-traumatiques , 1999 .

[131]  B. Roozendaal,et al.  The effect of stress doses of hydrocortisone during septic shock on posttraumatic stress disorder in survivors , 2001, Biological Psychiatry.

[132]  A. H Kemp,et al.  Gender differences in the cortical electrophysiological processing of visual emotional stimuli , 2004, NeuroImage.

[133]  Suzanne R. Best,et al.  PTSD symptoms predict waking salivary cortisol levels in police officers , 2005, Psychoneuroendocrinology.

[134]  S. Levine Influence of psychological variables on the activity of the hypothalamic-pituitary-adrenal axis. , 2000, European journal of pharmacology.

[135]  A. Baum,et al.  Psychoneuroimmunology and trauma. , 2004 .

[136]  R. Yehuda Current status of cortisol findings in post-traumatic stress disorder. , 2002, The Psychiatric clinics of North America.

[137]  Ronald E. Smith,et al.  Gender Differences in Coping with Stress: When Stressor and Appraisals Do Not Differ , 1994 .

[138]  Cecilia Cheng Processes underlying gender-role flexibility: do androgynous individuals know more or know how to cope? , 2005, Journal of personality.

[139]  G. Bagdy,et al.  Gender-dependent dissociation between oxytocin but not ACTH, cortisol or TSH responses to m-chlorophenylpiperazine in healthy subjects , 1998, Psychopharmacology.

[140]  S. Southwick,et al.  Psychogenic Lowering of Urinary Cortisol Levels Linked to Increased Emotional Numbing and a Shame-Depressive Syndrome in Combat-Related Posttraumatic Stress Disorder , 2001, Psychosomatic medicine.

[141]  A. Baum,et al.  Gender differences in posttraumatic stress disorder after motor vehicle accidents. , 2001, The American journal of psychiatry.

[142]  S. Plichta,et al.  Prevalence of violence and its implications for women's health. , 2001, Women's health issues : official publication of the Jacobs Institute of Women's Health.

[143]  P. Ouimette,et al.  Trauma and substance abuse: Causes, consequences, and treatment of comorbid disorders. , 2003 .

[144]  S. Southwick,et al.  Cortisol response to a cognitive stress challenge in posttraumatic stress disorder (PTSD) related to childhood abuse , 2003, Psychoneuroendocrinology.

[145]  R. Yehuda,et al.  Effect of previous trauma on acute plasma cortisol level following rape. , 1995, The American journal of psychiatry.

[146]  M J Horowitz,et al.  Stress-response syndromes: a review of posttraumatic and adjustment disorders. , 1986, Hospital & community psychiatry.

[147]  C. Classen,et al.  Dissociative responses in the immediate aftermath of the Oakland/Berkeley firestorm , 1996 .

[148]  W R True,et al.  A twin study of genetic and environmental contributions to liability for posttraumatic stress symptoms. , 1993, Archives of general psychiatry.

[149]  R. Yehuda,et al.  The Acute Stress Response Following Motor Vehicle Accidents and Its Relation to PTSD , 1997, Annals of the New York Academy of Sciences.

[150]  A. Harvey,et al.  Gender Differences in the Relationship Between Acute Stress Disorder and Posttraumatic Stress Disorder Following Motor Vehicle Accidents , 2003, The Australian and New Zealand journal of psychiatry.

[151]  Sarah E Ullman,et al.  Gender differences in social reactions to abuse disclosures, post-abuse coping, and PTSD of child sexual abuse survivors. , 2005, Child abuse & neglect.

[152]  R. Kessler,et al.  Posttraumatic stress disorder in the National Comorbidity Survey. , 1995, Archives of general psychiatry.

[153]  A. Reiss,et al.  Diurnal salivary cortisol in pediatric posttraumatic stress disorder , 2002, Biological Psychiatry.

[154]  J. Henry Psychological and physiological responses to stress: The right hemisphere and the hypothalamo-pituitary-adrenal axis, an inquiry into problems of human bonding , 1993, Integrative physiological and behavioral science : the official journal of the Pavlovian Society.

[155]  N. Breslau,et al.  Traumatic events and posttraumatic stress disorder in an urban population of young adults. , 1991, Archives of general psychiatry.

[156]  S. Buka,et al.  Prevalence and risk factors for posttraumatic stress disorder among chemically dependent adolescents. , 1997, The American journal of psychiatry.

[157]  H. Eriksen,et al.  The cognitive activation theory of stress , 2004, Psychoneuroendocrinology.

[158]  M. Hill,et al.  Age and sex related differences in serum levels of unconjugated dehydroepiandrosterone and its sulphate in normal subjects. , 1997, The Journal of endocrinology.

[159]  John-Paul Wilson,et al.  Assessing psychological trauma and PTSD , 1997 .

[160]  Amar K. Das,et al.  Gender differences in posttraumatic stress disorder among primary care patients after the World Trade Center attack of September 11, 2001. , 2005, Gender medicine.

[161]  G. Koob,et al.  Stress: Neurobiology and Neuroendocrinology , 1990 .

[162]  C. A. Morgan,et al.  Relationship Among Plasma Cortisol, Catecholamines, Neuropeptide Y, and Human Performance During Exposure to Uncontrollable Stress , 2001, Psychosomatic medicine.

[163]  Bruce McEwen,et al.  Gender differences in age-related changes in HPA axis reactivity , 2001, Psychoneuroendocrinology.

[164]  Z. Solomon,et al.  Repressive Coping Style, Acute Stress Disorder, and Posttraumatic Stress Disorder After Myocardial Infarction , 2002, Psychosomatic medicine.

[165]  D. Weiss,et al.  Predictors of posttraumatic stress disorder and symptoms in adults: a meta-analysis. , 2003, Psychological bulletin.

[166]  J. Brosschot,et al.  Experimental Stress and Immunological Reactivity: A Closer Look at Perceived Uncontrollability , 1998, Psychosomatic medicine.

[167]  C. Brewin,et al.  Meta-analysis of risk factors for posttraumatic stress disorder in trauma-exposed adults. , 2000, Journal of consulting and clinical psychology.

[168]  K. Uvnäs‐Moberg,et al.  Oxytocin linked antistress effects--the relaxation and growth response. , 1997, Acta physiologica Scandinavica. Supplementum.

[169]  K. Brady,et al.  Comorbidity of psychiatric disorders and posttraumatic stress disorder. , 2000, The Journal of clinical psychiatry.

[170]  R. Dahl,et al.  Corticotropin Releasing Hormone Stimulation Test and Nocturnal Cortisol Levels in Normal Children , 1992, Pediatric Research.

[171]  J. Buitelaar,et al.  Determinants of salivary cortisol levels in 10–12 year old children; a population-based study of individual differences , 2005, Psychoneuroendocrinology.

[172]  Miranda Olff,et al.  The psychobiology of PTSD: coping with trauma , 2005, Psychoneuroendocrinology.

[173]  Alan Booth,et al.  Gender differences in testosterone and cortisol response to competition , 2005, Psychoneuroendocrinology.

[174]  Eric Vermetten,et al.  Circuits and systems in stress. II. Applications to neurobiology and treatment in posttraumatic stress disorder , 2002, Depression and anxiety.

[175]  A. Young,et al.  Basal activity of the hypothalamic–pituitary–adrenal axis in patients with depersonalization disorder , 2001, Psychiatry Research.

[176]  S. Rosenman Trauma and Posttraumatic Stress Disorder in Australia: Findings in the Population Sample of the Australian National Survey of Mental Health and Wellbeing , 2002, The Australian and New Zealand journal of psychiatry.

[177]  J. Cacioppo,et al.  Marital conflict and endocrine function: are men really more physiologically affected than women? , 1996, Journal of consulting and clinical psychology.

[178]  G. Bonanno,et al.  Predicting the Willingness to Disclose Childhood Sexual Abuse from Measures of Repressive Coping and Dissociative Tendencies , 2003, Child maltreatment.

[179]  Maureen O’Brien,et al.  Loss of consciousness and post-traumatic stress disorder , 1998, British Journal of Psychiatry.

[180]  D. Hellhammer,et al.  A new view on hypocortisolism , 2005, Psychoneuroendocrinology.

[181]  M. Olff,et al.  Effects of appraisal and coping on the neuroendocrine response to extreme stress , 2005, Neuroscience & Biobehavioral Reviews.

[182]  R. Rosner,et al.  The weaker sex? Gender and post‐traumatic stress disorder , 2003, Depression and anxiety.

[183]  T. Traustadóttir,et al.  Gender Differences in Cardiovascular and Hypothalamic-Pituitary-Adrenal Axis Responses to Psychological Stress in Healthy Older Adult Men and Women , 2003, Stress.

[184]  J. Kiecolt-Glaser,et al.  Perceived Stress and Cellular Immunity: When Coping Counts , 2001, Journal of Behavioral Medicine.

[185]  M. Stein,et al.  Gender differences in susceptibility to posttraumatic stress disorder. , 2000, Behaviour research and therapy.

[186]  Rami Benbenishty,et al.  The contribution of wartime, pre-war, and post-war factors to self-efficacy: A longitudinal study of combat stress reaction , 1991 .

[187]  Martin H. Teicher,et al.  Childhood neglect is associated with reduced corpus callosum area , 2004, Biological Psychiatry.

[188]  Tony W Buchanan,et al.  Enhanced memory for emotional material following stress-level cortisol treatment in humans , 2001, Psychoneuroendocrinology.

[189]  H. Ursin,et al.  Modulatory effects of defense and coping on stress-induced changes in endocrine and immune parameters , 1995, International journal of behavioral medicine.

[190]  G. J. Horst,et al.  Gender-specific effects of social housing in rats after chronic mild stress exposure , 2003, Progress in Neuro-Psychopharmacology and Biological Psychiatry.

[191]  Deborah A. Small,et al.  Recent EFFECTS OF FEAR AND ANGER ON PERCEIVED RISKS OF TERRORISMA National Field Experiment , 2015 .

[192]  L. Robins,et al.  Post-traumatic stress disorder in the general population. Findings of the epidemiologic catchment area survey. , 1987, The New England journal of medicine.

[193]  D. Hellhammer,et al.  Increased responsiveness of the hypothalamus–pituitary–adrenal (HPA) axis to stress in newborns with atopic disposition , 2004, Psychoneuroendocrinology.

[194]  P. Cowen,et al.  Modelling a loss event: effect of imagined bereavement on the hypothalamic–pituitary–adrenal axis , 2000, Psychological Medicine.

[195]  E. Lenz,et al.  Self-Efficacy and Social Support , 1987, Kango kenkyu. The Japanese journal of nursing research.

[196]  R A Bryant,et al.  Avoidant coping style and post-traumatic stress following motor vehicle accidents. , 1995, Behaviour research and therapy.

[197]  N. Nicolson Childhood parental loss and cortisol levels in adult men , 2004, Psychoneuroendocrinology.

[198]  Ann Rasmusson,et al.  Relationships among plasma dehydroepiandrosterone sulfate and cortisol levels, symptoms of dissociation, and objective performance in humans exposed to acute stress. , 2004, Archives of general psychiatry.

[199]  B. Roozendaal,et al.  Can Posttraumatic Stress Disorder Be Prevented with Glucocorticoids? , 2004, Annals of the New York Academy of Sciences.

[200]  L. Cahill,et al.  Propranolol for Reemergent Posttraumatic Stress Disorder Following an Event of Retraumatization: A Case Study , 2002, Journal of traumatic stress.

[201]  E. Young,et al.  Sex differences and the HPA axis: implications for psychiatric disease. , 1998, The journal of gender-specific medicine : JGSM : the official journal of the Partnership for Women's Health at Columbia.

[202]  Jessica Turner,et al.  Sex-related hemispheric lateralization of amygdala function in emotionally influenced memory: an FMRI investigation. , 2004, Learning & memory.

[203]  O. Wolkowitz,et al.  Psychoneuroendocrinology: The Scientific Basis of Clinical Practice , 2003 .

[204]  R. Eisler,et al.  Masculine Gender Role Stress , 1987, Behavior modification.

[205]  Chronic stress influences cardiovascular and neuroendocrine responses during acute stress and recovery, especially in men. , 2001 .

[206]  R. Yehuda Biological Factors Associated with Susceptibility to Posttraumatic Stress Disorder , 1999, Canadian journal of psychiatry. Revue canadienne de psychiatrie.

[207]  Mats Fredrikson,et al.  Stress on and off the job as related to sex and occupational status in white‐collar workers , 1989 .

[208]  R. McNally,et al.  Psychological mechanisms in acute response to trauma , 2003, Biological Psychiatry.

[209]  M. Biondi,et al.  Psychological Stress and Neuroendocrine Function in Humans: The Last Two Decades of Research , 1999, Psychotherapy and Psychosomatics.

[210]  E. Vermetten,et al.  Stress and development: Behavioral and biological consequences , 2001, Development and Psychopathology.

[211]  R. Kimerling An investigation of sex differences in nonpsychiatric morbidity associated with posttraumatic stress disorder. , 2004, Journal of the American Medical Women's Association.

[212]  M. Maes,et al.  Risk and preventive factors of post-traumatic stress disorder (PTSD): alcohol consumption and intoxication prior to a traumatic event diminishes the relative risk to develop PTSD in response to that trauma. , 2001, Journal of affective disorders.

[213]  Monique Ernst,et al.  A developmental examination of gender differences in brain engagement during evaluation of threat , 2004, Biological Psychiatry.

[214]  J. Davidson,et al.  Posttraumatic Distress and Coping Strategies among Rescue Workers after an Earthquake , 2003, The Journal of nervous and mental disease.

[215]  H. Resnick,et al.  PTSD as a mediator between childhood rape and alcohol use in adult women. , 1998, Child abuse & neglect.

[216]  M. Olff,et al.  Effects of brief eclectic psychotherapy in patients with posttraumatic stress disorder: randomized clinical trial. , 2005, Journal of traumatic stress.

[217]  C. Brewin,et al.  Gender, Social Support, and PTSD in Victims of Violent Crime , 2003, Journal of Traumatic Stress.

[218]  Suzanne R. Best,et al.  The Peritraumatic Distress Inventory: a proposed measure of PTSD criterion A2. , 2001, The American journal of psychiatry.

[219]  D. Clark,et al.  Gender and comorbid psychopathology in adolescents with alcohol dependence. , 1997, Journal of the American Academy of Child and Adolescent Psychiatry.

[220]  J. Fahey,et al.  Shaking up Immunity: Psychological and Immunologic Changes after a Natural Disaster , 1997, Psychosomatic medicine.

[221]  R. Yehuda,et al.  Basal norepinephrine in depersonalization disorder , 2003, Psychiatry Research.

[222]  S. Matthews,et al.  Programming of the Hypothalamo–Pituitary–Adrenal Axis: Serotonergic Involvement , 2004, Stress.

[223]  H. Resnick,et al.  Prevalence of civilian trauma and posttraumatic stress disorder in a representative national sample of women , 1993 .

[224]  S. Shiffman,et al.  Coping and Substance Use , 1985 .

[225]  L. Cahill,et al.  Pilot study of secondary prevention of posttraumatic stress disorder with propranolol , 2002, Biological Psychiatry.

[226]  W. Drevets,et al.  Glucocorticoid regulation of diverse cognitive functions in normal and pathological emotional states , 2003, Neuroscience & Biobehavioral Reviews.

[227]  L. Canetti,et al.  Predictors of PTSD in injured trauma survivors: a prospective study. , 1996, The American journal of psychiatry.

[228]  Luis Baumela Molina,et al.  Posttraumatic stress and depressive reactions among Nicaraguan adolescents after hurricane Mitch. , 2001, The American journal of psychiatry.

[229]  A. Ehlers,et al.  Maintenance of Intrusive Memories in Posttraumatic Stress Disorder: A Cognitive Approach , 1995, Behavioural and Cognitive Psychotherapy.

[230]  R. Kessler,et al.  Previous exposure to trauma and PTSD effects of subsequent trauma: results from the Detroit Area Survey of Trauma. , 1999, The American journal of psychiatry.

[231]  L. Poisson,et al.  Estimating post-traumatic stress disorder in the community: lifetime perspective and the impact of typical traumatic events , 2004, Psychological Medicine.

[232]  J. Bremner,et al.  Higher Cortisol Levels Following Exposure to Traumatic Reminders in Abuse-Related PTSD , 2003, Neuropsychopharmacology.

[233]  D. Delahanty,et al.  Peritraumatic Dissociation Is Inversely Related to Catecholamine Levels in Initial Urine Samples of Motor Vehicle Accident Victims , 2003 .

[234]  H. Selye What is stress? , 1956, Metabolism: clinical and experimental.

[235]  John A Updegraff,et al.  Biobehavioral responses to stress in females: tend-and-befriend, not fight-or-flight. , 2000, Psychological review.

[236]  M. Olff Stress, depression and immunity: the role of defense and coping styles , 1999, Psychiatry Research.

[237]  D. A. Thomas,et al.  Sex role orientation, personality structure, and adjustment in women. , 1984, Journal of personality assessment.

[238]  Bruce S. McEwen,et al.  The neurobiology of stress: from serendipity to clinical relevance. , 2000, Brain research.

[239]  P. Veinante,et al.  Vasopressin and Oxytocin Excite Distinct Neuronal Populations in the Central Amygdala , 2005, Science.

[240]  K. Uvnäs‐Moberg,et al.  OXYTOCIN MAY MEDIATE THE BENEFITS OF POSITIVE SOCIAL INTERACTION AND EMOTIONS 1 The purpose of this paper is to describe the neuroendocrine mechanisms of positive social interactions. 1 , 1998, Psychoneuroendocrinology.

[241]  Ulf Lundberg,et al.  Stress hormones in health and illness: The roles of work and gender , 2005, Psychoneuroendocrinology.

[242]  Deborah J. Weatherston Infant Mental Health , 2001 .

[243]  P. Charlton,et al.  Ways of coping with psychological distress after trauma. , 1996, The British journal of clinical psychology.

[244]  C. Koopman,et al.  Relationships of Dissociation and Childhood Abuse and Neglect with Heart Rate in Delinquent Adolescents , 2004, Journal of traumatic stress.

[245]  B. Perry,et al.  Homeostasis, stress, trauma, and adaptation. A neurodevelopmental view of childhood trauma. , 1998, Child and adolescent psychiatric clinics of North America.

[246]  L. Hansson,et al.  Elevated Blood Levels of Dehydroepiandrosterone Sulphate Vary with Symptom Load in Posttraumatic Stress Disorder: Findings from a Longitudinal Study of Refugees in Sweden , 2002, Psychotherapy and Psychosomatics.

[247]  U. Ehlert,et al.  Psychoneuroendocrinological contributions to the etiology of depression, posttraumatic stress disorder, and stress-related bodily disorders: the role of the hypothalamus–pituitary–adrenal axis , 2001, Biological Psychology.

[248]  Steven Taylor,et al.  COGNITIVE FACTORS IN TRAUMATIC STRESS REACTIONS: PREDICTING PTSD SYMPTOMS FROM ANXIETY SENSITIVITY AND BELIEFS ABOUT HARMFUL EVENTS , 2000, Behavioural and Cognitive Psychotherapy.

[249]  R. Derijk,et al.  Signaling Pathways in Brain Involved in Predisposition and Pathogenesis of Stress‐Related Disease: Genetic and Kinetic Factors Affecting the MR/GR Balance , 2004, Annals of the New York Academy of Sciences.

[250]  Peter Salovey,et al.  Sex differences in stress responses: social rejection versus achievement stress , 2002, Biological Psychiatry.

[251]  D. Hoyt,et al.  The impact of major trauma: quality-of-life outcomes are worse in women than in men, independent of mechanism and injury severity. , 2004, The Journal of trauma.

[252]  C. Fullerton,et al.  Posttraumatic stress disorder, alcohol use, and perceived safety after the terrorist attack on the pentagon. , 2003, Psychiatric services.