No one is immune from either trauma or PTSD: men, women, children – everyone is vulnerable. However, decades of research indicate that girls and women who have traumatic experiences have a heightened risk of developing posttraumatic stress disorder.
Recent studies suggest that women also face more severe physical effects of PTSD, including cardiovascular and neurological damage.
What is PTSD?
Posttraumatic stress disorder, or PTSD, is a mental health condition that a person can develop after witnessing or living through one or more traumatic experiences.
Some experts call it posttraumatic stress injury (PTSI) or simply posttraumatic stress. Others use the term complex posttraumatic stress disorder (C-PTSD) to describe cases that involve particularly severe symptoms of extended duration.
Though symptoms can vary from one person to the next, all cases of PTSD have one similarity: they develop after a person endures at least one type of trauma.
In a mental health context, trauma typically refers to an occurrence that causes a person to fear that they or someone else is at risk of death or serious injury. Types of traumatic events that can precede PTSD include:
- Military combat
- Acts of terrorism
- Life-threatening weather (such as tornadoes and hurricanes)
- Automobile accidents
- Abuse or neglect during childhood
- Physical attacks
- Sexual assaults
- Relationship violence
- Verbal or online harassment
- Serious illnesses
- Sudden death of a loved one
A person doesn’t have to be directly involved in events like these in order to develop PTSD. For example, emergency medical technicians (EMTs), firefighters, and others frequently exposed to the aftermaths of traumatic events are also at risk.
Prevalence of Trauma & PTSD Among Women
Traumatic events are common in the United States and throughout the rest of the world. In October 2015, the journal Psychological Medicine published a report on the global prevalence of trauma. This report, based on a review of data from more than 68,000 adults in 24 nations, revealed the following:
- 70.4% of respondents said they lived through at least one traumatic event over the course of their lifetime.
- 30.5% of respondents reported four or more types of trauma.
- The most common factor in traumatic experiences included accidents or injuries, involved in 36.3% of reported events.
- Men more often reported trauma related to accidents, physical assaults, and injuries.
- Women showed greater risk of trauma that involved relationship violence, sexual assault, having a child with a serious illness, and being a refugee.
Determining how many people experience trauma is far from an exact science. Some people may not recall a traumatic event, while others may not realize that a certain experience qualifies as a type of trauma. In still other cases, people may be hesitant to reveal their history of trauma, even when speaking with mental health experts.
Even with these caveats, most sources agree on the following two statements about trauma, PTSD, and gender:
Men are more likely to report a greater number of traumatic experiences.
Women are more likely to develop posttraumatic stress disorder.
The National Institute on PTSD, part of the U.S. Department of Veterans Affairs, reports that 8% of women and 4% of men in the United States will develop posttraumatic stress disorder at some point in their life.
An October 2019 study in the journal General Hospital Psychiatry concurs with the conclusion that the overall risk of PTSD is twice as high among women as among men. However, this study noted that the size of this gap can vary when the data is organized by race or ethnicity.
If we stay with the general 8% lifetime rate of PSTD among women, here’s what that means in terms of actual cases:
- With an estimated 168 million girls and women currently living in the United States, an 8% rate equals about 13.4 million cases of PTSD involving female patients.
- With a current global female population of about 3.95 billion, this works out to about 316 million cases of PTSD among girls and women.
The reasons PTSD is so much more common among women than among men is a topic worthy of a separate article. For now, we’ll focus our attention on another gender-related PTSD disparity: the degree to which this disorder affects the heart and brain.
PTSD, Cardiovascular Health, and Neurological Concerns
On Nov. 2, 2023, the medical journal JAMA Network Open published a cross-sectional study on the potential impact that PTSD may have on women’s cardiovascular and neurological health.
This study, conducted by three experts from the University of Pittsburgh, focused on 274 women ages 45-67. Participants completed a variety of assessments, including:
- PTSD Checklist–Civilian Version (PCL-C) to identify posttraumatic stress disorder symptoms
- Carotid ultrasonography to evaluate blockage or narrowing in arteries that connect the heart with the brain
- MRI scans to ascertain brain white matter hyperintensity volume (WMHV)
- Several cognitive performance exams to assess attention, working memory, processing speed, learning capacity, and related functions
- Various medical tests to document BMI, blood pressure, and other physical health measurements
After analyzing the data collected during these assessments, the research team reached the following conclusions:
- Women with a greater number of PTSD symptoms were more likely to show carotid atherosclerosis, a buildup of fatty deposits in the carotid artery.
- Among the women in the study who carried the APOEε4 gene (which has previously been linked to Alzheimer’s disease), increased PTSD symptoms were associated with greater WMHV and diminished cognitive performance.
The research team stressed the genetic component of their research:
“Our findings indicate that the APOEε4 genotype may identify a group of women with PTSD symptoms at particular risk for poor neurocognitive health.”
While establishing a possible link among PTSD, cardiovascular disease, and cognitive challenges, the researchers acknowledged their study did not identify the mechanism through which PTSD may lead to these medical complications.
The researchers noted that they controlled for several known cardiovascular disease risk factors, and took factors such as education, prior head injuries, depressive symptoms, and history of substance use into consideration.
“PTSD symptoms have been associated with altered emotion processing and neural circuitry implicated in cognition and stressor-induced cardiovascular reactivity,” they wrote. “Other potential pathways, such as inflammatory, autonomic, hypothalamic pituitary adrenal, or epigenetic processes, warrant future consideration.”
PTSD, Heart Attack, and Stroke
The University of Pittsburgh study wasn’t the first effort to explore the physical health implications of PTSD among women.
In June 2015, a study in the journal Circulation, published by the American Heart Association, revealed that women who experienced trauma showed significantly higher risk of heart attack or stroke than women with no history of trauma.
The research team reviewed data from more than 49,000 women, collected over 20 years as part of the Nurses Health Study II. Their findings included the following:
- Women exposed to trauma, but didn’t show PTSD symptoms, were 45% more likely to have a heart attack or stroke, compared with women who had no history of trauma.
- Among women with a history of trauma and four or more PTSD symptoms, the risk of heart attack or stroke was 60% greater than among women without a history of trauma.
Sumner discusses the results in a CNN article about her team’s study:
“This study raises awareness that the effects of PTSD don’t just stop in the head and that they have more holistic consequences for health. Our hope is that providers and patients (with PTSD) can be aware of this link and monitor cardiovascular health and try to engage in prevention efforts.”
As with the University of Pittsburgh researchers, Sumner’s team didn’t establish exactly why PTSD raises women’s risk of heart- or brain-related damage. But they theorized that behavioral factors common among trauma survivors may partially explain their results.
For example, they noted that higher rates of cigarette smoking among women with histories of trauma and PTSD than among those with no prior traumatic experience. They called for additional research in to identify other possible causes.
“Although we accounted for several health behaviors, data were unavailable on additional behavioral correlates of PTSD that may contribute to [cardiovascular disease, or CVD],” they wrote. “For example, insomnia and poor sleep quality (eg, attributable to nightmares) are common in PTSD, and sleep problems (eg, daytime sleepiness) have been associated with CVD risk.”
How Will These Findings Affect Treatment for PTSD?
The research discussed so far focuses on how PTSD can affect women, not how women with PTSD should be treated in a clinical setting. But that doesn’t mean there aren’t treatment-related lessons to be learned from these and similar studies. Here are three examples:
- Revelations about the potential cardiovascular and neurological impact of PTSD underscore the importance of seeking professional care.
- These studies demonstrate the necessity for further female-focused research on PTSD. Even with these and other recent reports, explorations of PTSD among girls and women lag considerably behind similar efforts involving boys and men.
- Finally, studies such as the ones we discuss above will help more people understand the connection between physical and mental health and eradicate stigma around getting help for the latter. Seeking mental health treatment is no different than consulting with a doctor about a medical problem.
If someone in your life experiences severe symptoms of PTSD or another complex mental health disorder, Crownview Psychiatric Institute is here to help. We offer a dynamic array of customized therapies and adjunct services within a safe and highly supportive environment. We’re committed to helping each patient make sustained progress toward improved health and a much more hopeful future.
To learn more about our programming or to discuss how we can help your loved one, please visit our Contact Us page or call us today.
Gianna Melendez
Jodie Dahl, CpHT