Masculinity as an avoidance symptom of posttraumatic stress.

Abstract

For individuals diagnosed with posttraumatic stress disorder (PTSD), trauma-related stimuli signal danger and provoke high levels of anxiety. Avoidance of these stimuli, a key feature of PTSD, prevents emotional processing of the thoughts, feelings, and cognitions associated with a traumatic event. This study examined how masculinity norms can function as a precipitant of trauma-related avoidance behaviors for male survivors of sexual assault. The gendered context of trauma, as well as the survivor’s gender identity, may lead survivors to employ avoidance behaviors associated with traditional masculinities in an attempt to protect from future harm. Interviews were conducted with 21 male veterans who had reported experiencing military sexual trauma (MST) to their clinician. Data were drawn together using a grounded theory methodology. A 3-category model emerged depicting the gendered behaviors participants described following arousal to threatening stimuli (e.g., enact heterosexuality to avoid blame, engage in sex to avoid negative thoughts, appear strong to avoid feeling weak). The resulting model is discussed in light of evidence-based PTSD treatments.

Gender- and Sex-Based Contributors to Sex Differences in PTSD

“…All effects were relatively small. Though none of the qualitative studies set out specifically to examine masculinity, it emerged as a central topic in all three studies [14,24,25]. The studies focused both on individual traits, shared masculine ideals (hegemonic masculinity) within the military, and on gender-role stress when they felt that they couldn't live up to these ideals.…”

“…The studies focused both on individual traits, shared masculine ideals (hegemonic masculinity) within the military, and on gender-role stress when they felt that they couldn't live up to these ideals. Male combat veterans in group therapy focused very much on the camaraderie and respect that they had for each other [14,24,25] and perceived the group as a band of brothers. Many male veterans found it easier to come to terms with their own PTSD when they could see some of the same challenges in men whom they respected, admired, and considered masculine in spite of their PTSD symptoms [24].…”

“…Many male veterans found it easier to come to terms with their own PTSD when they could see some of the same challenges in men whom they respected, admired, and considered masculine in spite of their PTSD symptoms [24]. Veterans often developed a new common masculine identity within the group in which fighting PTSD head on was perceived as the manly thing to do [14,25]. In addition, drawing on some of the positive aspects of military masculinity, namely agency, loyalty, and selfless service to others, the sense of belonging and responsibility within the group made it difficult to drop out of therapy [24].…”

“…In order for therapy to be perceived as helpful, veterans needed to respect not only the other veterans in the group but also the therapist, and to feel respected in return [24]. Finally, one qualitative study examining masculinity in a group of men exposed to military sexual assault found that when masculine identity was perceived as being threatened it was common to exhibit hyper-masculine behaviours, including displays of aggression and sexual dominance and high-risk behaviour [25]. Such hyper-masculine behaviour may explain why men with PTSD are often found to have higher levels of aggression, anger, and substance abuse compared to women with PTSD [9] and could be interpreted as examples of avoidance, in cases where the victim felt extremely powerless at the time of the traumatic event, such as in cases of sexual assault [25].…”

Medical Narratives of Military PTSD: Moving Beyond the Biomedical Approach

“…The notable interaction between masculinity and PTSD is evident in a variety of contexts, with masculine identity being utilized by soldiers as cultural capital (Lahelma, 2005) and affecting soldiers' conceptions and experiences of PTSD (Caddick, Smith & Phoenix, 2015;Elder, W. B., Domino, J. L., Mata-Galán, E. L., & Kilmartin, C., 2017;Shields, 2016).…”