Sex differences in recovery from PTSD in male and female interpersonal assault survivors

Abstract

Men and women differ in exposure to trauma and the development of posttraumatic stress disorder (PTSD); however, research regarding sex differences in recovery from PTSD has been sparse. This study evaluated the treatment response trajectory for 69 male and female interpersonal assault survivors, using a modified Cognitive Processing Therapy (CPT) protocol that allowed survivors to receive up to18 sessions of CPT, with treatment end determined by therapy progress. Few sex differences were observed in trauma history, baseline PTSD and depressive severity, Axis I comorbidity, anger, guilt and dissociation. Women did report more sexual assault in adulthood and elevated baseline guilt cognitions, whereas men reported more baseline anger directed inward. Attrition and total number of sessions did not differ by sex. Over the course of treatment and follow-up, men and women demonstrated similar rates of change in PTSD and depressive symptoms. However, medium effect sizes on both of these primary outcomes at the 3-month follow-up assessment favored women. Several differences in the slope of change emerged on secondary outcomes such that women evidenced more rapid gains on global guilt, guilt cognitions, anger/irritability, and dissociation. Results suggest that male survivors may warrant additional attention to address these important clinical correlates.

Military Sexual Assault, Gender, and PTSD Treatment Outcomes of U.S. Veterans

“…The findings from this study were consistent with previous findings that women with PTSD, on average, had lower aggressive/violent symptoms, but higher comorbid severity of depressive symptoms than men with PTSD (e.g., Galovski et al., ; Maguen et al., ). Having more depressive symptoms was probably related to our finding that women also had lower quality of life than men at treatment initiation.…”

“…Men and women might react to sexual assault and trauma differently. In both veteran and nonveteran populations, women showed more severe PTSD and depressive symptoms, whereas men reported more subsequent substance abuse and anger/aggression (Galovski, Blain, Chappuis, & Fletcher, ; Maguen et al., ; Zlotnick, Zimmerman, Woldsdorf, & Mattia, ). Sexual assault might have an impact on the victim's sexual identity, masculinity/femininity, and self‐concept (Mezey & King, ; Walker, Archer, & Davies, ).…”

Peritraumatic Tonic Immobility and Trauma-Related Symptoms in Adult Survivors of Childhood Sexual Abuse: The Role of Posttrauma Cognitions

“…We also focused on female survivors in this study, although peritraumatic TI is not gender-specific. In fact, male survivors might be at heightened risk for negative cognitions and anger toward the self following sexual assault (e.g., Galovski, Blain, Chappuis, & Fletcher, 2013), and might in particular misinterpret the TI response as personal weakness. Additional research on other forms of cognitive peritraumatic distress such as dissociation has been largely inconclusive regarding the effects of dissociation on PTSD symptoms (e.g., Dalenberg et al, 2012; Otis, Marchand, & Courtois, 2012), and our findings indicate that dissociation and other cognitive components of peritraumatic distress such as perceived inescapability are distinct phenomena.…”

Examining Sex and Gender Differences in Anxiety Disorders

“…Sex differences in treatment outcome remained even after controlling for initial OCD severity and psychosocial functioning. Finally, a study on cognitive processing therapy in patients with PTSD found that males and females did not differ significantly on the primary outcomes of PTSD and depression [59]. This was found both following the last session and at 3 months follow-up in spite of medium effect sizes favouring females.…”

“…One study reported comparable attrition rates and treatment length for males and females undergoing cognitive processing therapy for PTSD [59]. Other studies have found that males are more likely than females to drop out of treatments including aspects of exposure [26,51,57].…”