Article

The epidemiology of trauma, PTSD, and other posttrauma disorders.

Department of Epidemiology, Michigan State University College of Human Medicine, USA.
Trauma Violence & Abuse (impact factor: 3.27). 04/2009; 10(3):198-210. DOI:10.1177/1524838009334448
Source: PubMed

ABSTRACT Epidemiologic studies have reported that the majority of community residents in the United States have experienced posttraumatic stress disorder (PTSD)-level traumatic events, as defined in the DSM-IV. Only a small subset of trauma victims develops PTSD (<10%). Increased incidence of other disorders following trauma exposure occurs primarily among trauma victims with PTSD. Female victims of traumatic events are at higher risk for PTSD than male victims are. Direct evidence on the causes of the sex difference in the conditional risk of PTSD is unavailable. The available evidence suggests that the sex difference is not due to (a) the higher occurrence of sexual assault among females, (b) prior traumatic experiences, (c) preexisting depression or anxiety disorder, or (d) sex-related bias in reporting. Observed sex differences in anxiety, neuroticism, and depression, inducing effects of stressful experiences, might provide a theoretical context for further inquiry into the greater vulnerability of females to PTSD.

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    Nina C Donner, Christopher A Lowry
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    ABSTRACT: Research has elucidated causal links between stress exposure and the development of anxiety disorders, but due to the limited use of female or sex-comparative animal models, little is known about the mechanisms underlying sex differences in those disorders. This is despite an overwhelming wealth of evidence from the clinical literature that the prevalence of anxiety disorders is about twice as high in women compared to men, in addition to gender differences in severity and treatment efficacy. We here review human gender differences in generalized anxiety disorder, panic disorder, posttraumatic stress disorder and anxiety-relevant biological functions, discuss the limitations of classic conflict anxiety tests to measure naturally occurring sex differences in anxiety-like behaviors, describe sex-dependent manifestation of anxiety states after gestational, neonatal, or adolescent stressors, and present animal models of chronic anxiety states induced by acute or chronic stressors during adulthood. Potential mechanisms underlying sex differences in stress-related anxiety states include emerging evidence supporting the existence of two anatomically and functionally distinct serotonergic circuits that are related to the modulation of conflict anxiety and panic-like anxiety, respectively. We discuss how these serotonergic circuits may be controlled by reproductive steroid hormone-dependent modulation of crfr1 and crfr2 expression in the midbrain dorsal raphe nucleus and by estrous stage-dependent alterations of γ-aminobutyric acid (GABAergic) neurotransmission in the periaqueductal gray, ultimately leading to sex differences in emotional behavior.
    Pflügers Archiv - European Journal of Physiology 04/2013; · 4.46 Impact Factor
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    Social Psychiatry 11/2012; · 2.05 Impact Factor
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    Debra A Bangasser
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Keywords

available evidence
 
Direct evidence
 
Epidemiologic studies
 
Female victims
 
greater vulnerability
 
higher occurrence
 
higher risk
 
Increased incidence
 
inducing effects
 
male victims
 
Observed sex differences
 
posttraumatic stress disorder
 
PTSD)-level traumatic events
 
sex difference
 
sexual assault
 
stressful experiences
 
theoretical context
 
trauma victims
 
traumatic events
 
United States
 

Naomi Breslau