Why More Women Have PTSD Than Men But Fewer Are Diagnosed
Here's a heartbreaking fact: More than half of women will suffer at least one serious trauma in their life, and experiencing trauma can cause post-traumatic stress disorder, a devastating mental illness that affects about 10 percent of women, according to the National Center for PTSD. Worse? Women experience PTSD at twice the rate of men yet take far longer to receive a correct diagnosis and are misdiagnosed more often than men.
But because we most often hear about PTSD in the context of male veterans, most of the research has been done on men. Many even consider it a "man's disease," and this blind spot leaves many female sufferers undiagnosed, untreated, and feeling terribly alone.
Why the gender gap? One reason may be the type of trauma. The most common trauma women experience is sexual assault or childhood sexual abuse and traumatic sexual events are far more likely to cause PTSD than other types of trauma, the NCforPTSD explains. They add that women may be more likely to blame themselves for the traumatic event which also heightens the risk of getting PTSD. Another issue is the different ways women manifest PTSD symptoms, says Ken Yeager, Ph.D., an associate professor of psychiatry and trauma specialist at the Ohio State University Wexner Medical Center.
"PTSD is characterized by avoidance, control issues, lack of trust and intimacy, and hypervigilance," he explains. "While both men and women experience these same symptoms, women tend to show more anxiety and depression, which can cause a clinician to focus solely on treating those symptoms rather than looking for an underlying cause." He adds that many PTSD sufferers themselves don't see the link between a past traumatic event and their current feelings and may not even tell their doctor about the past trauma, thinking it's all in the past.
All of this can make it tough for women to get an accurate diagnosis, something Helaina Hovitz understands all too well. On September 11, 2001, Hovitz was 12 years old and living just three blocks from the World Trade Center, an event she chronicles in her book After 9/11: One Girl's Journey Through Darkness to a New Beginning. The terrorist attacks that day brought her entire world crashing down around her-literally.
"They sent us home from school when the first plane hit, which meant I was running through all of that smoke, debris, and chaos trying to find my family," she says. "Everyone thought I was dead, I was terrified they were all dead, it was a nightmare."
Hovitz's family wasn't evacuated, so she spent the next two weeks in a neighborhood "that was essentially a war zone" with no food, water, or electricity and patrolled by the National Guard. But even after things settled down and returned to normal, nothing felt the same to her again. As she got older she had nightmares, couldn't focus, was terrified to be alone, was impulsive and was ultra-sensitive to her environment. She self-medicated by skipping school, having sex, and becoming addicted to alcohol. She also had a host of physical symptoms including stomach ulcers and chronic migraines. During this time she saw many doctors, but instead of recognizing her classic PTSD symptoms they diagnosed her as bipolar, ADHD, and depressed. The treatments only made her feel worse.
At age 18, after six years of suffering, she found a therapist who was able to recognize the source of her pain and start her on cognitive behavioral therapy, which helped her get relief. Adding in dialectical behavioral therapy, EMDR therapy, exercise, and sobriety helped her finally find the healing she needed.
While she did find some relief telling her story, talk therapy alone wasn't enough to help her deal with the trauma. "Asking a survivor to retell their story forces them to relive the trauma and every time they do, they remember more and gets bigger and more upsetting," Yeager says. "It's retraumatizing and not helpful."
It also took Erica Jones* six years to get diagnosed with PTSD after being hit by a roadside bomb while serving in the military in Afghanistan-partly because she didn't feel like she deserved it. "I have so many friends who went through way worse than me, including two buddies who actually committed suicide, that it didn't seem right or fair to compare what I was going through with what they suffered," she says.
Eventually, both a civilian and military doctor diagnosed her with severe PTSD and that helped her realize her pain was just as real as what her friends experienced. But even though she's working with a trauma counselor now, she's having a hard time letting go of the blame and the memories.
"A lot of my life is smoke and mirrors. On the outside, I look and act totally fine but on the inside, I'm a wreck," she says. "I still have sleepless nights and night terrors. I'm constantly paranoid, and I'm easily triggered by normal everyday things. The worst part is remembering my friends I lost to suicide."
Jones' reaction is sadly not uncommon, Yeager says. "It's a defense mechanism, to minimize your own trauma and compare it to others," he explains. "The truth is all of us are vulnerable to trauma and you can't compare your experience. If you're wondering if your trauma is 'bad enough' to warrant getting help then the answer is yes."
Amy Smith* decided to finally accept help for her PTSD, years after being sexually abused as a child, and she says that decision has changed her life. For years she says her main symptom was a fear of going out, making her avoid all social situations. At first, she was diagnosed with social anxiety but through therapy discovered the root cause of her fears was the abuse. Smith is now on medication for her anxiety symptoms and is doing exposure-response prevention therapy (ERP) to help her overcome her triggers of going out, both of which have been very successful.
"The key for me has been to learn to see my symptoms as just symptoms, not who I am," she says. "For too long, I defined myself by my past. I blamed myself and thought if I'd done things differently it wouldn't have happened, but the truth is I am a victim of a crime. It's something that happened to me, not something I am."
Hovitz has similarly claimed her own story and is now on a mission to help other women with PTSD. "Women are often called drama queens or hormonal when we're angry or sad but if you're feeling upset, that's a real feeling; you're not crazy," she says. "We need to honor and respect our life experiences and our bodies reactions to them."
If you think you may be suffering from PTSD, know that it's not just in your head and that there are effective treatments available, Yeager says. He encourages women to seek out "trauma-informed" therapists (look for that phrase on their site or ask them about it specifically) as they are trained to recognize and treat PTSD. "You have nothing to lose and everything to gain by reaching out," he says.
*Name has been changed