While men and women have similar experiences with Post-Traumatic Stress Disorder (PTSD) overall, symptoms of PTSD in men are significantly more likely to include increased alcohol or substance use, hypervigilance, emotional numbness, and reckless behavior. Statistically, men are twice as likely as women to experience a traumatic event but only half as likely as women to develop PTSD.1,2,3
PTSD is understood to be part of our body’s natural reaction to an overwhelming traumatic experience. People can recover from PTSD with treatment to effectively decrease or eliminate symptoms through the use of different therapy techniques along with medications. PTSD is not a condition that men should have to live with on their own!
What Is Post-Traumatic Stress Disorder (PTSD)?
Post-Traumatic Stress Disorder (PTSD) is a debilitating condition that can arise following exposure to a single or multiple traumatic experience(s). For men who have developed PTSD, they might perceive a situation as “traumatic” if it has involved the threat of or the reality of death, serious injury, or sexual assault.4
The core features of PTSD include:4
- Experiencing, witnessing, or hearing about one or more traumatic events
- Reliving trauma through symptoms such as flashbacks, nightmares, and emotional/physical distress when reminded of the trauma
- Active avoidance of experiences that are reminders of the trauma, such as thoughts, memories, people, places, and things
- Increased physical/emotional distress that can lead to; increased irritability, self-destructive/reckless behavior, hypervigilance for perceived threats, overconcentration of problems, and/or sleep problems
- Negative changes in thoughts and emotions (e.g., forgetting essential parts of the trauma; negative beliefs about yourself, others, or the world; persistent shame, guilt, horror, or anger; social withdrawal; inability to feel positive emotions)
How Many Men Have PTSD?
Almost 9% of Americans can expect to experience PTSD in their lifetime. The lifetime prevalence of PTSD among men is 6% as compared to 12 % for women.1,4 In any given year, approximately 3% of men will suffer from their symptoms of PTSD.1
Rates of PTSD are even higher among emergency responders and veterans who are more likely to be exposed to extreme violence and death.4 Among veterans, the prevalence of PTSD varies, depending on the specific combat events they participated in:5
- Vietnam War – 30.9% (*lifetime prevalence)
- Operations Iraqi Freedom or Enduring Freedom – 11-20% (*12-month prevalence)
- The Gulf War: Operation Desert Storm – 12% (12-month prevalence)
Is PTSD More Common in Males or Females?
The estimated lifetime risk of developing PTSD among civilians In the US is currently at 9%, where women with PTSD outnumber men with PTSD by a nearly 2:1 ratio. 1,4 The exception to these gender differences is among military members, where there is no significant difference in the PTSD rate between men and women.6,7
PTSD Symptoms in Men
PTSD in men is characterized by trauma-related symptoms of avoidance, re-living, hyperarousal and distress, negative changes to thoughts and mood, and possibly emotional/physical numbness. While men and women generally have many of the same symptoms, men with PTSD are more likely than women to experience emotional numbness, alcohol/substance use disorders, reckless behavior, and hypervigilance. 2,3,8
Common PTSD Symptoms in men include:
Avoidance
Avoidance behavior is a hallmark of PTSD; actively avoiding certain things that remind a person of their trauma (e.g., thoughts, memories, people, places, things, emotions). This avoidance can happen consciously or unconsciously and serves as a biological survival mechanism to protect oneself from harm. Avoidance behavior works to prevent further instances of unbearable physical and emotional trauma-related distress that these trauma reminders would trigger.4
Re-experiencing the Trauma
One of the most distressing characteristics of PTSD in men is that the worst moments of one’s life aren’t just memories. They are re-experienced and re-lived in the mind and body as though they are currently happening in the present moment. This re-living might take the form of:4
- Nightmares
- Night Terrors (i.e., waking up terrified but not knowing why)
- PTSD flashbacks
- Severe physical or emotional distress that results from a fight or flight response when faced with trauma reminders
Arousal & Reactivity Symptoms
Men with PTSD often find it difficult, or even impossible, to relax. Instead,, they feel constantly on edge and on guard for threats. Common PTSD hyperarousal and reactivity symptoms include:4
- Irritability
- Increased angry outbursts (i.e., in the form of physical or emotional aggression)
- Self-destructive or reckless behavior
- Continuously scanning surroundings for possible threats
- Concentration problems
- Sleep issues
- Extreme or exaggerated startle response (e.g., if someone comes up behind them without their awareness)
Mood & Cognition Symptoms
PTSD in men can cause changes in how a person feels and thinks. It can result in exaggerated negative beliefs about the self, others, and the world. Some examples of how someone reliving trauma might verbalize these thoughts include:4
- “I am unlovable/damaged/not good enough.”
- “No one cares.”
- “No one can be trusted.”
- “The world is dangerous.”
Suppose the individual experienced dissociation during the trauma where they either froze, “zoned out,” or their mind stopped recording memories. In that case, they might be unable to remember parts or all of the trauma. They might continue to have experiences of dissociation in everyday life whenever they encounter reminders of their trauma.
Other mood & cognition symptoms of PTSD in men include:
- persistent negative emotions (e.g., fear, guilt, anger, shame)
- inability to experience positive emotions/mood
- social withdrawal and disinterest in others.
Numbness
Some men with PTSD also report experiencing emotional and/or physical numbness. This numbness refers to feeling disconnected from the present moment where one might feel emotionally “lost,” “flat,” or “disconnected.” They might even feel disconnected from their physical body as a whole, or more specifically, individual body parts. These symptoms are typically the result of survival mechanisms they used or developed to survive the initial trauma that is still active or are re-activated by reminders of their trauma.4
Signs of PTSD in Men to Watch For
If you think a male loved one may have PTSD, here are the signs to look out for:4,2
- Increased alcohol or substance use
- Increased reckless behaviors (e.g., provoking physical fights, driving while impaired)
- Active avoidance of reminders of the trauma (e.g., people, places, things, discussions, memories)
- Difficulty relaxing
- Increased irritability or angry outbursts
- Social withdrawal
- Sleep problems
- Comments or behaviors that indicate the person might be considering suicide
What Causes PTSD in Men?
Differences in the types of trauma can disproportionately cause PTSD in men versus women. The following types of traumas are more likely to lead to PTSD among men:7,9,10
- Combat/war
- Intimate partner violence
- Physical assault
- Witnessing severe injury or death of another person
- Fire or disaster
- Surviving a life-threatening accident
- Being threatened with a weapon
Are Some Men More Likely to Develop PTSD?
While the main cause for developing PTSD for men is the exposure to a traumatic event, there are some additional factors at play that can lead other men to having a higher risk of developing the condition. The same goes for those men who have protective factors that help prevent the development of PTSD after experiencing a traumatic event.
Risk Factors
Risk factors for men who may develop PTSD include:7,11,4,12,2,3
- History of interpersonal physical and/or psychological violence
- History of sexual trauma
- Having prior mental illness (e.g., depression, anxiety, obsessive-compulsive disorder, PTSD)
- Mild traumatic brain injury
- Lower socioeconomic status
- Lower education level
- Being a racial minority
- Experiencing trauma of high magnitude/severity
- Having dissociated during the trauma
- Having experienced significant trauma-related losses (e.g., loss of life, home, financial stability)
- Lack of social support
- High current life stressors
Protective Factors
Protective factors that help to protect men from developing PTSD include: 11,4
- Higher education/socioeconomic status
- Being married
- Being in a safe setting (where trauma is no longer occurring)
- Having good social support
PTSD & Comorbidities in Men
More than 88% of men who are diagnosed with PTSD will experience at least one co-occurring mental illness during their lifetime.13 PTSD is related to an increased risk of the developing the following co-occurring mental illnesses:4,12,14,15,16
- Substance abuse or dependence (i.e., alcohol or drugs)
- Major Depression
- Mood and Anxiety Disorders
- Specific Phobias
- Obsessive-Compulsive Disorder
- Suicidal thoughts/attempts
Several commonly co-occurring physical health concerns appear to be related to PTSD. These include:16,19
- Heart disease*
- Arthritis
- Chronic pain
- Headaches
- Diabetes*
- Bone and joint disease
- Neurological conditions
- Respiratory conditions
- Metabolic disease
*significantly more prevalent among men as compared to women
How Is PTSD Diagnosed?
PTSD can be diagnosed in as little as one appointment with a psychiatrist, psychologist, or physician with specialized training. The medical professionals do so by conducting interviews about your trauma history, the types of symptoms you experience, and how they may be affecting your life. However, the diagnosis process might take longer if there are complicating factors or if more information is required, especially if memories regarding the trauma have been affected.
PTSD Treatment
The past two decades have seen tremendous advances in PTSD therapies. The following treatments are currently the most effective in treating PTSD:17,18,19
Cognitive Behavior Therapy (CBT) or Cognitive Processing Therapy (CPT)
These therapies focus on identifying, exploring, and rewriting distressing and maladaptive beliefs that arose from the trauma experience(s), to reflect a more logical/compassionate view of the self related to the trauma. CBT and CPT also focus on self-destructive behaviors, using interventions to shift those behaviors so that their impact is more supportive and adaptive.
Prolonged Exposure (PE) Therapy
PE therapy focuses on gradually desensitizing the client to reminders of the trauma that typically triggers PTSD symptoms. The goal is to help the person get to a place where the mind and body will no longer need to use survival mechanisms in response to these triggers.
Eye Movement Desensitization and Reprocessing (EMDR) Therapy
EMDR is a therapy that involves imagining the details of the trauma while the brain is bilaterally stimulated (e.g., through light, sound, or tapping). EMDR’s objective is to allow the mind and body to refocus and reprocess their memories, releasing them of their trauma.
Group Trauma-Focused CBT (TF-CBT)
CBT techniques used in a group therapy setting allows group members to change maladaptive thoughts and behaviors related to their trauma. TF-CBT allows them to come to terms with their trauma while reclaiming their thoughts and actions in the present in a social support setting.
Medications
Selective Serotonin Reuptake Inhibitors (SSRIs) and Serotonin-Norepinephrine Reuptake Inhibitors (SNRIs) are a “first-line” intervention to provide some relief from PTSD symptoms.20,21,22
Note: Medications still have the best result when paired with therapies such as those listed above. Be sure to speak with your licensed professional to ensure these medications are the right fit for you.
Finding PTSD Treatment
PTSD treatment is different from general counseling or therapy (see trauma-informed), and it is crucial to find a therapist who has a specialization in working with trauma clients. Your primary care physician is an excellent place to ask for a trauma counseling referral. College students can typically access therapy through their college counseling or health centers. Happen to have a coworker, friend, or family member who has benefitted from trauma therapy? Their experiences finding a therapist that has worked for them would be a good source of information to point you in the right direction. One simple way to find the best treatment for you is using an online therapist directory.
Final Thoughts
PTSD can be a cruel illness. Due to how trauma changes brain functions, you could find yourself re-living the worst moments of your life over and over again – and sometimes several times in a day. Remembering that PTSD is not about weakness or a character flaw is essential. Instead, it is an expected and natural reaction to an overwhelming traumatic experience, and it is possible to recover from PTSD. Several effective therapies are now available that can help “re-set” the brain and decrease or eliminate PTSD symptoms. Several medications can also be a helpful way to reduce distressing trauma symptoms.
The first step is asking for help!
For Further Reading
- 10 Best PTSD & Trauma Books for 2021 -Choosing Therapies Top 10 books relating to PTSD and surviving traumatic events.
- National Alliance on Mental Illness: PTSD – provides an overview of PTSD and information on treatment and support.
- National Center for PTSD – Veteran’s Affairs – provides educational information (written, video, apps, etc.) on PTSD and treatment – for survivors of trauma, their loved ones, and health care providers.
- National Institute of Mental Health – provides information on PTSD, treatments, how to help yourself, and opportunities to be part of research studies to understand PTSD and how to treat it.
PTSD Symptoms in Men Infographics
