PTSD in Women: Symptoms, Causes, & Treatments

What Is PTSD?

Post-traumatic stress disorder (PTSD) is a debilitating mental health illness caused by a psychological reaction to a traumatic event; One loses the ability to regain a felt sense of safety following a traumatic experience, even though the threat has passed. Symptoms of PTSD in women significantly disrupt everyday functioning.

PTSD Symptoms in Women

PTSD symptoms in women can feel like living with an unidentified constellation of symptoms including the follow:¹

• Pervasive feelings of unsafety in one’s body and environment
• Negativistic changes in beliefs and mood
• Heightened physiological reactivity
• Re-living or experiencing flashbacks to the trauma
• Feelings of depression, unwarranted guilt
• Feeling disconnected/estranged from self and others
• Feeling of hopelessness
• Loss of reality or time
• Sleep disturbances, insomnia
• Nightmares
• Anxiety
• Anger
• Memory and concentration problems
• Increased substance use/misuse
• Avoidance of people or places that remind one of the traumatic events
• Strains on relationships
• Suicidal thoughts
• unexplained physical pains

Being a woman can increase your risk of developing PTSD. Women consistently meet lifetime and annual criterion for PTSD at rates at least double that of men, with rates as high as 50% among women.^2,3 PTSD can result in suicidal action and contribute to the development of other life-threatening diseases if not treated properly.¹

Why Does PTSD Go Unnoticed in Women?

Many of the reasons women go untreated for PTSD are intrinsically linked to identity as a woman. Things like a lack of resources, cultural attitudes, and delayed presentation of symptoms all factor into the rate in which this serious disorder goes unnoticed and unreported.

Lack of Resources

Women are exposed to higher levels of diffuse types of violence combined with a lack of resources, according to the research.¹ They also have less economic stability and lack the institutional and systemic protections necessary to avoid traumatic events.²

For example, workplace violence often places an increased burden on women to have to weigh economic and psychological safety against the threat of retaliating against their abuser. The same is true of domestic violence. Women with PTSD symptoms are forced to re-engage with many of the same individuals and or systems of power that inflicted their trauma.⁴

Sociocultural Attitudes/Stereotypes, Discrimination & Shame

Women in general are stereotyped as “unbelievable” and “hysterical”. Violence against women has often been blamed on the woman. Shame has also been a factor that discourages women with PTSD from seeking treatment.³

Stressors Related to Gender, Racial/Ethnic & LGBTQ Identities

The emotional and cognitive loads associated with having to navigate systemic/institutional oppression, discrimination and microaggressions, in addition to their symptoms among non-White and LGBTQ women, further reduces treatment seeking and symptoms recognition.^3,4 Women of diverse identities report feeling unwelcome in many healthcare facilities, thus reducing their opportunities for care.⁶

Delayed Presentation of Symptoms

Women may be more likely than men to present with delayed-onset PTSD-defined as not meeting full clinical criteria until 6 months after the event.³ One sample indicated some women live with symptoms of PTSD for four years before getting diagnosed or treated—compared with one year for men—and suggested that may be more representative than is understood.⁴ Living without immediate symptoms may make it more difficult for individuals to recognize symptoms when they do set in.

Co-Occurring Disorders

Women with untreated PTSD often have high rates of chronic illness, autoimmune disorders, endometriosis, gastrointestinal, and other “unexplained” chronic pains that become the primary reason for treatment.^5,6 Rarely do the women themselves or their physicians  directly assess for trauma or PTSD, but it is crucial that we do. Primary-care physicians, physical therapists, and OB-GYNs may be able to intervene more often than currently reported.¹

Co-occurring disorders and cross-over symptoms can also make it more difficult to recognize and treat PTSD disorder in women  such as:^1,5

• Cross over symptoms from anxiety, insomnia, and depression
• Chronic relational problems
• Changes in weight
• substance abuse and use disorders,
• feeding and eating disorders,
• borderline personality disorder,
• generalized anxiety disorder,
• attachment disorders,
• major depressive disorder

Causes of PTSD in Women

Women of all identities experience adverse/traumatic experiences that can cause the development of PTSD; For example, some lifetime estimates indicate that 23% and 30%  of women experience at least one incident of gender-based violence (GBV) and or Intimate partner violence (IPV) respectively.^5,6 Someone may have complex PTSD (C-PTSD), which differs from PTSD in that it happens when there is a recurring traumatic event, like domestic abuse.

Causes of PTSD in women include:

• Physical violence
• Early childhood neglect or abuse
• Sexual assault
• Sexual coercion
• Rape
• Race-based violence
• Sexual and or gender identity based violence
• Death of loved one
• Miscarriage(s)
• Domestic or interpersonal violence
• Minority stressors and violence
• Emotional abuse or emotional neglect
• Severe or chronic childhood illness
• Environmental/natural disaster
• Political/national warfare
• Exposure to environmental violence (e.g., war-torn cities, violence in inner cities)

Additional risk factors include:^{1,6,7,8,9,10,14}

• Pre-dispositional biological/genetic factors – potential links between certain serotonin transporter genes and individual stress response system functions.
• Psychological – a history of pre-existing mood disorders, anxiety. As well as personality factors like neuroticism and having passive coping styles.
• Women of diverse ethnic/racial identities – women of colors have a higher risk of developing PTSD. For example, one study showed that African American females were 3 times as likely to meet criterion for PTSD than comparison group Rates of childhood sexual traumas among minority women have been reported as high as 51%
• Being a woman of diverse sexual and gender identities – Estimated prevalence rates of PTSD are higher among LGBTQ populations for example, one study estimated among lesbian, gay and bi-sexual individuals (LGBs), rates of PTSD between 1.3% to 47.6% and among transgender and gender diverse (TGD), 17.8% and 42.%. Women in these groups report feeling unwelcome in many healthcare facilities thus reducing their opportunities for care

Protective factors against developing PTSD include:¹

• Access to and maintenance of social support.
• Securely attached relationships.
• Access to trauma-informed, culturally competent treatment

Treating PTSD in Women

Not every treatment will work for every woman. Patience is necessary. It is important to find a safe place that provides client-centered trauma informed care. Talk therapies are the gold standard of treating PTSD in women, with or without medications. More recently some practitioners have moved towards an incorporation and emphasis on increasing connection with loved ones including yourself, your body and nature.

The following are some helpful treatments for women with PTSD:¹¹

• Trauma Focused Cognitive Behavioral Therapy: This approach uses techniques designed to help one recognize and change their thinking patterns related to trauma and its aftermath; the goal here is to change the way one thinks to change the way one feels
• Eye Movement Desensitization Reprocessing (EMDR): This approach aims to help different areas of the brain to fully process the traumatic event and an event that is in the past, and no longer poses a threat thus reducing overall symptoms of PTSD.
• Exposure & Response Therapy: In this approach, the client is provided psychoeducation about PTSD, relaxation techniques, imaginal and in-vivo (real-life) exposure to safe stimuli that evokes PTSD symptoms to gradually decrease their potency over time. This approach may not be best suited for those with multiple unaddressed lifetime traumas.
• Medication: Typical treatment involves the use of selective serotonin reuptake inhibitors (SSRI) or medications targeting nightmares. Talk therapy in conjunction with medication has shown more success in the treatment of PTSD than taking medication alone. For many, medication alone does not improve symptoms of PTSD.

Adjunctive therapies & complementary methods for PTSD include:

• Trauma processing groups
• Narrative therapy
• Narrative exposure therapy
• Brainspotting
• Music and dance/movement based therapy for trauma
• Trauma-informed yoga therapy
• Somatic therapy
• Aerobic therapy for trauma
• Animal-assisted therapies
• Clinician-led psychedelic treatment
• PTSD journaling

How to Find Help

What is most important is that you feel comfortable with your therapist. Find someone who makes you feel comfortable talking to them. Ask them about their experience treating women with PTSD and voice any concerns you have about pursuing treatment. Remember, there are different treatment types for different types of women, for example, somatic or body focused therapies may appeal to some women more than others. An online therapist directory is a great resource for finding a therapist.