Sex and gender differences in post-traumatic stress disorder: an update
Sex and gender differences in post-traumatic stress disorder: an update
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DOI：
10.1080/20008198.2017.1351204
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发表时间：
2017-09-29
影响因子：
5
通讯作者：
Olff M
中科院分区：
文献类型：
--
作者：
Olff M
背景：与男性相比，女性患创伤后应激障碍（PTSD）的风险高出两到三倍。有几个因素可以解释这种差异（Christiansen &汉森，）。社会心理学和生物学的解释（如催产素相关）已经提出，并将在本文中进行审查。迄今为止，我们在对性别和性敏感的研究和报告方面仍然落后。 创伤的患病率和类型：PTSD的终生患病率在女性中约为10-12%，在男性中约为5-6%。在抑郁症和焦虑症等（共病）疾病方面，两性之间也存在类似的差异。已经发现女性的PTSD亚群评分增加，例如对于重新经历和焦虑唤醒（Charak等人，）。男子和妇女在私人生活和工作中经历不同类型的创伤（例如，警官、货车der梅尔等人），妇女比男子更容易受到严重创伤（如性创伤），而且年龄更小。生命早期的创伤有更多的影响，特别是当它涉及II型创伤干扰神经生物学发育和人格时。创伤压力影响不同年龄的男孩和女孩大脑的不同区域。 急性期、压力应对和心理治疗：在急性期，女性在急性主观反应方面的得分通常高于男性，例如威胁感知、创伤周围分离和创伤后应激障碍的已知预测因素。女性处理压力情况的方式不同，并且为了支持这些不同的行为，她们的进化也不同。例如，处于压力情境中的女性可能会使用照顾和友好的反应，而不是通常认为的战斗或逃跑反应。注重预防、防御和姑息的应对方式在妇女中更为普遍，而注重问题的应对方式在男子中更为普遍。女性寻求更多的社会支持，缺乏社会支持是创伤负面结果的最一致预测因素。女性已经被证明在减少PTSD症状方面比男性更能从心理治疗中受益。 催产素的心理生物学反应和影响：尽管只有2%的心理生物学研究是在雌性（主要是大鼠）中进行的，但已经显示出性别差异。女性似乎比男性有更敏感的下丘脑-垂体-轴，而男性似乎有敏感的生理性过度觉醒系统。PTSD一直与杏仁核过度活跃、腹内侧前额叶皮层（vmPFC）活动减退以及vmPFC和杏仁核之间的交流（功能连接）减少有关，PFC对杏仁核的控制较低为PTSD中过度恐惧反应提供了解释。我们假设，催产素系统，这是与社会支持，恐惧和压力反应，很可能发挥性别特异性的作用，在压力反应。在最近遭受创伤的患者中，我们发现催产素对杏仁核对情绪刺激的反应性的影响取决于刺激的效价和性别（Frijling，）。在创伤后应激障碍患者中，我们发现单一催产素给药对杏仁核减少焦虑（恐惧学习）和恐惧表达的潜力的影响具有性别特异性途径：男性中央内侧核对vmPFC的抑制性控制增加，女性基底外侧核对前扣带回背侧皮质的兴奋性投射减少。因此，虽然我们的研究结果增加了越来越多的证据，表明催产素管理可能会增强创伤后应激障碍的治疗反应，但男性和女性的途径不同（Frijling）。 性别政策：总之，所有这些大脑和行为的性别差异可以解释为什么PTSD在女性中比男性更普遍。显然，我们不应该简单化。不存在男女定型观念，但有些特征在女性中更为常见，有些则在男性中更为常见。为了充分了解这些差异，我们需要更多对性别和性别敏感的研究和报告（例如，见欧洲科学编辑协会的性别政策）。2016年，《欧洲心理治疗学杂志》（European Journal of Psychotracheology）率先实施了性别政策（Olff），即要求作者：报告研究对象的性别，证明单一性别研究的合理性，区分性别和性别（主要是人类研究），分析性别或性别如何影响结果，并在相关时讨论性别和性别问题。这不仅适用于心理创伤领域，而且值得更广泛地实施。在这样做的时候，我们希望获得的信息，将改善性和性别的具体方法，以帮助那些受心理创伤。
Background: Women have a two to three times higher risk of developing post-traumatic stress disorder (PTSD) compared to men. Several factors are involved explaining this difference (Christiansen & Hansen,). Both psychosocial and biological explanations (e.g. oxytocin related) have been suggested and will be reviewed in this paper. To date, we are still behind in gender- and sex-sensitive research and reporting. Prevalence and type of trauma: The lifetime prevalence of PTSD is about 10–12% in women and 5–6% in men. There are similar differences between the sexes for (comorbid) disorders such as major depression and anxiety disorders. PTSD subcluster scores have been found to be increased in women, e.g. for re-experiencing and anxious arousal (Charak et al.,). Men and women experience different types of trauma, both in private life and at work (e.g. police officers, Van der Meer et al.,), with women being exposed to more high-impact trauma (e.g. sexual trauma) than men, and at a younger age. Trauma early in life has more impact, especially when it involves type II trauma interfering with neurobiological development and personality. Traumatic stress affects different areas of the brains of boys and girls at different ages. Acute phase, stress-coping and psychotherapy: In the acute phase, women generally score higher than men on acute subjective responses, e.g. threat perception, peritraumatic dissociation and known predictors of PTSD. Women handle stressful situations differently and have evolved differentially to support these different behaviours. For instance, women in stressful situations may use a tend-and-befriend response rather than the fight-or-flight response that is often assumed. Emotion-focused, defensive and palliative coping are more prevalent in women, while problem-focused coping is higher in men. Women seek more social support, the lack of it being the most consistent predictor of negative outcome of trauma. Women have been shown to benefit more from psychotherapy then men in the reduction of PTSD symptoms. Psychobiological reactions and effects of oxytocin: Although only 2% of psychobiological research has been conducted in females (mainly rats), sex differences have been shown. Women appear to have a more sensitized hypothalamus–pituitary–axis than men, while men appear to have a sensitized physiological hyperarousal system. PTSD has consistently been associated with amygdala hyperactivity, ventromedial prefrontal cortex (vmPFC) hypoactivity and reduced communication (functional connectivity) between the vmPFC and amygdala, with the lower PFC control over the amygdala providing an explanation for the excessive fear response in PTSD. We hypothesized that the oxytocin system, which is associated with social support, fear and stress responses, was likely to play a sex-specific role in the stress response. In recently traumatized patients, we found that the effects of administration of oxytocin on amygdala reactivity to emotional stimuli depend on stimulus valence and sex (Frijling,). In PTSD patients, we showed sex-specific routes for the effects of single oxytocin administration on the potential to diminish anxiety (fear learning) and fear expression by the amygdala: increased inhibitory control of the vmPFC over the centromedial nucleus in men and fewer excitatory dorsal anterior cingulate cortex projections to the basolateral nucleus in women. So, while our findings add to accumulating evidence that oxytocin administration could potentially enhance treatment response in PTSD, the routes in men and women differ (Frijling,). Gender policy: In summary, all of these sex and gender differences in brain and behaviour together may explain why PTSD is more prevalent in women than in men. Clearly, we should not simplify. There are no male or female stereotypes, but some features are more common in women and others in men. To fully understand the differences, we need more gender- and sex-sensitive research as well as reporting (e.g. see the gender policy of the European Association of Science Editors). In 2016, the European Journal of Psychotraumatology was the first to implement a gender policy (Olff,), i.e. authors are asked to: report the sex of research subjects, justify single-sex studies, discriminate between sex and gender (mostly for human research), analyse how sex or gender impact the results, and discuss sex and gender issues when relevant. This should not only apply to the field of psychotrauma, but deserves a much broader implementation. In doing so, we hope to obtain information that will improve sex- and gender-specific approaches to helping those affected by psychotrauma.
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影响因子：
5
作者：
Charak R;Armour C;Elklit A;Angmo D;Elhai JD;Koot HM
通讯作者：
Koot HM
影响因子：
5
作者：
Christiansen DM;Hansen M
通讯作者：
Hansen M
影响因子：
5
作者：
Frijling JL
通讯作者：
Frijling JL
影响因子：
1.9
作者：
van der Meer, Christianne A. I.;Bakker, Anne;Olff, Miranda
通讯作者：
Olff, Miranda