Book Review
Posttraumatic Stress Disorder 
Gender and PTSD. Rachel Kimerling, Paige Ouimette, Jessica Wolfe, editors. New York: The Guilford Press; 2002. 460 p. US$66.00.
Reviewer
rating*: Good
Review by:George Fraser, MD
Ottawa, Ontario
Posttraumatic stress disorder (PTSD) is second only to social anxiety disorder in lifetime prevalence of anxiety disorders. Exposure to a significant traumatic event is experienced by more than 50% of male and female subjects in US epidemiologic studies (slightly higher in male than in female subjects). However, women are approximately twice as likely as men to develop PTSD (10% of men vs 5% of women), and women tend to have a more chronic course. Neither types of traumatic events nor perceptions of threat fully explain why girls or women are more susceptible to developing PTSD. This edited book attempts to answer the question of this interesting difference in prevalence. While those not managing psychological trauma may not be especially interested in this search for causes of sex difference, it is nonetheless an exciting area for students and therapists of psychological trauma disorders.
This multiauthored book takes a comprehensive look at the many sex issues that might explain the increased vulnerability of girls and women to PTSD. Many readers will likely be surprised by how many issues need to be considered in the management of male vs female PTSD patients or clients. Knowledge of these issues will certainly assist PTSD therapists in being more alert to therapy issues that previously might not have even been considered.
The reader will be alerted to the fact that sex differences to be considered include fluctuations in reproductive hormones across the menstrual cycle and reproductive stage. These fluctuations may influence sympathetic system reactivity at the time of the trauma. Medication responses may vary, depending on the hormonal state of the patient. Cognitive factors also play a role; for example, girls or women may view the world as more dangerous and therefore react more to a specific trauma. They may experience more “betrayal traumas” by caretakers, which may increase distress of abuse.
Another interesting area pointed out in this book is that female sex may result in an underdiagnosis of PTSD. Girls and women are more likely be diagnosed instead with various other disorders, including depression and borderline personality disorder. Approximately 85% of persons with PTSD have additional diagnoses, suggesting that PTSD most commonly occurs within the context of multiple disorders. However, the possibility of PTSD must not be ignored when comorbid psychiatric disorders are encountered.
Other areas that may lead to increased female vulnerability include greater subjective reaction to a trauma or the shattering of a sex-identity script because of the trauma. Also, chronic stress may increase the magnitude of cardiovascular reactivity or lower the threshold to the cues that provoke a physiological response to a trauma. One chapter proposes an interesting prophylactic idea: “It is possible that prophylactic pharmacotherapy in individuals who have experienced a traumatic event will become standard practice” (because those who have experienced earlier trauma, such as sexual abuse, may be more prone to develop PTSD with the new traumatic event).
There are many other pertinent areas discussed, which help explain women’s vulnerability to PTSD. Serious practitioners of PTSD will benefit from having this book in their library. The various authors do point out that much of the data analyzed and presented is early in its development; more research, especially research addressing the sex differences in PTSD studies, is necessary to better examine the sex variations that will guide the theory and therapy of PTSD in women. This book may be the first to address gender issues in PTSD and will be a guide to therapists. It also presents a challenge to future researchers to follow up on the pioneering work presented here.
Like many multiauthored books, some chapters read more easily than others. The first chapter, for instance, was somewhat tedious. The price of the book is reasonable. Those interested in the field of PTSD will find this book quite useful. This is a comprehensive overview of a little-studied but very important area.
*Reviewer
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Not recommended / Pas recommandé
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