Study Identifies Gender Differences in Early PTSD Symptoms

A new study found women experience more severe early PTSD symptoms than men, with re-experiencing and avoidance symptoms identified as the strongest and most interconnected symptom clusters.1

“…our findings underscore the importance of understanding both gender similarities and possible differences in the development of early PTSD symptoms,” wrote investigators, led by Line Ronning, from the department of psychology at Norwegian University of Science and Technology, in Norway. “Such understanding may provide valuable insights into the mechanisms driving later development of PTSD.”

Gender plays a role in the manifestation of PTSD symptoms, and studies have shown women often exhibit greater PTSD symptom severity than men during the early post-trauma period. However, conflicting evidence exists whether gender differences in early PTSD symptom severity explain the difference in longer-term PTSD prevalence.2

Believing examining the interrelationships among PTSD symptoms may help inform gender differences in early PTSD symptoms, investigators conducted a network analysis to assess potential gender differences in PTSD symptom clusters during the early post-trauma period.1 The study included 475 participants (aged ≥ 18 years, 57.5% females) from the ongoing larger prospective cohort study, Towards Accurate Screening and Prevention (2-ASAP) who in the last 2 months experienced a traumatic event in the Netherlands. This could either be a traffic accident involving injuries or acts of violence such as assault, threat, robbery, or theft by force; acts of violence were considered interpersonal trauma.

The study collected data on sex, gender, age, educational level, marital status, occupational status, any children, and living situation. The PTSD Checklist for DSM-5 measured past month PTSD symptoms, which were composited based on 5 node PTSD symptom cluster dysphoric arousal model.

““Notably, our study employed a five-node symptom cluster model, which separates the DSM-5 ‘alterations in arousal and reactivity’ symptom cluster into distinct dysphoric arousal and anxious arousal symptom nodes,” investigators wrote. “This approach allowed us to more thoroughly characterize PTSD symptom interrelationships, specifically associations between facets of arousal and other PTSD symptom clusters.”

The analysis revealed interpersonal trauma was significantly more frequent in men than women. Moreover, women had significantly greater PTSD severity, as indicated by their higher PCL-5 total scores and cluster scores compared with men.

The re-experiencing and avoidance symptoms were the strongest and most interconnected clusters in women. As for men, the anxious arousal and avoidance clusters were the strongest and the re-experiencing and avoidance clusters were the most interconnected.

“Tentatively, this finding in men may have been influenced by societal gender norms and roles influencing the way men and women perceive and express distress,” investigators wrote.

Men and women had a marginally statistically significant difference in global network structure (P = .054) but not strength (P = .067). However, a post-hoc analysis revealed a significantly stronger presence of re-experiencing and negative alterations in cognition and mood in men compared with women (P = .005).

“Our results revealed marginally significant sex/gender differences in the global structure but not global strength of the networks,” investigators explained. “This means that the constellation of edge weights in the network for women differed somewhat from the constellation of edge weights in the network for men; however, the summed absolute strength of the edge weights (reflecting overall connectivity) across the two networks did not differ significantly.”

References

Rønning L, Zelkowitz RL, Piccirillo ML, Liu J, Thomas JL, Guler J, Kyei JJ, Hoeboer CM, Karchoud JF, Olff M, Witteveen AB, van Zuiden M. Gender differences in early posttraumatic stress disorder symptoms: a network analysis. Eur J Psychotraumatol. 2025 Dec;16(1):2448385. doi: 10.1080/20008066.2024.2448385. Epub 2025 Jan 23. PMID: 39846426.

Haering S, Schulze L, Geiling A, Meyer C, Klusmann H, Schumacher S, Knaevelsrud C, Engel S. Higher risk-less data: A systematic review and meta-analysis on the role of sex and gender in trauma research. J Psychopathol Clin Sci. 2024 Apr;133(3):257-272. doi: 10.1037/abn0000899. PMID: 38619461.