A new perspective on PTSD symptoms after traumatic vs stressful life events and the role of gender

Abstract

Background: There is an ongoing debate about the validity of the A1 criterion of PTSD. Whereas the DSM-5 has opted for a more stringent A1 criterion, the ICD-11 will leave it out as a key criterion. Objective: Here we investigated whether formal DSM-IV-TR traumatic (A1) and stressful (non-A1) events differ with regard to PTSD symptom profiles, and whether there is a gender difference in this respect. Method: This was examined in a large, mostly clinical sample from the Netherlands Study of Depression and Anxiety (n = 1433). Participants described their most bothersome (index) event and were assigned to either an A1 or non-A1 event group according to this index event. Results: Remarkably, in men PTSD symptoms were even more severe after non-A1 than A1 events, whereas in women symptoms were equally severe after non-A1 and A1 events. Moreover, while women showed significantly higher PTSD symptoms after A1 events than men (29.9 versus 15.4% met PTSD criteria), there was no gender difference after non-A1 events (women: 28.2%; men: 31.3%). Furthermore, anxiety and perceived impact were higher in women than men, which was associated with PTSD symptom severity. Conclusion: In sum, while women showed similar levels of PTSD symptoms after both event types, men reported even higher levels of PTSD symptoms after non-A1 than A1 events. These findings shed a new light on the role of gender in PTSD symptomatology and the clinical usefulness of the A1 criterion.

Prevalence of Potentially Traumatic Events, Other Life Events and Subsequent Reactions Indicative for Posttraumatic Stress Disorder in the Netherlands: A General Population Study Based on the Trauma Screening Questionnaire

“…The revision of Criterion A1 in DSM-5 narrowed qualifying traumatic events, such that the unexpected death of family or a close friend due to natural causes is no longer included. In addition to the previously cited Van den Berg study [44], our data add to the discussion on the broadening of Criterion A1, especially to the question of the inclusion of loss of loved ones. The loss of loved ones does not fulfill the DSM-IV A1 Criterion or the DSM-5 A Criterion, although participants who were exposed to this event scored high on PTSD symptoms.…”

“…In addition, women's higher PTSD risk might also be due to other factors, like higher levels of peritraumatic dissociation, inadequate social support resources, or gender-specific acute psychobiological reactions to trauma [36]. In addition, a remarkable finding regarding gender was recently published: while women showed similar levels of PTSD symptoms after both PTEs (or A1 events) and OLEs (or non-A1 events), men reported even higher levels of PTSD symptoms after non-A1 than A1 events [44].…”

The association between different traumatic life events and suicidality

“…A study by Arnberg et al (2015), for example, found increased risk of PTSD in individuals exposed to the 2004 South-East Asian tsunami compared to unexposed individuals, and that the risk was higher for male survivors [hazard ratio (HR) 11.5, 95% CI 6.77–19.47] than for female survivors (HR 6.30, 95% CI 4.25–9.34). In addition, a study on stressful and traumatic life events found that men had higher levels of PTSD after stressful life events than traumatic events, while women had similar levels of PTSD for both type of events (van den Berg, Tollenaar, Spinhoven, Penninx, & Elzinga, 2017). …”

Interdisciplinary approaches to understand traumatic stress as a public health problem

“…This is the more true if we realize that stressful events not fulfilling the strict A1 criterion may give rise to similar or even higher rates of PTSD than A1 events (e.g. Van Den Berg, Tollenaar, Spinhoven, Penninx, & Elzinga, 2017). As the authors themselves discuss, their study findings represent a call to action.…”