Post-Traumatic Stress Disorder (PTSD) and NIH Women's Health Research

Signs, Symptoms, and Risk Factors

PTSD is a mental health condition that can develop after a person experiences or witnesses a traumatic event or series of events such as sexual assault, domestic abuse, combat exposure, serious accidents, natural disasters, or the sudden death of a loved one.^{1 - 5} While it is normal to feel fear, distress, or anxiousness after trauma, PTSD occurs when these reactions persist for more than a month and significantly interfere with daily functioning.^{1 , 3} Core symptoms of PTSD fall into four clusters: intrusive re-experiencing, such as flashbacks and nightmares; avoidance of trauma reminders, such as certain places, events, or objects; changes in mood and cognition, including guilt, negative thoughts, or trouble concentrating; and heightened arousal, such as difficulty sleeping or being easily startled or constantly on edge.^{1 - 5} Symptoms commonly begin within 3 months of the trauma, or they may emerge months or even years later and can fluctuate over time.^{1 , 3}

An estimated 6% of people in the United States experience PTSD at some point in their lives.^{3 , 6 , 7} PTSD can occur at any age and after many types of trauma, but not everyone who is exposed to trauma develops the disorder. Personal factors that increase vulnerability to PTSD include a prior history of trauma, particularly in childhood; co-existing mental health conditions, such as depression, anxiety, or substance use disorders; limited social support following a traumatic event; and exposure to additional stressors, such as injury, loss of housing, or job disruption.^{1 - 4 , 8} Other factors, including genetics and trauma-related neurological changes in the brain, also play a role in determining who develops PTSD.^{1 - 3 , 9} Military veterans, especially those who are deployed to a war zone, are at high risk of PTSD because they are often exposed to life-threatening events and other traumatic combat-related experiences.^{4 , 6 , 10}

Impact on Women's Health

PTSD disproportionately affects women, who are about twice as likely as men to develop PTSD over their lifetime despite being less likely to experience certain types of traumatic events such as combat or severe accidents.^{4 , 8 , 9 , 11 , 12} This higher risk is partly attributed to women's greater exposure to traumas with especially high PTSD risk, including sexual assault, intimate partner violence, and childhood sexual abuse.^{8 , 9 , 11 - 13} Research suggests that about half of all women are exposed to at least one traumatic event in their lifetime, with about one in four experiencing rape or attempted rape.^{8 , 14 , 15} Women may also experience perinatal or childbirth-related PTSD following traumatic events during pregnancy, delivery, or the postpartum period. These can include miscarriage; childbirth trauma, such as an unplanned cesarean delivery or a life-threatening complication; or a newborn baby's health complications.^{16 - 18} In addition, women with PTSD often report greater severity of certain symptoms, including anxiety and depression, than men.^{4 , 11} Biological factors, including the menstrual cycle and its underlying hormones and the effects of the neuroendocrine system on fear-related neural circuits in the brain, further shape how PTSD develops and is experienced by women.^{9 , 19}

Diagnosis and Treatment

PTSD is diagnosed by a trained mental health professional and typically requires the presence of characteristic symptoms for at least 1 month and meaningful impairment of work, relationships, or daily life.^{1 - 3} Evidence-based treatments for PTSD include trauma-focused psychotherapies, with cognitive processing therapy and prolonged exposure strongly recommended as primary interventions.^{20 , 21} Other forms of therapy, including trauma-focused cognitive behavioral therapy, eye-movement desensitization and reprocessing therapy, and narrative exposure therapy, may also be used. Medications, including selective serotonin reuptake inhibitors and serotonin-norepinephrine reuptake inhibitors, are often used in combination with psychotherapy, and scientists are also exploring the use of psychedelic drugs to augment psychotherapy.^{1 - 4 , 7 , 21 , 22} Group therapy and support from family and friends can also be helpful.

Treatment can substantially reduce PTSD symptoms, and some people recover within 6 months while others have symptoms that persist for a year or longer.^{2 , 3} In addition, research suggests that women tend to experience greater reductions in PTSD symptom severity following treatment than men.^{8 , 23 , 24} Although complementary therapies are often used by individuals with PTSD, the supporting evidence for these modalities is limited; Mindfulness-Based Stress Reduction may offer some benefit, but there is insufficient evidence to recommend other approaches, such as yoga or acupuncture.^{7 , 20} The use of cannabis is not recommended for people with PTSD.^{20 , 21}

Ongoing Research

The National Institute of Mental Health (NIMH) supports research to better understand the biological, cognitive, behavioral, and developmental factors that influence why some individuals develop PTSD after trauma while others do not. This work also aims to improve early identification, prevention strategies, and the development and delivery of more effective treatments across diverse populations and trauma contexts.²⁵ Additional research is needed to better understand comorbidities, trauma types, and trauma timing in females with PTSD, as well as to elucidate how the neuroendocrine system shapes the clinical manifestations of PTSD in this group.⁹ Research is also needed to improve early detection of women who may experience traumatic pregnancy- or childbirth-related events and to understand how menstrual cycle phases affect mood and PTSD symptoms.^{17 - 19} Further efforts are also required to close existing evidence gaps related to the efficacy and safety of PTSD treatments in the perinatal population, as well as to expand therapeutic options and improve the scalability of care for this population.^{17 , 18}

To address the elevated risk of PTSD and opioid misuse among women who have experienced sexual violence, NIH is supporting research to develop early interventions that can improve recovery and reduce the likelihood of these adverse outcomes. In one of these studies, researchers at the University of Wisconsin-Madison are developing and testing a brief video and text messaging program that is designed to be offered in emergency departments, where survivors often receive medical care shortly after an assault. The researchers will work with sexual violence survivors to refine and test the materials, with the goal of providing a low-cost, widely available way to support recovery and improve long-term outcomes.