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创伤反应不仅对于男人和女人有所不同，对于每个人的反映也不尽相同。所以，我们需要更为高级的诊断工具。

华盛顿—美国心理学会11月份出版的心理学手册中一篇总结了25年研究结果的综述提到，男性所经历的创伤事件要多于女性，但是女性更容易患创伤后应激障碍。

作者总结了1980年至2005年的290个研究结果。希望从中得出结论，到底是男性还是女性更容易遭遇潜在的创伤事件以及是否会产生创伤后应激障碍。研究结果表明男性更容易遭遇创伤事件，而妇女则有更高的患伤后应激障碍的风险。伤后应激障碍是一种创伤事件导致的加速焦虑失调，逃避、麻木、觉醒过度，以及有重新经历创伤事件的症状特点。

这篇综述中，生活研究中心的研究人员David F. Tolin博士和宾夕法尼亚大学医学院的Edna B. Foa博士发现在研究中女性比男性更容易经历性暴力以及儿童性虐待。但是，一般很少经历非性虐待、目睹死亡、受伤、灾难、火灾、打斗、战争等事件。作者指出，性暴力比其他形式的创伤更容易造成感情伤害并且更容易诊断为伤后应激障碍。

Tolin解释说，妇女更高的伤后应激障碍发病率不仅归咎于其更高的遭遇成年性暴力以及儿童性虐待的风险。在同等伤害的情况下，女性的应激障碍发病率仍然要高一些。

“女性更多的被诊断为应激障碍一部分也是由于应激障碍的诊断标准本身。创伤事件后的认知以及感情反应很有可能让医生作出应激障碍的诊断结果。如果男性也同样经历了更多的创伤，他们也许不会对创伤事件作出同样的反映”Tolin和Foa说。

更进一步来说，作者提到如果那些经历过多起创伤事件者在遇到新的创伤时更容易复发旧的应激障碍症状。比如：如果在实验中，摩托车车祸中的男女幸存者中，女性一般会有比男性更多的应激障碍症状报告。“但是，数据表明这些女性患者先前有更高的虐待以及性暴力的风险；此事件将使他们面临更高的导致应激障碍的危险，甚至目前的事件并不是造成其所有症状的原因。”Tolin说。

我们经常忽略这些发现中所涉及的人群、性别检查以及试验类型也就评估工具的使用。

Tolin说男性不符合应激障碍诊断标准的原因可能是他们的症状表现很不同。在这篇综述中，男性很少报告他们的不安或是沮丧，但是，他们更多的会有行为或是药物报告。他们在创伤后很有可能变得易怒或是暴力。

了解到创伤后人与人的反映会有所不同将会更好的帮助我们确定是否一个人经历过创伤，Tolin说。对于9/11的恐怖袭击的创伤作用研究可以作为一个例子说明主观创伤症状。很多研究表明，很多距离零层有一段距离的受访者更容易经历严重的应激障碍。但是，Tolin说，“所有的美国人都可以从技术上被分类为已经通过电视或是目击的形式经历恐怖袭击。这是创伤研究的一个主要问题，因为我们很年判断一个人是否真的受到伤害。”

“简单的清单或是简短的探视是不足以评估创伤的，但是此方式在这种情况下使用得最多。更全面的评估应该知道一个人是否在不幸、打击或是灾难中遭受了长时间的症状反应”作者说。

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篇名：创伤以及应激障碍在性别间的不同：一项量化25年研究的综述
生活研究中心的研究人员David F. Tolin博士以及Connecticut医学院和宾夕法尼亚大学医学院的Edna B. Foa博士

Public release date: 19-Nov-2006
Contact: Pam Willenz
pwillenz@apa.org
202-336-5707
American Psychological Association

Women are diagnosed with PTSD more than men, says research

Trauma response varies not only from men to women, but between individuals therefore sophisticated diagnosis tools are needed
WASHINGTON -- Males experience more traumatic events on average than do females, yet females are more likely to meet diagnostic criteria for Posttraumatic Stress Disorder (PTSD), according to a review of 25 years of research reported in the November issue of Psychological Bulletin, published by the American Psychological Association (APA).

The authors reviewed 290 studies conducted between 1980 and 2005 to determine who is more at risk for potentially traumatic events (PTE) and posttraumatic stress disorder (PTSD) ?males or females? The results of the meta-analysis found that while males have a higher risk for traumatic events, women suffer from higher PTSD rates. PTSD is defined as an anxiety disorder precipitated by a traumatic event and characterized by symptoms of re-experiencing the trauma, avoidance and numbing and hyperarousal.

From the review, researchers David F. Tolin, PhD of the Institute of Living and Edna B. Foa, PhD, of the University of Pennsylvania School of Medicine found that female study participants were more likely than male study participants to have experienced sexual assault and child sexual abuse, but less likely to have experienced accidents, nonsexual assaults, witness death or injury, disaster or fire and combat or war. Sexual trauma, the authors conclude, may cause more emotional suffering and are more likely to contribute to a PTSD diagnosis than other types of trauma.

Women's higher PTSD rates were not solely attributable to their higher risk for adult sexual assault and child sexual abuse, explained Tolin. PTSD rates were still higher for women even when both sexes were compared on the same type of trauma.

"PTSD may be diagnosed more in women in part because of the criteria used to define it. Cognitive and emotional responses to traumatic events make a diagnosis of PTSD more likely. So even though men may experience more traumas, they don't seem to have the same emotional responses to traumatic events," said Tolin and Foa.

Furthermore, according to the authors, those participants who experienced multiple traumas may be more vulnerable to re-experiencing old PTSD symptoms when confronted with a new trauma. For example, if one studies male and female survivors of a motor vehicle accident, typically the female accident victims report more PTSD symptoms than do the male accident victims. "However, the data suggest that the female victims will have brought to the table a much greater risk of abuse and sexual assault prior to the accident; this could place them at higher risk of developing PTSD after the accident even though the current accident may not have caused all the symptoms," said Tolin.

These findings were consistent regardless of the population and age examined and the type of study and assessment tool used.

A reason that men may not fit the current diagnosable criteria of PTSD, said Tolin, is that their symptoms may manifest themselves differently. The male participants examined in this review were less likely to report anxiety or depression, but were more likely to report behavior and drug problems. They were also more likely to become irritable, angry or violent after traumas.

Understanding that responses to trauma can vary from person to person will help better determine if a person has experienced a trauma, said Tolin. An example of how subjective trauma symptoms can be illustrated in research investigating the traumatic effects of 9/11 terrorist attacks. Quite a few studies showed that participants' distance from ground zero was directly related to the likelihood of experiencing severe PTSD symptoms. But, said Tolin, "People from all over the U.S. could technically have been classified in research as having 'experienced' a terrorist attack just by watching it on TV. This is a major problem for trauma research because it's hard to determine whether someone has really been traumatized or not."

"Simple checklists or short interviews are insufficient for assessing trauma and this is what is used most in these types of situations. More thorough assessments are needed to know if someone will suffer long-lasting symptoms from an accident, attack or disaster," said the authors.

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Article: "Sex Differences in Trauma and Posttraumatic Stress Disorder: A Quantitative Review of 25 Years of Research," David F. Tolin, PhD, Institute of Living and University of Connecticut School of Medicine and Edna B. Foa, PhD, University of Pennsylvania School of Medicine; Psychological Bulletin, Vol. 132, No. 6.

Full text of the article is available from the APA Public Affairs Office or at http://www.apa.org/journals/releases/bul1326959.pdf.

http://www.eurekalert.org/pub_releases/2006-11/apa-wad111306.php

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