Fullerton C S, Ursano R J, Epstein R S, Crowley B, Vance K, Kao T C, Dougall A, Baum A
Department of Psychiatry, Uniformed Services University of the Health Sciences, Bethesda, MD 20814-4799, USA.
Am J Psychiatry. 2001 Sep;158(9):1486-91. doi: 10.1176/appi.ajp.158.9.1486.
Women have higher rates of posttraumatic stress disorder (PTSD) than men. The authors examined prior trauma, PTSD, major depression, anxiety disorder not including PTSD, and peritraumatic dissociation; current peritraumatic dissociation; and passenger injury as possible explanations for the different rates of acute PTSD in women and men after a serious motor vehicle accident.
Subjects age 18-65 years who had been in a serious motor vehicle accident (N=122) were assessed with the Structured Clinical Interview for DSM-III-R and the Peritraumatic Dissociative Experiences Questionnaire-Rater Version 1 month after the accident.
Women did not differ from men in meeting the overall reexperiencing criterion for a diagnosis of PTSD (criterion B), but women were at greater risk for the specific reexperiencing symptoms of intense feelings of distress in situations similar to the motor vehicle accident and physical reactivity to memories of the motor vehicle accident. Women were 4.7 times more likely than men to meet the overall avoidance/numbing criterion (criterion C) and 3.8 times more likely to meet the overall arousal criterion (criterion D). Women were more likely than men to report the criterion C symptoms of avoiding thoughts and situations associated with the accident, loss of interest in significant activities, and a sense of foreshortened future and the criterion D symptoms of trouble sleeping, difficulty concentrating, and exaggerated startle response. Multiple logistic regression analysis indicated that the gender differences in acute PTSD were not associated with prior trauma, PTSD, peritraumatic dissociation, major depression, or anxiety disorder not including PTSD or with passenger injury. However, peritraumatic dissociative symptoms at the time of the accident were associated with a significantly higher risk for acute PTSD in women than in men.
Gender differences in peritraumatic dissociation may help explain differences in risk for PTSD and for some PTSD symptoms in women and men.
女性创伤后应激障碍（PTSD）的发病率高于男性。作者研究了既往创伤、PTSD、重度抑郁、不包括PTSD的焦虑症和创伤时解离；当前创伤时解离；以及乘客受伤情况，以此作为严重机动车事故后女性和男性急性PTSD发病率不同的可能解释。
对18 - 65岁曾遭遇严重机动车事故的受试者（N = 122）在事故发生1个月后，使用《精神疾病诊断与统计手册》第三版修订本（DSM - III - R）的结构化临床访谈和创伤时解离体验问卷评定版进行评估。
在符合PTSD诊断的总体重新体验标准（标准B）方面，女性与男性没有差异，但女性在与机动车事故类似情境中出现强烈痛苦情绪和对机动车事故记忆产生身体反应等特定重新体验症状方面风险更高。女性符合总体回避/麻木标准（标准C）的可能性是男性的4.7倍，符合总体觉醒标准（标准D）的可能性是男性的3.8倍。女性比男性更有可能报告标准C中避免与事故相关的想法和情境、对重要活动失去兴趣以及对未来感到前途黯淡的症状，以及标准D中睡眠困难、注意力不集中和惊吓反应过度的症状。多元逻辑回归分析表明，急性PTSD的性别差异与既往创伤、PTSD、创伤时解离、重度抑郁、不包括PTSD的焦虑症或乘客受伤无关。然而，事故发生时的创伤时解离症状与女性急性PTSD的风险显著高于男性有关。
创伤时解离的性别差异可能有助于解释女性和男性在PTSD风险及某些PTSD症状方面的差异。
