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Sex Differences in Trauma-Related Psychopathology: a Critical Review of Neuroimaging Literature (2014–2017)

  • Sex and Gender Issues in Behavioral Health (CN Epperson, Section Editor)
  • Published:
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Abstract

Purpose of Review

Sex differences in the epidemiology and clinical presentation of trauma-related psychopathology have long been documented. Multiple underlying mechanisms have been examined, both psychosocial and biological. Among the most promising biological mechanisms are neural substrates of trauma-related psychopathology that have been uncovered in recent years.

Recent Findings

Neuroimaging studies of sex-related heterogeneity published over the past 3 years (2014–2017) demonstrate an interaction between sex and type, timing, and load of trauma exposure. These studies suggest that, for males, early trauma exposure may involve a loss of gray matter in the limbic system, including the prefrontal cortex (PFC), amygdala, and hippocampus, and an over-activity and increased connectivity of salience hubs, and particularly dorsal anterior cingulate cortex (dACC). For females, however, early trauma exposure may involve overactive and possibly an enlarged amygdala, as well as decreased connectivity of salience hubs such as the dACC. Underlying mechanisms may include interaction with several endocrine systems and result in differential neural response to naturally occurring and added endocrine ligands, as well as sex-specific genetic and epigenetic risk and resilience factors. This complex interaction between multiple biological systems may be associated with sex-specific behavioral patterns, in turn associated with trauma-related psychopathology.

Summary

While substantial number of published studies present preliminary evidence for neural mechanisms of sex-specific posttraumatic responses, there is a paucity of research directly designed to examine sex as a biological factor in trauma-related psychopathology. Specific foci for future studies aiming to bridge current gaps in the literature are discussed.

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Authors and Affiliations

  1. Department of Psychiatry and the New York State Psychiatric Institute, Columbia University Medical Center, 1051 Riverside Dr. Unit no. 69, New York, NY, 10025, USA

    Liat Helpman, Xi Zhu, Benjamin Suarez-Jimenez, Amit Lazarov, Catherine Monk & Yuval Neria

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  1. Liat Helpman
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  2. Xi Zhu
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  3. Benjamin Suarez-Jimenez
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  4. Amit Lazarov
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  5. Catherine Monk
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  6. Yuval Neria
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Correspondence to Liat Helpman.

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Conflict of Interest

Xi Zhu and Catherine Monk each declare no potential conflicts of interest. Liat Helpman’s work on this manuscript was funded by NIMH T32 MH096724 fellowship. Benjamin Suarez-Jimenez’s work on this manuscript was funded by NIMH T32 MH015144 fellowship. Amit Lazarov’s work on this manuscript was funded by NIMH T32 MH020004 fellowship. Yuval Neria reports partial support for this manuscript was supported by NIMH grants R01MH072833 and R01MH105355.

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All reported studies/experiments with human or animal subjects performed by the authors have been previously published and complied with all applicable ethical standards (including the Helsinki declaration and its amendments, institutional/national research committee standards, and international/national/institutional guidelines).

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This article is part of the Topical Collection on Sex and Gender Issues in Behavioral Health

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Helpman, L., Zhu, X., Suarez-Jimenez, B. et al. Sex Differences in Trauma-Related Psychopathology: a Critical Review of Neuroimaging Literature (2014–2017). Curr Psychiatry Rep 19, 104 (2017). https://doi.org/10.1007/s11920-017-0854-y

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