Sex and Gender Differences in PTSD and Substance Use Disorder Comorbidity

Abstract

This chapter discusses the sex- and gender-related differences in the epidemiology of post traumatic stress disorder (PTSD), substance use disorder (SUD), and their comorbidity. It focuses on differences between binary conceptualizations of sex and gender. The chapter also discusses factors that may help explain and contribute to binary sex and gender differences, and reviews gender considerations in the delivery and outcome of integrated PTSD/SUD treatment programs. Gender differences in rates of exposure to potentially traumatic events and rates of PTSD diagnosis have also been observed. Differences in likelihood of being sexually assaulted explain some but not all gender differences in PTSD. Alternative models of PTSD/SUD comorbidity focus on substance use as a risk factor for PTSD. Health care providers in the settings should be trained appropriately to identify both PTSD and SUD and refer clients to specialty services. With regard to non-trauma-focused integrated treatments, a number of randomized controlled trials have examined their effects in adult single-gender samples with PTSD/SUD.