Sex Differences In Personality Traits Coping And Stressrelated Psychiatric Disorders

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Gender differences in personality styles and coping responses have been well documented (see Table 10.1 for a summary of these). In a classic review of research, Maccoby and Jacklin (1974) reported that men are more assertive and dominant than women, and that women are more anxious than men. Feingold (1994) extended these findings in a meta-analysis and reported that men are more assertive and have higher self-esteem, whereas women have higher levels of extraversion, anxiety, trust, and nurturance. On the other

TABLE 10.1. Sex Differences in Factors Influencing Stress Responses

A. Differences in personality traits

1. Men are more assertive and have higher self-esteem than women.

2. Women have higher levels of anxiety, trust, extraversion, and nurturance.

B. Differences in stress-related psychopathology

1. Men have higher rates of externalizing disorders characterized by impulsive, dyscontrolled behaviors, such as substance abuse and antisocial personality disorder.

2. Women have higher rates of internalizing disorders, including anxiety and depressive disorders.

C. Differences in trauma exposure

1. Early life stress, particularly childhood sexual abuse, is more common in women than in men.

2. Childhood abuse increases risk of psychiatric illness in women more than in men.

3. Men have higher rates of war-related trauma.

4. Women have higher rates of civilian violence and sexual abuse. Rates of violent victimization and PTSD are higher in women.

D. Differences in biobehavioral responses to stress

1. Males show greater evidence of "fight-flight" response to stress than women do, with higher levels of sympathetic arousal, blood pressure, catecholamines, and HPA responses, both at baseline and after stress challenge.

2. Stress response in women is associated with a "tend and befriend" response, with lower sympathetic and HPA response to stress, and with oxytocin, endogenous opioid peptides, and sex steroid hormones regulating the stress response. HPA responses vary as a function of the phase of the menstrual cycle.

E. Differences in coping responses to stress

1. Men are more likely to respond with instrumental or activity-oriented coping.

2. Women are more likely to respond by using verbal and self-other directed coping strategies.

Note. PTSD, posttraumatic stress disorder; HPA, hypothalamic-pituitary-adrenal.

hand, no sex differences have been reported in social anxiety, impulsiveness, activity levels, reflectiveness, locus of control, and orderliness. To the extent that these personality traits influence appraisal of life events and the degree to which such events are perceived as threatening/challenging and controllable, they are likely to influence sex differences in stress responses in men and women.

Consistent with these sex differences in personality traits, there are sex differences in the epidemiology of stress-related psychiatric disorders, including personality disorders. Men are prone to "externalizing" disorders characterized by aggressive, dyscontrolled behaviors, such as substance use disorders and antisocial personality disorder. In contrast, women have higher rates of "internalizing" disorders, including anxiety disorders, depression, and borderline personality disorder (Sinha & Rounsaville, 2002; Paris, 2004). Sex differences in the literature on coping strategies provide further confirmation of the "externalizing" and "internalizing" trends, as men tend to respond to stress with instrumental or activity-oriented coping strategies, whereas women report using more passive, self-directed strategies (McCrae & Costa, 1986). Such differences suggest that functional representations of stress appraisal, and behavioral and cognitive responses to stress in the brain, are likely to be sex-specific as well.

There also appear to be some sex differences in physiological and behavioral coping with traumatic and chronic adverse life events. For example, women are more likely than men to develop posttraumatic stress disorder (PTSD) following traumatic events (Weiss, Longhurst, & Mazure, 1999; Widom, 1999). Furthermore, experiences of early trauma, such as physical and childhood sexual abuse, have been found to confer a greater susceptibility to developing psychiatric illness and illicit drug abuse on women than on men (MacMillan et al., 2001). The well-known association between adverse life events and increased risk of major depression is significantly higher in women than in men (Maciejewski, Prigerson, & Mazure, 2001). Early life trauma is associated with an increased HPA reactivity to acute and chronic stressors in women (Heim et al., 2000; Nemeroff, 1996). Women with major depression show greater abnormalities in HPA axis responses as compared to men (Young, 1995; Young & Korszun, 1999). Abnormal cerebrospinal fluid levels of corticotropin-releasing factor and other HPA axis responses, as well as plasma catecholamine regulation, have been reported in traumatized children and adults with or without PTSD (Baker et al., 1999; De Bellis et al., 1994, 1999; Friedman et al., 2001; Heim et al., 2000; Kaufman et al., 1997; Rasmusson et al., 2000, 2001; Yehuda, 1997). These findings indicate that the psychobiological effects of chronic adverse life events confer differential psychiatric disease risk for men and women.

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