A new perspective on PTSD symptoms after traumatic vs stressful life events and the role of gender

Publication Type:

Journal Article


European Journal of Psychotraumatology, Volume 8, Issue 1 (2017)




PTSD; aetiology; gender; traumatic events; life events


Background: There is an ongoing debate about the validity of the A1 criterion of PTSD.
Whereas the DSM-5 has opted for a more stringent A1 criterion, the ICD-11 will leave it out
as a key criterion.
Objective: Here we investigated whether formal DSM-IV-TR traumatic (A1) and stressful
(non-A1) events differ with regard to PTSD symptom profiles, and whether there is a gender
difference in this respect.
Method: This was examined in a large, mostly clinical sample from the Netherlands Study of
Depression and Anxiety (n = 1433). Participants described their most bothersome (index)
event and were assigned to either an A1 or non-A1 event group according to this index
Results: Remarkably, in men PTSD symptoms were even more severe after non-A1 than A1
events, whereas in women symptoms were equally severe after non-A1 and A1 events.
Moreover, while women showed significantly higher PTSD symptoms after A1 events than
men (29.9 versus 15.4% met PTSD criteria), there was no gender difference after non-A1
events (women: 28.2%; men: 31.3%). Furthermore, anxiety and perceived impact were
higher in women than men, which was associated with PTSD symptom severity.
Conclusion: In sum, while women showed similar levels of PTSD symptoms after both event
types, men reported even higher levels of PTSD symptoms after non-A1 than A1 events.
These findings shed a new light on the role of gender in PTSD symptomatology and the
clinical usefulness of the A1 criterion.