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

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

Research output: Contribution to journalReview articlepeer-review


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.

Original languageEnglish
Article number104
JournalCurrent Psychiatry Reports
Issue number12
StatePublished - 1 Dec 2017
Externally publishedYes

Bibliographical note

Funding Information:
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.

Publisher Copyright:
© 2017, Springer Science+Business Media, LLC.


  • Gender medicine
  • Neurobiology
  • Sex as a biological variable
  • Traumatic stress
  • Women’s mental health

ASJC Scopus subject areas

  • Psychiatry and Mental health


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