What Exactly Is PTSD?

Post-traumatic stress disorder (PTSD) doesn't discriminate; it can affect anyone who has been directly or indirectly exposed to a traumatic event. However, the way PTSD manifests can differ between men, women, and other gender identities. Understanding these differences facilitates effective treatment and support. In this informational guide, we'll explore how PTSD symptoms vary by gender identity, what triggers them, and personal considerations you might take into account when managing this complex condition. While this content addresses general experiences of PTSD by gender identity and biological sex, it's important to remember that these are generalizations. We acknowledge that every individual is unique and may have different experiences and responses to trauma that differ from what we've outlined here. What is PTSD? PTSD is a mental health condition triggered by experiencing or witnessing a traumatic event, which could include anything from natural disasters and serious accidents to personal assaults and military combat. Individuals with PTSD often relive the traumatic event through flashbacks or nightmares, leading to severe anxiety and emotional distress. PTSD symptoms typically include: Intrusive memories Avoidance behaviors Negative changes in thinking and mood Alterations in physical and emotional reactions These symptoms can be debilitating and interfere with daily life, but they can also vary significantly based on one’s biological sex and/or gender identity. PTSD in men vs. women vs. others PTSD affects individuals differently based on a variety of factors, including biological sex, gender identity, and gender expression: Biological sex: Refers to the physical characteristics (such as reproductive organs, chromosomes, and hormones) that are typically categorized as male or female. Gender identity: Refers to a person's internal sense of their gender, which may be male, female, both, neither, or somewhere along the gender spectrum. Gender expression: Refers to how a person presents their gender outwardly through behavior, clothing, haircut, voice, and other forms of presentation. Sexuality could also play a role, as it can be closely related to one’s gender identity and expression. Individuals who identify as lesbian, gay, or bisexual may face unique stressors and traumatic experiences related to their sexual orientation, which can influence the development and manifestation of PTSD. Each group may experience distinct types of trauma, exhibit different acute responses, and adopt varying coping mechanisms. Understanding these differences helps to tailor effective treatment plans and provide comprehensive care for all individuals affected by PTSD. Prevalence of PTSD Studies show that the condition is more common in females than in males. Approximately 10% of females and 4% of males will develop PTSD at some point in their lives. PTSD in transgender and gender-diverse individuals is significantly higher, with estimates suggesting that up to 42% of transgender and gender-diverse individuals meet the criteria for PTSD​. The high rate may stem from compounded stress from societal stigma, discrimination, and frequent experiences of violence and harassment that transgender and non-binary people face​. Type of trauma The types of trauma that lead to PTSD in men, women, and transgender and non-binary individuals can also differ. Males: More likely to experience trauma related to accidents, physical assault, combat, or witnessing death or injury.  Females: More likely to experience trauma related to sexual assault, childhood abuse, or domestic violence. LGBTQIA+ individuals: In addition to the common traumas related to any relevant gender(s), they are more likely to experience trauma from hate crimes, harassment, homophobic/transphobic violence, and discrimination. Males in this community may also have experienced domestic violence or have endured childhood abuse. Transgender and non-binary individuals: May also experience trauma related to gender dysphoria. These differences in trauma types can influence how PTSD manifests and is treated. Immediate responses to trauma The immediate response to trauma can also vary by gender identity. Those who identify as men generally exhibit more externalizing behaviors, such as aggression, irritability, or substance abuse. In comparison, people who identify as women may show more internalizing behaviors, such as intense fear, helplessness, or anxiety. Gender-diverse individuals might experience a mix of these responses or different reactions altogether, influenced by their unique experiences and societal pressures. These differences in acute responses can affect how quickly PTSD is recognized and diagnosed. Neurobiological stress response  Research indicates that the neurobiological responses to stress and trauma differ between gender identities: Men with PTSD: Tend to have a more pronounced ‘fight or flight’ response, characterized by physiological reactions like increased adrenaline, cortisol levels, and heart rate.  Women with PTSD: Might exhibit a stronger emotional response, potentially due to hormonal variations like estrogen and cortisol, and can often have a ‘tend and befriend’ response, involving nurturing behaviors and seeking social support, driven by the hormone oxytocin. LGBTQIA+ individuals with PTSD: May have unique stress responses influenced by how they express their gender identity and the ongoing societal pressures and discrimination they face. Stress responses can influence the development and severity of PTSD symptoms, so it’s important to recognize and consider them based on how you identify. Comorbidity rates PTSD often occurs alongside other mental health conditions, and these comorbidity rates can vary by gender identity. Men with PTSD: More likely to have concurrent issues with substance abuse or anger management. Women with PTSD: More likely to experience depression, anxiety disorders, or eating disorders. PTSD in transgender and non-binary individuals: Higher rates of co-occurring mental health conditions such as anxiety, depression, and substance abuse. Understanding these — as well as other — comorbidities is important for developing comprehensive treatment plans. Coping styles Men, women, and gender-diverse individuals will often use different coping styles to manage PTSD symptoms. Males: More likely to use active (‘fight or flight’) coping strategies where they either confront the trauma head-on or avoid it altogether, both of which can provide temporary relief but also often exacerbate PTSD symptoms in the long run. Females: More likely to use relational (‘tend and befriend’) coping strategies, such as seeking support from friends and family or engaging in caregiving activities, which can be beneficial for emotional healing but may not address the root causes of PTSD symptoms. Transgender and non-binary individuals: Coping mechanisms can vary and may include both active and relational strategies. These coping styles can influence the effectiveness of different PTSD treatment approaches. Seeking help Across the spectrum of genders, there are significant differences in one’s willingness to seek help or ability to access help for PTSD. Men with PTSD: Could delay seeking help due to societal expectations of toughness and self-reliance, though mental healthcare is becoming more and more accepted among this group. Women with PTSD: Generally more willing to seek professional help and participate in therapy. LGBTQIA+ individuals with PTSD: Might hesitate to seek help due to previous negative experiences with the healthcare system or fears of encountering homophobia, discrimination, or prejudice from providers. PTSD in non-binary and transgender individuals: May face additional barriers to seeking help, including lack of access to gender-affirming care. These differences can impact treatment outcomes and highlight the importance of tailored outreach and support strategies. PTSD treatment considerations Treating PTSD effectively requires understanding the unique needs of each individual, which can vary based on gender identity, type of trauma experienced, and personal history.  Treatment options for PTSD  Treatment for PTSD in women, men, and gender-diverse individuals often involves a combination of options. These are some of the commonly prescribed medications and frequently used types of therapy: Medication: Antidepressants, such as selective serotonin reuptake inhibitors (SSRIs), are often prescribed to help manage PTSD symptoms. They can help stabilize mood and reduce anxiety, augmenting other forms of therapy. Cognitive behavioral therapy (CBT): This type of therapy focuses on changing negative thought patterns and behaviors associated with PTSD. Prolonged exposure therapy (PE): PE involves repeated, detailed imagining or recounting of the trauma in a safe environment to reduce the distress it causes. Eye movement desensitization and reprocessing therapy (EMDR): EMDR uses guided eye movements to help the brain process and integrate traumatic memories. Therapies such as CBT, PE, and EMDR offer structured ways to process and manage trauma. Both therapy and medications like SSRIs can provide symptom relief. Transgender and non-binary PTSD treatment  To provide effective PTSD treatment for transgender and non-binary individuals at Cerebral, we focus on providing gender-affirming mental healthcare, including using correct pronouns and preferred names, creating a safe and inclusive environment, and being knowledgeable about the unique experiences of transgender and non-binary individuals. Our mental health professionals can also tailor treatment plans to address the specific types of trauma and stressors faced by transgender and non-binary individuals. This might include addressing issues related to gender dysphoria and societal discrimination. At Cerebral, we are committed to delivering personalized care by professionals who recognize that each person's path to mental wellness is unique to them, and that absolutely includes individualized mental healthcare for the LGBTQIA+ community. Images by freepik, freepik, and freepik on Freepik. *The information in this blog is provided as a general educational resource only, and is not to be used or relied on for any diagnostic or treatment purpose. This information should not be used as a substitute for professional diagnosis and treatment and does not create any patient-physician relationship between you and Cerebral. Please consult your health care provider before making any health care decisions or to get guidance about a specific medical condition.

Even in the face of its seriousness, suicidal ideation often goes undiscussed because of the stigma that can surround it. But, as we're talking more and more openly about mental health, it's essential that we approach the subject of suicidal thoughts with as much empathy, openness, and support as possible. If you find yourself grappling with these thoughts, or if you're trying to understand and support someone you care about who is, this guide is for you.  Suicide prevention support If you're thinking about acting on suicidal thoughts, reach out for help immediately.  Call 911 if you’re having a mental health emergency. Text HOME to 741-741 if you're emotionally distressed and need immediate support. Call 988 for the National Suicide Prevention Hotline. What is suicidal ideation? Suicidal ideation transcends mere fleeting thoughts about death; it's a whole range of thinking that might start with not wanting to wake up and can go all the way to planning how to end one's life. Often accompanied by a sense of hopelessness, these intrusive thoughts can be potentially dangerous. Despite the severity, feeling this way doesn't have to be permanent. Instead, these thoughts can be a signal that indicates deeper psychological distress and emotional pain that need to be addressed.  The prevalence of intrusive thoughts  While it can feel isolating to experience, this mental health condition affects many. Every year, millions of people report these thoughts to medical professionals. Between 2015 and 2019, the CDC found that an estimated annual average of 10.6 million U.S. adults had thoughts of suicide in the past year, which accounted for about 4.3% of the adult population. Intrusive thoughts don't discriminate — depression can affect individuals of any age, gender, education level, socioeconomic status, or background. Suicidal ideation is part of a broader mental health landscape; it’s not a ‘character flaw.’  What causes suicidal thoughts? The causes of suicidal ideation are as varied as the individuals who experience it. They often stem from life circumstances, mental health disorders, or personal resilience levels. Common underlying conditions can include:  Major depressive disorder Bipolar disorder Post-traumatic stress disorder (PTSD) Social isolation Chronic pain Substance use disorder Understanding the warning signs of suicidal ideation in others For friends and family, recognizing the warning signs for suicide is paramount for timely intervention. The signals can look similar to the signs of depression and anxiety, but are typically more severe. Look for these behaviors: Withdrawal from social circles  Giving away possessions Sudden calmness after a period of depression Statements of feeling hopeless or having no purpose  Remember: Not everyone exhibits clear ‘red flags,’ and a person at risk might go to great lengths to hide their pain. How is suicidal ideation diagnosed? Identifying suicidal ideation typically occurs during a supportive conversation with a mental health expert. These caring professionals will talk with a patient, sometimes using questionnaires, to better understand their feelings and the severity of the thoughts they're facing.  They will also look for any underlying mental health conditions or life experiences that may be contributing to or exacerbating the intrusive thoughts. The recognition of suicidal ideation is less about certainty and more about concern. The presence of suicidal ideation often prompts an immediate need for intervention, regardless of other diagnoses. It's about recognizing that these feelings are a call for help and responding with the urgent care and support needed. What to do if you are experiencing suicidal ideation When you’re experiencing suicidal ideation, seeking help and taking action are crucial. Getting urgent help Seek help immediately if you're thinking about acting on suicidal thoughts. The 988 Lifeline provides 24/7, free, confidential support and crisis resources. Your options also include calling 911 or going to the nearest emergency room. No matter what course of urgent help is seen as the best fit at the moment, you will want to seek the support of a mental health professional as soon as possible. That also can be your first step when experiencing distress. Steps to take when it isn’t an emergency If you’re not in immediate danger, these are the first steps you could take toward getting the judgment-free help you deserve. 1. Make an appointment with a mental health professional Professional intervention is crucial in managing the risk of suicide or self harm. A mental health professional will provide a safe space to explore the thoughts and feelings you are experiencing. They can guide you to understanding the factors and strategies to manage your mental well-being effectively. 2. Identify and remove triggers Start by identifying the triggers that lead to these intrusive thoughts. They might be certain places, people, or events that consistently lead to distress. It might not necessarily mean avoiding them permanently, but it can allow for a safer environment while you address this mental health condition. 3. Reach out to a close friend or loved one  You’ll need a strong support system. You may be nervous about opening up, but doing so with a trusted, supportive connection can be a critical step in alleviating the burden, finding relief, and embarking on recovery. 4. Call a suicide hotline If you don’t feel comfortable talking to someone close to you at the time, a suicide hotline can be an invaluable mental health resource. Specialists on these hotlines are trained to support and assist those in crisis.  Managing suicidal ideation is a process; there will be ups and downs. The most crucial thing is to keep moving forward and continue seeking help from mental health resources. Treatment options for suicidal ideation There is no one-size-fits-all approach to treating suicidal ideation. Treatment will vary based on the individual’s needs but may include psychotherapy, medication, or a combination of the two. Hospitalization or intensive outpatient programs may be necessary for those at immediate risk of self-harm.  Additionally, new approaches to reducing suicidal ideation are continually being explored and implemented, often creating expanded access to care.  Treatment goals Regardless of the course of treatment, the focus will be on achieving several key goals. Address the underlying factors contributing to the intrusive thoughts.  Build coping strategies for preventing suicide. Create a support network for the individual.  Individuals will be actively involved in their treatment plan, working collaboratively with their care team. The path to recovery Recovery from suicidal thoughts comes with its own challenges, but many individuals who have once experienced these thoughts have gone on to live fulfilling lives. Recovery often involves finding the right treatment, building a solid support system, and learning healthy coping mechanisms. We know that each person's road to recovery is unique, but it’s important to avoid projecting set timelines or expectations. Celebrating the small victories can make a world of difference. Whether it’s practicing a new coping skill or continuing to seek help, these concrete steps signify resilience and strength. Remember: Patience and consistency in support are key if you’re standing by someone in recovery.  The myth and reality of suicidal thoughts and creativity There is a common misconception that suicidal ideation is a byproduct of creativity. While individuals with artistic inclinations might be predisposed to deeper emotional experiences, it’s crucial not to romanticize or normalize the suffering that comes with suicidal thoughts. The art lies in expressing your emotions in a healthy manner that supports your well-being rather than harming it. Art, writing, and other creative outlets can be a powerful force in recovery. However, these outlets should be harnessed under the guidance of a mental health professional so their benefits can enhance structured therapy and/or medication like anti-depressants or mood stabilizers. The role of community in suicide prevention Support can take many forms, from suicide prevention organizations and support groups to simply being there for someone in need. By building a community that is educated on the warning signs of suicide and the steps to take to support someone in crisis, we can provide a safety net for those who are in need.  Engaging in open, honest conversations about mental health and suicide removes the stigma that often surrounds these topics. Creating a safe space to talk makes it easier for people to seek help and for those around them to provide support. If you or someone you know is struggling with suicidal thoughts, please know that there is hope and help available. Reach out to a mental health professional, call the national suicide prevention hotline at 988, or talk to someone you trust.  Remind yourself: You are not alone — there are people who care and want to help.  Working to stop suicidal thoughts Cerebral is continuing to make strides in improving clinical quality and safety for those experiencing suicidal ideation. With systems in place to connect you to care quickly in crisis situations, not only can unnecessary emergency room visits and hospitalizations be avoided, but meaningful improvements in symptoms can be made in a short period. Of the patients who come to Cerebral considering suicide, half of the individuals stopped having thoughts of suicide within an average of 6 months of treatment. This highlights the powerful impact of seeking support and the real possibility of regaining a sense of hope and purpose. Critical resources 988 Suicide & Crisis Lifeline offers free and confidential support via phone, text, or chat. Crisis Text Line allows one to text with a trained crisis counselor for free by texting TALK to 741-741. Veterans Crisis Line enables veterans to get help via text by sending one to 838255. Vets4Warriors provides free, 24/7 peer support for veterans via phone at 855-838-8255 or by email. The Trevor Project offers immediate crisis support for LGBTQ+ youth via phone at 1-866-488-7386 or by texting START to 678-678. Image by rawpixel.com on Freepik.

Veterans face a unique set of challenges upon ending active duty, with caring for their mental health as arguably the most significant. Traumas they may have experienced while deployed don’t simply disappear once they take off their uniform. Veterans may suffer any one of numerous invisible wounds during service or while reintegrating back into civilian life. For example, nearly 1 in 3 are reported to struggle with PTSD. And the National Alliance on Mental Illnesses (NAMI) reports veterans are five times more likely to have depression than non-veterans.  Unfortunately, many barriers stop veterans from seeking the mental health services they need to overcome their challenges and lead happier lives. In this article, we explore the barriers veterans face in getting proper treatment and how Cerebral is expanding access to online care to better serve those who served our country.  Barriers to accessing mental health services Military servicemembers report facing stigma when trying to address their mental health issues. In a study involving active-duty military soldiers, 44.2% of participants admitted to being deterred from seeking mental health services due to fear of how their unit leadership might perceive them. Additionally, 42.9% expressed concern about being viewed as weak by their peers. As a result, many current and former soldiers suffer in silence. But that’s not all.  Research highlights that a staggering 70% of veterans avoid seeking mental health services out of fear of being diagnosed with a mental illness. This fear serves as yet another barrier to veterans achieving mental wellness.  Veterans not only face a higher risk of experiencing PTSD compared to the general population but also encounter distinct challenges in accessing adequate treatment. These challenges involve prerequisites such as needing an honorable or general discharge to access Department of Veterans Affairs (VA) medical benefits and extended waiting lists at VA medical centers.  A study by the RAND Center for Military Health Policy Research found that less than half of returning veterans in need of mental health services actually receive any treatment. Additionally, of those undergoing treatment for PTSD and major depression, less than one-third are receiving evidence-based care. Online care expands access to mental health services for our heroes Cerebral’s mission is to provide high-quality, affordable mental health services to all. In support of that objective, we’re launching our Cerebral Heroes program which expands access to life-changing care to America’s heroes. Veterans, active duty service members, and their families can join to receive professional therapy and medication management—100% online.   The online nature of Cerebral brings a transformative advantage to our heroes by providing virtual access to mental health professionals. This approach eliminates geographical constraints, enabling individuals to connect with a broader range of specialized therapists and medication prescribers from the comfort of their homes. For those in remote areas or facing mobility challenges, this virtual accessibility is a game-changer, ensuring they receive high-quality care regardless of location. The convenience of virtual meetings also addresses the often-cited barrier of time constraints for veterans and active-duty members. Moreover, our online platform offers a level of privacy that is particularly crucial for those dealing with the stigma surrounding mental health in military communities. By conducting sessions from the privacy of their own space, individuals can seek the support they need without the fear of judgment, fostering a more open and confidential environment for their mental health journey.  And when it comes to efficacy, research published by the Journal of Clinical Psychology found that virtual therapy sessions were equally as effective as standard in-person treatment, and led to a significant reduction in PTSD symptoms. Exclusive savings on our mental health services All of Cerebral’s subscription plans are cost-effective and insurance-free, so patients can affordably access the help they need without complicated bureaucracy. And under our Cerebral Heroes program, we now offer veterans, active military, and their families exclusive savings of 15% off any Cerebral plan when using discount code HERO at checkout. It’s our way of serving those who served our country. Join Cerebral today and start your journey to better mental health and a happier life.