Sexual assault and PTSD disproportionally affect women, and we need better
treatments
Written by Jennifer Chesak, Author of “The Psilocybin Handbook for Women“
Post-traumatic stress disorder can affect any person of any gender. In fact, it affects
about 6% of people during their lifetime. But as the author of The Psilocybin Handbook
for Women and an advocate for improved healthcare for women and gender nonbinary
folks, I want to point out that those assigned female at birth are two to three times more
likely to develop the condition. That’s according to research published in 2017 by the
European Journal of Psychotraumatology. The prevalence for women is 10%.
One reason for the high prevalence in women might be the high rates of sexual assault
among those assigned female at birth. The events most associated with PTSD in
women are sexual assault and childhood sexual abuse, according to older research
published in the journal American Family Physician. A meta-analysis, published in
Trauma, Violence, and Abuse in 2023 found that of more than 2,000 survivors of sexual
assault nearly 75% met the criteria for a PTSD diagnosis within the first month after the
assault. The therapeutic use of psilocybin may be able to help. I explain after unpacking
a bit about sexual assault and PTSD.
Looking at the statistics, half of women and one third of men in the United States will
experience some type of sexual violence in their lifetime, according to the Centers for
Disease Control and Prevention. The Trevor Project reports that nearly half of
transgender women, men, and nonbinary people who participated in a recent survey
reported experiences of sexual assault. Again, sexual assault happens to all genders.
And although it disproportionately affects women, we know that sexual assault is also
likely under reported in everyone. The bottom line is that it can lead to PTSD.
PTSD is a serious mental health condition that can occur in people who have directly
experienced or witnessed a traumatic event. According to the National Institutes of
Mental Health, for a diagnosis, symptoms must last longer than a month. Symptoms
include reexperiencing (such as having flashbacks), avoidance (such as avoiding
thinking about the traumatic event), reactivity (such as being on edge), and cognition
and mood issues (such as difficulty remembering the event).
PTSD is a chronic condition that can be hard to treat. Only about one-third of patients
recover within a year, according to research published in the journal Cureus in 2022,
and one-third remain symptomatic a decade after the trauma exposure. More than that,
estimates show that up to half of people with PTSD who seek treatment do not have an
adequate response to conventional treatments.
Although more research is needed, researchers report that traumatic stress may impact
those assigned female at birth differently than those assigned male at birth. While males
may have a more “physiological hyperarousal system,” females may have a more
sensitized hypothalamic-pituitary-adrenal (HPA) axis, at least according to animal
models. This information was reported in the European Journal of Psychotraumatology.
The HPA axis is concerned with how we respond to stress. For example, when faced
with a threat, our senses—often sight and sound—send a message to our brain’s
amygdala. The amygdala sends a message to the hypothalamus, also in the brain. The
hypothalamus then jolts our sympathetic nervous system into action, causing the
release of stress hormones to help meet the demands of the threat. Thus, we
experience our fight-flight-freeze response.
But not every threat we experience is an actual threat. Think about those times when
you see your coat rack out of the corner of your eye and think, just for a second, that it’s
a person who’s broken into your place. In response to a threat, the amygdala is prone to
acting quickly to flood your system with adrenaline if needed. But thankfully we also
have our more rational frontal lobes located in the cerebral cortex. The frontal lobes
assess the threat. If it’s not really a threat—as in “Hey, it’s just a coat rack”—you can
quickly calm yourself down.
The clincher is that we also store our fear in the amygdala, and therefore when we
experience triggers, something that reminds us of a past threat, such as sexual assault,
we can experience what’s called “amygdala hijack.” During an amygdala hijack, your
frontal lobes don’t get a chance to assess the threat; the amygdala puts fight-flight-
freeze into motion no matter what. Amygdala hijack is common in PTSD, which is
characterized by amygdala hyperactivity. Therefore, even threats that aren’t really
threats can activate our stress response, leading us to have an outsized emotional
reaction to something minor that’s not really a threat. For example, if you were sexually
assaulted, you might feel absolute panic if someone accidentally brushes against your
arm. Your triggers will be different from the next person’s.
Talk therapy is one tool we can use to navigate trauma and try to retrain our brains to
better assess threats. But one issue with talk therapy alone is that any thoughts of the
original trauma, of the sexual assault or otherwise, can trigger the fight-flight-freeze
response, impeding progress. Talk therapy does work for some people, but certainly not
all.
So here’s where I discuss the potential of magic mushrooms. Psilocybin downregulates
our response to fearful stimuli, decreases that hyperactivity. In therapy then, note the
authors of the study published in Cureus, possibly people with PTSD are more able to
process trauma without having a trauma response.
In a previous installment of my column for Authentic Insider Magazine, I wrote about a
concept called the “helioscope effect,” a term coined by researcher Gregor Hasler, MD.
A helioscope is an instrument scientists use to safely look at the sun. Well, when we’re
on a psychedelic, we view trauma through a safe lens as well, often seeing it with more
detail but without the overwhelming triggers. This can allow us to reprocess our trauma
and reduce the psychological effects of it.
At the same time, psilocybin may boost mood, helping to reduce negative thoughts,
note the authors of the Cureus article. Additionally, the researchers discuss the default
mode network. The DMN is a network of brain regions that work together to form our
sense of self or identity, autobiographical memories, and more. An underactive DMN,
the researchers say, is linked to the avoidance symptom that is characteristic of PTSD.
Psilocybin temporarily alters DMN connectivity, which may have beneficial effects for
PTSD.
I do hope that research progresses on how therapeutic use of psilocybin, under
supervision of a mental health professional, and therapy afterward, may be able to help
people with PTSD, because an overwhelming number of people are dealing with the
condition—many of them women—often stemming from sexual assault.
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