Nervous and Endocrine System Dysfunction in Posttraumatic Stress Disorder: An Overview and Consideration of Sex as a Biological Variable

Biol Psychiatry Cogn Neurosci Neuroimaging. 2020 Apr;5(4):381-391. doi: 10.1016/j.bpsc.2019.12.006. Epub 2019 Dec 19.


Decades of research into the biological mechanisms of posttraumatic stress disorder (PTSD) suggests that chronic activation of the stress response leads to long-lasting changes in the structure and function of the nervous and endocrine systems. While the prevalence of PTSD is twice as high in females as males, little is known about how sex differences in neuroendocrine systems may contribute to PTSD. In response to the paucity of research on sex-related mechanisms, the National Institutes of Health created a policy that asks researchers to consider sex as a biological variable. This review provides an overview of the current understanding of nervous and endocrine dysfunction in PTSD (e.g., neural circuitry, autonomic arousal, hormonal response), highlighting areas where the influence of sex has been characterized and where further research is needed. We also provide recommendations for using the sex-as-a-biological-variable policy to address specific gaps in PTSD neuroscience research.

Keywords: Endocrine; Imaging; PTSD; Physiology; SABV; Sex.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Arousal
  • Endocrine System
  • Female
  • Humans
  • Male
  • National Institutes of Health (U.S.)
  • Sex Characteristics
  • Stress Disorders, Post-Traumatic*
  • United States