Stress Response: Understanding Gender Differences in Dealing with Stress

// Corey Schuler, MS, DC, CNS

Stress Response: Understanding Gender Differences in Dealing with Stress

Assessing stress is complicated business. Many disciplines are asking profound and perhaps age-old questions about the differences between men and women and how they go about dealing with stress. There are questions for epidemiologists, biopsychologists, geneticists, basic scientists, as well as social scientists. With lots of questions come lots more questions!
Self-reported stress was not associated with the cortisol response.Women are being treated at a rate of 1.5-2 times the frequency of men for mood and stress response goals.1 Some studies suggest that women are more likely than men to seek professional treatment, especially if they are also diagnosed with one or more comorbidities.2
Although limited, data available has suggested that there is no significant gender differences for response to oral agents.3,4 Yet, evidence shows that prescribing habits of practitioners vary for the same situation when treating women.5 A gender difference is noted in the absorption, bioavailability, and distribution of agents used to support the stress response.6,7 Imaging studies have suggested women with a distinct fear response and high harm avoidance scores as compared to men have a more active and larger anterior cingulate cortex.8,9 Whether these pieces of information are clinically meaningful is up for debate, but so goes the nature of science.
I am fascinated by the results of the Trier Social Stress Test (TSST). It is an established tool that attempts to measure stress response by inducing a social/ evaluation-type threat. This is done in a biopsychology laboratory by subjecting participants to a mock job-interview. The TSST measures acute, sub-maximal stress responses.
In biopsychology circles, the 1995 Kirschbaum study in Psychosomatic Medicine was a real eye-opener.10 In this study, male and female participants either received social support by their romantic partners, by an opposite-sex stranger, or no support immediately before the TSST.
The support was provided verbally. Designers of the study describe the support as “focusing on positive appraisals and information on effective self-presentation.” I imagine it to be like a pre-game pep talk. What investigators found surprised the biopsychology community. Social support attenuated the stress reaction only for men. Men showed a lower cortisol response when supported by their partners and men benefitted when supported by strangers to some degree. Women, however, did not benefit from social support as the study was designed. In fact, there was a tendency for increased levels of cortisol when obtaining support from their partners. This is the physiologic response to stress. Participants were asked to rate their stress and all participants reported a moderate level of stress. That’s an important nugget of information. Self-reported stress was not associated with the cortisol response.
The initial conclusions of this experiment might be that the effectiveness of social support is based on the gender of who is receiving the intended support and by familiarity with the support provider. However, the study was confounded since male participants were always supported by females and vice versa.
So, does this mean that verbal “pre-game” social support is less useful for women in dealing with stress? What about social support in general for women? Does it mean that men, as romantic partners, are less equipped to provide support? Are these results due to physiological, psychological, or sociological variables? Good questions which remain largely unanswered.
There does seem to be gender differences in stress responses. Data from female twin registries surveys suggest the potential role of genetic versus environmental factors in the stress response.11-13 The potential role of female reproductive hormones and related cycles in the development, course, and outcome of stress response in women is also very intriguing.14,15
For the practicing clinician, most of this information has to be set aside at the time of the patient encounter to address her concerns and goals. I do my best to paint a picture of the individual’s response to stress using various tools including examining the HPA axis. A few of the practical tools I use include the Holmes and Rahe’s Personal Stress Inventory which asks patients to check off major life stressors over the past year. The Hamilton Anxiety Rating Scale is a clinician observation tool that attempts to quantify visible stress responses. The good ol’ visual (or more commonly verbal) analog scale has limited utility but is not without value.16 It is so easy that almost everyone uses it and is a natural part of the clinical discussion. In addition, this HPA Axis Optimization Program is designed to help accurately assess common and complex symptoms within various stress response stages - thereby improving patients' ability to respond and adapt to stressful stimuli while promoting energy recovery and restorative sleep.

HPA Axis Optimization Program

Corey Schuler, MS, DC, CNS

Corey Schuler is the Director of Clinical Affairs for Integrative Therapeutics. He is a certified nutrition specialist, licensed nutritionist, and chiropractic physician board-certified in clinical nutrition. He has earned degrees in nursing and phytotherapeutics, and has a private integrative medicine practice in Hudson, Wisconsin.

Dr. Schuler is an adjunct assistant professor at the School of Applied Clinical Nutrition at New York Chiropractic College. He volunteers for the Board of Certification for Nutrition Specialists and is a member of Institute for Functional Medicine, American College of Nutrition, and American Nutrition Association. He has conducted dozens of national seminars, media, and podcast interviews including CBS-WCCO and other radio stations, Intelligent Medicine, Underground Wellness, Five to Thrive Live, Aging but Dangerous, Rebel Health Tribe, and countless online summit appearances. He is on the board of directors for the International Probiotics Association and an advisor to Functional Medicine University.
1. Kessler RC, McGonagle KA, Zhao S, et al. Lifetime and 12-month prevalence of DSM-III-R psychiatric disorders in the United States: results from the National Comorbidity Survey. Arch Gen Psychiatry. 1994;51(1):8-19.
2. Fagioli-Petrillo L, Viguera A, Kennen J, Cohen L. Utilization of health care services by obstetric patients with psychiatric disorders [abstract]. In: 13° Annual Meeting of American Psychiatric Association 2002; Philadelphia, 18-23 May
3. Steiner M, Allgulander C, Ravindran A, et al. Gender differences in clinical presentation and response to sertraline treatment of generalized anxiety disorder. Hum Psychopharmacol. 2005;20(1):3-13.
4. Burnham D, Iyengar M, Gellew K, et al. Paroxetine: effective treatment for GAD regardless of patient gender, race, or GAD severity? [abstract]. In: 12° Annual Meeting American Psychiatric Association 2001; New Orleans, 5-10 May
5. van der Waals FW, Mohrs J, Foets M. Sex differences among recipients of benzodiazepines in Dutch general practice. BMJ. 1993;307(6900):363-6.
6. Jensvold M, Halbreich U, Hamilton J, eds. Psychopharmacolgy and women: sex, gender, and hormones. Washington, DC: American Psychiatric Press; 1996.
7. Pollock BG. Gender differences in psychotropic drug metabolism. Psychopharmacol Bull. 1997;33(2):235-41.
8. Pujol J, Lopez A, Deus J, et al. Anatomical variability of the anterior cingulate gyrus and basic dimensions of human personality. Neuroimage. 2002;15(4):847-55.
9. Butler T, Pan H, Epstein J, et al. Fear-related activity in subgenual anterior cingulate differs between men and women. Neuroreport. 2005;16(11):1233-6.
10. Kirschbaum C, Klauer T, Filipp SH, Hellhammer DH. Sex specific effects of social support on cortisol and subjective responses to acute psychological stress. Psychosom Med 1995; 57:23–31.
11. Kendler KS. Major depression and generalized anxiety disorder. Same genes, (partly) different environments-revisited. Br J Psychiatry. 1996;Suppl 30:68-75.
12. Kendler KS, Walters EE, Neale MC, Kessler RC, Heath AC, Eaves LJ. The structure of the genetic and environmental risk factors for six major psychiatric disorders in women. Phobia, generalized anxiety disorder, panic disorder, bulimia, major depression, and alcoholism. Arch Gen Psychiatry. 1995;52(5):374-83.
13. Kendler KS, Neale MC, Kessler RC, Heath AC, Eaves LJ. Generalized anxiety disorder in women. A population-based twin study. Arch Gen Psychiatry. 1992;49(4):267-72.
14. Shear MK. Anxiety disorders in women: gender-related modulation of neurobiology and behavior. Semin Reprod Endocrinol. 1997;15(1):69-76.
15. Redmond G. Mood disorders in the female patient. Int J Fertil Womens Med. 1997;42(2):67-72.
16. Lesage FX, Berjot S, Deschamps F. Clinical stress assessment using a visual analogue scale. Occup Med (Lond). 2012 Dec;62(8):600-5. 

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