Gender Differences in Trauma and Addictions

This week, I am attending a Scientific Symposium called “Recovery From Addiction“, organised as part of the Alberta Family Wellness Initiative of the Norlien Foundation. My interest in this meeting (where, for once, I am not a speaker on the program), comes from the close links between mental health, addictions and obesity that I regularly note in my patients.

As someone with no formal training in diagnosing or treating addiction disorders, this symposium is turning out to be most interesting.

Yesterday, much of the program focussed on the link between trauma and addictions; on how addictive behaviours (including food addictions) can result from a wide range of traumatic experiences.

I was particularly interested in the presentation by Stephanie Covington from the Institute for Relational Development at the Center for Gender and Justice, La Jolla, CA, who talked about the important differences in both the nature and behavioural impact of trauma between genders.

Some of these differences are profound and should be noted by anyone dealing with trauma in men and women. For example, while much of the mental, physical or sexual trauma in men is often inflicted by strangers, women often experience these traumas from very people they love and want to be close to. Perhaps not surprisingly, women often have a history of domestic violence, something men are far less likely to have experienced.

This perhaps explains the very different responses that men and women have to trauma: while men tend to respond to trauma with destructive actions (aggression, violence, rages), women tend to respond more often with retreat (isolation, dissociation, depression, anxiety). Interestingly, both genders can respond with self-destructive action (substance abuse, eating disorder, deliberate self-harm, suicidal actions). Overall it appears that women are more likely to respond to trauma with depression than with classical PTSD as defined in DSM IV.

While men will use addictive behaviours to escape and distance themselves from the realities of their lives, women will often manifest addictive behaviours in order to maintain a relationship, to fill a void of what is missing in a relationship, or to self-medicate the pain of abuse or betrayal.

These important differences have a direct relevance for addressing addictions (or obesity) in group settings, which is why Covington made a strong case for running separate groups for men and women.

Overall, Covington made a strong case for using a trauma-informed gender-responsive intervention for women in addiction treatments. Thus, in a paper published in the Journal of Psychoactive Drugs back in 2008, Covington and colleagues found that applying manualised programs (Helping Women Recover and Beyond Trauma), founded on research and clinical practice and grounded in the theories of addiction, trauma, and women’s psychological development, resulted in significantly less substance use, less depression, and fewer trauma symptoms, including anxiety, sleep disturbances, and dissociation.

Covington also notes that the way that women look at the classical 12-steps approach to dealing with addictions, is very different from how men approach the 12-steps. These differences are nicely summarised in Covington’s book A Woman’s Way Through The Twelve Steps.

All of this not only reconfirms my own views on the close links between trauma, addictions and obesity but also made me realise that anyone working with obese clients must be well versed in assessing trauma history, addictions and understanding these powerful emotional and neurobiological influences on ingestive behaviour.

On a closing note, Covington recommended that when working in a setting where there are likely to be many trauma patients, it may be important to do a walk-thru to ensure that the physical environment of the clinic does not have subtle triggers of traumatic memories.

Simply prescribing a diet plan to someone who is using food as a coping strategy is neither useful nor respectful. Relating back to my post yesterday on the secondary prevention of obesity, I sincerely believe that addressing mental health and addictions will be an important part of the solution.

I, for my part, will certainly be paying more attention to the literature on trauma and addictions from now on.

AMS
Banff, Alberta

Covington SS, Burke C, Keaton S, & Norcott C (2008). Evaluation of a trauma-informed and gender-responsive intervention for women in drug treatment. Journal of psychoactive drugs, Suppl 5, 387-98 PMID: 19248396