Front. Psychiatry Frontiers in Psychiatry Front. Psychiatry 1664-0640 Frontiers Media S.A. 10.3389/fpsyt.2022.858304 Psychiatry Brief Research Report Social Construction and Evolutionary Perspectives on Gender Differences in Post-traumatic Distress: The Case of Status Loss Events Azoulay Roy * Gilboa-Schechtman Eva Department of Psychology and Gonda Multidisciplinary Brain Center, Bar-Ilan University, Ramat Gan, Israel

Edited by: Rachel G. Zsido, Max Planck Institute for Human Cognitive and Brain Sciences, Germany

Reviewed by: Marco Antonio Correa Varella, University of São Paulo, Brazil; Justin Kyle Mogilski, University of South Carolina Salkehatchie, United States

 *Correspondence: Roy Azoulay, royazoulaypsy@gmail.com; royazoulay87@gmail.com

This article was submitted to Anxiety and Stress Disorders, a section of the journal Frontiers in Psychiatry

 16 05 2022 2022 13 858304 19 01 2022 19 04 2022 Copyright © 2022 Azoulay and Gilboa-Schechtman. 2022 Azoulay and Gilboa-Schechtman

This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

Women report greater post-traumatic distress (PTD) than men following physically threatening events. However, gender differences in PTD following social stressors such as status losses are understudied. Whereas the social construction account points to a general sensitivity in women following any type of stressor, the evolutionary account suggests enhanced sensitivity to status losses in men, especially following inter-males aggressions. These propositions were examined in two studies (Study 1, N = 211; Study 2, N = 436). Participants were asked to recall a status loss and to fill out measures assessing PTD and depression severity. In line with the evolutionary account, men, as compared to women, displayed enhanced PTD following status loss. Status losses conducted by men against men were associated with greater PTD than were instances involving other target-aggressor pairings. Finally, age was negatively associated with PTD in men but not in women. The examination of evolutionary challenges modifies the standard view linking the female gender to enhanced sensitivity to trauma. Thus, the pattern of enhanced sensitivity to stressful events appears to be affected by gender- and development-specific adaptive challenges.

 trauma gender social-rank evolutionary psychology humiliation status sex PTSD Introduction

Studies have shown small to moderate effect sizes of gender on the prevalence of post-traumatic distress (PTD) following exposure to trauma [For review: (1)]. Women are diagnosed with post-traumatic stress disorder approximately twice as often as men (2), and report higher levels of both re-experiencing, avoidance, and arousal symptoms (3). Furthermore, consistent meta-analysis results documented enhanced PTD in women compared to men following a wide variety of events including assaults, accidents, disasters, combat of war and injury or death witnessing, whereases enhanced PTD in men compared to women was not found following any type of stressor (4).

However, the scope of these gender differences is debated. On the one hand, the social construction account points to a general sensitivity in women due to lower (perceived and actual) social status and a propensity for more internalized coping styles (5). The evolutionary account, in contrast, suggests that the traumatic impact of an event is associated with its interruption of sociobiological goals, and thus, is likely to differ between the genders (6, 7). Specifically, evolutionary theorists argue that whereas women tend to be more susceptible to physical threats, men are more sensitive to status losses (8–10). Notably, most studies examining gender differences and PTD focused on physically threatening events [falling inside Criterion A definition in the DSM-V, (11, 12)]. Clearly, such data do not differentiate between the predictions of the social construction and the evolutionary accounts. Examining gender differences in response to status loss events (SLEs; e.g., humiliation, demotion) which are known to provoke PTD (13), is central to differentiating between the two theories. This is the main goal of the present study.

Social Construction Theory

According to social construction theorists, women’s propensity to develop PTD is explained by their perceived lower status, feelings of powerlessness, and reinforced shame responses following traumatic events (5). According to this reasoning, PTD is expected to be more severe in women following any type of traumatic event (including SLE). Indeed, low-status individuals report higher distress following SLEs (14), and feelings of powerlessness or increased activation of shame responses contribute to reported distress following such events (15–17). Notably, if women’s enhanced PTD originates from status deficiency as suggested by social constructionists, that tendency is expected to be present, and even emphasized, in events that compromise social status.

Furthermore, the social construction account suggests that, due to status gender inequality, women tend to encounter more SLEs instigated by men (18, 19). Importantly, according to this account, because traditional male gender roles emphasize dominance and power, men are more prone to challenge the status of women, often as an inter-gender aggressive means to maintain low status in women and enhance men’s own social standing (5, 18, 19). Notably, women experience more shame and display more submissive behaviors following SLEs that are committed by men (20, 21). Thus, according to the social construction theory, SLEs conducted by men against women are suggested to be more traumatic than other types of victim-aggressor gender combinations.

Finally, according to the social construction theory, gender-roles are predicted to become more salient with age due to continuous endorsements of social constructs (22). Because gender-roles predict response to trauma more than biological gender does, PTD severity in women is expected to increase with age (23). Moreover, the status differential between genders increases throughout adulthood (24, 25), again consistent with women’s predicted vulnerability to SLEs. In summary, social construction theory is consistent with a generalized scope of women’s vulnerability and predicts that such vulnerability echoes the women’s endorsement of their traditional cultural gender-roles.

 Evolutionary Theory

According to the evolutionary perspective, SLEs reduce access to resources and mating options for both genders (26, 27, 94, 96). However, status is more strongly linked to reproductive prospects and wellbeing among men, than among women (28–30). Importantly, status change in men is often determined by single events (such as SLE) whereas in women this change tends to be associated with continuous accumulation of events (31, 32). Moreover, SLEs were found to affect objective markers of social dominance (e.g., testosterone) to a greater extent in men than in women (33, 34). Taken together, evolutionary theories suggest that, as compared to men, men are likely to be more susceptible to severe PTD following SLEs.

Evolutionary models further suggest that status is attained differently among men and women (35), and is more preferentially determined via intrasexual conflicts among men [(36); p. 429; (37, 98)]. Indeed, replicated findings indicate that social status in males, but not females, is strongly associated with the (perceived and actual) ability to physically win intrasexual conflicts [for reviews, see (37, 38)]. Notably, the exercise of status-related physical inter-males competition was partially replaced by knowledge- and skills-based competition among humans (39). Moreover, in primates, losing in intrasexual conflicts is the most common precursor to social demotion only among males (32, 40, 41). Accordingly, evolutionary accounts indicate that sensitivity for SLEs may be enhanced when both the aggressor and the victim of SLEs are men.

Finally, evolutionary theorists expect status concerns to mirror men’s fertility (42). Consequently, status concerns are predicted to be weakened by age due to age-related reductions in reproductive goals (43, 44). Indeed, testosterone levels decline with age especially among men (45). Moreover, results based on large samples document that discrepancy in status motivations between men and women, which emerges in adolescence and persists throughout early adulthood, is diminished in late adulthood (46). Hence, the enhanced sensitivity in men in response to SLEs is suggested to be age dependent.

Taken together, evolutionary models highlight the differences between women and men’s reproduction strategies which map onto discrepancies in psychological features such as anxiety, intra-gender aggression and status seeking (47, 48, 99). Those discrepancies are postulated to be amplified in early adulthood, when reproduction goals are most salient (49). Accordingly, the predictions of the evolutionary theory are consistent with a limited and specific scope of vulnerability in women which mirrors the activation of survival and reproductive goals.

 Current Research

The aim of the current research is to contrast the social construction and the evolutionary theories regarding gender differences in PTD following SLEs. Specifically, according to the social construction account, SLE would induce more severe PTD in women as compared to men, especially when the aggressor is a man. Furthermore, because the status differential between genders increases with age (24), women’s sensitivity to SLE is expected to increase with age. In contrast, the evolutionary theory hypothesizes that SLEs would induce more severe PTD in men compared to women, especially following SLEs that were carried out by other men. Finally, the evolutionary account further suggests that the enhanced PTD among men following SLE would decrease with age.

Accordingly, we contrasted three pairs of hypotheses. First, we hypothesized that women would differ in their PTD levels compared to men following SLEs (the men sensitivity vs. women sensitivity hypotheses); Second, we hypothesized that the gender of the aggressor would affect PTD levels. Specifically, we predicted based on evolutionary theories that SLEs conducted by men against men would be most traumatic (the inter-males aggression hypothesis) or that in accordance with social construction theories, SLEs conducted by men against women would be the most distressing (the males against females aggression hypothesis). Finally, we expected that gender and age would interact to predict PTD. In line with the evolutionary account, we predicted that SLEs would correlate with age especially among men (the age-men link hypothesis), whereases based on the social construction theory we predicted that age would correlate especially with PTD among women (the age-women link hypothesis).

Two studies were conducted to address these hypotheses. In both studies, we asked participants to recall an SLE and report on event related, as well as general, measures of distress. In the first study we invited participants who encountered a significant SLE (N = 212), whereas in the second study we included all individuals who were able to identify any specific SLE experience (N = 436). Notably, because detecting interaction in regression requires a sample size four times larger than that requires to detect the main regression effect (50), we examined the age-related PTD hypotheses by combining our two samples. Furthermore, depression was included as a covariate due to its robust association with distress following SLEs (51).

 Method Study 1 Participants

Based on the reported moderate effects in studies that investigated the relation between gender and PTD (4), a sample size of 210 was chosen as providing sufficient power for identifying the anticipated effects [G*Power 3.1; (52)]. A greater number of participants (N = 374) was recruited based on the exclusion rate in prior similar studies (53). Participants were recruited via the Amazon Mechanical Turk (MTurk) platform and received 5$ for their participation. All participants were from the United States with English as their native language. Exclusion criteria were: (a) filling out the survey from an I.P used by another participant/s [(53); n = 37]; (b) completing the autobiographical task in a non-conscientious manner (i.e., writing irrelevant text in the description of the memory as assessed by the two authors; n = 126). The final sample consisted of 211 participants (80 women). Participants’ ages were between 22 and 69 (Mean = 36.7; SD = 10.2). The average number of education years was 15.1 (SD = 4.1).

 Procedure

Participants were invited to take part in a 30-min survey geared to understand responses to severely stressful social events. After filling a consent form, participants were requested to recall an SLE. Following the recall, the participants were asked to indicate the age at which the recalled event occurred and the gender of their aggressor(s) (a man, a woman, or both). Next, they filled out PTD and depression severity questionnaires. Finally, they completed a series of demographic questions (e.g., age, education, gender) and were thanked and debriefed. All measures were administered in English.

 Measures

Recollection of status loss was induced by asking participants to recall an event in which they “felt belittled or that their dignity was compromised by others.” Next, they were asked to write a detailed description (at least 50 words) of the event. The instructions were based on the recall task used by Tangney et al. (54), which is designed to examine the characteristics of unpleasant social memories. Importantly, to modify the task for recollection of SLEs, we used Klein (55) definition for humiliation (an event in which one is being belittled or treated with indignity). In order to examine whether participants recalled SLEs, the two authors read all narrative independently. Narratives that were not social or did not include a threat to status were excluded (Inter-rater reliability = 0.96). Furthermore, to evaluate whether the recall task induced memories which are perceived as loss of status, we asked participants to rate their emotions during the event on five emotions scales (Humiliation, Shame, Sadness, Guilt, Anxiety). As expected, emotions which are associated with status loss such as humiliation and shame were significantly higher compared to the other negative emotions [F(209,1) = 186.60, ηp2 = 0.33].

Post-traumatic distress (PTD) was assessed using the Post-traumatic Diagnostic Scale for DSM-V [PDS-5; (56)]. In PDS-5, the symptom items are rated on a scale of frequency and severity. Specifically, the scale includes items assessing intrusion (e.g., Unwanted upsetting memories about the event), avoidance (e.g., Trying to avoid thoughts or feelings related to the event), negative cognitions and mood (e.g., Having intense negative feelings like fear, horror, anger, guilt or shame), and arousal (e.g., Being jumpy or more easily startled). Because the sample included participants who did not perceive the event as a trauma, the word “trauma” in the questionnaire was replaced with the word “event.” The use of post-traumatic measures to assess PTD following socially stressful events was found to be reliable (13) and was constantly applied to assess PTD following SLEs (13, 57–59). The internal reliability of the scale was 0.85.

Depression severity was assessed using the Beck Depression Inventory [BDI–II; (60)], consisting of 20 items (the suicidality item was excluded due to the online nature of the study). The internal reliability of the questionnaire in our sample was 0.91.

 Results

Descriptive statistics are presented in Table 1. As can be seen in the Table, there were no significant differences between men and women in age, trauma recency, or depression. To examine the gender-sensitivity hypotheses, we first conducted an ANCOVA with PTD as a dependent variable, gender as an independent variable, and depression and age as covariates. Consistent with the evolutionary account, we found a main effect for gender [F(1,207) = 5.68, p = 0.01, ηp2 = 0.03], such as that the PTD-severity was greater for men than for women (Table 1). Next, we examined the percentage of participants whose PDS scores were above the cutoff for PTSD [PDS Score above 28; (56)]. Again, we found a significant main effect of gender [X2(1) = 5.91, p = 0.01]. Notably, men were more likely than women to meet the PTSD-cutoff.

Age, depression, and event related factors among men and women.

Study 1
 Study 2
Women (N = 80) Men (N = 131) Women (N = 250) Men (N = 187)
Age 39.3 (11.4) 35.1 (9.1) 42 (13.1) 38.9 (12.5)
Trauma Recency 13.2 (12) 10.6 (9.4) 12.1 (14.3) 11.0 (10.9)
Depression Severity 17.4 (14.8) 19 (14.8) 10.6 (11.9) 11.4 (10.9)
Post-traumatic distress 24.4 (23.8)A 32.6 (24.7)B 12.7 (17)A 18 (11.1)B
% PTSD 40A 57B 7A 18B
% Men as aggressors 47 77 42 58

Mean; (Standard deviation); Means at the same row and study that do not share the same superscript differ at p < 0.05.

Next, we examined the aggression hypotheses comparing events in which both the aggressor and the victims were men (N = 101) and events in which the aggressor was a man and the victim was a woman (N = 35). In line with the evolutionary account, SLEs that were conducted by men against men were associated with a more severe PTD compared to SLEs in which the aggressors were men and the victim woman [t(187) = 2.02, p = 0.008, Cohen’s d = 0.58; Figure 1]. We further conducted a contrast between events in which both the aggressor and the victim were men and the three other aggressor-victim configurations (i.e., woman-man, man-woman, and woman-woman). In line with the evolutionary account, the contrast was significant [t(187) = 4.64, p < 0.001, Cohen’s d = 0.67].

Post-traumatic distress severity by gender of victim and aggressor. PTD, post-traumatic distress as measured by PDS-V.

To sum, both hypotheses of the evolutionary account were supported. However, because we invited participants that define their recalled event as impactful, it is possible that gender differences are explained by higher prevalence or accessibility of impactful SLEs among men, as compared to women. To address this possibility, in Study 2 we invited participants who could recall a specific SLE regardless of the level of its impact.

 Study 2 Participants

Based on the small effect size found in Study 1, and because we anticipated an even smaller effect due to the inclusion of less intense social events, a sample size of 400 was chosen to provide sufficient power for identifying the anticipated effects [G*Power 3.1; (52)]. Based on the exclusion rate in similar prior studies, 455 participants were recruited via TurkPrime, which enables to recruit more conscientious Mturk workers (61). All participants were from the United States with English as their native language. Exclusion criteria were: (a) filling out the survey from an I.P used by another participant/s (n = 9); (b) completing the recall task in a non-conscientious manner (i.e., writing irrelevant text in the description of the memory as assessed by the two authors; n = 10). The final sample consisted of 436 participants (250 women). Participants’ ages were between 18 and 79 (Mean = 40.6; SD = 13.0). The average number of education years was 15.5 (SD = 2.3).

 Procedure

The procedure was identical to Study 1 with one exception; Participants were invited to take part in a 30-min survey that sought to enhance our understanding of unpleasant social memories. All reliabilities of the scales were satisfactory as in Study 1 (PDS-5 = 0.87; BDI = 0.92).

 Results

As can be seen from Table 1, there were no significant differences between the genders in age, trauma recency, or depression. To test the first two hypotheses, we repeated the analyses from Study 1. As in Study 1, we found a main effect for gender in ANCOVA [F(1,433) = 15.96, p < 0.001,ηp2 = 0.04] and in Chi-square test [X2(1) = 14.2, p < 0.001] such as that the PTD score and estimated PTSD-diagnoses percentages were higher for men than for women (Table 1). We also found that inter-males SLEs were associated with more severe PTD compared to PTD following SLEs conducted by men against women [t(332) = 2.38, p = 0.02, Cohen’s D = 0.12; Figure 1]. As in Study 1, we contrasted events in which both the aggressor and the victims were men and the three other configurations: we found that inter-males SLEs were higher than the three other victim-aggressor type events [t(332) = 3.28, p < 0.001, Cohen’s D = 0.12].

Finally, combining the data from both samples, we examined the gender-age link hypotheses. A GLM was conducted with PTD as a dependent variable, and depression, age, gender (man = 1; woman = 2), and Gender × Age as predictors. A significant Gender × Age [β = 0.45, b = 0.31, SE = 0.1, t(646) = 2.95, p < 0.01; 95% CI(0.10,0.51)] interaction was found. Further analysis revealed that the age was associated with PTD severity in men but not in women (β = −0.11, b = −0.22, SE = 0.07, p = 0.01;β = −0.02, b = 0.64, SE = 0.07, p > 0.5, for men and women respectively; Figure 2).

Linear regression for PTD predicted by age in Women (gray solid line) and Men (black dashed line). PTD, post-traumatic distress as measured by PDS-V.

 Discussion

The present study examined gender differences in PTD following status loss using two competing theoretical perspectives: social construction and evolution. Accordingly, three pairs of hypotheses were tested. First, we hypothesized that women would differ in their distress levels compared to men; Second, we hypothesized that the gender of the aggressor would affect distress levels. Finally, we expected that gender and age would interact to predict distress following status loss. Overall, our results are consistent with the evolutionary account. Specifically, women reported less severe PTD following status losses as compared to men, thus exhibiting greater resilience to these events. In addition, men reported severe PTD following events in which another man was a perpetrator. Finally, the PTD severity was unrelated to age in women, whereas in men this association was negative.

Our results joint those of van den Berg et al. (12) who reported gender differences in PTD following physical- but not social- stressors. Taking an evolutionary perspective, social and physical threats affect women’s and men’s reproductive success asymmetrically. Status is associated with low fertility and high offspring mortality among men but not women (62, 63), whereases women’s, but not men’s, fertility and attractiveness are highly linked with health (42). Differences in reproductive meanings of various stressors may partially account for gender discrepancy in PTD (6). For example, the cost of bodily harm may be relatively greater for women because of their central role in ensuring infant survival (64–66). Furthermore, among women, offspring survival is linked with a strong dyadic support network (67, 95), indicating that inclusionary events may be more influential for women, as compared to men.

We also found that the gender of the aggressor was associated with PTD severity. The genderial context in which a stressful event took place may affect the levels of elicited distress by threatening specific salient goals. For example, due to females’ high selectiveness, mating options for males are reduced and intra-sexual competition is enhanced (68) – leading to increased male sensitivity for intrasexual aggression (69). However, intra-sexual competition among females may take a different manifestation, such as covert verbal aggression (66, 70) or exclusion (71). Furthermore, the focus of the intrasexual competition may differ across genders. Whereas males tend more to compete on status, power, strength, and resources (47, 72), females’ competition resolve more around attractiveness and promiscuity (73–76). Future studies could examine what types of intrasexual aggression are most distressing in women.

Finally, for men, but not for women, age was found to be associated with ameliorated distress following status losses. Those results are in-line with evolutionary accounts emphasizing the enhanced prevalence of intrasexual aggressions among young males [“The young male syndrome”; (77)]. Furthermore, our age-gender interaction mirrors other gender discrepancies which declined with age and are status related such as risk-taking (78). Notably, the decline in status loss distress among men may reflects a decline in competitiveness due to the decrease of women’s reproductive value with age (79, 80). Importantly, the age-effect echoes gender-related differences in the prevalence of PTSD following physically threatening events which are reduced throughout adulthood (3, 81). It is possible that such changes in prevalence and severity mirror fluctuations in the levels of gonadal hormones associated with status motivations (34, 82). Specifically, reductions in testosterone levels in men and estradiol levels in women may contribute to the reduced gender discrepancy in the severity of distress following status losses (45).

 Theoretical Implications

The current findings add to the growing body of research demonstrating pervasive and deleterious post-traumatic effects of status losses(91, 92, 93). These findings support the claim that reproduction threats may engender full-blown PTSD, given that reproductive goals are comparable to, and sometimes even outweigh, survival goals (83, 97). From an evolutionary perspective, any life event that interferes with the achievement of short-term biological goals such as status can qualify as a trauma due to its relevance to biological adaptation in the ancestral environment (6). A focus on physical threats as sole potential PTSD-provokers narrows essential goals pursuit to the physical arena and dismiss the evolutionary importance of our social environment. Importantly, our results challenge the general women sensitivity hypothesis. Following a variety of events, women report higher distress compared to men (84). Ignoring the evolutionary context may over-emphasize, and even over-pathologize, women’s adaptive responses. As suggested by Troisi (6), social distress is induced following experiences which jeopardize sociobiological goals, as an adaptive response that facilitates the maintenance of the threaten goals. Thus, the distress is likely to be associated with the importance of sociobiological goals which is moderated by factors such as age and gender. Evolutionary theorists claim that to a certain level, gender differences in distress symptoms would remain, and that the gender gap in PTD could be narrowed by adopting a gender-sensitive nosology. Our results are in line with the latter position, indicating that gender by itself does not predict PTD and that its interaction with type of stressor need to be considered in PTSD classification.

 Limitations

In closing, several limitations of the present research need to be noted. First, our study relies on self-report measures which may lead to biased report of PTD and depression severity (85). Second, gender differences in PTD may reflect some yet untapped distinctions in nature of the recalled events. Future studies may rely on response to pre-scripted status losses scenarios and examine gender differences in anticipated distress. Third, evolutionary approaches suggest that status can be reduced via loss of dominance (experiencing physical or psychological intimidation) as well as prestige [incompetence to display valued skills and abilities; (86)]. The current study did not distinguish between losses of status via prestige from those losses via dominance. Whereases loss of prestige is predicted to affect both genders, loss of dominance is predicted to affect mostly men (87). Forth, we decided to use the gender terminology (and not the sex terminology) due to the self-report nature of our study. Specifically, participants were asked to indicate their gender and not their assigned sex at birth, thus only their gender identity was examined. Future studies could investigate whether the reported discrepancies are present when biological markers of sex are examined. Finally, our data does not distinguish whether men’s reactions to SLEs are less intense because it mirrors their fertility or because men tend to become more established in older age (and thus are less susceptible to status loss). Although prior studies indicate that both men and women tend to be more established with age, it is possible that the age-status enhancement affects more men than women (88).

 Conclusion

The last decades are witnessing an evolutionary turn in clinical psychology (89, 90). Psychopathologies are examined through adaptiveness framework and therapy is formulated as a mean to acquire flexible ways to navigate, toward and between, evolutionary goals. Women and men differ in their evolutionary challenges, and consequently in the type of events most relevant to those challenges. To date, studies documenting greater vulnerability of women to traumatic events did not consider variability in evolutionary-relevant goals and challenges. The evolutionary revolution is not complete without taking gender, age, and other survival and reproduction relevant variables into consideration. Consideration of these variables may help us appreciate the way the nature and timing of events individuals encounter on their unique journeys impact their development, identity, and wellbeing.

 Data Availability Statement

The original contributions presented in the study are included in the article/Supplementary Material, further inquiries can be directed to the corresponding author.

 Ethics Statement

The studies involving human participants were reviewed and approved by the Bar-Ilan University, Psychology Department. The patients/participants provided their written informed consent to participate in this study.

 Author Contributions

RA: conceptualization, methodology, software, formal analysis, investigation, data curation, and writing – original draft. EG-S: conceptualization, supervision, writing – review and editing, and funding acquisition. Both authors contributed to the article and approved the submitted version.

 Conflict of Interest

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

 Publisher’s Note

All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article, or claim that may be made by its manufacturer, is not guaranteed or endorsed by the publisher.

 Supplementary Material

The Supplementary Material for this article can be found online at: https://www.frontiersin.org/articles/10.3389/fpsyt.2022.858304/full#supplementary-material

 References Christiansen DM Elkit A. Sex differences in PTSD. In: Ovuga E editor. Post Traumatic Stress Disorders in a Global Context. London: InTech (2012). p. 114–42. Olff M. Sex and gender differences in post-traumatic stress disorder: an update. Eur J Psychotraumatol. (2017) 8:1351204. 10.1080/20008198.2017.1351204 Ditlevsen DN Elklit A. The combined effect of gender and age on post traumatic stress disorder: do men and women show differences in the lifespan distribution of the disorder? Ann Gen Psychiatry. (2010) 9:32. 10.1186/1744-859X-9-32 20663164 Tolin DF Foa EB. Sex differences in trauma and posttraumatic stress disorder: a quantitative review of 25 years of research. Psychol Trauma Theory Res Pract Policy. (2008) S:37–85. 10.1037/1942-9681.S.1.37 Street AE Dardis CM. Using a social construction of gender lens to understand gender differences in posttraumatic stress disorder. Clin Psychol Rev. (2018) 66:97–105. 10.1016/j.cpr.2018.03.001 29580673 Troisi A. Social stress and psychiatric disorders: evolutionary reflections on debated questions. Neurosci Biobehav Rev. (2020) 116:461–9. 10.1016/j.neubiorev.2020.07.016 32687885 Perilloux C Duntley JD Buss DM. The costs of rape. Arch Sex Behav. (2012) 41:1099–106. 10.1007/s10508-011-9863-9 21975924 Benenson JF Webb CE Wrangham RW. Self-protection as an adaptive female strategy. Behav Brain Sci. (2021) 1–86. 10.1017/S0140525X21002417 [Epub ahead of print]. 34742359 Campbell A Copping LT Cross CP. Fear, sex differences and the ‘staying alive’ hypothesis. In: Campbell A Copping LT Cross CP editors. Sex Differences in Fear Response. Cham: Springer (2021). p. 1–6. Winstok Z Weinberg M. From posttrauma to gender and back: a gender motivation theory-explanation of gender differences in trauma exposure, symptoms, diagnosis, and implications. J Aggress Maltreat Trauma. (2018) 27:959–82. 10.1080/10926771.2017.1420719 American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association (2013). van den Berg LJM Tollenaar MS Spinhoven P Penninx BWJH Elzinga BM. A new perspective on PTSD symptoms after traumatic vs stressful life events and the role of gender. Eur J Psychotraumatol. (2017) 8:1380470. 10.1080/20008198.2017.1380470 29435199 Bjornsson AS Hardarson JP Valdimarsdottir AG Gudmundsdottir K Tryggvadottir A Thorarinsdottir K Social trauma and its association with posttraumatic stress disorder and social anxiety disorder. J Anxiety Disord. (2020) 72:102228. Fernández S Halperin E Gaviria E Agudo R Saguy T. Understanding the role of the perpetrator in triggering humiliation: the effects of hostility and status. J Exp Soc Psychol. (2018) 76:1–11. 10.1016/j.jesp.2017.12.001 Ginges J Atran S. Humiliation and the inertia effect: implications for understanding violence and compromise in intractable intergroup conflicts. J Cogn Cult. (2008) 8:281–94. 10.1163/156853708X358182 Leidner B Hammad S Jeremy G. Affective dimensions of intergroup humiliation. PLoS One. (2012) 7:e46375. 10.1371/journal.pone.0046375 23029499 Torres WJ Bergner RM. Severe public humiliation: its nature, consequences, and clinical treatment. Psychotherapy. (2012) 49:492. 10.1037/a0029271 22889101 Leslie H. Tortillas, trauma and tears: gendering El salvadoran women’s participation in the 1980-1992 civil war. J Interdiscip Gender Stud. (2001) 6:3–17. Segalo P. Gender, social cohesion and everyday struggles in South Africa. Psychol Soc. (2015) 49:70–82. 10.17159/2309-8708/2015/n49a6 Mendible M. Visualizing abjection: gender, power, and the culture of humiliation. Genderforum. (2005) 11:1–26. Hartling LM Lindner E Spalthoff U Britton M. Humiliation: a nuclear bomb of emotions? Psicol Polít. (2013) 46:55–76. Bale TL Epperson CN. Sex differences and stress across the lifespan. Nat Neurosci. (2015) 18:1413–20. 10.1038/nn.4112 26404716 Barlow MR Hetzel-Riggin MD. Predicting posttraumatic growth in survivors of interpersonal trauma: gender role adherence is more important than gender. Psychol Men Mascul. (2018) 19:446. 10.1037/men0000128 Brower A James A. Research performance and age explain less than half of the gender pay gap in New Zealand universities. PLoS One. (2020) 15:e0226392. 10.1371/journal.pone.0226392 31967992 Kehn A Ruthig JC. Perceptions of gender discrimination across six decades: the moderating roles of gender and age. Sex Roles. (2013) 69:289–96. 10.1007/s11199-013-0303-2 Björkqvist K. Social defeat as a stressor in humans. Physiol Behav. (2001) 73:435–42. 10.1016/S0031-9384(01)00490-5 Sapolsky RM. The influence of social hierarchy on primate health. Science. (2005) 308:648–52. 10.1126/science.1106477 15860617 Buss DM Schmitt DP. Mate preferences and their behavioral manifestations. Annu Rev Psychol. (2019) 70:77–110. 10.1146/annurev-psych-010418-103408 30230999 Hoebel J Maske UE Zeeb H Lampert T. Social inequalities and depressive symptoms in adults: the role of objective and subjective socioeconomic status. PLoS One. (2017) 12:e0169764. 10.1371/journal.pone.0169764 28107456 Levenstein S Smith MW Kaplan GA. Psychosocial predictors of hypertension in men and women. Arch Intern Med. (2001) 161:1341–6. 10.1001/archinte.161.10.1341 11371264 Benenson JF Abadzi H. Contest versus scramble competition: sex differences in the quest for status. Curr Opin Psychol. (2020) 33:62–8. Foerster S Franz M Murray CM Gilby IC Feldblum JT Walker KK Chimpanzee females queue but males compete for social status. Sci Rep. (2016) 6:1–11. 10.1038/srep35404 27739527 Maner JK Miller SL Schmidt NB Eckel LA. Submitting to defeat: social anxiety, dominance threat, and decrements in testosterone. Psychol Sci. (2008) 19:764–8. 10.1111/j.1467-9280.2008.02154.x 18816282 Oxford JK Tiedtke JM Ossmann A Özbe D Schultheiss OC. Endocrine and aggressive responses to competition are moderated by contest outcome, gender, individual versus team competition, and implicit motives. PLoS One. (2017) 12:e0181610. 10.1371/journal.pone.0181610 28750061 Rodriguez Mosquera PM. Masculine and feminine honor codes. Rev Psicol Soc. (2011) 26:63–72. 10.1174/021347411794078499 25131292 Sapolsky RM. Behave: The Biology of Humans at Our Best and Worst. New York, NY: Penguin (2017). Puts DA. Beauty and the beast: mechanisms of sexual selection in humans. Evol Hum Behav. (2010) 31:157–75. 10.1016/j.evolhumbehav.2010.02.005 Sell A Hone LS Pound N. The importance of physical strength to human males. Hum Nat. (2012) 23:30–44. 10.1007/s12110-012-9131-2 22477166 Geary DC. Male, Female: The Evolution of Human Sex Differences. 2nd ed. Washington, DC: American Psychological Association (2021). 10.1037/12072-000 Kutsukake N. Assessing relationship quality and social anxiety among wild chimpanzees using self-directed behaviour. Behaviour. (2003) 140:1153–71. Zuroff DC Fournier MA Moskowitz DS. Depression, perceived inferiority, and interpersonal behavior: evidence for the involuntary defeat strategy. J Soc Clin Psychol. (2007) 26:751–78. 10.1521/jscp.2007.26.7.751 Buss DM Schmitt DP. Sexual strategies theory: an evolutionary perspective on human mating. Psychol Rev. (1993) 100:204–32. 10.1037/0033-295X.100.2.204 8483982 Harris ID Fronczak C Roth L Meacham RB. Fertility and the aging male. Rev Urol. (2011) 13:e184. Wood AM Boyce CJ Moore SC Brown GD. An evolutionary based social rank explanation of why low income predicts mental distress: a 17 year cohort study of 30,000 people. J Affect Disord. (2012) 136:882–8. 10.1016/j.jad.2011.09.014 22078299 Stanworth RD Jones TH. Testosterone for the aging male; current evidence and recommended practice. Clin Interv Aging. (2008) 3:25. 10.2147/cia.s190 18488876 LeFebvre A Huta V. Age and gender differences in eudaimonic, hedonic, and extrinsic motivations. J Happiness Stud. (2021) 22:2299–321. 10.1007/s10902-020-00319-4 Archer J. The reality and evolutionary significance of human psychological sex differences. Biol Rev. (2019) 94:1381–415. 10.1111/brv.12507 30892813 Luoto S Varella MAC. Pandemic leadership: sex differences and their evolutionary-developmental origins. Front Psychol. (2021) 12:633862. 10.3389/fpsyg.2021.633862 33815218 Geary DC. Now you see them, and now you don’t: an evolutionarily informed model of environmental influences on human sex differences. Neurosci Biobehav Rev. (2021) 125:26–32. 10.1016/j.neubiorev.2021.02.020 33609571 Leon AC Heo M. Sample sizes required to detect interactions between two binary fixed-effects in a mixed-effects linear regression model. Comput Stat Data Anal. (2009) 53:603–8. 10.1016/j.csda.2008.06.010 20084090 Wetherall K Robb KA O’Connor RC. Social rank theory of depression: a systematic review of self-perceptions of social rank and their relationship with depressive symptoms and suicide risk. J Affect Disord. (2019) 246:300–19. 10.1016/j.jad.2018.12.045 30594043 Faul F Erdfelder E Buchner A Lang AG. Statistical power analyses using G*power 3.1: tests for correlation and regression analyses. Behav Res Methods. (2009) 41:1149–60. 10.3758/BRM.41.4.1149 19897823 Azoulay R Berger U Keshet H Niedenthal PM Gilboa-Schechtman E. Social anxiety and the interpretation of morphed facial expressions following exclusion and inclusion. J Behav Ther Exp Psychiatry. (2020) 66:101511. 10.1016/j.jbtep.2019.101511 31614264 Tangney JP Miller RS Flicker L Barlow DH. Are shame, guilt, and embarrassment distinct emotions? J Pers Soc Psychol. (1996) 70:1256. Klein DC. The humiliation dynamic: an overview. J Primary Prev. (1991) 12:93–121. Foa EB McLean CP Zang Y Zhong J Powers MB Kauffman BY Psychometric properties of the posttraumatic diagnostic scale for DSM–5 (PDS–5). Psychol Assess. (2016) 28:1166–71. 10.1037/pas0000258 26691504 Carleton RN Peluso DL Collimore KC Asmundson GJG. Social anxiety and posttraumatic stress symptoms: the impact of distressing social events. J Anxiety Disord. (2011) 25:49–57. 10.1016/j.janxdis.2010.08.002 20800426 Erwin BA Heimberg RG Marx BP Franklin ME. Traumatic and socially stressful life events among persons with social anxiety disorder. J Anxiety Disord. (2006) 20:896–914. 10.1016/j.janxdis.2005.05.006 16490343 Sapach MJT Carleton RN. Can words be worse than stones? Understanding distressing social events and their relationship with social anxiety. J Anxiety Disord. (2020) 72:102225. Beck AT Steer RA Ball R Ranieri WF. Comparison of beck depression inventories-IA and-II in psychiatric outpatients. J Pers Assess. (1996) 67:588–97. Litman L Robinson J Abberbock T. TurkPrime.com: a versatile crowdsourcing data acquisition platform for the behavioral sciences. Behav Res Methods. (2017) 49:433–42. Hopcroft RL. Sex, status, and reproductive success in the contemporary United States. Evol Hum Behav. (2006) 27:104–20. Von Rueden CR Jaeggi AV. Men’s status and reproductive success in 33 nonindustrial societies: effects of subsistence, marriage system, and reproductive strategy. Proc Natl Acad Sci U.S.A. (2016) 113:10824–9. Benenson JF. The development of human female competition: allies and adversaries. Philos Trans R Soc B. (2013) 368:20130079. 10.1098/rstb.2013.0079 24167309 Campbell A. Staying alive: evolution, culture, and women’s intrasexual aggression. Behav Brain Sci. (1999) 22:203–14. Vaillancourt T Krems JA. An evolutionary psychological perspective of indirect aggression in girls and women. In: Coyne SM Ostrov JM editors. The Development of Relational Aggression. Oxford: Oxford University Press (2018). p. 111–26. Benenson JF Markovits H Wrangham R. Rank influences human sex differences in dyadic cooperation. Curr Biol. (2014) 24:R190–1. 10.1016/j.cub.2013.12.047 24602881 Niederle M Vesterlund L. Gender differences in competition. Negot J. (2008) 24:447–63. 10.1111/j.1571-9979.2008.00197.x Janicke T Häderer IK Lajeunesse MJ Anthes N. Darwinian sex roles confirmed across the animal kingdom. Sci Adv. (2016) 2:e1500983. 10.1126/sciadv.1500983 26933680 Archer Coyne (2005). Deaner RO McClellan A Zeigler-Hill V Benenson JF. Sex differences in exclusion and aggression on single-sex sports teams. Evol Behav Sci. (2021) 15:159–74. 10.1037/ebs0000247 Buss Schmitt (2021). Bleske AL Shackelford TK. Poaching, promiscuity and deceit: combatting mating rivalry in same-sex friendships. Pers Relat. (2001) 8:407–24. 10.1111/j.1475-6811.2001.tb00048.x Clayton KD Trafimow D. A test of three hypotheses concerning attributions toward female promiscuity. Soc Sci J. (2007) 44:677–86. 10.1016/j.soscij.2007.10.003 Mafra AL Varella MAC Defelipe RP Anchieta NM de Almeida CAG Valentova JV. Makeup usage in women as a tactic to attract mates and compete with rivals. Pers Individ Diff. (2020) 163:110042. 10.1016/j.paid.2020.110042 Varella MA Valentova JV Fernández AM. Evolution of artistic and aesthetic propensities through female competitive ornamentation. In: Fisher ML editor, The Oxford Handbook of Women and Competition. Oxford: Oxford University Press (2017). p. 757–83. 10.1093/oxfordhb/9780199376377.013.46 Wilson M Daly M. Competitiveness, risk taking, and violence: the young male syndrome. Ethol Sociobiol. (1985) 6:59–73. Tamás V Kocsor F Gyuris P Kovács N Czeiter E Büki A. The young male syndrome—an analysis of sex, age, risk taking and mortality in patients with severe traumatic brain injuries. Front Neurol. (2019) 10:366. 10.3389/fneur.2019.00366 31031696 Maestripieri D Klimczuk A Traficonte D Wilson C. A greater decline in female facial attractiveness during middle age reflects women’s loss of reproductive value. Front Psychol. (2014) 5:179. 10.3389/fpsyg.2014.00179 24592253 Conroy-Beam D Buss DM. Why is age so important in human mating? Evolved age preferences and their influences on multiple mating behaviors. Evol Behav Sci. (2019) 13:127. 10.1037/ebs0000127 Norris FH Friedman MJ Watson PJ Byrne CM Diaz E Kaniasty K. 60,000 disaster victims speak: part I. An empirical review of the empirical literature, 1981–2001. Psychiatry Interpers Biol Process. (2002) 65:207–39. 10.1521/psyc.65.3.207.20173 12405079 Gogos A Ney LJ Seymour N Van Rheenen TE Felmingham KL. Sex differences in schizophrenia, bipolar disorder, and post-traumatic stress disorder: are gonadal hormones the link? Br J Pharmacol. (2019) 176:4119–35. Kenrick DT Griskevicius V Neuberg SL Schaller M. Renovating the pyramid of needs: contemporary extensions built upon ancient foundations. Perspect Psychol Sci. (2010) 5:292–314. 10.1177/1745691610369469 21874133 McLean CP Anderson ER. Brave men and timid women? A review of the gender differences in fear and anxiety. Clin Psychol Rev. (2009) 29:496–505. Hunt M Auriemma J Cashaw AC. Self-report bias and underreporting of depression on the BDI-II. J Pers Assess. (2003) 80:26–30. Cheng JT. Dominance, prestige, and the role of leveling in human social hierarchy and equality. Curr Opin Psychol. (2020) 33:238–44. Witkower Z Tracy JL Cheng JT Henrich J. Two signals of social rank: prestige and dominance are associated with distinct nonverbal displays. J Pers Soc Psychol. (2020) 118:89–120. 10.1037/pspi0000181 31021104 Bleidorn W Arslan RC Denissen JJA Rentfrow PJ Gebauer JE Potter J Age and gender differences in self-esteem—a cross-cultural window. J Pers Soc Psychol. (2016) 111:396–410. 10.1037/pspp0000078 26692356 Nesse RM. Good Reasons for Bad Feelings: Insights from the Frontier of Evolutionary Psychiatry. New York, NY: Penguin (2019). Hayes SC Hofmann SG Ciarrochi J A process-based approach to psychological diagnosis and treatment: the conceptual and treatment utility of an extended evolutionary meta model. Clin Psychol Rev. (2020) 82:101908. Boals A Schuettler D. PTSD symptoms in response to traumatic and non-traumatic events: the role of respondent perception and A2 criterion. J Anxiety Disord. (2009) 23:458–62. 10.1016/j.janxdis.2008.09.003 19013754 Gilbert P. Introducing compassion-focused therapy. Adv Psychiatr Treat. (2009) 15:199–208. 10.1192/apt.bp.107.005264 Gold SD Marx BP Soler-Baillo JM Sloan DM. Is life stress more traumatic than traumatic stress? J Anxiety Disord. (2005) 19:687–98. 10.1016/j.janxdis.2004.06.002 15927781 Jiménez M Aguilar R Alvero-Cruz JR. Effects of victory and defeat on testosterone and cortisol response to competition: evidence for same response patterns in men and women. Psychoneuroendocrinology. (2012) 37:1577–81. 10.1016/j.psyneuen.2012.02.011 22429747 Luxen MF. Gender differences in dominance and affiliation during a demanding interaction. J Psychol. (2005) 139:331–47. 10.3200/JRLP.139.4.331-347 16097273 Mafra AL Defelipe RP Varella MAC Townsend JM Valentova JV. Mate value, intrasexual competition and sociosexual desire drive Brazilian women’s well-being. Evol Hum Sci. (2021) 3:E25. 10.1017/ehs.2021.18 Manlik O McDonald JA Mann J Raudino HC Bejder L Krützen M The relative importance of reproduction and survival for the conservation of two dolphin populations. Ecol Evol. (2016) 6:3496–512. 10.1002/ece3.2130 28725349 Ovadia O Abramsky Z Kotler BP Pinshow B. Inter-specific competitors reduce inter-gender competition in Negev Desert gerbils. Oecologia. (2005) 142:480–8. Salk RH Hyde JS Abramson LY. Gender differences in depression in representative national samples: meta-analyses of diagnoses and symptoms. Psychol Bull. (2017) 143:783–822. 10.1037/bul0000102 28447828 Stein JY Wilmot DV Solomon Z. Does one size fit all? Nosological, clinical, and scientific implications of variations in PTSD Criterion A. J Anxiety Disord. (2016) 43:106–17. 10.1016/j.janxdis.2016.07.001 27449856