Emotional Trauma Affects Boys and Girls Differently 

More than a decade ago, I published an article proposing a tool that providers could use to help assess the risk of someone’s developing opioid aberrant drug-related behaviors if prescribed an opioid.

The instrument is commonly called the opioid risk tool, and it is still commonly used today. It can be found here.

As you can see, it is a simple, self-assessment questionnaire that covers five areas:

• family history of substance abuse,
• personal history of substance abuse,
• age,
• history of preadolescence sexual abuse,
• and psychological disease that are known to be associated with opioid risk.

Each question is given a point value based on the relative importance of each question. Risk probability is determined by the total score for the individual.

Some of the questions are weighted differently for genders. The difference in weight is based upon the different risks that had been identified in the literature at the time that I developed the tool.

How Sexual Trauma Increases Risk for Substance Abuse 

One question asks if the patient has a history of preadolescent sexual abuse. The tool attributes 3 points for females, and 0 for males, who answer affirmatively. That difference of attribution has been challenged by some clinicians who have misinterpreted this scoring as meaning that males with a history of preadolescent sexual abuse have no increased risk for aberrant drug-related behaviors.

The scoring reflects the relative difference in risk between genders. That’s not to say that males who were sexually abused before they reached adolescence are not at increased risk for substance abuse because of their sexual abuse. Sexual abuse is a traumatic experience for both males and females, but research has been shown it to be even more so for females.

The evidence is plentiful in the literature for this difference in weight. Most substance abuse treatment centers report that nearly 100% of females admitted for treatment have a history of physical and/or sexual abuse and, very commonly, this abuse occurs during, or before, adolescence. This type of experience is generally felt to contribute to the clinical problem of post traumatic disorder (PTSD), which then might lead to substance abuse. Multiple studies have reported sexual abuse in early life to be associated with substances use disorders and PTSD.

Traumatic Stress Affects The Brains of Boys and Girls Differently 

A study by researchers at Stanford University School of Medicine provides more support for this difference. An article about the study in PsychCentral points out that “traumatic stress affects the brains of adolescent boys and girls differently.” In fact, the scientists were able to detect structural differences in the brain between male and female genders following trauma or stress. This may be a partial explanation for what society has been observing for decades.

This report does not prove the validity of the opioid risk tool I developed, but it seems to bolster the reason for the differences in gender that I integrated into the assessment, and to answer some of the questions it raised. More importantly, the new findings about gender suggest that we need to consider gender differences in response to emotional stress and to individual therapies.

Treating both genders as if they were the same for the sake of political correctness won’t make the differences go away, nor will it be helpful.

Purchase my book, The Painful Truth: What Chronic Pain Is Really Like and Why It Matters to Each of Us (available on Amazon), or read a free excerpt here.

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Copyright 2016, Lynn Webster, MD