Risk-Taking, Impulsivity, and PTSD: Why Men with PTSD May Engage in Greater Risk-Taking and Impulsivity, and What This Means for PTSD Intervention

a climber hangs from a sheer rock
Maggie Talbot

Do you consider yourself to be a risk-taker, enjoying or even seeking out activities like skydiving, gambling, or off-roading? Do you notice that you enjoy the thrill of trying something daring? Or perhaps you notice that you seek risk in your life to feel more alive. While the thrill of risk-taking is titillating to some, others actively avoid risks at all costs. To these individuals, risk-taking is a frightening phenomenon that moves someone farther away, rather than closer to, living.

Interestingly, risk-taking has become a unique topic of research in those with posttraumatic stress disorder (PTSD) since becoming a defined symptom of the diagnosis in 2013. Gambling, reckless driving, unsafe sexual behaviors, extreme drinking, and the use of weapons are all examples of what risky behavior can look like in those with PTSD. 

It is likely that gender plays a role in who develops the risky behavior symptom of PTSD. Gender differences in posttraumatic stress disorder (PTSD) prevalence are well documented, with women showing a nearly twofold risk of PTSD diagnosis compared to men. However, in contrast to other symptoms of PTSD, risky behavior has been shown to be more prevalent in men than in women. Why might this be? Why is it that men show greater risk-taking when women have greater rates of most other symptoms of PTSD?

The answers to these questions might lie in cognitive capabilities. Executive functions are in charge of some of our more complex behaviors such as planning for the future, problem-solving when we get ourselves into sticky situations, and being able to change our plans on the fly due to the unpredictability of life. A type of executive function is inhibitory control, which is the ability people have to exert control over their behaviors. We know that PTSD is related to difficulty with executive functioning. Therefore, it is reasonable to question whether men with PTSD show greater risk-taking and impulsivity than women due to deficits in inhibitory control.
Given the relatively new field of research devoted to risk-taking and PTSD, and the lack of understanding of mechanisms underlying men’s increased propensity for risk, I embarked upon research to determine how risk-taking, impulsivity, and inhibitory control interact with gender in trauma-exposed adults. 

In a sample of 105 trauma survivors, I explored the relationships between gender, PTSD symptomology, risk-taking, impulsivity, and inhibitory control. In the sample, men showed greater overall risk-taking compared to women on specific measures of risk-taking, but they did not show an overall greater endorsement of the risky behavior symptom of PTSD. Additionally, inhibitory control explained the relationship between gender and impulsivity. 

This study provides further understanding of the risk-taking symptom of PTSD. Inhibitory control was the mechanism through which men with PTSD showed greater impulsivity. Although risk-taking was greater in men than women, specific endorsement of the risk-taking symptom of PTSD was no different for men and women. It may be that risk-taking as defined by the symptom is much narrower than the types of risk-taking behavior encountered in everyday life. There are now measures that specifically assess risk-taking related to PTSD, which will be helpful for future studies to get a better understanding of risky behavior that meets PTSD criteria. 
Overall, the results of the study have implications for clinical interventions. Knowing that inhibitory control plays a role in differences in impulsivity in men and women helps us determine how to intervene for PTSD to reduce behaviors and personality traits that may result in harm. Risk-taking and impulsive tendencies may be targeted through neurocognitive mechanisms to minimize risk and potential harm specifically for men with PTSD.

Our understanding of risk-taking as a symptom of PTSD still has a long way to go. However, this study gives us a greater understanding of gender differences in risk-taking, as well as mechanisms underlying those differences.

Tags: Newsletter November 2020Past Digital Newsletters