On the stress of being a woman: The synergistic contribution of sex as a biological variable and gender as a psychosocial one to risk of stress-related disorders

Stress-related disorders (SRD) disproportionately affect women. Cortisol blunting, a failure to demonstrate a typical rise and fall of cortisol in response to stress, is associated with SRDs and has been found to be more pronounced among women. Cortisol blunting relates to both sex as a biological variable (SABV; e.g., estrogens and their fluctuations, impact on neural circuits) and gender as a psychosocial variable (GAPSV; e.g., discrimination, harassment, gender roles). I suggest a theoretical model linking experience, sex- and gender-related factors, and neuroendocrine substrates of SRD to the heightened risk among women. The model thus bridges multiple gaps in the literature to create a synergistic conceptual framework with which to understand the stress of being a woman. Utilizing such a framework in research may allow identifying targeted, sex-and genderdependent risk factors, informing psychological treatment, medical advice, educational and community programming, and policy.

Automated summary

Stress-related disorders (SRD) have a greater impact on women, and cortisol blunting, a failure in cortisol response to stress, is more pronounced among women with SRDs. Cortisol blunting is influenced by both biological factors, such as estrogen and its fluctuations, and psychosocial factors, such as discrimination, harassment, and gender roles. A theoretical model is proposed to link experience, sex- and gender-related factors, and neuroendocrine substrates to explain the heightened risk of SRDs among women, providing a comprehensive framework for understanding the stress experienced by women. Utilizing this framework in research can help identify targeted risk factors specific to sex and gender, informing interventions, medical advice, education, community programming, and policies.