PTSD in Young Women

Health Chatter Podcast

Topic: PTSD in Young Women
Host: Stanton Shanedling
Co-hosts: Clarence Jones & Dr. Barry Baines
Guest: Dr. Ida-Arlaine T. Fonkoue, University of Minnesota

Stanton Shanedling:
Hello, everybody! Welcome to Health Chatter. Today’s topic is an important one—post-traumatic stress disorder (PTSD) in young women. I learned a lot just researching this, and we’re excited to dig in with our special guest today.

Before we start, I want to thank our amazing crew—Maddy Levine Wolf, Erin Collins, Deondra Howard, Matthew Campbell, and Sheridan Nygard—who handle recording, research, production, and marketing. They’ve been with us since day one. And happy 30th birthday to Maddy!

Also with me today is my co-host Clarence Jones and Dr. Barry Baines, who will offer some medical insights. A quick shout-out to our sponsor, HueMan Partnership Alliance, a wonderful community health organization. You can find them at huemanpartnershipalliance.org and check out all our past episodes and transcripts at healthchatterpodcast.com.

Now, to today’s guest. We’re joined by Dr. Ida-Arlaine Fonkoue from the University of Minnesota. She’s an assistant professor in the Physical Therapy Division, Department of Family Medicine and Community Health, and Director of the Neurobiology of Emotion, Sleep, and Trauma Lab. Her research examines how trauma affects the heart, blood vessels, and hormones—especially in women.

Ida, welcome to Health Chatter!

Dr. Ida-Arlaine T. Fonkoue:
Thank you. It’s great to be here.

Stanton Shanedling:
For many people, PTSD is just a term they’ve heard. Could you start by defining it clearly?

Dr. Fonkoue:
Of course. Post-traumatic stress disorder is often associated with the military, but it’s a psychological disorder that can develop after any traumatic event. Symptoms can include poor sleep, re-experiencing the trauma, and avoiding people or places that trigger memories.

What’s important is time and persistence: while many people have these symptoms immediately after trauma, about 50% still experience them after four weeks. That’s when it becomes PTSD. So, two things matter for diagnosis—the traumatic event and the duration of symptoms.

I should note, I’m not a psychiatrist. I’m a cardiovascular physiologist. I don’t diagnose PTSD; my research focuses on what’s happening in the body—heart, blood vessels, metabolism—so people can see it’s not “all in their head.”

Stanton Shanedling:
One thing I wondered while reading about this—trauma can happen directly to someone, but what about their family? For example, if someone is injured or killed in war, can their family members also develop PTSD from that experience?

Dr. Fonkoue:
That’s an excellent question. Yes, you can experience what’s often called “secondary” or “vicarious” trauma. For example, I had a participant who’d been sexually assaulted. When she completed our survey, she asked if she could fill out another one. She explained she felt she had two traumas—her own assault and the trauma of hearing her mother describe her own experiences in the military.

Her mother’s trauma wasn’t war-related but still occurred within the military. Later in life, the mother felt her daughter was old enough to hear about it. But hearing those details was traumatic for the daughter.

This isn’t uncommon. People can develop PTSD symptoms from witnessing or hearing about someone else’s trauma. Think about the widespread reactions to the George Floyd video—many people were deeply affected despite not being physically present. It’s similar to “secondhand smoke”—you can have “secondhand trauma.”

Stanton Shanedling:
That makes sense. It reminds me of Holocaust survivors sharing their stories with their children, who may also experience psychological effects. Clarence, you had a question?

Clarence Jones:
Yes, thank you. I wanted to ask about your journey—what drew you into studying this topic?

Clarence Jones: Yeah, thank you for that. You started with something I wanted to dive into—your journey into this topic. Could you share a bit about how you came to study PTSD?

Dr. Ida-Arlaine T. Fonkoue: Thank you. I don’t often share this story, but I’m originally from Cameroon, and I have a medical degree from there. I grew up with a younger sister who had sickle cell disease, which meant constant hospital visits. When I started medical school—even as a first-year—I became the default “doctor” of the family. I took on a caretaker role for my sister, especially when I realized how exhausted my father was.

She has since passed away, but those experiences deeply impacted me. In hindsight, I believe my father had an undiagnosed case of PTSD. The constant uncertainty of whether his child would survive the next hospital visit—it takes a toll. And many parents of children with chronic illness experience similar trauma.

Later, I moved to the U.S. and pursued a Ph.D. in Integrative Physiology at Michigan Tech. Initially, I was interested in stress and how it affects the heart and blood vessels. We ran acute stress experiments—things like mental arithmetic under pressure—while measuring physiological responses like heart rate, blood pressure, and sympathetic nervous system activity.

Eventually, I met a physician at Emory who studied PTSD. At first, I thought, “Well, PTSD is something that happens in the military,” and didn’t think it aligned with my interests. But as I learned more, I realized PTSD is essentially a chronic stress model—which fits perfectly with what I was already studying.

Fast-forward to my postdoc at Emory. I worked closely with veterans and started to notice gender differences in PTSD. For men, PTSD was often tied to combat exposure. But for women, the source was typically interpersonal trauma—not combat. That really struck me. I realized that women, both in and outside the military, often experience trauma through interpersonal channels. That’s what inspired me to focus my research on civilian women with PTSD caused by interpersonal trauma.

So here I am today—studying the neurobiology of emotion, sleep, and trauma, and how PTSD affects cardiovascular health, especially in young women.

Clarence Jones: You explained that incredibly well. Thank you for being willing to share all of that.

Stanton Shanedling: That was an amazing story. As you were speaking, my dog got stressed because the recycling truck came—he has his own stress triggers!

Dr. Fonkoue: We all have our triggers!

Stanton Shanedling: Exactly. So, one thing you touched on—and I’d love for you to expand—is comorbidities, especially cardiovascular issues. You're studying how PTSD links to those conditions, right?

Dr. Fonkoue: Yes. I first noticed this during my time studying veterans, particularly African American men at the Atlanta VA. We found that veterans with PTSD had significantly elevated sympathetic nervous system activity—that's the “fight or flight” response—even at rest. They also had higher resting heart rates and exaggerated responses to stress.

These are all established cardiovascular risk factors: high inflammation, increased resting heart rate, impaired parasympathetic (“rest and digest”) activity, and poor baroreflex sensitivity, which normally helps regulate blood pressure. So in one person with PTSD, you could see four independent cardiovascular risk factors.

Then I turned to studying young women—specifically premenopausal women between 18 and 40. Normally, women in this age group are protected from cardiovascular disease due to the hormone estrogen. Estrogen helps keep blood vessels flexible, calms the fight-or-flight system, regulates cortisol, and suppresses inflammation. It’s what I call the “happy hormone.”

But what I’m seeing in young women with PTSD is really concerning. They physiologically resemble postmenopausal women. Even though they’re young, their vascular and hormonal profiles suggest they’ve lost the protective effects of estrogen.

So now the question is: Is PTSD lowering estrogen levels, or is it making the body less responsive to estrogen? Either way, it’s alarming to see these signs of early cardiovascular risk in such a young population.

Stanton Shanedling: Wow, that’s a fascinating and important finding. Barry, go ahead.

Dr. Barry Baines: Yes, this is really interesting. My question is: once someone develops PTSD and their neurocirculatory and hormonal systems are affected, are they essentially "primed" to overreact to even small stressors? Does the body maladapt in a way that makes everyday stress overload the system?

It’s worrying to think that young women, who are chronologically in their 20s or 30s, could be aging physiologically because of trauma.

Dr. Fonkoue: That’s a great question, and yes—what you’re describing is the difference between chronological and physiological age. That idea is common in metabolic disease research too.

In my current study, we’re still analyzing the data to see exactly how the fight-or-flight system responds to acute stress in women with PTSD. We already know they start with a higher baseline—higher resting sympathetic activity, higher blood pressure—but we want to see if their stress response is also exaggerated compared to peers who experienced trauma but didn’t develop PTSD. All of our participants have trauma exposure, but only some meet the criteria for PTSD.

What we’ve published already is about vascular function. Using ultrasound, we found that these women have increased vasoconstriction during stress and their vessels are stiffer even at rest. Normally, when stressed, blood vessels should dilate to accommodate increased blood flow to the muscles and brain. But in these women, the vessels constrict instead, which can elevate blood pressure dangerously.

Stanton Shanedling: That’s incredible. Let me ask you this—how does the severity or type of trauma play into whether someone develops PTSD? Some people experience major trauma and don’t develop PTSD, while others may develop it from something less extreme. How do we define the threshold?

Clarence Jones: Let’s give her a minute to catch her breath before jumping into the next question.

Stanton Shanedling: Absolutely—take a moment.

Dr. Fonkoue: Thank you, I’m good now! And actually, before we move on, I wanted to add something to Barry’s earlier question.

When I was a Ph.D. student, I studied young Black men with a family history of hypertension and compared them to age-matched white men. We expected the Black men to have a higher fight-or-flight response under stress, but we didn’t see that. Instead, they already had a higher baseline, and their response didn’t go up much more—almost like a ceiling effect. It was as if their system was already maxed out.

With the young women in my current study, we’re seeing abnormal vascular responses—more vasoconstriction under stress, even when the vessel is already stiffer at rest. So the question becomes: will we also see a ceiling effect in their fight-or-flight response, like with the young Black men? Or will their system ramp up even more in response to stress? That’s something I’m really interested in finding out.

Stanton Shanedling: That's fascinating. So going back—what level or type of trauma leads to a PTSD diagnosis? Is there a clinical threshold?

Ida-Arlaine T. Fonkoue: That's a good question you're asking. And again, my disclaimer is that I'm not a clinical psychologist. But what I would say is that the gold standard for the diagnosis of PTSD is called the Clinician Administered PTSD Scale.

Stanton Shanedling: Okay.

Ida-Arlaine T. Fonkoue: Or CAPS. The reason why it's a clinician-administered one is because it's not a survey. You're not given a survey that you answer—it's an interview. It usually takes about an hour, an hour and a half, and I know this because I work with the Grady Trauma Project in Atlanta. It's the largest civilian trauma project. They've been around for almost 20 years now and have more than 15,000 participants, mostly women. And it's in downtown urban Atlanta, Grady.

So, this interview takes about an hour and a half, and usually it's recorded because it allows the clinician to also go back and review it and check. So it's not just your answers—it's also how you answer the question. And then, just like an interview, they can probe further into things you say.

So that’s the gold standard for diagnosis. However, the diagnosis is made based on certain criteria—and I don’t want to go into those because, given that I'm not a clinical psychologist, I don't want people to start diagnosing themselves. It's important to know that there are categories of symptoms the clinician will pay attention to: mood, re-experiencing, hypervigilance, avoidance, etc.

They have a criteria for how many symptoms you need to have in each category to meet the threshold. There’s a number, because each question and how you answer it is scored. There's a threshold where they can say you're borderline, mild, moderate, or severe. So it's at the discretion of the clinical psychologist to make that diagnosis.

Actually, a sideline here is that PTSD diagnosis in the military comes with disability benefits. So there's controversy sometimes around who gets the diagnosis and who doesn’t. It’s discretionary.

But the most important thing for the diagnosis is always the traumatic event. It's like a detective going to a crime scene—if there’s no crime, there’s no investigation. So it always starts with that traumatic event. It could be a gunshot, or where you were born, and it can start early in children. It could be interpersonal trauma, natural events, war, neglect—especially adverse childhood events.

So it’s complex. But it’s important to know that there’s a traumatic event, symptoms, how many you have in each category, how long you’ve had them. Not everybody will have symptoms the day after a trauma. That’s why that minimum 4-week period matters.

If you see a clinical psychologist soon after a traumatic event, they’ll probably want to evaluate you later, to see if the criteria are still met after time has passed. That’s when a formal diagnosis happens.

Stanton Shanedling: So there’s a scale.

Ida-Arlaine T. Fonkoue: There is a scale.

Stanton Shanedling: Yeah.

Ida-Arlaine T. Fonkoue: Yeah, called the Clinician-Administered PTSD Scale.

Clarence Jones: Another question I have is about societal things that happen—like stress that's happening across the U.S., whether political, economic, deportations, etc. Are those considered trauma-oriented? If these have longer-lasting implications, do they fall under PTSD? Or are societal issues like that not part of the definition?

Ida-Arlaine T. Fonkoue: That’s a good question. Although we don’t diagnose with it, we use a questionnaire called the PTSD Checklist to determine severity. One thing it asks is about an event. For severity, we focus on the last three weeks.

But it’s not any type of stress. Chronic stress is not necessarily a traumatic event.

People often say, “I’m stressed all the time,” but that doesn’t mean you’ll develop PTSD. Acute traumatic events are different—they’re usually tied to some immediate, severe threat.

(1 min later...)

Okay, I have the questionnaire now. The PTSD Checklist is not used for diagnosis—it evaluates severity after diagnosis. The instructions say:

“This questionnaire asks about problems you may have had after a very traumatic experience involving actual or threatened death, serious injury, or sexual violence.”

It can be something that happened to you, something you witnessed, or something that happened to a close family member or friend. Examples: serious accident, fire, natural disaster, physical or sexual assault, war, homicide, suicide.

You answer a few questions about your worst event—the one that bothers you the most right now. You list the event, how long ago it happened, whether it involved actual or threatened death, and how you experienced it—whether directly, witnessing, or through repeated exposure (like the George Floyd footage). I had to turn off the TV because I’m raising a Black son—I didn’t want him to keep seeing it.

This is important: we shouldn’t casually say, “I have PTSD, I’m just too stressed.” That undermines what people with actual PTSD go through. This is a debilitating disorder.

People can’t function normally—can’t get in elevators alone, can’t go to work due to overstimulation. That’s why they can’t hold jobs. So it’s not a diagnosis to be taken lightly.

Stanton Shanedling: Yeah. You’re really defining specific parameters. I have cousins who lost their home in Pasadena to fires—they seem okay, but others may develop PTSD from that acute event.

Barry Baines: On a more positive note—what can people do? I’ve read that personal resilience reduces PTSD risk. Do you study interventions that reduce the neurohormonal response, like meditation or breathing?

Ida-Arlaine T. Fonkoue: That’s a great question. Some people are naturally more resilient—but community is key. Two people can experience the same trauma—only one develops PTSD. Community starts with family, then expands: teachers, coaches, role models.

At Emory, we tested device-guided breathing paired with music. It included a chest belt sensor and music to match inhale/exhale. The intervention group breathed at 6 breaths/min (low); control group at 14. We measured fight-or-flight response using an electrode behind the knee (I do that in my lab too).

We found that deep breathing reduced that response acutely. After 8 weeks, the group with real devices had a slower response during a mental math stress test compared to the sham group.

So yes—breathing, meditation, mindfulness, and music therapy all help. PTSD used to be categorized as an anxiety disorder, and these methods help with that rising anxiety response.

Clarence Jones: What percentage of the population struggles with PTSD?

Ida-Arlaine T. Fonkoue: In the military, it’s about 10–16%. It fluctuates. In the civilian population, it's likely increasing—especially after COVID. COVID wasn’t just a disease—it forced people into unsafe environments. Quarantine meant people couldn’t leave harmful situations. Lawyers and therapists were unavailable. That increased trauma exposure. So if new numbers are collected, I believe they’ll show a rise.

Stanton Shanedling: When did PTSD first enter the medical literature?

Ida-Arlaine T. Fonkoue: That’s a good question. It started in the military but wasn’t called PTSD then.

Barry Baines: Shell shock?

Ida-Arlaine T. Fonkoue: Yes, exactly—shell shock. Veterans came back with symptoms, but it wasn't named yet. Later, it became PTSD, but it was still mainly applied to military cases. Eventually, it expanded to civilians when the same symptoms were seen in other forms of trauma.

Stanton Shanedling: When people are diagnosed with PTSD, who treats them—for PTSD and related issues like heart disease? Is it a team?

Ida-Arlaine T. Fonkoue: Yes—it should be a team approach. That’s why I study young women—to say, “Hey, don’t overlook this group!” It’s not one-size-fits-all. Clinical psychologists can’t manage internal medicine, and vice versa.

When someone comes to me because of sleep problems (which I also study), I tell them we can’t treat it separately from the trauma. Communication between providers is key.

Unfortunately, I see a lot of disjointed care. One provider sends the patient away, thinking it’s another issue. But PTSD affects the whole body.

Stanton Shanedling: Yeah, better coordination in treatment is needed in general.

Wow—this is a complicated and sad subject, but I commend you for addressing it. We’ll look forward to more of your research.

Clarence Jones: Thank you. It’s been a pleasure.

Barry Baines: This was fabulous. PTSD is usually framed as a mental health issue, but if we connect it to physical health—high blood pressure, strokes—it’ll help move it into the medical mainstream, which may improve treatment access.

Also, I’d love the playlist from the breathing study!

Ida-Arlaine T. Fonkoue: I wish I could share it. I believe the Respira device company owns the copyright for the music. But yes, just like we use different music for exercise or relaxation, we could do the same for breathwork.

Barry Baines: I’ll pass on my granddaughter’s rap playlist and go with this instead!

Ida-Arlaine T. Fonkoue: (laughs) Probably a good idea!

Also, I want to emphasize this: PTSD is not just in your head. In minority communities, especially where I’m from in Africa, we’re often taught to suppress trauma. “Get over it.” But pushing it aside without proper care—therapy, medical attention—can have real consequences. The body keeps the score, as that book says.

Even if you think you’ve gotten over it, you might start seeing symptoms—heart palpitations, hypertension, even diabetes—with no family history. PTSD alone can trigger these diseases.

Stanton Shanedling: Yes, it can absolutely exacerbate health conditions.

Ida-Arlaine T. Fonkoue: Even if you look fit and healthy, untreated trauma can still wreak havoc internally.

Stanton Shanedling: Thank you so much for your insights and research. You’ve helped uncover how complex and far-reaching PTSD really is.

We’ll post updates to your research on our website. For everyone listening, stay tuned for our next episode on men’s stories about health—another important topic. Until then, keep health chatting away.