Editorial Perspective: Childhood maltreatment - the problematic unisex assumption.

Childhood maltreatment (CM) is a heterogeneous group of childhood adversities that can range from different forms of abuse (physical, sexual, emotional) or neglect (physical, emotional, cognitive), to severe bullying by peers. With an annual estimated cost of $500 billion in the United States alone, CM is recognized as one of the most significant risk factors for a range of psychiatric and medical conditions (White and Kaffman, 2019). Further, rates of numerous psychiatric, neurological, and medical conditions differ significantly between males and females (Gillies and McArthur, 2010), inspiring decades of research on how sex moderates consequences of CM (Gershon et al., 2008). Although vulnerability to CM has been reported to vary by sex, very few findings have been consistent across studies. Moreover, most work to date has focused on how sex alters the frequencies of different psychopathologies in maltreated individuals, with little attention to whether different developmental processes may underlie these psychopathologies in males and females (White and Kaffman, 2019). The primary goal of this editorial was to advocate for more effective research strategies to address these questions. We first examine the rationale for studying sex as an important moderator of consequences of CM, briefly summarize some of the most consistent clinical findings, and discuss the implications of sex in treatment response. We then highlight important obstacles that contribute to the large number of inconsistent findings and make five recommendations on how to move forward.