Full text of DOI:10.1207/S15327558IJBM0803_6

INTERNATIONAL JOURNAL OF BEHAVIORAL MEDICINE, 8(3), 240–250
Copyright © 2001, Lawrence Erlbaum Associates, Inc.
Sex Differences in
Cardiovascular Reactivity to Physical
Appearance and Performance Challenges
Laura R. Stroud, Raymond S. Niaura,
and Catherine M. Stoney
We examined sex differences in cardiovascular reactivity to a novel body image speech
task and to three performance-oriented challenges: serial subtraction, handgrip, and
mirror tracing tasks. Forty-nine men and 64 women completed the four tasks while
heartrate, systolicbloodpressure, diastolicbloodpressure, andmeanarterialpressure
were measured. The speech was perceived as requiring more emotionality and empa-
thy for success, whereas the performance tasks were perceived as requiring greater
competitiveness. As predicted, women showed greater heart rate reactivity to the
body image speech, but men showed greater blood pressure reactivity to the subtrac-
tion, grip, and mirror tracing tasks. Results underscore the importance of contextual
factors in influencing sex differences in stress responses; women may be more physi-
ologically vulnerable to challenges in the domain of physical appearance, whereas
men may react to competitive, performance-oriented challenges.
Key words: sex differences, stress, cardiovascular reactivity, physical appearance,
performance
Men’s greater physiological reactivity to acute stress has been posited as one expla-
nation for their greater morbidity from coronary heart disease (Anderson,
Kochanek, & Murphy, 1997; Matthews, 1989; Stoney, Davis, & Matthews, 1987).
In support of this hypothesis, men have shown greater increases in blood pressure,
epinephrine, and lipids in response to certain laboratory stressors, as well as to such
Laura R. Stroud and Raymond S. Niaura, Brown University Center for Behavioral and Preventive
Medicine, Providence, RI, USA;Catherine M. Stoney, The Ohio State University, Columbus, OH, USA.
Correspondence concerning this article should be addressed to Laura Stroud, Brown University
Centers for Behavioral and Preventive Medicine, Coro West, Suite 500, 1 Hoppin Street, Providence,
RI 02903. E-mail: laura_stroud@brown.edu

SEX DIFFERENCES IN STRESS REACTIVITY
241
“real-world” challenges as examination and work stress (Allen, Stoney, Owens, &
Matthews, 1993; Frankenhaeuser et al., 1978). However, in response to stressors in
“traditionally female” areas of competence such as child care and marital conflict,
women have shown greater cardiovascular (CV), neuroendocrine, and immune re-
activity than men (Kiecolt-Glaser et al., 1996; Lundberg, de Chateau, Winberg, &
Frankenhaeuser, 1981). Most recently, women were shown to exhibit greater reac-
tivity to communal or interpersonal stressors, whereas men showed greater reactiv-
ity to agentic or achievement-oriented stressors (Smith, Gallo, Goble, Ngu, &
Stark, 1998; Stroud, Salovey, & Epel, 1999).
In addition to interpersonal challenges, evaluations of physical appearance tra-
ditionally have been seen as more salient stressors for women (Gillespie & Eisler,
1992). Women show greater awareness and concern about physical appearance
and weight than do men (Striegel-Moore & Cachelin, 1999). Women also show
significantly greater body and weight dissatisfaction at the same level of over-
weight (Pingatore, Spring, & Garfield, 1997), are more vulnerable to eating disor-
ders (Kendler et al., 1991), and have greater affective investment in their bodies
compared with men (Lerner & Brackney, 1978). Although physical appearance
appears to be of greater concern to women, categories rated most stressful for men
tend to fall in the domain of performance inadequacy—e.g., physical fitness, per-
formance failures at instrumental tasks, and intellectual inferiority (Eisler &
Skidmore, 1987).
Despite evidence for women’s greater concern with physical appearance and
men’s concern with performance-oriented domains, we know of no study compar-
ing sex differences in physiological responses to a physical appearance evaluation
with responses to more performance-oriented stressors. In this experiment, we
compared men’s and women’s CV responses to both a physical appearance evalu-
ation (body image speech) and to typical laboratory stressors involving perfor-
mance-oriented challenges (handgrip task, mirror star tracing, and mental
arithmetic). We hypothesized that women would show greater reactivity to the
speech task but men would show greater reactivity to the performance-oriented
laboratory challenges (grip, tracing, and math tasks).
METHOD
Participants
Fifty-eight men and 78 women participated in the experiment as part of a larger
study of physiological responses to examination stress. They received $20 for their
participation. Participants who reported use of steroids, antihistamines, cardiac
medications, or hypertensive medications and those with a history of major physi-
cal or mental illness were excluded from analyses, leaving 49 men and 64 women.
All participants were nonsmokers and normotensive (<90 mmHg diastolic blood

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pressure [DBP]). Ages ranged from 20 to 36 (M = 24), body mass index from 18 to
46 (M = 24). Fifteen women used oral contraceptives; we report analyses both in-
cluding and excluding these women.
Cardiovascular Measures
DBP, systolic blood pressure (SBP), mean arterial pressure (MAP), and heart rate
(HR) were measured by using a Dinamap, automated, oscillometric blood pressure
monitor (Model 1846SX; Critikon Inc., Tampa, FL).
Task Impressions Questionnaire
Participants used the Task Impressions Questionnaire (Matthews, Davis, Stoney,
Owens, & Caggiula, 1991) to rate their impressions of each stress task on
5-point Likert scales ranging from 1 (not at all) to 5 (very). Five items from the
masculinity and femininity scales of the Personal Attributes Questionnaire
(Spence, Helmreich, & Stapp, 1975) were used to validate descriptions of each
task. Items included emotionality, awareness of others’ feelings, self-confidence,
dominance, and competitiveness.
Stressors
Physical appearance challenge. For the physical appearance challenge
(Niaura, Wilson, & Westrick, 1988), participants were asked, “What you like and
dislike about your body and physical appearance?” They were given 2 min to pre-
pare and 4 min to present a speech on this topic. Participants were told that their
speech would be videotaped for later scoring by psychologists for openness, hon-
esty, and defensiveness. Task level included two CV readings taken 1 and 3 min
into the 4-min speech.
Serial subtraction task. Participants were asked to subtract by 7s starting
from 2,193 “as quickly and as accurately as possible” for 6 min. Mistakes were cor-
rected by the experimenter, after which the participant was asked to begin again
from the missed number. Task level constituted the average of three CV readings
taken 1, 3, and 5 min into the 6-min task.
Mirror tracing task. Participants were asked to trace the figure of a six-sided
star while viewing only the mirror image of the figure. Participants used their
nondominant arm and were asked to trace the star as quickly as possible without al-
lowing the pen to stray to the metal sheet around it. Participants completed two
3-min star tracing trials separated by a brief rest period. Task levels were the aver-
age of four CV measures taken 0.5 and 1.5 min into each 3-min trial.

SEX DIFFERENCES IN STRESS REACTIVITY
243
Isometric grip task. Participants were asked to squeeze a handgrip dyna-
mometer (Lafayette Instruments, Lafayette, IN) at 30% of maximum grip strength
for 2.5 min. Task levels were the average of two CV readings taken 0.5 and 1.5 min
into the 2.5-min steady grip with the dynamometer set to average maximum grip
strength.
Procedure
All sessions took place between 9 a.m. and 3 p.m. Participants were asked to refrain
from exercise and alcohol beginning the evening before and from caffeine for at
least 4 hr before the experiment. Participants were seated upright in a comfortable
chair and connected to the physiological recording equipment. During the 10-min
initial baseline period, participants relaxed while sitting quietly and listening to soft
music. Physiological recordings were taken at 1-min intervals during the last 4 min
of the baseline period. After this, the four stressors (described previously) were pre-
sented in random order at different stations. The Task Impressions Questionnaire
was completed after each task, followed by a 5-min recovery period.
Data Reduction and Analyses
For CV variables, task levels were the average of the CV measures during each
task, and baseline levels were the average of the four CV measures from the initial
baseline period. Reactivity was the difference between the average task and base-
line levels (Llabre, Spitzer, Saab, Ironson, & Schneiderman, 1991). Sex differences
for each CV measure (HR, SBP, DBP, MAP) across tasks were tested with a series
of repeated measures analyses of covariance (ANCOVAs) with sex as the be-
tween-participant factor, four reactivity scores (for speech, grip, math, and tracing
tasks) as repeated measures, and baseline CV levels as covariates (Benjamin,
1967). Significant Sex × Task interactions were followed with univariate
ANCOVAs for each task and CV variable with baseline levels as covariates.
Greenhouse–Geiser corrections were applied in all repeated measures analyses
(Vasey & Thayer, 1987).
RESULTS
Effectiveness of the Experimental Manipulation
Task perceptions. Participants perceived the tasks as significantly different
on emotionality, awareness of others’ feelings, self-confidence, dominance, and
competitiveness, Fs(3, 333) > 4.08, ps < .01. The speech challenge was seen as re-
quiring significantly more emotionality and awareness of the feelings of others

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STROUD, NIAURA, STONEY
compared with the other three tasks (ps < .05), whereas the handgrip, math, and
tracing tasks were perceived as requiring significantly more competitiveness com-
pared with the speech challenge (ps < .0001). The handgrip task was seen as requir-
ing significantly more dominance to perform well compared with the speech task (p
< .005), and the speech task was seen as requiring significantly more self-confi-
dence to do well compared with the handgrip (p < .05). No significant sex differ-
ences in task perceptions emerged.
Stressor-induced cardiovascular levels. We found significant changes
across all CV parameters between baseline and all task levels, Fs(4, 448) >
48.75, ps < .0001. Furthermore, each task was found to induce significant
changes in each CV measure compared with baseline, Fs(1, 111) > 44.67, ps <
.0001.
Sex Differences in Cardiovascular Levels at Baseline
Consistent with previous studies (Stoney et al., 1987), males showed significantly
higher SBP (117 vs. 105 mmHg) compared with women at baseline (p < .001). Men
alsoshowedgreaterDBP(68vs. 63mmHg)andMAP(86vs. 79mmHg)atbaseline
(ps < .001). Unexpectedly, no significant sex differences in HR emerged (67 vs. 70
bpm).
Sex Differences in Cardiovascular Responses to Physical
Appearance and Performance-Oriented Stressors
Sex differences in reactivity across tasks for each CV measure are shown in Figure
1. As predicted, significant Sex × Task interactions emerged for HR, SBP, DBP,
and MAP reactivity scores across tasks, Fs(3, 330) = 4.03, 5.65, 5.07, and 7.68, re-
spectively, ps < .01. In particular, women showed significantly greater HR reactiv-
ity to the speech task than men, F(1, 110) = 6.59, p < .05, but no significant sex dif-
ferences in HR emerged for the grip, math, and tracing tasks. For SBP the opposite
pattern emerged. Although there were no significant sex differences for the speech
task, men showed significantly greater SBP reactivity to the grip, math, and tracing
tasks, Fs(1, 110) = 43.67, 6.17, and 4.00, respectively, ps < .05. For DBP, men
showed significantly greater DBP responses to the grip task, F(1, 100) = 16.55, p <
.0001, but no significant sex differences in DBP emerged for the speech, math, and
tracing tasks. Finally, men showed significantly greater MAP reactivity to the grip
task, F(1, 110) = 29.63, p < .0001, but no significant sex differences emerged in
MAP reactivity for the speech, math, and tracing tasks.

FIGURE 1 Change from baseline to task ± SEM for each task for men and women. (a) Heart
rate reactivity, (b) systolic blood pressure (SBP) reactivity, (c) diastolic blood pressure reactiv-
ity (DBP), and (d) mean arterial pressure (MAP) reactivity. *Sex differences significant at the p
< .05 level by simple contrast.
245

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STROUD, NIAURA, STONEY
Removing participants who were taking oral contraceptives (n = 15) from
analyses did not change the pattern or significance of results. Controlling for
body mass index and task order also did not change patterns or significance of
results except that sex differences in SBP responses to the tracing task trended
toward significance (p < .06) when we controlled for task order.
Differences in Reactivity in Women Using Oral
Contraceptives
As a post hoc analysis, we compared women who were taking oral contraceptives
with those who were not in a series of 2 (contraceptive status) × 4 (task) repeated
measures ANCOVAs (baseline levels as the covariate) followed by univariate
ANCOVAsforeachtask.Wefoundasignificantmaineffectforcontraceptivestatus
for MAP, F(1, 64) = 4.95, p < .05; a trend toward a main effect for SBP, F(1, 64) =
3.65, p < .06; but no significant interactions between contraceptive status and task.
Contraceptive users showed greater MAP and SBP reactivity to the grip task com-
paredwithnonusers, Fs(1, 64)>4.24, ps<.05;trendstoward greaterSBPandMAP
reactivity to the math task; and a trend toward greater MAP reactivity to the tracing
task, Fs(1, 64) > 2.49, ps < .15.
DISCUSSION
We examined sex differences in CV reactivity to a physical appearance stressor
(body image speech) and three performance-oriented stressors (a handgrip task,
mentalarithmetic,andmirrorstartracing).Aspredicted,womenshowedgreaterHR
reactivitytothephysicalappearancechallenge, butmenshowedgreaterbloodpres-
sure (BP) reactivity to the performance-oriented challenges. This experiment is the
first to compare a speech regarding physical appearance with typical laboratory
stressors in terms of sex differences in CV reactivity. However, results complement
previous studies in which women have shown greater reactivity to more
stereotypicallyfemininetasksincludinginterpersonal(Stroudetal.,1999),commu-
nal (Smith et al., 1998), and marital conflict tasks (Kiecold-Glaser et al., 1996), or
neutraltasksframedasemphasizingcloserelationshipsorempathy(Lash, Eisler, &
Southard, 1995). More interesting, participants’ weight did not appear to influence
reactivity to the physical appearance challenge. Sex differences remained when we
statisticallycontrolledforbodymassindex,andposthocanalysesshowednosignif-
icant correlations between body mass index and reactivity to the body image chal-
lenge. Like interpersonal concerns, then, physical appearance may represent an im-
portant area of greater female vulnerability. Indeed, the combination of
interpersonal orientation (with its emphasis on the opinions of others) and physical
appearance as “core aspects” of the feminine identity, together with the media’s de-

SEX DIFFERENCES IN STRESS REACTIVITY
247
pictionofanunattainablefemalephysicalideal,mayleavewomenvulnerabletolow
self-esteem and disordered eating (Striegel-Moore & Cachelin, 1999).
Our results also complement studies in which men showed greater reactivity to
academic (Frankenhaeuser et al., 1978), agentic (Smith et al., 1998), and perfor-
mance-oriented tasks (Allen et al., 1993), or neutral tasks with instructions empha-
sizing performance skills (Lash, Gillespie, Eisler, & Southard, 1991). Results are
inconsistent with those of Matthews and colleagues (Davis & Matthews, 1996;
Matthews et al, 1991), who also examined experimental manipulations of neutral
tasks. One possibility is that the objective gender relevance of the “gender-neutral
tasks” (e.g., performance tasks may elicit greater reactivity in men, whereas inter-
action tasks may elicit greater reactivity in women) may have overridden the in-
struction sets in the studies conducted by Matthews and colleagues, whereas Lash
et al.’s cold pressor task might have been more gender-neutral. In this study, task
perceptions served as an important manipulation check. Both men and women
rated the body image task as requiring more feminine attributes for success and the
performance stressors as requiring more masculine attributes. However, because
there were no sex differences in overall perceptions of the task, one possibility is
that gender differences in the personal relevance of the tasks (e.g., stereotypically
feminine tasks are more personally relevant to women, and masculine tasks to
men) might underlie sex differences in reactivity. Another possible mechanism in-
volves sex differences in peripheral physiology, which might underlie both sex
differences in response patterns (HR vs. BP reactivity) as well as domains (appear-
ance vs. performance tasks). For example, women’s greater HR reactivity and
men’s greater BP reactivity are consistent with previous studies where men tended
to be vascular reactors (showing greater BP and peripheral resistance changes) and
women tended to be myocardial reactors (showing greater HR and cardiac output
changes) after certain stressors (Allen et al., 1993; Girdler, Turner, Sherwood, &
Light, 1990). Potential mechanisms underlying sex differences in response pat-
terns include sex differences in sensitivity and density of peripheral α- and
β-adrenergic receptors (e.g., Kneale, Chowienczyk, Brett, Coltart, & Ritter, 2000)
and estrogen’s effects on vascular contractility, myocardial contractility, or both
(e.g., Li, Bian, Kwan, & Wong, 2000; Mercuro et al., 1997). A third possibility is
that both perceptions and peripheral physiological mechanisms play a role in sex
differences in reactivity. For example, the grip task showed the most consistent sex
differences in reactivity of the three performance stressors. More interesting, this task
also was perceived as most different in attributes from the speech task. At the same
time, this was the only task that was adjusted for individual’s level of competence
(30% grip strength); thus, differences in reactivity may also be due to sex differences
in vascular responses to muscle exertion.
Although based on a post hoc analysis of a small sample of contraceptive users,
we also found that contraceptive users trended toward greater magnitude of BP re-
activity to most tasks compared with nonusers. Previous studies regarding the ef-

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STROUD, NIAURA, STONEY
fects of contraceptive use on CV reactivity have yielded inconsistent results, with
some showing increased reactivity in contraceptive users (McDermott, Ernst,
Nevels, & Robertson, 1997; Straznicky, Barrington, Branley, & Louis, 1998) and
others showing increased reactivity only in contraceptive users who smoked (Da-
vis & Matthews, 2000; Girdler, Jamner, Jarvik, Soles, & Shapiro, 1997). Discrep-
ancies in this study and previous literature may be due to small numbers of partici-
pants and differences in progestin and androgen potencies of the contraceptive users
involved (Ellis, 1986).
We acknowledge several limitations to this study. First, we did not assess
phases of the menstrual cycle for the female participants. However, the large
number of women makes it likely that there were approximately equal numbers
of women in each phase of the menstrual cycle. Second, we did not assess possi-
ble physiological (e.g., hemodynamic, parasympathetic) and cognitive (percep-
tions of the personal relevance of the tasks) mechanisms that might underlie the
sex differences in responses to the different types of tasks. Finally, participants
were medical students at a prestigious university, limiting the generalizability of
results.
In sum, women appear physiologically more vulnerable to tasks emphasizing
physical appearance, whereas men may be more vulnerable to performance and
physical stressors. Results suggest that studies of reactivity should include
stressors relevant to both sexes and that stressor type needs further examination
as a moderator of the relation between physiological reactivity and health out-
comes. Although men’s greater responses to agentic stressors may help to ex-
plain negative health outcomes for men, women’s reactivity to physical
appearance and interpersonal concerns also may represent health risks.
ACKNOWLEDGMENTS
This work was supported by a T-32 fellowship from the National Institute on Alco-
hol Abuse and Alcoholism to Laura Stroud and a grant from the National Institutes
of Health (HL48363) to Raymond Niaura and Catherine Stoney.
Portions of this article were presented at the American Psychosomatic Society
Annual Meeting, March 2000, and the Society of Behavioral Medicine Annual
Meeting, March 1998.
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