Cognitive Therapy of Anxiety Disorders

Posttraumatic Stress Disorder 503

Clinician Guideline 12.6

Even though PTSD is a transient reaction to trauma exposure that remits in two- thirds of

individuals in 3–6 months, nevertheless as many as one-third of individuals exposed to

trauma will develop a chronic form of the disorder that can persist for many years. Segments

of the population with greater exposure to life- threatening traumas have a higher rate of the

d isorder.

Gender and Ethnicity

Both population-based and conditional risk studies have found that stress- related symp-
toms and PTSD are evident in more women than men (e.g., Breslau et al., 1998; Jeon
et al., 2007; Galea et al., 2002; Galea et al., 2007; Kessler et al., 1995; Silver et al.,
2002). Various explanations have been proposed for this gender effect on PTSD such as
(1) women’s higher rate of exposure to particularly toxic traumas like rape and sexual
assault (Creamer et al., 2001; Kessler et al., 1995), (2) an elevated psychiatric history for
other anxiety disorders and depression, (3) a greater tendency to endorse an emotional
response of fear, helplessness, or horror to trauma (Breslau & Kessler, 2001), or (4) a
differential endorsement rate to a small subset of symptoms (Peters, Issakidis, Slade, &
Andrews, 2006). There are, then, a number of possible reasons why women exhibit a
higher rate of PTSD than men.
There has been considerable debate over ethnic and cultural differences in response
to trauma and PTSD. Although there have been cross- national differences in rates of
PTSD, no ethnic differences in lifetime prevalence of PTSD were found in the NCS (Kes-
sler et al., 1995) or in the Australian National Survey of Mental Health and Well-Being
(Creamer et al., 2001). There was some indication that a higher rate of PTSD after 9/11
was associated with Hispanic ethnicity (Galea et al., 2002) and PTSD prevalence was
higher in black and Hispanic male veterans compared to white male Vietnam veterans
(e.g., Koenen, Stellman, Stellman, & Sommer, 2003; Kulka et al., 1990; see also Tan-
ielian & Jaycox, 2008, for similar results among Afghanistan and Iraq deployments),
although this could be due to differences in severity of combat exposure or pretrauma
variables such as younger age, lower education, and aptitude test scores (Dohrenwand,
Turner, Turse, Lewis- Fernandez, & Yager, 2008).

Clinician Guideline 12.7

Although PTSD is more prevalent in women than men, this gender difference may be due to

a higher rate of interpersonal trauma. Ethnic and cultural diversity may play a weaker role in

stress- related responses and development of PTSD after traumatic exposure.

Onset and Age Differences

PTSD has a swift onset with prevalence rates for PTSD symptoms and disorder peak-
ing within the first month of traumatic exposure, followed by steep remission rate in