504 TREATMENT OF SPECIFIC ANXIETY DISORDERS
40–60% of cases within 6–12 months posttrauma (e.g., Breslau et al., 1998; Kessler et
al., 1995; Galea et al., 2003). Kessler et al. (1995) reported that remission was shorter in
those who obtained treatment (i.e., mean of 36 months) compared with those who did
not seek treatment (i.e., mean of 64 months), although this finding has not always been
replicated in other studies (e.g., Milliken et al., 2007). DSM-IV-TR (APA, 2000) allows
for a specifier indicating that PTSD can have a delayed onset of at least 6 months after a
traumatic stressor. However, delayed-onset appears to be rare, especially in nonmilitary
samples, occurring in 5% or less of cases (e.g., Mayou et al., 2001; North et al., 1999;
see Andrews, Brewin, Philpott, & Stewart, 2007).
Trauma occurs in all ages and so PTSD symptoms are also prevalent across the
lifespan, although 23 years was the median onset age in the NCS-R (Kessler, Berglund,
et al., 2005). The majority of children and adolescents, especially in urban centers,
are exposed to traumatic events (e.g., Breslau, Lucia, & Alvarado, 2006; Seedat et al.,
2004). Breslau et al. (2006) determined that 8.3% of 17-year-olds who experienced a
traumatic event met criteria for PTSD, whereas Pynoos et al. (1993) reported an aston-
ishing 93% of children exposed to the 1988 Armenian earthquake had severe chronic
PTSD 18 months after trauma exposure. As noted previously childhood physical and
sexual abuse as well as other childhood adversities may be especially likely to lead to
PTSD in adults (see also Norris & Slone, 2007, for discussion). However, new cases
of PTSD are rare after the early 50s and the prevalence of PTSD even with trauma
exposure may decline with increasing age (Kessler et al., 1995; Kessler, Berglund et al.,
2005).
Clinician Guideline 12.8
PTSD is a disorder that is particularly prevalent in adolescence to midadulthood, with expo-
sure to traumatic events during the early years having a cumulative negative effect that can
persist well into adulthood.Quality of Life and Functional Impairment
Chronic PTSD is associated with significant decrements in social, occupational, and
educational attainment as well as in quality of life. Compared to the other anxiety
disorders, individuals with PTSD have some of the highest rates of physical disorder
(e.g., Sareen et al., 2005; Zatzick et al., 1997). In addition chronic PTSD is associated
with significant work or school functional impairment (Stein, Walker, Hazen, & Forde,
1997; Zatzick et al., 1997) and significantly worse social functioning in marital and
family relationships, parenting, and sexual satisfaction (e.g., Koenen, Stellman, Som-
mer, & Stellman, 2008). In addition PTSD is associated with a number of negative
health behaviors such as increased nicotine and drug use (Breslau, Davis, & Schultz,
2003; Koenen et al., 2008; Vlahov et al., 2002). A meta- analysis of quality-of-life stud-
ies revealed that PTSD and panic disorder were associated with the greatest impair-
ments across quality-of-life domains (Olatunji et al., 2007; see also Hansson, 2002).
In the NCS-R 34.4% of individuals with PTSD made contact with a mental health
professional in a 12-month period, which is one of the higher utilization rates among the