tom clusters of PTSD may vary culturally, particularly with respect to avoidance and
numbing symptoms, distressing dreams, and somatic symptoms (e.g., dizziness, short-
ness of breath, heat sensations).
Cultural syndromes and idioms of distress influence the expression of PTSD and the
range of comorbid disorders in  different cultures by providi ng behavioral and cognitive
templates that link traumatic exposures to specific symptoms. For example, panic attack
symptoms may be salient in PTSD among Cambodians and Latin Americans because of
the association of traumatic exposure with panic-like khyâl attacks and ataque de nervios.
Comprehensive evaluation of local expression s of PTSD should include assessment of cul-
tural concepts of distress (see the chapter “Cultural Formulation” in Section III).
Gender-Related Diagnostic Issues
PTSD is more prevalent among females than among males across the lifespan. Females in
the general population experience PTSD for a longer duration than do males. At least some
of the increased risk for PTSD in females appe ars to be attributable  to a greater likelihood
of exposure to traumatic events, such as rape, and other forms of interpersonal violence.
Within populations exposed specifically to such  stressors, gender differences in risk for
PTSD are attenuated or nonsignificant.
Suicide Risk
Traumatic events such as childhood abuse increa se a person’s suicide risk. PTSD is associated
with suicidal ideation and suicide attempts, an d presence of the disorder may indicate which
individuals with ideation even tually make a suicide plan or actually attempt suicide.
Functional Consequences of 
Posttraumatic Stress Disorder
PTSD is associated with high levels of social , occupational, and physical disability, as well
as considerable economic costs and high leve ls of medical utilization. Impaired function-