This chapter describes how the impact of psychological trauma and posttraumatic stress disorder (PTSD) differ, depending on individual differences and the social and cultural context and culture-specific teachings and resources available to individuals, families, and communities. We use the framework (Kira et al., 2011) formulated to differentiate the impact on the individual's or group's (i) personal, unique physical characteristics, including skin color, racial background, gender, and sexual orientation; and (ii) family, ethnocultural, and community membership, including majority or minority group status, religious beliefs and practices, socioeconomic resources, and political and civic affiliations. While personal and social factors can be a positive resource contributing to safety and well-being, they also can be a basis for placing the person or group in harm's way. Disadvantaged persons and communities-such as those in poverty or who face stigma and discrimination, disabilities, homelessness, political repression, communal/ societal violence (including paramilitary, military, and gang warfare), forced immigration (refugees and asylum seekers), interrogation and torture, terrorism, genocide, and catastrophic disasters-are particularly vulnerable both to being exposed to traumatic stressors and to developing PTSD and associated psychiatric disorders and psychosocial problems (Betancourt et al.This vulnerability largely is explained by exposure to chronic and cumulative stressors (such as stigma, discrimination, and poverty), ongoing interpersonal and group victimization, intergroup conflict, systems of belief and tradition, and exposure to chronic or particularly horrific traumatic stressors (including the often lengthy aftermath of catastrophic disasters, and societal conflicts), rather than being due solely to ethnic or cultural differences (Kira et al., 2011) . Racially or ethnoculturally based discrimination is widely recognized as having been a scourge on the human race for millennia. Genocide-the attempt to eradicate an entire racial, ethnic, or cultural group-has caused untold suffering and cost the lives of hundreds of millions of people across the planet throughout human history. The term historical trauma has been coined to describe the traumatic impact that racially or ethnoculturally based genocide has on not only the immediate targets but moreover on their progeny for generations afterward. The living memory of traumatic assaults on the survival and human dignity of entire groups or societies can persist as a form of vigilance against any sign of a potential recurrence of the genocide. Posttraumatic Stress Disorder 504 Posttraumatic Stress Disorder 506 5. PTSD therapists must avoid stereotypic assumptions in order to ensure that assessment and treatment are genuinely collaborative and sensitive to each client's ethnocultural and other expectations, goals, and preferences. A culturally competent approach to treating PTSD begins with a collaborative discussion in which the therapist adopts the stance of a respectful visitor to the client's outer and inner world-clarifying the client's expectations and preferences, and the meaning of sensitive interpersonal communication modalities (such as spatial proximity, gaze, choice of names, private versus public topics, synchronizing of talk and listening, use of colloquialisms, providing advice or education). 6. A systematic assessment of trauma history and PTSD thus should include not only a listing of events and symptomatic or resilient responses in the aftermath but how the person interpreted these events and reactions based on his or her cultural framework, beliefs, and values. 7. In contrast to the general pattern of stigma-related violence being directed toward girls and women, gay and bisexual boys and men were more likely to report violent victimization or threats than lesbian or bisexual women or girls. The findings from a survey of gay, lesbian, and bisexual (GLB) adolescents suggest that stigma and victimization begin early in life, with physical and sexual attacks occurring as early as ages 8-9 years old. One in 11 GLB adolescents have been found to have PTSD, as much as 20 times more than other children and adolescents. 8. Poverty puts people at risk for traumatic violence, and not having a stable residence (homelessness) compounds this risk and further increases the likelihood of developing PTSD and associated mental health distress and health conditions. 9. Political repression, genocide, and mass armed conflicts involve psychological (and often physical as well) assaults by the people and institutions in power on people, families, communities, and organizations who are deprived of access to political power and socioeconomic resources-and therefore also on their fundamental freedoms and values. Without access to self-determination and the resources necessary to sustain independence, people are vulnerable not just to traumatic exploitation and violence but also to the traumatic loss of their intimate relationships, their families, their way of life, and their values. 10. Refugees and "internally displaced" or "stateless" persons who have been displaced from or lost their families, homes, and communities due to armed conflicts or mass disasters (such as tsunamis, hurricanes, or earthquakes) are at least 10 times (and as much as 30 times) more likely than other children or adults to develop PTSD, with as many as one in three refugees or disaster survivors developing Acute Stress Disorder (ASD) or PTSD.
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