A guidebook to the official American Psychiatric Association's diagnostic manual says: “It is noteworthy that once Posttraumatic Stress Disorder occurs, its symptom pattern is remarkably uniform regardless of the individual's previous psychological history or cultural background” (Frances, First, & Pincus, 1995, p. 258). If the symptom pattern is consistent regardless of varying cultural circumstances, and if the extreme traumas that cause this symptom pattern are ones that occur throughout human history in different cultures, then human communities must have come up with adaptive mechanisms and group responses to this phenomenon. Accepting the dimension of perpetration as a trauma adds to this understanding, since it has also been common across varying cultures.
Studies of various ethnocultural groups would be necessary to ascertain the extent to which PTSD in general and PITS in particular is a culture-bound concept or is useful cross-culturally. The most comprehensive work on this is a volume entitled Ethnocultural Aspects of Posttraumatic Stress Disorder (Marsella et al., 1996). This work shows that PTSD has been diagnosed in a wide variety of cultures worldwide, from Southeast Asian refugees to Latin American disaster survivors to Navajo and Sioux veterans. The authors were unaware of any ethnocultural cohort in which it was absent, though of course prevalence rates and symptom patterns did vary. The idea of perpetration as a causal trauma mechanism, however, is not considered; such additional consideration could greatly improve cross-cultural studies.
Different understandings of social realities can be expected to provide vari-