The Emotion Dysregulation Model of Anxiety: A preliminary path analytic examination

Both temperamental (e.g., behavioral inhibition) and environmental (e.g., family emotional environment) factors are associated with etiology and maintenance of anxiety; however, few studies have explored mechanisms through which these risk factors operate. The present study investigation of a developmental model of anxiety (i.e., the Emotion Dysregulation Model of Anxiety; EDMA) that hypothesizes that emotion dysregulation is the mechanism through which temperamental and emotion parenting variables relate to anxiety. Emerging adults (N = 676, M age = 19.5) retrospectively reported on behavioral inhibition and emotion parenting factors in childhood, and current emotion regulation skills and symptoms of anxiety. Results of path analyses provide initial support for the EDMA. Emotion dysregulation fully mediated the relationship between behavioral inhibition and anxiety and partially mediated the relationship between family emotional environment and anxiety.     

Test of the stress sensitization model in adolescents following the pipeline explosion

PurposeThe stress sensitization model states that early traumatic experiences increase vulnerability to the adverse effects of subsequent stressful life events. This study examined the effect of stress sensitization on development of posttraumatic stress disorder (PTSD) symptoms in Chinese adolescents who experienced the pipeline explosion.MethodsA total of 670 participants completed self-administered questionnaires on demographic characteristics and degree of explosion exposure, the Childhood Trauma Questionnaire (CTQ), and the Posttraumatic Stress Disorder Checklist—Civilian Version (PCL-C). Associations among the variables were explored using MANOVA, and main effects and interactions were analyzed.ResultsOverall MANOVA tests with the PCL-C indicated significant differences for gender (F = 6.86, p = .000), emotional abuse (F = 6.79, p = .000), and explosion exposure (F = 22.40, p = .000). There were significant interactions between emotional abuse and explosion exposure (F = 3.98, p = .008) and gender and explosion exposure (F = 2.93, p = .033).ConclusionsBeing female, childhood emotional abuse, and a high explosion exposure were associated with high PTSD symptom levels. Childhood emotional abuse moderated the effect of explosion exposure on PTSD symptoms. Thus, stress sensitization influenced the development of PTSD symptoms in Chinese adolescents who experienced the pipeline explosion as predicted by the model.     

Posttraumatic stress disorder and somatic complaints: Contrasting Vietnam and OIF/OEF Veterans' experiences

ObjectiveTo replicate and expand upon the relationship of somatic symptoms and posttraumatic stress disorder (PTSD) by comparing symptoms among service eras in US Veterans.MethodData were collected from 226 Vietnam and 132 Operation Iraqi Freedom/Operation Enduring Freedom (OIF/OEF) Veterans who were referred to a Veterans Affairs (VA) hospital PTSD outpatient clinic between 2005 and 2013. Veterans were administered self-report inventories and a clinical interview to measure somatic symptoms and PTSD severity. A subset of Veterans (n = 185) screening positive for PTSD were administered the Clinician Administered PTSD Scale (CAPS) to measure PTSD severity. Multiple moderated linear regressions were used to examine the influence of service era on the relationship between somatic and PTSD symptoms.ResultsThere were no significant differences between service eras in pain severity, pain interference, and total somatic symptoms reported. Vietnam Veterans were more likely to report limb/join pain (p < .05), fainting (p < .01), and shortness of breath (p < .001), whereas OIF/OEF Veterans were more likely to complain of headaches (p < .001). A significant interaction effect occurred between service era and dizziness (p < .05) and chest pain (p < .01), with OIF/OEF Veterans reporting higher levels of these symptoms significantly more likely than Vietnam Veterans to also experience more severe PTSD.ConclusionFindings are consistent with previous research demonstrating the relationship of somatic symptoms and PTSD across service eras but provide additional data concerning similarities and differences of somatic symptoms between eras. Potential explanations for observed service era differences in somatic symptoms are discussed.     

Traumatic brain injury and PTSD symptoms as a consequence of intimate partner violence

ObjectiveTo effectively diagnose and treat women who have experienced intimate partner violence (IPV), it is important to identify the full range of physical and mental health consequences, including hidden wounds such as traumatic brain injury (TBI) and posttraumatic stress disorder (PTSD). We aimed to identify the occurrence of IPV-related TBI and associated PTSD symptoms among women veterans who experienced IPV.MethodsA web-based survey was administered in 2014 to a national sample of U.S. women veterans. Among 411 respondents (75% participation rate), 55% reported IPV during their lives. These participants (N = 224) completed screening measures of IPV-related TBI, PTSD, and past-year IPV and comprised the current sample.ResultsA total of 28.1% (n = 63) met criteria for IPV-related TBI history, and 12.5% (n = 28) met criteria for IPV-related TBI with current symptoms. When adjusting for race, income, and past-year IPV, women with IPV-related TBI with current symptoms were 5.9 times more likely to have probable IPV-related PTSD than those with no IPV-related TBI history. Despite symptom overlap between TBI and PTSD, women with IPV-related TBI with current symptoms were significantly more likely to meet criteria for all four DSM-5 PTSD symptom clusters compared to women with an IPV-related TBI history without current symptoms (Cramér's V′s = .34–.42).ConclusionFindings suggest there may be clinical utility in screening women who experience lifetime IPV for both TBI and PTSD symptoms in order to help clinicians better target their examinations, treatment, and referrals.     

Trouble stress post traumatique,dépression et anxiété chez les parents d’enfant(s) atteint(s) d’épilepsie

IntroductionPost-traumatic Stress Disorder (PTSD), depression and anxiety are the most common psychiatric consequences among parents of children with epilepsy.ObjectivesWe aimed to investigate the prevalence and predictors of PTSD, depression and anxiety in a sample of parents of children with epilepsy.MethodsA survey of 135 parents of children with epilepsy, treated in the pediatric neurology department at the Sfax Teaching Hospital in Tunisia, was conducted in the last quarter of 2019. The PTSD Checklist for DSM-5 and the Hospital Anxiety and Depression Scale (HADS) were used to assess, respectively, PTSD, depression and anxiety in parents. Associations with clinical and demographic variables with PTSD, depression and anxiety were evaluated in a logistic regression model.ResultsResults revealed PTSD rates of 20.7%, depression rates of 28.9% and anxiety rates of 55.6%. The main factors associated with PTSD on multivariable analysis were female gender (P = 0.026, ORa = 13.1), insufficient involvement of partner in disease management (P < 10^?3, ORa = 12.1) and duration of epilepsy less than 12 months (P = 0.001; ORa = 0.1). Female gender (P = 0.006, ORa = 18.1) and restriction of social life (P = 0.006, ORa = 4.1) were associated with depression. Factors associated with anxiety were insufficient involvement of partner in disease management (P = 0.03, ORa = 4.6) and PTSD (P = 0.005, ORa = 9.1).ConclusionThese findings suggest that clinicians should pay more attention to psychological health of parents of children with epilepsy and help healthcare providers to develop preventive and intervention strategies for parents of such children.     

A meta-analysis and scoping review of social cognition performance in social phobia,posttraumatic stress disorder and other anxiety disorders

Social cognition deficits are observed in a variety of psychiatric illnesses. However, data concerning anxiety disorders are sparse and difficult to interpret. This meta-analysis aims at determining if social cognition is affected in social phobia (SP) or posttraumatic stress disorder (PTSD) compared to non-clinical controls and the specificity of such deficits relatively to other anxiety disorders. The scoping review aims to identify research gaps in the field. Forty studies assessing mentalizing, emotion recognition, social perception/knowledge or attributional style in anxiety disorders were included, totalizing 1417 anxious patients and 1321 non-clinical controls. Results indicate distinct patterns of social cognition impairments: people with PTSD show deficits in mentalizing (effect size d = −1.13) and emotion recognition (d = −1.6) while other anxiety disorders including SP showed attributional biases (d = −0.53 to d = −1.15). The scoping review identified several under investigated domains of social cognition in anxiety disorders. Some recommendations are expressed for future studies to explore the full range of social cognition in anxiety disorders and allow direct comparisons between different disorders.     

Do prolonged grief disorder symptoms predict post-traumatic stress disorder symptoms following bereavement? A cross-lagged analysis

BackgroundBereavement can precipitate different forms of psychopathology, including prolonged grief disorder (PGD) and posttraumatic stress disorder (PTSD) symptoms. How these symptoms influence each other is unclear. The aim of this study was to examine the temporal relationship of symptoms of PGD and PTSD following bereavement.MethodsWe included 204 individuals, confronted with the loss of a loved one within the past year, who completed self-report measures of PGD and PTSD and again completed these measures one year later. We conducted a cross-lagged analysis to explore cross-lagged and autoregressive relationships.ResultsA significant cross-lagged relationship was found between PGD symptoms at time point 1 (T1) and PTSD symptoms at time point 2 (T2) (β − = 0.270, p < 0.001). Furthermore, PGD symptoms at T1 predicted PGD symptoms at T2 and PTSD symptoms at predicted PTSD symptoms at T2 (β − = 0.617 and β − = 0.458, ps < 0.001, respectively). In addition, PGD and PTSD symptoms were significantly correlated on both time points.ConclusionsWe found that PGD symptoms predict PTSD symptoms after a loss. Potentially, this could help to design new strategies and interventions for bereaved individuals. Additionally, PGD symptom levels predicted PGD symptom levels one year later, independently of the PTSD levels. This finding adds to the accumulating evidence that PGD is a distinct disorder.     

Posttraumatic stress symptoms and smoking among World Trade Center disaster responders: A longitudinal investigation

PurposeThe current longitudinal study examined posttraumatic stress disorder (PTSD) symptom severity in relation to smoking abstinence and reduction over time among responders to the World Trade Center (WTC) disaster.MethodParticipants were 763 police and 1881 non-traditional (e.g., construction workers) WTC responders who reported being smokers at an initial examination obtained between July 2002 and July 2011 at the WTC Health Program (WTC-HP). WTC responders were reassessed, on average, 2.5 years later.ResultsFor police WTC responders, higher levels of WTC-related PTSD symptoms at the initial visit were associated with a decreased likelihood of smoking abstinence (OR = 0.98, p = .002) and with decreased smoking reduction (β = −.06, p = .012) at the follow-up visit. WTC-related PTSD symptom severity was not related to likelihood of smoking abstinence or change in number of cigarettes smoked among non-traditional responders. Post hoc analyses suggested that for police, hyperarousal PTSD symptoms were predictive of decreased abstinence likelihood at the follow-up visit (OR = 0.56, p = .006).DiscussionThe present findings suggest that PTSD symptoms may be differentially related to smoking behavior among police and non-traditional WTC responders in a naturalistic, longitudinal investigation. Future work may benefit from exploring further which aspects of PTSD (as compared to each other and to common variance) explain smoking maintenance.     

First empirical evaluation of the link between attachment,social cognition and borderline features in adolescents

ObjectiveSeveral developmental models of borderline personality disorder (BPD) emphasize the role of disrupted interpersonal relationships or insecure attachment. As yet, attachment quality and the mechanisms by which insecure attachment relates to borderline features in adolescents have not been investigated. In this study, we used a multiple mediational approach to examine the cross-sectional interplay between attachment, social cognition (in particular hypermentalizing), emotion dysregulation, and borderline features in adolescence, controlling for internalizing and externalizing symptoms.MethodsThe sample included 259 consecutive admissions to an adolescent inpatient unit (M_age = 15.42, SD = 1.43; 63.1% female). The Child Attachment Interview (CAI) was used to obtain a dimensional index of overall coherence of the attachment narrative. An experimental task was used to assess hypermentalizing, alongside self-report measures of emotion dyregulation and BPD.ResultsOur findings suggested that, in a multiple mediation model, hypermentalizing and emotion dysregulation together mediated the relation between attachment coherence and borderline features, but that this effect was driven by hypermentalizing; that is, emotion dysregulation failed to mediate the link between attachment coherence and borderline features while hypermentalizing demonstrated mediational effects.ConclusionsThe study provides the first empirical evidence of well-established theoretical approaches to the development of BPD.     

Death by request in Switzerland: Posttraumatic stress disorder and complicated grief after witnessing assisted suicide

BackgroundDespite continuing political, legal and moral debate on the subject, assisted suicide is permitted in only a few countries worldwide. However, few studies have examined the impact that witnessing assisted suicide has on the mental health of family members or close friends.MethodsA cross-sectional survey of 85 family members or close friends who were present at an assisted suicide was conducted in December 2007. Full or partial Post-Traumatic Distress Disorder (PTSD; Impact of Event Scale–Revised), depression and anxiety symptoms (Brief Symptom Inventory) and complicated grief (Inventory of Complicated Grief) were assessed at 14 to 24 months post-loss.ResultsOf the 85 participants, 13% met the criteria for full PTSD (cut-off ≥ 35), 6.5% met the criteria for subthreshold PTSD (cut-off ≥ 25), and 4.9% met the criteria for complicated grief. The prevalence of depression was 16%; the prevalence of anxiety was 6%.ConclusionA higher prevalence of PTSD and depression was found in the present sample than has been reported for the Swiss population in general. However, the prevalence of complicated grief in the sample was comparable to that reported for the general Swiss population. Therefore, although there seemed to be no complications in the grief process, about 20% of respondents experienced full or subthreshold PTSD related to the loss of a close person through assisted suicide.     

Posttraumatic stress disorder in OEF/OIF veterans with and without traumatic brain injury

Veterans of Operation Enduring Freedom (OEF) and Operation Iraqi Freedom (OIF) are presenting with high rates of co-occurring posttraumatic stress disorder (PTSD) and traumatic brain injury (TBI). The purpose of this study was to compare the clinical presentations of combat-veterans with PTSD and TBI (N = 40) to those with PTSD only (N = 56). Results suggest that the groups present two distinct clinical profiles, with the PTSD + TBI group endorsing significantly higher PTSD scores, higher overall anxiety, and more functional limitations. The higher PTSD scores found for the PTSD + TBI group appeared to be due to higher symptom intensity, but not higher frequency, across PTSD clusters and symptoms. Groups did not differ on additional psychopathology or self-report of PTSD symptoms or executive functioning. Further analysis indicated PTSD severity, and not TBI, was responsible for group differences, suggesting that treatments implicated for PTSD would likely be effective for this population.     

Intolerance of uncertainty,anxiety sensitivity,health anxiety,and anxiety disorder symptoms in youth

Intolerance of uncertainty (IU) – difficulty coping with uncertainty and its implications – is traditionally studied in adult populations, but more recently has been explored in children and adolescents. To date, the association between IU and health anxiety has not been explored in a child or adolescent sample. Further, it is unknown whether the relationship between IU and health anxiety may be mediated by anxiety sensitivity (i.e., fear of anxiety-related sensations) in this population. We sought to extend the existing research and expand our understanding of IU as a transdiagnostic construct by exploring the association between IU and health anxiety, anxiety sensitivity, and DSM-IV anxiety disorder symptom categories in 128 youth (M age = 12.7 years, SD = 0.82, range 11–17 years). Participants completed measures of IU, health anxiety, anxiety sensitivity, and anxiety disorder symptom categories. Results demonstrated significant positive associations between IU and all measures. Mediation analyses supported the direct and indirect importance of each IU subscale on health anxiety. Future directions and implications are discussed.     

Anxiety sensitivity class membership moderates the effects of pre-quit reduction in anxiety sensitivity on quit-day tobacco craving

BackgroundAlthough anxiety sensitivity has been primarily conceptualized as a dimensional latent construct, empirical evidence suggests that it also maintains a latent class structure, reflecting low-, moderate-, and high-risk underlying classes. The present study sought to explore whether these anxiety sensitivity classes moderated the relations between the degree of pre-quit reductions in anxiety sensitivity and the severity of nicotine withdrawal symptoms and craving experienced on quit-day.MethodsParticipants included 195 adult smokers (47% female; Mage = 39.4) participating in a larger “anxiety sensitivity reduction-smoking cessation” intervention trial.ResultsAnxiety sensitivity class significantly moderated relations between pre-quit reduction in anxiety sensitivity and quit-day craving. Specifically, smokers within the anxiety sensitivity high-risk class, who also demonstrated lesser pre-quit reductions in anxiety sensitivity, experienced the highest levels of craving on quit-day.ConclusionsThese findings highlight the importance of ‘high-risk' classes of anxiety sensitivity to better understand the experience of craving on quit day.     

Group cognitive behaviour therapy (CBT) for social interaction anxiety in adults with autism spectrum disorders (ASD)

BackgroundGroup social skills interventions (SSI) are partially effective for addressing the communication and social interaction impairments experienced by individuals with autism spectrum disorders (ASD). Social anxiety has been found to be a moderating mechanism for SSI in young people with ASD. Comparatively few studies have investigated the effectiveness of SSI in the adult ASD population, and none so far have investigated group approaches incorporating SSI and anxiety management techniques.MethodThe present study describes the design and evaluation of a non-randomised single-arm, 11 week group interaction anxiety and social skills intervention, piloted on three occasions during routine clinical practice at an adult ASD service. The intervention was informed by a cognitive behaviour therapy (CBT) framework. Eighteen cognitively-able adult males with ASD attended. Outcome measures were completed pre- and post-intervention.ResultsSelf-reported social anxiety improved (p = 0.01, d = 0.65). Low mood, general anxiety and functioning did not change significantly (p > 0.05, d < 0.20). Qualitative feedback indicated that participants found the intervention to be acceptable and useful for improving social knowledge and coping strategies, and reducing avoidance behaviours. Attrition was low (n = 2).ConclusionsThese results suggest that integrating SSI and anxiety management techniques in a group format is acceptable to adults with ASD, and can reduce symptoms of social anxiety. Whether SSI enhance social skills in adults requires further investigation. In clinical practice, consideration should be given to augmenting SSI with CBT techniques designed to target concurrent symptoms of social anxiety.     

An examination of the differential effects of the experience of DSM-IV defined traumatic events and life stressors

Recent evidence suggests that individuals exposed to traumatic events report similar, if not lower, levels of posttraumatic stress disorder (PTSD) symptoms than individuals exposed to nontraumatic stressful life events [J. Anxiety Disord. 19 (2005) 687–698; Br. J. Psychiatry 186 (2005) 494–499]. The current study compared the level of self-reported PTSD symptoms in a large sample (n = 668) of trauma and nontrauma exposed college students. Participants were assessed for past trauma history as well as current symptoms of PTSD, depression, social interaction anxiety, and current positive and negative affect. Results indicated that while those who had experienced a traumatic event reported statistically significantly higher levels of PTSD symptoms, these differences were no longer clinically significant after other psychological distress factors were accounted for. Additional analyses suggested that those who had experienced events of an interpersonal nature had significantly higher levels of PTSD symptoms than those who had experienced other types of events.     

Self-referral to group cognitive behavioural therapy: Is it effective for treating chronic insomnia?

ObjectivesTo evaluate the effectiveness of a short (3 session) programme of group cognitive behavioural therapy (CBT) on insomnia, sleepiness and symptoms of anxiety and depression.MethodsProspective observational study of group CBT with follow-up at 3 months. Participants were self-referred patients with chronic insomnia. Outcome measures were the insomnia severity scale (ISI), the Epworth sleepiness scale (ESS), depression (Pichot scale), and the number of anxiety symptoms.ResultsParticipation in CBT was offered to 489 patients of whom 474 completed the programme and 154 were followed up at 3 months. Significant improvements in insomnia were seen: ISI score (17.74–14.27, P < 0.0001) after CBT and at follow-up (13.78, P < 0.0001). At the end of CBT, 76% (59/78) with initial severe insomnia and 52% (132/255) with moderate insomnia were improved, maintained at 3 months in 71% (15/21) with severe insomnia and 56% (50/90) with moderate insomnia. Depression and anxiety symptoms were significantly improved: mean depression symptoms (4.15–3.35, P < 0.0001) and anxiety symptoms (4.52–3.95, P < 0.0001), maintained at 3 months with mean depression symptoms (3.17, P < 0.0001) and mean anxiety symptoms (3.62, P < 0.0001). Sleepiness increased between baseline and the end of the group (6.67–7.24, P = 0.015) followed by a reduction at 3 months (7.19–6.34 at 3 months, P = 0.001). Initial ISI score but neither sex nor age were predictive of outcome.ConclusionsA short programme of CBT can improve sleep, depression and anxiety symptoms in self-referred patients suffering from chronic insomnia with good adherence and maximum benefit in patients with severe insomnia.     

Utilization of care among drug resistant epilepsy patients with symptoms of anxiety and depression

PurposeEpilepsy patients have a significantly higher rate of anxiety and depression than the general population, and psychiatric disease is particularly prevalent among drug resistant epilepsy patients. Symptoms of anxiety and depression might serve as a barrier to appropriate epilepsy care.The aim of this study was to determine if drug resistant epilepsy patients with symptoms of anxiety and/or depression receive different epilepsy management than controls.MethodWe identified 83 patients with drug resistant focal epilepsy seen at the Penn Epilepsy Center. Upon enrollment, all patients completed 3 self-report scales and a neuropsychiatric inventory and were grouped into those with symptoms of anxiety and/or depression and controls. Each patient's medical records were retrospectively reviewed for 1–2 years, and objective measures of outpatient and inpatient epilepsy management were assessed.ResultsAt baseline, 53% (n = 43) of patients screened positive for symptoms of anxiety and/or depression. The remaining 47% (n = 38) served as controls. Patients with anxiety and/or depression symptoms had more missed outpatient visits per year compared to controls (median 0.84 vs. 0.48, p = 0.02). Patients with symptoms of both anxiety and depression were more likely to undergo an inpatient admission or procedure (56% vs. 24%, p = 0.02).ConclusionFor most measures of epilepsy management, symptoms of anxiety and/or depression do not alter epilepsy care; however, drug resistant epilepsy patients with anxiety and/or depression symptoms may be more likely to miss outpatient appointments, and those with the highest burden of psychiatric symptoms may be admitted more frequently for inpatient services compared to controls.     

The From Survivor to Thriver program: RCT of an online therapist-facilitated program for rape-related PTSD

This study evaluated the efficacy of the From Survivor to Thriver program, an interactive, online therapist-facilitated cognitive-behavioral program for rape-related PTSD. Eighty-seven college women with rape-related PTSD were randomized to complete the interactive program (n = 46) or a psycho-educational self-help website (n = 41). Both programs led to large reductions in interview-assessed PTSD at post-treatment (interactive d = 2.22, psycho-educational d = 1.10), which were maintained at three month follow-up. Both also led to medium- to large-sized reductions in self-reported depressive and general anxiety symptoms. Follow-up analyses supported that the therapist-facilitated interactive program led to superior outcomes among those with higher pre-treatment PTSD whereas the psycho-educational self-help website led to superior outcomes for individuals with lower pre-treatment PTSD. Future research should examine the efficacy and effectiveness of online interventions for rape-related PTSD including whether treatment intensity matching could be utilized to maximize outcomes and therapist resource efficiency.     

Treatment rates for PTSD and depression in recently hospitalized cardiac patients

ObjectivePosttraumatic stress disorder (PTSD) and depression are common after evaluation for suspected acute coronary syndrome (ACS), and are associated with poor prognosis. However, it is unclear whether patients discharged after suspected ACS access treatments for subsequent psychological distress. We examined self-reported rates of receiving psychotherapy and/or medication for psychological distress in patients one month after a suspected ACS event.MethodsA sample of 448 adults (age 60.4 ± 12.5; 47.8% female; 52.7% Hispanic, 32.1% Black) presenting to the emergency department with suspected ACS were recruited for the REactions to Acute Care and Hospitalization (REACH) study, an ongoing cohort study of medical and psychological outcomes after ACS evaluation. Socio-demographics and depressive symptoms were assessed in-hospital, and PTSD symptoms related to the suspected ACS event were queried via phone one month after enrollment. Participants also indicated whether they received either medication or counseling to deal with their emotions and coping after their heart problem.ResultsApproximately 15% (n = 68) of the sample reported receiving some form of treatment. Treatment rate did not differ significantly as a function of demographics, ACS status, or insurance coverage, ps > 0.1. Over a quarter of participants (25.3%) who screened positive for PTSD and/or depression reported receiving treatment. Participants with PTSD and depression had a higher treatment rate (47.6%) vs. those with only depression (12.8%) or PTSD (30%) or no psychopathology (10.3%).ConclusionFindings suggest that 1 in 4 patients who screened positive for PTSD and/or depression reported receiving counseling or medication in the first month after a suspected ACS event.     

Association of CRHR1 variants and posttraumatic stress symptoms in hurricane exposed adults

Posttraumatic stress disorder (PTSD) is a moderately heritable anxiety disorder that may develop after exposure to trauma. However, only few genetic variants that relate to PTSD have been studied. This study examined the relationship between 12 single nucleotide polymorphisms (SNPs) in the corticotropin-releasing hormone receptor 1 gene (CRHR1) and post-disaster PTSD symptoms and diagnosis in adults exposed to 2004 Florida hurricanes. CRHR1 regulates the hypothalamic-pituitary-adrenal (HPA) axis; dysregulation of the HPA axis is characteristic of stress phenotypes. Final analyses were conducted in the European-American (EA) subsample (n = 564) due to population stratification. After correction for multiple testing, rs12938031 and rs4792887 remained associated with post-hurricane PTSD symptoms. Additionally, rs12938031 was associated with post-hurricane diagnosis of PTSD. This study is the first to examine CRHR1 in relation to PTSD in adults, and provides evidence for the importance of CRHR1 variation in the etiology of PTSD. Although results are preliminary and require replication, they justify follow-up efforts to characterize how this gene relates to PTSD.