20 years of research into violence and trauma: past and future developments

This reflection on major developments in the past, present, and future of the wider field of violence and trauma is a personal (and probably biased) sampling of what the authors hold to be important. The authors reviewed advances for victims and perpetrators of violence separately. For victims, the authors note that empirical research has established the potential traumatic impact of violence as well as various predictors of what makes persons vulnerable to adverse psychological consequences. The authors also note that the definitions of violence and trauma have evolved to include such behavioral patterns as stalking. Finally, encouraging evidence regarding the efficacy of exposure-based treatments for victims of violence is reviewed, as well as discouraging evidence regarding the efficacy of single-session debriefing following trauma. For the perpetrators, the importance of individual assessment in planning interventions is underscored, and advances in explicit and implicit assessment techniques are discussed.     

The biology of trauma: implications for treatment

During the past 20 years, the development of brain imaging techniques and new biochemical approaches has led to increased understanding of the biological effects of psychological trauma. New hypotheses have been generated about brain development and the roots of antisocial behavior. We now understand that psychological trauma disrupts homeostasis and can cause both short and long-term effects on many organs and systems of the body. Our expanding knowledge of the effects of trauma on the body has inspired new approaches to treating trauma survivors. Biologically informed therapy addresses the physiological effects of trauma, as well as cognitive distortions and maladaptive behaviors. The authors suggest that the most effective therapeutic innovation during the past 20 years for treating trauma survivors has been Eye Movement Desensitization and Reprocessing (EMDR), a therapeutic approach that focuses on resolving trauma using a combination of top-down (cognitive) and bottom-up (affect/body) processing.     

Patterns of Trauma Induced by Motorboat and Ferry Propellers as Illustrated by Three Known Cases from Rhode Island*

Abstract: Understanding patterns of trauma is important to determining cause and manner of death. A thorough evaluation of taphonomy, trauma, and bone fracture mechanisms is necessary to reconstruct the circumstances of the death. This study examines the skeletal trauma caused by boat propeller strikes in terms of wound characteristics and location based on three cases from Rhode Island. These case studies review the traumatic characteristics caused by propeller injuries and highlight the anatomic regions most likely to sustain skeletal trauma. With this information, investigators may be able to identify propeller trauma even in severely decomposed remains. The discussion of boat propeller trauma also raises issues regarding how forensic anthropologists and forensic pathologists classify trauma (specifically blunt force vs. sharp) and highlights semantic issues arising in trauma classification. The study also discusses why these propeller cases should be classified as blunt trauma rather than sharp or chop/hack trauma. Ultimately, the authors urge consistency and communication between pathologist and forensic anthropologists performing trauma analyses.     

Correlation of trauma and cause of death to accident reconstruction: a case of a flight accident report.

This paper reports on the disaster that occurred after a flight was hijacked at Baiyuen International Airport in Guangzhou, China, on Tuesday, 2 Oct. 1990. The authors show the results of analyses for the causes of death and trauma and compare the disaster with several previous flight accidents that have occurred in China. The authors show, with the analysis on this accident, the possibility and reliability of reconstructing a disaster by medicolegal investigation.     

A Novel Method for Removing a Spinal Cord with Attached Cervical Ganglia from a Pediatric Decedent

A diagnosis of child abuse is dependent on a comprehensive and accurate assessment of injury in the context of a thorough investigation. However, signatures of trauma are often subtle and interpretation can be very difficult. Recently, researchers have refocused their attention from the head to the neck in search of traumatic signatures of abusive head trauma. HCIFS has developed a technique to remove the cervical spinal cord with the ganglia attached that is less destructive and more time and cost efficient than alternative methods previously published. Once removed, the dorsal nerve roots and ganglia are evaluated for the presence of hemorrhage. The authors performed a small pilot study using the novel method to evaluate 20 decedents with a history of blunt force trauma and eight without a traumatic history. Fifteen of the traumatic deaths and two of the nontraumatic deaths were found to have dorsal nerve root and/or ganglia hemorrhage.     

Hyperpigmentation in the long bones of the lower limbs as a basis for vehicle identification and traffic accident reconstruction

Following the earlier studies on the identification of injuries in unbroken cranial bones, the described method was adapted for the examination of the long bones in fatal casualties of traffic accidents.Two types of bumper injuries might occur: the bumper was found to cause fracturing of limbs [1], and femoral muscle contusions and microtraumas within compact and spongiose parts in the femoral with subsequent maculate hyperpigmentation [2].The authors show that the correlation of above mentioned traces of the trauma, facilitates the reconstruction of the accident and also the identification of the vehicle.     

Fetal death following maternal trauma: two case reports and a survey of the literature.

When a fetus dies after its mother has suffered trauma, questions often arise about whether the fetal death was linked to the maternal injury. Many state statutes make it a criminal act to cause the death of a fetus by injuring the mother. The authors present two cases in which fetal death resulted from maternal trauma. In addition, we review the pertinent literature on this subject and offer guidelines that may help forensic pathologists evaluate these difficult and often emotionally charged cases.     

Thoughts on interpersonal violence and lessons learned: fact or fiction

Although interpersonal violence is evident in all strata of society, every geographical area in the country, and across each gender, it takes courage to acknowledge our passivity about the phenomena, particularly when people of color are involved. Thus, the mass incarcerations of African American men and women and data citing the overrepresentation of African American children not being adequately served in the child welfare system are highlighted to address the three questions posed to authors: What have we learned about violence and trauma over two decades? What should be learned over the next 10 years about violence and trauma? What methodologies exist that show promise of affecting a better understanding of violence and trauma?     

Fracture pattern interpretation in the skull: differentiating blunt force from ballistics trauma using concentric fractures

There have been several anthropological studies on trauma analysis in recent literature, but few studies have focused on the differences between the three mechanisms of trauma (sharp force trauma, blunt force trauma and ballistics trauma). The hypothesis of this study is that blunt force and ballistics fracture patterns in the skull can be differentiated using concentric fractures. Two-hundred and eleven injuries from skulls exhibiting concentric fractures were examined to determine if the mechanism of trauma could be determined by beveling direction. Fractures occurring in buttressed and non-buttressed regions were examined separately. Contingency tables and Pearson's Chi-Square were used to evaluate the relationship between the two variables (the mechanism of trauma and the direction of beveling), while Pearson's r correlation was used to determine the strength of the relationship. Contingency tables and Chi-square tests among the entire sample, the buttressed areas, and the non-buttressed areas led to the null hypothesis (no relationship) to be rejected. Pearson's r correlation indicated that the relationship between the variables studied is greater than chance allocation.     

Possibilities of the positive following violence and trauma: informing the coming decade of research

The effects of trauma and violence may be better understood by taking a broader perspective that includes resilience and recovery as well as damage and symptomatology. Based on this broader view, this article describes three interrelated, cutting-edge trends in mental health research: (a) the positive psychology movement, (b) the recognition of the role of spirituality and religion in health and well-being, and (c) stress-related growth. The integration of these trends into mainstream studies of trauma and violence will provide a counterbalance to the predominant orientation of victimization and pathology currently evidenced in the literature. All three have important implications for survivors of violence and trauma.     

How to Maintain Emotional Health When Working with Trauma

Vicarious traumatization, compassion fatigue, or secondary traumatization refers to the cumulative effect of working with survivors of traumatic life events as part of everyday work. Although this issue has been acknowledged and addressed among professionals such as police officers and medical professionals, it has been discussed less among juvenile and family court judges who also experience secondary traumatic stress. In fact, in one recent study, a majority of judges reported one or more symptoms of secondary traumatization. This article describes the common signs and symptoms of secondary trauma, job‐related factors that contribute to secondary trauma among judges, and the potential negative impact on organizational performance. The authors conclude with specific recommendations tailored for juvenile and family court judges.     

PTSD symptoms and sexual harassment: the role of attributions and perceived control

Researchers have compiled significant evidence demonstrating that sexual harassment leads to psychological harm, including the full symptom picture of PTSD, but few have examined the psychological processes involved. Research on attributions among trauma victims would suggest that causal attributions and perceptions of control may be important predictors of outcomes. The authors discuss a study involving a path model that used data from 189 women involved in sexual harassment litigation. Results indicate that both self-blame and harasser blame were positively related to PTSD symptoms. Control over recovery and the perception that future harassment is unlikely were both related to fewer PTSD symptoms. Unexpectedly, perceived control over future harassment is related to higher levels of PTSD symptoms. Implications for research and practice are discussed.     

Acute Fatal Coronary Artery Dissection Following Exercise‐related Blunt Chest Trauma

Coronary artery injury such as acute coronary dissection is an uncommon and potentially life‐threatening complication after blunt chest trauma. The authors report an unusual autopsy case of a 43‐year‐old healthy man who suddenly collapsed after receiving a punch to the chest during the practice of kung fu. The occurrence of the punch was supported by the presence of one recent contusion on the left lateral chest area at the external examination and by areas of hemorrhage next to the left lateral intercostal spaces at the internal examination. The histological examination revealed the presence of an acute dissection of the proximal segment of the left anterior descending coronary artery. Only few cases of coronary artery dissection have been reported due to trauma during sports activities such as rugby and soccer games, but never during the practice of martial arts, sports usually considered as safe and responsible for only minor trauma.     

Interpreting perimortem blast trauma from skeletal remains: Complications and considerations

Blast trauma results from highly variable events that can lead to similar effects in the skeleton. Clinical literature, which largely focuses on soft tissue, provides limited efficacy for interpreting fully skeletonized cases. Interpretation of skeletal blast trauma is hampered by the low number of fully skeletonized case studies and experimental replication studies, which mainly use nonhuman proxies. The purpose of this study is to discuss fracture patterns on two individuals from WWII as a means to better understand and identify fracture patterns associated with blast trauma. Existing clinical and anthropological criteria are reviewed and applied to two World War II cases, both presumed to exhibit blast trauma based on historical contexts. These case studies exhibit combinations of complicated and extensive signs of blunt-force and projectile trauma, reflecting the diversity of skeletal trauma resulting from blast-related events. This analysis emphasizes the arguably impossible task of establishing a diagnosis based on the available literature and lack of prior knowledge about specific losses. Ultimately, analysts must consider the totality of skeletal trauma, combining biomechanical theory and relevant clinical and anthropological literature to arrive at useful yet defensible assessments of trauma. However, refined criteria and additional studies are needed to assess complicated trauma from blast-related events in anthropological contexts.     

Nature-nurture interplay: genetically informative designs contribute to understanding the effects of trauma and interpersonal violence

The past two decades have seen an explosion in research in the fields of violence and trauma and behavior genetics. These two fields came into direct conflict when Lisabeth Fisher DiLalla and Irving I. Gottesman outlined a fundamental conceptual limitation of trauma and violence research: that rather than being causal, the well-documented relationship between exposure to trauma or violence and later negative outcomes could be explained by gene-environment correlation. In the past decade, researchers have addressed this limitation by studying the effects of trauma and violence using genetically informative designs. This report briefly discusses the gains made from this research approach and the promising future for genetically informative trauma and violence research.     

Dog saliva transmitted pathogens as etiology of fatal infections (on the topic of causal relationship)

The authors report on 4 deaths. 3 of the victims had been bitten by dogs shortly before death; in one case the victim had close contacts with a dog. In 3 of the cases death was caused by septicemia; microorganisms occurring in the saliva of dogs, but rarely causing infection could be determined in 2 of the cases. While in case 1 there was no bite injury so that transmission must have occurred by droplet infection (without trauma) or via a discrete skin lesion, case 2 showed a penetrating dog-bite injury; in both cases the spleen had been surgically removed some years before. In case 3 a causal relationship had to be assumed between a dog bite and death, although no pathogen could be identified in microbiological tests. In case 4 death was not attributable to the dog-bite injury suffered, but was due to an internal pathological cause.     

Cerebral tissue pulmonary embolization due to head trauma: a case report with immunohistochemical confirmation

Pulmonary embolization of cerebral tissue as the result of severe head trauma is an uncommon, if not rare, phenomenon, and few cases have been reported in the literature. The authors discuss the case of a 51-year-old male who died six days after suffering extensive head trauma in a motor vehicle collision. At autopsy, white-gray emboli were found in several subsegmental pulmonary arteries. The results of histologic examination with the hematoxylineosin stain gave the impression that the emboli were necrotic cerebral tissue; however, routine special stains for neural tissue produced inconclusive results. Immunohistochemical staining of the emboli with monoclonal mouse anti-human neurofilament protein (Dako Corp., Carpinteria, California) confirmed the cerebral nature of the emboli. To the authors' knowledge, this is the first reported case of pulmonary embolization of cerebral tissue confirmed by immunohistochemistry.     

Macroscopic Analysis of Axe and Hatchet Trauma in Fleshed and Defleshed Mammalian Long Bones*

Abstract: Recently, the authors have noted that many studies involving the characterization of chopping weapon wounds have used either semi‐fleshed or defleshed bones (e.g., J Forensic Sci 2001; 46: 228). As these types of specimens do not reflect the full range of actual cases of postmortem dismemberment or perimortem trauma, 11 fresh pig (Sus scrofa) articulated hind limbs, with contiguous surrounding flesh, were inflicted with wounds using two axes and two hatchets. Defleshed humeri and femora were subjected to the same treatment. While there were no great differences found between the fleshed and defleshed specimens, characteristics observed including entrance site width and the presence of chattering were inconsistent with some aspects of Humphrey and Hutchinson’s study (J Forensic Sci 2001; 46: 228). Further, it was found that curve transverse and spiral fractures were prevalent in femora, while longitudinal fractures were prevalent in fibulae. Hence, fracture types may play a role in characterizing some wounds caused by chopping weapons.     

Validities and abilities in criminal profiling: a critique of the studies conducted by Richard Kocsis and his colleagues

In a recent issue of this journal, Kocsis reviewed the criminal profiling research that he and his colleagues have conducted during the past 4 years. Their research examines the correlates of profile accuracy with respect to the skills of the individual constructing the profile, and it has led Kocsis to draw conclusions that are important to the profiling field. In this article, the authors review the contributions of the Kocsis studies and critique their methodological and conceptual foundations. The authors raise a number of concerns and argue that data from the Kocsis studies fail to support many of the conclusions presented in his recent review. The authors present evidence in support of their assertions and provide recommendations that will allow future research in the area to generate data that are more meaningful and generalizable.