One Quintillion Ways to Have PTSD Comorbidity: Recommendations for the Disordered DSM-5

Galatzer-Levy and Bryant (Perspect Psychol Sci 8:651–662, 2013) have calculated the number of ways that Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5; American Psychiatric Association, 2013) posttraumatic stress disorder (PTSD) symptoms can be combined as over 600,000. They concluded that the amount is astounding and the category is rendered amorphous. PTSD often occurs in the context of polytrauma or comorbidity. The epidemiological literature indicates that the most common comorbid conditions in cases of PTSD include major depressive disorder (MDD), chronic pain, neurocognitive disorder due to traumatic brain injury (e.g., mild), and alcohol use disorder, with premorbid personality disorder possible, as well (which we consider as exacerbated due to the traumatic incident at issue, as in borderline personality disorder). We calculated the possible symptom combinations for each of these disorders and then in comorbid combination with PTSD (e.g., PTSD with MDD, but also when all six conditions are present). The number of symptom combinations in full polytrauma involving all six conditions listed is truly astounding, over one quintillion. Also, we reviewed the range of PTSD comorbidities, which adds to the symptom heterogeneity in cases. We make recommendations to prioritize symptoms in disorders as primary (e.g., unique, marker), secondary (e.g., core essential), and tertiary (e.g., common, cross-diagnostic). The latter tertiary type of symptoms in a disorder, if any, should be kept apart in its own criterion. This approach might help make the next version of the DSM more clinically useful both to clinicians and to court.     

The Effect of Previous Traumatic Injury on Homicide Risk

Research has reported that a strong risk factor for traumatic injury is having a previous injury (i.e., recidivism). To date, the only study examining the relationship between recidivism and homicide reported strong associations, but was limited by possible selection bias. The current matched case–control study utilized coroner's data from 2004 to 2008. Subjects were linked to trauma registry data to determine whether the person had a previous traumatic injury. Conditional logistic regression was used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs) for the association between homicide and recidivism. Homicide risk was increased for those having a previous traumatic injury (OR 1.81, 95% CI 1.09–2.99) or a previous intentional injury (OR 2.53, 95% CI 1.24–5.17). These results suggest an association between homicide and injury recidivism, and that trauma centers may be an effective setting for screening individuals for secondary prevention efforts of homicide through violence prevention programs.     

Analogies to Terror: The Construction of Social Problems in Israel During the Intifada Al Aqsa

Studies of the construction of social problems suggest that claims makers only relate to the issue that they are trying to place on the national agenda. However, an analysis of the Israeli public discourse about a number of social problems during the Intifada Al Aqsa indicates that this is not the case. The external threat served as an inferential structure for understanding and explaining the country's internal ones. Because of the centrality of the Intifada in the public imagination, claimants made a wide variety of analogies to the problem of Palestinian terror. All four areas of the discourse—about the severity of the problems, their causes, the rationales given for taking preventive and/or ameliorative action, and the solutions offered—were replete with references and analogies to the uprising. Clearly, the claimants believed that this was a particularly effective way of competing in the social problems marketplace, but the analogies may, in fact, have reinforced the existing hierarchy of priorities rather than lead to a significant shift in the public agenda.     

Thinking strategically about ASEM: The subsidiarity question

Abstract

Aficionados of arcane European Union politics will know the importance of the term ‘subsidiarity’, for it relates to perhaps the most fundamental question facing any federal enterprise. Subsidiarity is supposed to be simple ‐ the notion that issues should be handled at the most effective level of authority ‐ but the devil is in the debate about what is ‘most effective’. The notion of subsidiarity, in all its complexity, is in fact most appropriate for those considering the shape of the agenda for the next Asia‐Europe Meeting (ASEM) in London in 1998. With the proliferation of meetings and organizations devoted to the next ASEM agenda, the time has come to pose and begin to answer the subsidiarity question. That question for ASEM would ask, ‘what is best done at the ASEM level’, as opposed to at a global, other regional, national, or even corporate, local or individual level? If officials and analysts feel that such a question is too tough for the ASEM process, perhaps they would be happier with a subsidiary subsidiarity question: ‘what can also be usefully done at the ASEM level'? If there are good answers to the main question, there is a good basis on which to engage in the ASEM process. If there are only good answers to the subsidiary question, the ASEM agenda will be less ambitious and perhaps even appear contrived.     

From support to pressure: The dynamics of social and governmental influences on environmental law enforcement in Guangzhou City,China

This paper examines how changes in governmental and social influences affect environmental enforcement in Guangzhou city, China, between 2000 and 2006. The paper finds that a form of “decentered regulation” has developed. Regulatory enforcement is no longer the sole affair of the government and the regulatory bureaucracy, but has been increasingly influenced by societal forces. The transformation over time shows the promises and limits of decentered regulation in Guangzhou's dynamic authoritarian setting. Analyzing a set of longitudinal survey data and qualitative interviews, the paper finds that by 2006, the rise of civil society and its increased support for protecting the environment had a double‐edged impact on the enforcement of environmental regulations. The paper demonstrates that on the one hand, by 2006, when government support for enforcement was low, societal forces developed an ability to counterbalance such lack of governmental support and positively influence enforcement. However, it also shows that when government support was high, a concurrent rise in societal support created a negative effect on enforcement. Thus too much societal support can become an enforcement burden.     

China’s response to the global financial crisis and its regional leadership in East Asia

This paper examines the role of China in the G20 and in East Asia in crafting appropriate responses and policies to the global financial crisis. Did China play an important part in the multilateralisation of the Chiang Mai Initiative, and how did China work with other players in East Asia to ‘inoculate’ East Asia against contagion and fallout from the crisis? The paper evaluates the type of leadership displayed by China and the decisions taken during the crisis. It assesses how the Chinese role in its own region and within global institutions such as the G20 would change in the aftermath of these crises.     

Age determination of blood spots in forensic medicine by force spectroscopy

We present a new tool for the estimation of the age of bloodstains, which could probably be used during forensic casework. For this, we used atomic force microscopy (AFM) for high-resolution imaging of erythrocytes in a blood sample and the detection of elasticity changes on a nanometer scale. For the analytic procedure we applied a fresh blood spot on a glass slide and started the AFM detection after drying of the blood drop. In a first step, an overview image was generated showing the presence of several red blood cells, which could easily be detected due to their typical "doughnut-like" appearance. The consecutively morphological investigations in a timeframe of 4 weeks could not show any alterations. Secondly, AFM was used to test the elasticity by recording force-distance curves. The measurements were performed immediately after drying, 1.5 h, 30 h and 31 days. The conditions were kept constant at room temperature (20 degrees C) and a humidity of 30%. The obtained elasticity parameters were plotted against a timeline and repeated several times. The elasticity pattern showed a decrease over time, which are most probably influenced by the alteration of the blood spot during the drying and coagulation process. The preliminary data demonstrates the capacity of this method to use it for development of calibration curves, which can be used for estimation of bloodstain ages during forensic investigations.     

Assessment of rape-supportive attitudes and beliefs in college men: development, reliability, and validity of the rape attitudes and beliefs scale

Discussed is the development and psychometric analysis of a measure of rape-supportive attitudes and beliefs called the Rape Attitudes and Beliefs Scale (RABS), intended for the use with college men. Items were developed from a literature review of "rape myths" that were correlated to some measure of sexual aggression. An exploratory factor analysis using only male participants revealed five factors: a) justifications for sexual aggression based on women's behavior, b) belief that women should hold more responsibility for sexual assault, peer c) pressure/need for sexual status and misreading women's sexual intent, d) acceptance of the use of alcohol and coercive tactics to acquire sexual compliance, and e) dislike for the feminine and acceptance of traditional gender roles. Initial reliability and validity studies were favorable for the RABS, including evidence that these factors were positively related to measures of sexual aggression. Each factor demonstrated differential power to predict sexual aggression, with justifications being the most powerful. Implications for counseling and education are discussed.     

Trends in Psychological/Psychiatric Injury and Law: Continuing Education, Practice Comments, Recommendations

This literature review of the major topics in the field of psychological/psychiatric injury and law is aimed at developing commentary for practice in the area. The field is a fast-developing one, with over ten major topics that it needs to integrate. In particular, the present review focuses current work on: law (evidence, tort); forensic psychology; assessment and testing; psychological injuries (posttraumatic stress disorder, chronic pain, traumatic brain injury, other); the APA DSM-5 draft (Diagnostic and statistical manual of mental disorders; American Psychiatric Association 2010); malingering; causality; multicultural considerations; disability; the American Medical Association (AMA) Guides to the evaluation of permanent impairment (Rondinelli et al. 2008); models; and treatment. At the end of each section of the article, practice comments introduce critical issues in applying the research to psychological work in the area. Whether undertaking tort evaluations, disability, and treatment plan assessments or treating individuals with psychological injuries, the professional needs state-of-the-art information in all the areas listed in order to remain scientifically informed, comprehensive, and impartial. The article concludes with recommendations for an integrated field in psychological/psychiatric injury and law, study in the field, research in its major areas, best practice policies, for example in assessment and treatment, and model building.