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.     

Characterising the psychiatric comorbidities among adults with ADHD who have a history of offending

The prevalence of attention deficit hyperactivity disorder (ADHD) among adult offenders is significantly higher than in the general population. Adults with ADHD often present with multiple psychiatric comorbidities. This study aims to characterise the comorbidities presented by adults with ADHD who have offended and also to investigate predictors of offending among this population. Seventy-three participants with a diagnosis of adult ADHD were divided into a group with a history of offending behaviour (n = 30) and a group of non-offenders (n = 43). Groups were compared on measures of ADHD symptoms, substance use and DSM-IV Axis I and Axis II disorders using the Millon Clinical Multiaxial Inventory – 3rd Edition. Major depression, cannabis use and childhood hyperactivity-impulsivity symptoms predicted offending. These findings indicate that adults with ADHD who have a history of offending behaviour are more likely to present with complex psychiatric needs.     

A Sensitivity Analysis of Egocentric Measures of Peer Delinquency to Latent Homophily: A Research Note

Objectives

Egocentric measures of peer delinquency, obtained through a census of a social network, have become the preferred operationalization for examining the relationships between social influence and delinquency. Studies regressing ego’s delinquency on the delinquency of nominated friend/s (i.e. alter/s) conclude that a statistically significant coefficient provides evidence of social influence. However, the inferences drawn from these studies may be biased by the introduction of artificial statistical dependence as a consequence of using social network data in a regression framework. Recent work (Shalizi and Thomas Sociol Methods Res 40:211–239, 2011) shows that latent homophily, or unmeasured confounding of observables, may lead to nonzero estimates of social influence, even if there is no causal significance. To examine this possibility, sensitivity analyses have been created (e.g. VanderWeele and Arah Epidemiology 22:42–52, 2011; VanderWeele Sociol Methods Res 40:240–255, 2011) to determine the robustness of an estimated coefficient to latent homophily.

Methods

In this research note, I examine the robustness of estimates for social influence from two articles (Haynie Am J Sociol 106:1013–1057, 2001; Meldrum et al. J Res Crime Delinq 46:353–376, 2009) using egocentric measures of peer delinquency.

Results

Findings indicate that for large, precise point estimates, highly improbable conditions are needed to explain away the effects of social influence. However, less precise point estimates (i.e. large standard errors) are more sensitive to latent homophily.

Conclusions

The analyses indicate that studies using egocentric measures should conduct sensitivity tests, particularly when the estimated effect is weak and/or has a relatively large standard error. Scripts written in the free programming language R (R Core Team R: a language and environment for statistical computing. R Foundation for Statistical Computing, Vienna, 2012) are provided for researchers to conduct such analyses.     

Everyone Knows the Game: Legal Consciousness in the Hawaiian Cockfight

Past legal consciousness research has revealed a great deal about what individuals think and do with regard to law, but less attention has been paid to the social processes that underpin these attitudes, beliefs, and actions. This article focuses particularly on a “second‐order” layer of legal consciousness: people's perceptions about how others understand the law. Ethnographic observations and in‐depth interviews with cockfighters in rural Hawaii reveal how law enforcement practices not only affect cockfighting rituals, but are embedded within them. Police practices and informal rules work in concert to shape fighters' second‐order beliefs. These beliefs have implications for participants' understanding of central concepts, including order, disorder, and illegality. Examining legal consciousness from a second‐order perspective also underscores that notions of legitimacy are constantly created and recreated. Recognizing legitimacy's inherently relational nature helps us understand how experiences of law are synthesized into beliefs—for example, when an unusual police action directed toward a subgroup of fighters compromised the law's legitimacy for them. Foregrounding the relational nature of legal consciousness offers scholars a means to better understand and operationalize the dynamic nature of human relationships to law.     

The ASEAN way of conflict management: Old patterns and new trends

In the current international environment, greater emphasis is placed on regional and international responses to conflict. ASEAN is widely regarded as one of the most successful regional organisations in this area. This paper identifies the principles and institutional mechanisms for conflict management in ASEAN, and examines the extent to which these have changed in the post‐Cold War era. It argues that ASEAN may face increasing challenges to its policy of conflict avoidance, as more and more conflicts take place within ASEAN countries rather than between them.     

Islamic versus other identities in the Greater Middle East: Comments on the Ex‐Soviet Muslim republics

The six newly independent, ex‐Soviet Muslim republics share many characteristics. Common to all are identity conflicts based on ethnic ties, cultural traditions and attitudes to Islam. Most ethno‐nationalist groups have been mythologizing their past history and culture. Islam remains, however, the most important factor determining identity throughout the area, although in diverse ways. Realizing this, most political elites take an unfavorable view of the flow of extreme religious propaganda from Iran and Saudi Arabia and of the incursions from Afghanistan. Aware of the revival of Islam, some political leaders of the new states strive to encourage various patterns of moderate religion as a bulwark against militant Islam.     

Does Democracy Decrease Fear of Terrorism?

ABSTRACT

Fear is an integral part of terrorism. Fighting fear can thus be a crucial part of counterterrorist policies. In the case of terrorism, citizens look to the state for protection. Yet, most studies of terrorist fear emphasize individual-level factors. We lack studies that link fear to features of the state, especially whether democratic states are capable of reducing fear among its citizens. Our study aims to fill part of this research gap by asking whether democratic government reduces or increases fear of terrorism. We find that there is substantial cross-country variance in citizens’ fear of terrorism. The results suggest that fear is more widespread among citizens in non-democratic countries compared to citizens in democratic countries. Actual exposure to terrorist attacks has no impact on citizens’ fear of terrorism when we account for whether the country is a democracy or not. Hence, democratic government displays resilience towards fear mongering.     

Is this Paper Dangerous? Balancing Secrecy and Openness in Counterterrorism

We analyze a seemingly simple question: When should government share private information that may be useful to terrorists? Policy makers' answer to this question has typically been “it is dangerous to share information that can potentially help terrorists.” Unfortunately, this incomplete response has motivated a detrimental increase in the amount of information government keeps private or labels “sensitive but unclassified.” We identify two distinct types of private information that are potentially useful to terrorists and identify the range of conditions under which sharing each can enhance counterterrorism efforts. Our results highlight the complex trade-offs policy makers face in deciding how much openness is right in a world where protecting the people from terrorists has become a central duty of government.