Trauma And Violence

Abortion trauma syndrome is a fabricated mental disorder conceived by anti-abortion activists to advance their cause and is not a scientifically based psychiatric disorder. So said 2 psychiatrists at the American Psychiatric Association’s recent annual meeting in San Francisco.

Many refugees have been victims of severe violence that has profoundly affected their physical, psychological, and spiritual lives.

PTSD filled a nosological gap by providing a way to characterize the long-lasting effects of trauma exposure.1 This led to a plethora of previously lacking scientific observations. Now the existence of PTSD is being called into question because some of the original assumptions that helped make the case for it have proved to be incorrect.2-4 However, it is possible to update some of the flawed assumptions of PTSD without rescinding the diagnosis. There is no reason to throw the baby out with the bathwater.

Psychological symptoms develop in some women who are victims of physical, sexual, and psychological abuse, making it difficult for them to regain control.

If I closed my eyes, it would have been easy to imagine that I was visiting a peaceful city park. The sounds of birdsong and children’s laughter rang in the air, and the odor of freshly cut grass filled my nostrils. But the sweet smells and soothing sounds belied the horror of the place where I actually stood-inside the wrought iron gates of Auschwitz-Birkenau, the Holocaust’s most infamous concentration camp. Today the camp is a museum, and there is an eerie dissonance between the tranquility of its sprawling grounds and the mass murders that were carried out here almost 70 years ago. Like many visitors to Auschwitz, I experienced powerful emotions-a mixture of revulsion, anger, and a deep empathy for the millions of souls who suffered and perished there. I also felt a discomfiting sense of doubt about the goodness of humanity, including my own.

The foreword to the Textbook of Vio­lence Assessment and Management promptly reminds readers that the mental health system has been invested in the prediction and prevention of violence since its inception. In a field dedicated to promoting wellness via the management of cognition, emotion, and behavior, violent thoughts, feelings, and actions are of primary concern. When psychiatric illness or psychological distress manifests as violence, the costs in terms of human suffering are extreme, wreaking havoc in the lives of patients, clinicians, and society at large-often with irrevers­ible consequences.

Traumatic experiences are common in childhood and adolescence and can have significant psychological effects on the child’s emotional well-being and overall development. Outcomes can be affected positively or negatively depending on responses and interventions.

Recent decades have seen an outpouring of publications about psychological trauma. With its formal diagnostic category of posttraumatic stress disorder (PTSD), Western psychiatric medicine has led the way in opening up this field of study. Many other disciplines of inquiry, including sociology, anthropology, legal studies, and literary studies, also have contributed their distinctive approaches and methodologies to the subject. Most recently, professional historians in Britain, Germany, Austria, Australia, Canada, and the United States have researched the origins of PTSD to great effect. These “new historical trauma studies” draw heavily on pioneering medical research from earlier places and periods. In addition, empirical findings from and analytical insights into humanity’s troubled, traumatic past provide ideas, observations, and insights that may be useful for mental health practitioners today.

Racial/ethnic and sexual orientation minorities and women historically have been relegated to social, legal, and economic disadvantage in the United States.

Elder abuse is a concern for all practitioners who care for elderly patients or their family members. An elderly person’s fears of aging and dependence may be heightened by stories and news accounts of abuse.

The term “domestic violence” emerged in the United States with the rise of the women’s movement in the 1970s. Before that, violence between partners was considered a private matter. A specific type of domestic violence, intimate partner violence, refers to violence between intimate partners. Public awareness campaigns help us identify one type of intimate partner violence in which one partner, typically the male partner, is the aggressor, and the other partner, typically the female, is the victim.

Traumatic brain injury (TBI) is the major cause of death and disability among young adults. In spite of preventive measures, the incidence of a TBI associated with motor vehicle accidents, falls, assault, and high-contact sports continues to be alarmingly high and constitutes a major public health concern. In addition, the recent military operations in Iraq and Afghanistan have resulted in a large number of persons with blast injuries and brain trauma. Taking into account that cognitive and behavioral changes have a decisive influence in the recovery and community reintegration of patients with a TBI, there is a renewed interest in developing systematic studies of the frequency, mechanism, and treatment of the psychopathological alterations observed among these patients.

Traumatology has become an increasingly multidisciplinary field. Originally the province of psychiatry and clinical psychology, the field has now been enriched by the contributions of epidemiologists, neuroscientists, anthropologists, and historians.

The 1994 death of Nicole Brown Simpson and the subsequent highly publicized murder trial of her ex-husband, O.J. Simpson, brought increasing national attention to the problems of domestic violence and intimate partner murder. In 2000, there were 1247 female victims of intimate partner murder in the United States.1 Fully one third of female murder victims were killed by an intimate partner.1 On the positive side, rates of female victimization by intimate partner violence and murder appear to have decreased in the recent past.

Nearly one sixth of the world's population has experienced mass violence, be it abducted Ugandan children who are forced to commit atrocities against their families and serve as child soldiers or Iraqi civilians who daily live with bomb blasts, killings, and sectarian violence.

A Public Health Approach to Intervening With Youth in Schools

I was very pleased to read Robert Langs' letter ("Violence Against Mental Health Professionals," Psychiatric Times, July 2007), in the wake of Dr Fenton's death.

Virtual games, such as World of Warcraft, The Sims, and Second Life, are played by thousands every day, allowing people, worldwide, to connect and share information. In fact, the virtual "worlds" that can be created in these games are now being used to make money (through buying and selling virtual objects), to form partnerships and friendships, and even to conduct business; it is easy to see how many become engrossed in this alternative life.

There is no shortage of hyperbole when politicians of all stripes describe the nature and effects of video games. Republican presidential candidate Mitt Romney proclaimed, "Pornography and violence poison our music and movies and TV and video games.

From our Readers

Psychiatrists who work in inpatient units are faced with daily decisions about predicting which patients will be violent, both in the hospital and after discharge. These decisions are often made using unstructured clinical judgment based on the clinician's experience and knowledge of the literature. How long such judgment stays the standard of care remains to be seen, because psychiatric researchers have produced a number of assessment and management tools to improve the accuracy and use of violence risk assessment. This article briefly outlines 3 tools: the Brøset Violence Checklist (BVC), the Classification of Violence Risk (COVR), and the Historical Clinical Risk-20 (HCR-20).

States will come under new pressure to provide mental health data to the FBI gun purchase check system if Congress passes a bill being touted as a response to the Virginia Tech catastrophe in which a student gunman with previous mental health problems shot and killed 32 people. The National Instant Criminal Background Check System (NICS) Improvement Act (HR 297) now seems destined to pass Congress this year. It would provide grants to states to help them provide a variety of data to the FBI’s NICS on whether a person has been convicted of a misdemeanor crime of domestic violence or has been the subject of court orders, mental health adjudications, or commitments.

Patients with severe mental illness (SMI), such as schizophrenia, bipolar disorder, and major depression, are more likely to have experienced trauma in childhood, adolescence, and throughout their adult lives than the general population. This high exposure to traumatic events such as physical and sexual abuse and assault takes a heavy toll.

Traumatic experiences are linked with a continuum of mental disorders and physical complaints. In the United States, posttraumatic stress disorder (PTSD) occurs in approximately 8% of adults during their lifetime, with different trauma types associated with varying rates of illness. PTSD is commonly associated with comorbid mental conditions such as depressive disorders, other anxiety disorders, impulse control disorders, and alcohol abuse.

The traumatic events surrounding the recent school shootings at Virginia Tech remind us that a disturbing aspect of our current culture is the rate at which America's youth are exposed to violence. Whether it is graphic episodes of violence on television, violent music, aggressive video games, hearing about or witnessing violence in the home or neighborhood, or being the direct victim of violence--violence is a pervasive part of society that disproportionately affects youth.

Posttraumatic stress disorder (PTSD) is a severe and often chronic anxiety disorder that can develop following exposure to an event involving actual or perceived threat to the life or physical integrity of oneself or another person. Epidemiological studies such as the National Comorbidity Survey1 estimate that more than half the population of the United States has experienced one or more traumatic events and that 8% of the population has met criteria for lifetime PTSD. Thus, trauma and PTSD are significant mental health problems.

Once his colleagues began to recover from the shock, the death of Dr Wayne S. Fenton triggered a discussion in the professional and lay press about the risks of violence to mental health professionals posed by mentally ill patients. Fenton was found unconscious and bleeding in his office in Bethesda, Md, on Sunday, September 3, 2006. He had been beaten severely around the head and died at the scene.

The study found that both young men and young women with psychiatric disorders were at greatest risk for being involved in abusive relationships. In addition, after controlling for a history of disorder at age 18 and for lifetime conduct disorder, findings from the study imply a connection between being in a clinically abusive relationship (defined as resulting in injury and/or official intervention) and a woman's risk at age 26 of major depressive episodes, marijuana dependence, and posttraumatic stress disorder.

The increase in youth violence and aggression in the past 50 years has been called an "epidemic." This epidemic has had a tremendous impact on society. From an economic and public health perspective, primary prevention of youth violence is obviously desirable.

Stalking is defined as repeated and persistent unwanted communications and/or approaches that produce fear in the victim. Stalking intrudes on the victim's privacy and evokes a fear of violence. Such fears are justified, as threats, property damage and assault occur all too frequently in association with stalking.