Secondary traumatic stress in emergency medicine clinicians

Previously called Secondary Traumatic Stress (STS), secondary exposure to trauma is now considered a valid DSM-5 Criterion A stressor for posttraumatic stress disorder (PTSD). Previous studies have found high rates of STS in clinicians who treat traumatically injured patients. However, little research has examined STS among Emergency Medicine (EM) physicians and advanced practice providers (APPs). The current study enrolled EM providers (N = 118) working in one of 10 hospitals to examine risk factors, protective factors, and the prevalence of STS in this understudied population. Most of the participants were physicians (72.9%), Caucasian (85.6%), and male (70.3%) with mean age of 39.7 (SD = 8.9). Overall, 12.7% of the sample screened positive for STS with clinical levels of intrusion, arousal, and avoidance symptom clusters, and 33.9% had at least one symptom cluster at clinical levels. Low resilience and a history of personal trauma were positively associated with positive STS screens and STS severity scores. Borderline significance suggested that female gender and spending ≥10% of one’s time with trauma patients could be additional risk factors. Findings suggest that resilience-building interventions may be beneficial.     

Prevalence of DSM-IV borderline personality disorder in two community samples: 6,330 English 11-year-olds and 34,653 American adults

This study had two main objectives. The first was to assess the prevalence of DSM-IV borderline personality disorder and its constituent symptoms in a community sample of late-latency children. The second was to compare these rates to those found in a community sample of American adults. A birth cohort of 6,330 11-year-old children in Bristol, England, was interviewed concerning borderline psychopathology in 2002-2004. A community sample of 34,653 American adults was interviewed about borderline psychopathology in 2004-2005. Rates of chronic emptiness, physically self-damaging acts, and stormy relationships were very similar in both samples (<2% difference). However, a significantly higher percentage of children than adults reported being angry and moody. In contrast, a significantly higher percentage of adults than children reported being paranoid/dissociated, having a serious identity disturbance, being impulsive, and making frantic efforts to avoid abandonment. In addition, a significantly higher percentage of adults than children met DSM-IV criteria for BPD (5.9% vs. 3.2%). Statistically significant but clinically minor gender differences were also found between girls and boys as well as men and women. Taken together, the results of this study suggest that late-latency children are about half as likely as adults to meet DSM-IV criteria for BPD. They also suggest that gender does not play a defining role in symptom expression.     

Ethnic Diversity and the Use of Humor in Counseling: Appropriate or Inappropriate?

Humor can reflect the healthy release of feelings during the counseling process, the type of emotional release that leads to significant therapeutic gains. It can also be a disturbing distraction, possibly causing early termination, if used inappropriately. Counselors need to exert particular caution before attempting to apply humor in working with a client from a culture different from the counselor's. This article explores the available literature and offers contributions on the subject from 4 “ethnically diverse” perspectives. Finally, a general approach based on existential theory is presented along with 5 general conditions to ascertain the appropriate use of humor.     

Transcendental Meditation,Reiki and Yoga: Suffering,Ritual and Self-Transformation

The paper explores three practices of eastern spirituality taken up by westerners for apparently secular purposes. As an 'emic' account that proceeds inductively from the author's experience, it shows how each of these practices is an attempt to change the meaning of suffering through the creative medium of ritual. Rituals are often used as initiations from one form of subjectivity to another. Yoga, Transcendental Meditation, and Reiki are undertaken as means of self-transformation. They may be adopted as 'magical' ways of achieving personal aims, but they also have the potential to take practitioners beyond the ego towards 'sacred' understandings or 'otherness'. The sacred (or 'spiritual'), however, is not necessarily 'the good'. The paper considers the effects of these practices. Do they become forms of self-mastery and power for the individual ego or do they hold out the promise of a more ethical self (in Lévinas's sense of 'ethics')? In other words, do they help resolve the problem of suffering through creating a more communicative body and a self-for-others?     

The Rule of Opposites: A Paradigm for Counseling Native Americans

The Rule of Opposites offers a cultural lesson in perspective that is useful for counselors working with Native American clients. The Rule of Opposites, based on the concept of the Circle of Life, is presented as a worldview that allows individuals to move beyond their current frame of reference toward an understanding of universal truths and underlying meanings. Use of the Rule's 7 lessons helps both the counselor and the client to recognize and resolve conflict, to ask more effective questions, to seek harmony and balance in life for greater purpose and direction, and to explore personal decision making and choices.     

Delineating paternalism in pediatric care

Theoretical Medicine and Bioethics - Paternalism in the medical care of children is appropriate and ethically justifiable. However, dilemmatic disagreement by paternalistic agents as to which...