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A Proposal for Postmodern Stress Disorder

      To the Editor:
      We thank Eiser
      • Eiser A.R.
      Postmodern stress disorder (PMSD): a possible new disorder.
      for raising the issue of media violence and its potential deleterious effects. Eiser argues for a newly defined diagnosis—Postmodern Stress Disorder—to categorize individuals whose violent acts result from media exposure.
      We agree with Eiser that physicians should take a media history, and caution patients to limit its use and choose media carefully. Media histories should be a part of all forensic evaluations.
      However, until we know more, we urge humility regarding risk, cause, and effect. The American Psychiatric Association's Diagnostic and Statistical Manual 5th Edition
      • American Psychiatric Association
      Diagnostic and Statistical Manual of Mental Disorders.
      aims for “consistent, strong and objective scientific validators of disorders” (p. 5). This caution is warranted.
      If mental health professionals assign inordinate influence to media as a cause of violence, this could distort understanding about the multifactorial nature of crime and violence. Lawyers would attempt to use this new disorder to diminish their client's personal responsibility. Media violence is pervasive, and examples of violent media exposure predating violent crime are common—whether or not they are causally related. Eiser's proposed “Postmodern Stress Disorder” could thus lead to many false positives.
      Over-focusing on the media could also inadvertently undermine steps to reduce violence by turning attention away from more important, but less easily addressed influences: mental health, substance abuse, family dynamics, the justice system, and socioeconomic factors.
      Reducing violence has always been a challenge for humanity. The substantial decrease in violence over the last millennia is an important human achievement, despite the headlines and common impression. We should not be complacent about continuing to decrease violence and crime. Reducing violent media use population-wide is an important, but small, part of that effort. The interplay between violence, media, and mental illness is a legitimate and vexing problem without easy solutions.
      • Elson M.
      • Ferguson C.J.
      Gun violence and media effects: challenges for science and public policy.
      On an individual level, we are just at the beginning of understanding the many relationships between violence, crime, and media use.
      • Hull J.G.
      • Brunelle T.J.
      • Prescott A.T.
      • Sargent J.D.
      A longitudinal study of risk-glorifying video games and behavioral deviance.
      We maintain that assigning a disorder label is premature and could have negative consequences.

      References

        • Eiser A.R.
        Postmodern stress disorder (PMSD): a possible new disorder.
        Am J Med. 2015; 128: 1178-1181
        • American Psychiatric Association
        Diagnostic and Statistical Manual of Mental Disorders.
        5th ed. American Psychiatric Association, Arlington, VA2013
        • Elson M.
        • Ferguson C.J.
        Gun violence and media effects: challenges for science and public policy.
        Br J Psychiatry. 2013; 203: 322-324
        • Hull J.G.
        • Brunelle T.J.
        • Prescott A.T.
        • Sargent J.D.
        A longitudinal study of risk-glorifying video games and behavioral deviance.
        J Pers Soc Psychol. 2014; 107: 300-325

      Linked Article

      • Postmodern Stress Disorder (PMSD): A Possible New Disorder
        The American Journal of MedicineVol. 128Issue 11
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          The murder of cardiovascular surgeon, Michael Davidson, MD, suggests the existence of a new disorder, postmodern stress disorder. This disorder is characterized by repetitive exposure to digital images of violence in a variety of electronic media, including films, television, video games, music videos, and other online sources. This disorder appears to be a variant of posttraumatic stress disorder, and shares with it excessive stimulation of the amygdala and loss of the normal inhibitory inputs from the orbitofrontal cingulate cortical gyrus.
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      • The Reply
        The American Journal of MedicineVol. 129Issue 7
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          Kaliebe's letter to the editor expressed concern about my article “The Postmodern Stress Disorder: A Possible New Disorder”1 for naming a possible new disorder regarding the phenomenon of violent digital media influences on human behavior. A name is an important part of any scientific discussion as well as any public policy debate, and even the title of the article indicates the theoretical nature of the term I coined. It will certainly not be codified in a future Diagnostic and Statistical Manual of Mental Disorders without further research and verification.
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