TERRORIST ATTACKS AT SPORTING EVENTS

This is a post about proposed refugee immigration of populations, who have been exposed to the current Terrorist Psychopathological Epidemic and the resultant increased potential for terrorist attacks at sport events.

For immigration visa interview completeness, interviews must include Structured Clinical Interviews (SCI) which include Psychopathic Terrorist Ideology Tests, designed to identify terrorists, not religious type tests. Potential immigrants could associate themselves with any religion, but fail expert SCI.

Terrorism is a medical matter, substantiated by 155 diagnostic codes for Terrorism in the newly revised ICD-10 2015/2016 codes in effect since Oct. 1, 2015. “A press release from the University of California, San Francisco on “UCSF Experts on War- and Terrorism-Related Topics” listed “clinicians and scientists who can provide expert information on health, medical, and scientific topics related to war and terrorism.” [Terrorism is a Medical Matter, MedicineNet.com]

“The UCSF staff who are listed include experts on bioterrorism & infectious disease; chemical weapons; physical trauma; PTSD (posttraumatic stress disorder ) and other psychological aspects of trauma; and, perhaps, most poignantly, the psychological aspects of trauma from war and terrorism that are specific to children and adolescents.” [Terrorism is a Medical Matter, MedicineNet.com]

“Sports remain Terrorism targets because leading competitions are so popular and also because huge numbers of people gather in a small area. This increases the likelihood of masses of deaths and it is a salutary to keep in mind that if an alert security guard had not spotted one of the spectators trying to enter the stadium in Paris during the attack had a bomb strapped to his body many would have been killed.” [Sport Is So Vulnerable to Terrorism, John Goodbody, Nov 19, 2015, Sports Features Communications]

The USA probably has more large sports gatherings for all amateur and professional ages and potential prevention measures and prevention professionals are probably more abundant in the USA than any other Terrorism targeted countries, but USA resources must be recognized, identified and applied. Terrorism prevention at USA Sport events, initiating meticulous, well vetted immigrations, is even more imperative in the USA, because USA sport events have been recognized and identified.

November 13, 2015, after a series of gun attacks occurred across Paris there were explosions outside the national Stade de France stadium, where France was hosting a friendly soccer match with Germany in Saint-Denis, north of Paris.

“Yet instead of detonating inside the national stadium packed with 79,000 people watching France beat Germany at soccer, they detonated on less crowded streets outside, during the match, including one in a lonely dead end street 500 yards away.”

“Clearly, the casualty count of just one bystander killed and several dozen injured in three explosions outside the Stade de France could have been far worse.”

“Such blasts inside the stadium or outside among crowds before and after the game would have been more murderous and caused even more panic, further overloading Paris hospitals and rescue services scrambling to treat hundreds of casualties with battlefield wounds shot or blown up in the city center.”

Now that fanatical, violent, murderous, psychopathological terrorist (FVMPT) attacks are common occurrences. Sporting events and venues are potential targets, because of the gathering of gigantic crowds.

Prevention of these attacks is imperative. However, prevention will become more perilous if terrorists immigrate, unbeknownst, into the USA with the current wave of terrified homeless refugees.

Herein is the problem. Vetting and Screening for fanatical, violent, murderous, psychopathological terrorist, immigrants, (FVMPT) who have been exposed-to and/or indoctrinated into terrorism is currently an impossible task because:

Upon receiving refugee status by the United Nations High Commission for Refugees (UNHCR)
• Persons are referred by the UNHRC for resettlement in a 3rd country ie US
• where they will be given legal resident status
• and eventually be able to apply for citizenship
• the application is processed by Resettlement Support Center, which gathers information about the candidate to prepare for an intensive screening process, which includes:
1. interview
2. medical evaluation and should now (* include a newly added Structured Clinical Interview (SCI) designed and conducted by mental health professionals ruling out Terrorism as defined by the ICD-10 diagnostic Codes.)
3. interagency security screening process aimed at ensuring the refugee does not pose a threat to the United States and should now (* include a newly added Structured Clinical Interview (SCI) designed and conducted by mental health professionals ruling out Terrorism as defined by the ICD-10 diagnostic Codes.)
4. average processing time for refugees is 18 to 24 months
5. Syrian applications can take significantly longer because of security concerns and difficulties in verifying their information and newly proposed SCI from ICD-10s.
6. In the newly adopted 2015/16 ICD-10-CM Diagnosis Codes, there are 155 diagnostic codes involving Terrorism. They range from code, Y38.1X3S, Terrorism involving destruction of aircraft, terrorist injured, sequela, to code, Y38.2, Terrorism involving other explosions and fragments. The ICD-10 are more complete than the Diagnostic and Statistical Manual of Mental Disorders (DSM-V), that can be used adjunctively.
[All above information is from UN Refugee Agency except (*Proposal by mbmsrmd)]

“ICD-10-CM (Clinical Modification) and -PCS’s (Procedure Coding System) finer detail, and the fact that the cleaner logic of the codes may lead to fewer coding errors in the long term, will help improve research. Code analysis is an essential component of research in which there is no direct access to patient medical records.
• “Greater detail offers the ability to discover previously hidden relationships or uncover phenomena such as an incipient epidemic early.
• “It will provide much-needed improvements in accurately classifying the nature of injuries and correlating them with cause, treatment, and outcome.
• “These improvements have important implications for the ability to rate the severity of injuries, “External cause of injury codes are also much more detailed in ICD-10-CM coding provides a framework for systematically collecting population-based information needed to fully describe and document how and where injuries occur.
• The codes are important for injury surveillance and for designing, implementing, and monitoring injury prevention and control programs.
• “Greater detail in the codes will help monitor progress on US objectives to measure progress on injury and violence prevention and control.” [Bowman, Sue. “Why ICD-10 Is Worth the Trouble.” Journal of AHIMA 79, no.3 (March 2008): 24-29]

• No Structured Clinical Interview (SCI) has been established for Terrorism by immigration authorities.
• SCI must be developed by psychologists and psychiatrists prior to immigration of persons potentially exposed-to and indoctrinated-with Terrorism.
• Screening topics / new assessment tools based on brain imaging/ related *translational* research must be developed before immigration.
(1) dimensional* conceptualizations of personality-related disorders and the corresponding *dimensional interpretation*
(2) Introduce some of the new, *dimensional measures* of adult, personality-related psychopathology,
(3) neurobiological substrates of personality-spectrum disorders
(4) advanced *personality-centered*, differential diagnosis and *psychodynamic* interpretation
• Therefore, immigrants from countries with these potential pathologies should be sequestered in sanctuary established, guarded cities within their own countries, where their health and well being can be maintained until it is safe to re-establish in their own country.
• These are new immigration psychopathological conditions, until now unknown.
• Not like other known screening for immigration for conditions like Ebola.

The key to prevention of homeland sporting events attacks by terrorists is the prevention of terrorist immigrations to the USA. Plane and simple.
[ICD-10 2015/2016 Diagnostic Codes]
[Quick Thinking During Attacks Averted Massacre at Stadium, CBS/AP November 16, 2015]
[Advanced Diagnostic Testing and Assessment: Adult Psychopathology, The New School for Social Research, NYC, course Number GPSY 6274Fall 2015]
[Journal of Abnormal Psychology 1968, Vol. 73, No. 1, 62-69 PSYCHOLOGICAL TEST FOR PSYCHOPATHOLOGY EUGENE I. BURDOCK Department of Psychiatry Columbia University ANNE S. HARDESTY 2 Biometrics Research, New York State Department of Mental Hygiene]

“Mainstream media outlets tend to focus on the atrocious actions of terrorists, leaving the American public without a true understanding of what encourages someone to become a violent, radicalized extremist.”

“While the concept of terrorism is by no means a new one, modern events have provided new opportunities for research and study.” [The Psychology of Terrorism and Radicalization Gina K. DeJacimo Department of Political Science Honors Research Project Submitted to The Honors College Spring 2015]

Herein is the quandary for massive foreign immigrations of people who have been exposed to modern terrorism into the USA and other countries. Vetting and screening to rule out fanatical, violent, murderous, psychopathological terrorist, who have been exposed-to and/or indoctrinated into terrorism is currently an impossible task, because UNHCR investigators do not have modern methods for vetting and screening.

“Psychopathic personality disorder is synonymous with antisocial, dissocial ad sociopathic personality disorder, different terms for the same disorder/ [DSM-V; American psychiatric Association, 1994, p. 646]

“Psychopathology is a term which refers to either the study of mental illness or mental distress or the manifestation of behaviors and experiences which may be indicative of mental illness or psychological impairment. [ScienceDaily]

2015/16 ICD-10-CM Diagnosis Code F60.2 and definition:
• Psychopathic personality disorder aka the following
• Antisocial personality disorder
• Amoral personality disorder
• Asocial personality disorder
• Dissocial personality disorder
• Sociopathic personality disorder

Clinical Information
• Personality disorder characterized by a pervasive pattern of disregard for and violation of the rights of others (adapted from DSM-V)
• begins in childhood or early adolescence and continues into adulthood
• characterized by conflict with others, low frustration tolerance
• inadequate conscience development, and rejection of authority and discipline
• aggressive, antisocial behavior, without remorse or loyalty to anyone [2015/16 ICD-10-CM Diagnosis Code]

“Psychopathy tends to be used as a label for people we do not like, cannot understand, or understand as evil,” [Jennifer Skeem, Professor of Psychology and Social Behavior at the University of California, Irvine. Skeem, Devon Polaschek of Victoria University of Wellington, Christopher Patrick of Florida State University, and Scott Lilienfeld of Emory University are the authors of a new monograph focused on understanding the psychopathic personality that will appear in the December issue of Psychological Science in the Public Interest, a journal of the Association for Psychological Science.”

“Psychopathy has long been assumed to be a single personality disorder. However, there is increasing evidence that it is a confluence of several different personality traits,” Skeem says. The authors of the monograph argue that rather than being “one thing” as often assumed, psychopathy appears to be a complex, multifaceted condition marked by blends of personality traits reflecting differing levels of disinhibition, boldness, and meanness. And scientific findings also suggest that a sizable subgroup of juvenile and adult offenders labeled as psychopathic are actually more emotionally disturbed than emotionally detached, showing signs of anxiety and dysphoria.”

“Although many people might assume that psychopaths are ‘born,’ not ‘made,’ the authors stress that psychopathy is not just a matter of genes – it appears to have multiple constitutional causes that can be shaped by environmental factors. Many psychologists also assume that psychopathy is unalterable – once a psychopath, always a psychopath. However, there is currently scant scientific evidence to support this claim. Recent empirical work suggests that youth and adults with high scores on measures of psychopathy can show reduced violent and other criminal behavior after intensive treatment.[Psychopathy: A Misunderstood Personality Disorder, Jennifer L. Skeem Association for Psychological Science]

Many terrorists do report feelings of
• doubt, persecution, and insecurity
• these emotions are important, framing a terrorist cell’s speech to gain new members

“The following psychological factors play a major role in determining the success and prevalence of terrorism.”
• Group dynamics
• Peer pressure
• Fear of isolation
• Quest for significance, influential in prompting someone to interact with extremist groups
• The manner in which terrorist organizations communicate with the public and their potential recruits is the defining variable that can determine to likelihood of radicalization
• “sociopathic personality disorder”
• More mental illness occurs after involvement with a terrorist organization than beforehand
• Few individuals have psychotic mental illness when they join
• All influence one to use violent extremism as a way of accomplishing their political goals. (Lord Alderdice, 2007, p. 201)
• Alderdice found that those who suffer from “sociopathic personality disorder” and do successfully enter a terrorist cell often break away and form their own branch of the organization as a result of intergroup arguments.

Other social major role in determining the success and prevalence of terrorism.
• disenfranchised
• live on the fringe of society

“More mental illness occurs after involvement with a terrorist organization than beforehand.” Relatively few individuals involved in terrorism join for relief of their psychoses, but to sustain their psychopathology. [mbmsrmd]

Group dynamics and social psychology play a far larger role than individual mental illness. (The Asian Journal of Social Psychology. Author A. W. Kruglanski (2013)
“While the affect of social relationships may be limited in the awareness stage, they can be crucial as people continue down the pathway towards radical activity.” (Helfstein, 2012, p. 20)

Group influential dynamics lead to the escalation of ideals and make radicalization much more likely. “Groups act like echo chambers, amplifying their grievances, intensifying the members’ bonds to each other… their turn to violence and the terrorist movement is a collective decision, not an individual one.” (“A Strategy for Fighting International Islamist Terrorists.” Marc Sageman, 2008a, p. 227)

The current relevant theories on this topic suggest that group psychology may outweigh individual psychology in its influence upon the process of radicalization to violent behavior.

[The Psychology of Terrorism and Radicalization Gina K. DeJacimo Department of Political Science Honors Research Project Submitted to The Honors College Spring 2015]

Once again, this is the quandary for massive foreign immigrations of people into the USA and other countries, who have been exposed to modern terrorism and potentially radicalized. Vetting and screening to rule out fanatical, violent, murderous, psychopathological terrorist, who have been exposed-to and/or indoctrinated into terrorism is currently an impossible task, because investigators do not have modern Structured Clinical Interview (SCI) methods for vetting and screening developed by psychologists and psychiatrists.

_________________________________________________________________________________________________________________

DSM-V Axis II is the assessment of personality disorders and intellectual disabilities in which fanatical, violent, murderous, Psychopathological Terrorist Disorders (PTD) would be classified in the Diagnostic and Statistical Manual of Mental Disorders (DSM-V). The professional Structured Clinical Interview (SCI) instrument for DSM-V Axis II Disorders is designed to be administered by clinicians or trained mental health personnel.

Persons with PTD would be hidden and undiagnosed among potential immigrants exposed to PTD and would be similar to looking for a needle in a hay stack of needles. These disorders are usually life-long problems that first arise in childhood.

Vetting and Screening for fanatical, violent, murderous, PTD immigrants, who have been exposed-to and/or indoctrinated into terrorism is currently an impossible task because the USA is ill-prepared for such unknown and un-knowhow vetting and screening:

• No Structured Clinical Interview (SCI) has been established for FVMPT.
• SCI must be developed by psychologists and psychiatrists prior to immigration of persons potentially exposed-to/indoctrinated-with FVMPT.
• Screening topics / new assessment tools based on brain imaging/ related *translational* research must be developed before immigration.
• Therefore, immigrants from countries with these potential pathologies should be sequestered in sanctuary established, guarded cities within their own countries, where their health and well being can be maintained until it is safe to re-establish in their own country.
• These are new immigration psychopathological conditions, until now unknown.
• Not like other known screening for immigration for conditions like Ebola.
[Advanced Diagnostic Testing and Assessment: Adult Psychopathology, The New School for Social Research, NYC, course Number GPSY 6274Fall 2015]
[Journal of Abnormal Psychology 1968, Vol. 73, No. 1, 62-69 PSYCHOLOGICAL TEST FOR PSYCHOPATHOLOGY EUGENE I. BURDOCK Department of Psychiatry Columbia University ANNE S. HARDESTY 2 Biometrics Research, New York State Department of Mental Hygiene]

The Fourth Edition of the Diagnostic and Statistical Manual of Mental Disorders, or DSM V is the standard classification of mental disorders used by mental health professionals in the United States. It used for patient diagnosis and treatment, and is important for collecting and communicating accurate public health statistics.
The DSM consists of three major components: the diagnostic classification, the diagnostic criteria sets, and the descriptive text.

The Multiaxial System of Diagnosis in DSM V Criteria arise in children.
The DSM uses a “multiaxial” system for assessment. This assessment model is designed to provide a comprehensive diagnosis that includes a complete picture of not just acute symptoms but of the entire scope of factors that comprise mental health.

There are five axes in the DSM diagnostic system, each relating to a different aspect of a mental disorder:

Axis I is the top-level diagnosis that usually represents the acute symptoms that need treatment; Axis 1 diagnoses are the most familiar and widely recognized (e.g., major depressive episode, schizophrenic episode, panic attack, PTSD). Axis I terms are classified according to V-codes by the medical industry (primarily for billing and insurance purposes).

Axis II is the assessment of personality disorders and intellectual disabilities. These disorders are usually life-long problems that first arise in childhood.

Axis III is for medical or neurological conditions that may influence a psychiatric problem. For example, diabetes might cause extreme fatigue which may lead to a depressive episode.

Axis IV identifies recent psychosocial stressors – a death of a loved one, divorce, losing a job, etc. – that may affect the diagnosis, treatment, and prognosis of mental disorders. Psychosocial and Environmental Problems

Axis V identifies the patient’s level of function on a scale of 0-100, (100 is top-level functioning). Known as the Global Assessment of Functioning (GAF) Scale, it attempts to quantify a patient’s ability to function in daily life.[PsyWeb, May 15, 2013]

DSM consists of three major components: the diagnostic classification, the diagnostic criteria sets, and the descriptive text.

The Structured Clinical Interview for DSM-V Axis I Disorders (SCID-I) is a semi-structured interview for making the major DSM-V Axis I diagnoses. The instrument is designed to be administered by a clinician or trained mental health professional. Many measures are intended for use by qualified mental health professionals and researchers. The less clinical experience the potential interviewer has had, the more training is required.

The SCID is broken down into separate modules corresponding to categories of diagnoses.

SCID Versions:
• The SCID-1 is a semi-structured interview for making the major DSM-V Axis I diagnoses (e.g., PTSD).
• The SCID-II is a semi-structured interview for making DSM-V Axis II (Personality Disorder) diagnoses.
• The Clinician Version is a streamlined version of the SCID-I (for Axis I Disorders) available from American Psychiatric Press, Inc.
• One significant difference is in formatting: the SCID-CV is published in two parts–a reusable Administration Booklet (with color-coded tabs) and one-time-use-only score sheets. The Research Version is available only as a single-sided master.
• The SCID-I/P (Patient Edition) is the standard SCID and is designed for use with subjects who are identified as psychiatric patients.

References
First, MB, Spitzer, RL, Gibbon, M. & Williams, JB (1996). Structured Clinical Interview for the DSM-V Axis I Disorders.
Spitzer RL, Williams JB, Gibbon M, & First MB. (1992). The Structured Clinical Interview for DSM-III-R (SCID). I: History, rationale, and description. Arch Gen Psychiatry, 49(8):624-9.
Ventura J, Liberman RP, Green MF, et al. (1998). Training and quality assurance with the structured clinical interview for DSM-V (SCID-I/P). Psychiat Res, 79, 163-173.
Werner, PD (2001). Structured Clinical Interview for DSM-V Axis 1 Disorders: Clinician Version. In B.S. Plake & J.C. Impara (Eds.), The fourteenth mental measurements yearbook (pp. 1123-1125). Lincoln: NE: Buros institute of Mental Measurements.
[Structured Clinical Interview for the DSM IV Axis I Disorders (SCID PTSD Module) First, Spitzer, Gibbon, & Williams, 1996 (last updated Aug 17, 2015), U.S. Dept of Veterans Affairs]

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