The American Psychiatric Association Presents the DSM-5

Based in Kentfield, CA, Stephen Raffle, MD, is a clinical and forensic psychiatrist with more than five decades of experience. He engages and consults with attorneys, insurers, and employers in venues and cases ranging from civil and criminal to administrative and employment. In addition to his professional responsibilities, Stephen Raffle, MD, belongs to various professional organizations, including the American Psychiatric Association.

The American Psychiatric Association (APA) manages the development and implementation of the Diagnostic and Statistical Manual of Mental Disorders. The current edition of the text, DSM-5, is the result of more than a decade of concentrated efforts by countless mental health professionals from around the globe. Through their work, the DSM-5 functions as a definitive resource for mental disorder classification and definition. Furthermore, the DSM-5 frames this information with a goal of optimizing diagnoses, treatment options, and ongoing research.

The DSM-5 is ubiquitous among American health professionals, as well as many international care providers. The text not only offers in-depth insight into symptoms and criteria for making diagnoses, but assists mental health professionals in conveying relevant information to individuals using common language.

Despite the authoritative nature of the DSM-5, the APA continues to improve its educational and professional offerings whenever possible. For example, a 2018 update took into account changes made to ICD-10-CM medical codes. Both a comprehensive breakdown and quick-reference overview to these changes are available at psychiatry.org.

Understanding the Pain of a Relationship Breakup

A clinical psychiatrist with decades of experience in areas ranging from forensic psychiatry to neuropsychiatry, Stephen Raffle, MD, maintains a private practice in Kentfield, CA. Through his practice, Stephen Raffle, MD, treats conditions ranging from posttraumatic stress disorder (PTSD) to emotional distress.

Often a romantic breakup can cause serious enough emotional distress that it presents similarly to PTSD. Those not responsible for the breakup tend to suffer more and may find themselves reliving the experiences, avoiding circumstances that trigger memories of their partners, numbing their emotions, and living in an aroused state, making them more anxious and irritable. They may also have trouble sleeping.

Studies show that such heartache has a neurological basis. Brain scans with functional magnetic resonance imaging (fMRI) indicate activity in certain areas of the brain similar to the activity in response to a hot probe placed on the arm. Hence, neurologically it seems that people experience emotional pain similarly to physical pain.

That fact has led psychologist Alain Brunet of McGill University in Montreal to explore treatment combining physiological suppression of the pain with the beta-blocker propanolol with therapy. He proposes this treatment to allow people to process through their memories, storing them without the associated pain.

The Daubert Standard for Admitting Expert Testimonies in Court

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Stephen Raffle, MD, is a clinical psychiatrist and neuropsychiatrist in Kentfield, CA. While Dr. Raffle’s work as an MD covers several fields, the bulk is related to tort cases in civil litigation in which he acts as an expert witness.

For an expert witness’ testimony to be admissible in court, it must meet either the Daubert standard or, in some states, the Frye test. The Daubert standard is used in all federal jurisdictions and some state jurisdictions to establish whether an expert witness’ testimony is grounded in scientific reasoning that is appropriately applied to the facts at issue.

The Daubert standard originated from the 1993 Supreme Court case of Daubert v. Merrell Dow Pharmaceuticals, in which the court listed five factors to guide judges in determining whether an expert witness' testimony should be admissible. Per the court, a testimony is admissible if its theory or technique:

1. has been tested,

2. is subjected to peer review and publication,

3. has a known potential error rate,

4. has standards controlling its operation, and

5. is widely accepted within the scientific community.

Before Daubert, the standard for admissible testimony was the Frye test. The Frye test required that testimony be founded on methods generally accepted by experts in that field. The Frye test is still used in some states, including California.

Common Psychological Attributes Shared by Serial Killers

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Stephen Raffle, MD, is a clinical and forensic psychiatrist specializing in criminal, administrative, and civil law proceedings and assessments with offices in Kentfield, CA. Board-certified in Psychiatry and Forensic Psychiatry, Stephen Raffle, MD, sometimes shares his expertise with journalists, scholars and others seeking a professional medical perspective on relevant legal matters. In the article “Golden State Killer, Part 2: Forensic Psychiatry and the Rapist and Serial Killer," author Nick Rishwain's interview of Dr. Raffle highlights common psychological attributes that serial killers share.

The article centers on answering the question: How could a person carry out the terrible crimes the Golden State Killer is alleged to have committed? Among the common psychological traits Dr. Raffle discusses is serial killers' lack of empathy for others. Most understand they are committing a crime because they go to great lengths not to get caught. Lack of empathy with victims is a common denominator in such cases.

Numerous other common psychopathologies exist in serial killers. A short list includes Antisocial Personality Disorder, Borderline Personality Disorder, Sadomasochistic Personality Disorder, and Paranoid Schizophrenia. Although these psychological attributes are risk factors for predicting violence, identifying when one individual at a particular moment in time will become violent is very difficult. As Dr. Raffle reports, the best we can do at this time is to identify individuals who are at low, medium, or high risk for committing violence.

Psychiatrist or Psychologist - Who Is the Better Expert Witness?

Based in Kentfield, CA, Stephen Raffle, MD, earned his BA in physiology from the University of California, Berkeley and his MD from Chicago Medical School. Dr. Raffle, a Forensic Psychiatrist who is certified by the American Board of Psychiatry and Neurology, frequently serves as an expert witness in legal proceedings. 

An expert witness possesses information acquired through education, training, and experience that can help a judge or jury understand specialized evidence in order to reach a verdict in a trial. In civil or criminal cases, whenever there is a medical issue bearing on emotional states or behavior, a forensic psychiatrist can provide expertise on the behavioral consequences of such conditions. Psychologists are not trained in medicine and are not qualified to evaluate or explain medical-psychiatric disorders. 

Psychiatrists are better expert witnesses because: 

 Psychiatrists can review prior medical records and render non-psychiatric opinions. Psychologists cannot.

 Psychiatrists are formally trained in pharmacology and understand pharmacologic interactions and the behavioral aspects of medication. Psychologists are not.

 Psychiatrists are required to demonstrate competence in neurology; hence, they are more knowledgeable about the neurological organic pathologies causing mental symptoms. Psychologists are not.

 Psychiatrists are trained to conduct physical (medical) examinations, read laboratory results, read radiological studies, and understand pathophysiology to diagnose patients. Psychologists are not. 

Presently, only three percent of all psychiatrists are board-certified in forensic psychiatry by the American Board of Psychiatry and Neurology.

The Importance of Treating Pain through Body and Mind

A board-certified forensic psychiatrist in Kentfield, CA, Stephen Raffle, MD, has nearly five decades of experience providing professional consultations in clinical practice settings and forensic psychiatric assessments, including testimony in numerous depositions and trials. Throughout his career, Stephen Raffle, MD, has had an interest in topics such as the relationship between the mind and pain.

Often the line between physical and emotional pain can become blurred as the mind affects the perception of bodily injury. Medical practitioners continue to research how mental disorders or emotional distress may result in negative physical manifestations.

In order to adequately treat a patient's complaint of pain, a physician may need to evaluate psychological elements of the individual in order to eliminate a mental disorder as a possible cause or treat any psychological component. Ultimately, pain arises as a symptom of an underlying cause, which may or may not be only a physical disease or condition.

Although it may take more time for a complete assessment, choosing to look at the root of the problem, rather than simply alleviating its symptoms with medications, can provide much greater relief for patients. Often, psychological disturbances and physical suffering work together to exacerbate each other. Therefore, the optimal treatment must address both the body and mind.

Traumatic Brain Injury May Affect Sleep Recovery, Research Suggests

Forensic psychiatrist Stephen Raffle, MD, based in Kentfield, CA, provides expert testimony in court cases involving personal injury. A resident of Kentfield, CA, Stephen Raffle, MD, has studied the effects of Traumatic Brain Injury (TBI), including concussions.

Research indicates that persons who have experienced concussions have greater than usual problems dealing with lost sleep. The study suggests that patients with TBI had slower reaction times and made more wrong moves after sleep deprivation, compared to a control group.

TBI is a significant problem for combat veterans - explosions and proximity to guns being fired exact a toll on performance. The extreme stress of modern warfare exacerbates the effects of concussions.

Experiment volunteers with a history of concussions were kept awake for 40 hours and compared to sleep-deprived persons with no history of TBI. After they caught up on their sleep, researchers tested their reaction times through a prompt on a computer screen.

Lag times of the concussed individuals were 100 milliseconds longer than persons without TBI. Although the delay seems small, it could have serious consequences in combat. The lack of deep sleep meant their bodies had less time to restore themselves.

The author of the study concluded that since military tactics were not going to change, science would have to find better ways to treat sleep deprivation.