Self-harm as an expression of emotional pain and hurt is starting to become the consensus view amongst professionals. This present study explored how young people who self-harm and their parents experience the young person’s self-harm and how it affects the relationships in the family. The research was a case study with three families, each consisting of an adolescent and of their parents. Semi-structured interviews were used to explore the lived experiences of each participant. In addition, relational scenarios and conjoint interviews were conducted with the parents. All interviews were audio-recorded and transcribed. These sets of data were analysed in accordance with Interpretative Phenomenological Analysis (IPA) guidance. The meta themes were presented in detail in the Findings section. The key themes for the adolescents were: Feeling Responsible and Self-Harm Creates Closeness. The main themes for the parents were: Feeling Emotionally Overwhelmed and the Impact on Couple Relationship. The individual and couple analyses were linked together to provide a family-based analysis of the data. The meta themes were linked with one another to acknowledge the pre-existing connections between different participants and to add a richer, systemic perspective to the results. Mutual influences of the different family members on each other were identified. The findings indicated that a young person’s self-harm can be seen to be part of triadic interactional processes within the family. The various layers of analysis were integrated which enabled a systemic and attachment based theoretical model to be proposed in relation to self-harm in the context of the family. Wider cultural perspectives were also considered in the way that they shaped the understandings and relationship strategies in how to deal with the self-harm. The proposed theoretical model is used to offer implications for therapeutic practice and recommendations for future research are suggested.

The overall focus of the thesis is on Personality Disorders (PD) and the factors that influence the development and maintenance of these. This thesis consists of three parts. Part one presents a systematic literature review on the relationship between childhood emotional abuse and emotional neglect and Borderline Personality Disorder (BPD). Although existing research evidences the link between childhood trauma and BPD, no systematic review has considered the specific impact of emotional abuse and emotional neglect as opposed to sexual or physical abuse. Evidence of variables that may account for or contribute to the relationship is considered. Part two is an empirical paper on the stability of PDs in adolescence over a two year period and the role that attachment plays in the maintenance of PD traits during this time. The results showed that PD traits in adolescence decline over time to an extent. Higher levels of overall quality of attachment and lower levels of alienation from peers, as measured at baseline, were predictive of improvement in the number of PD traits over time. The validity of the results is discussed in relation to problems of sample size and statistical power. The data collection for this study was conducted jointly with another trainee and in conjunction with a trial into Mentalization-Based Therapy (MBT) for adolescents with emerging PD. Part three is a critical appraisal discussing reflections on issues that arose during the process of the research and commenting more generally on current debates within the field of PD research.

Literature Review: Abstract Aims. There is concern that childhood weight-reduction programs may lead to eating disorder (ED) pathology. The aim was to provide a recent review of the impact of weight-reduction interventions on ED psychopathology or risks. Method. Reference lists and five electronic databases were searched to identify articles on overweight interventions for children aged five to 18, from 2008 to present. Papers were required to report on ED psychopathology. Results. The search yielded 267 articles on obesity interventions, of which 54 reported on psychosocial variables. Twenty-five articles, covering 24 studies, reported specifically on ED pathology or risks, and met inclusion criteria. Conclusions. Higher quality studies indicated that interventions had a beneficial or neutral influence on ED pathology. The ED pathology most likely to be adversely affected included weight concern, body dissatisfaction, and weight-related teasing. Studies used varying methodologies and assessment tools, and often did not report effect sizes, limiting the conclusions that could be drawn. Empirical Paper: Aims. The study aimed to investigate affective responses to fasting, in particular whether personality traits of high persistence and constraint, and low novelty-seeking, which have been linked to restricting anorexia nervosa (ANR), affect these experiences. Method. A non-clinical sample of 52 women with a mean age of 25 completed personality scales at baseline. A repeated-measures design was used, whereby participants provided diary measures of psychological variables throughout both 18-hour fasting and non-fasting periods. Results. Fasting led to increased irritability, and also to positive affective experiences of increased sense of achievement, reward, pride, and control. Self-reported persistence, constraint, and novelty-seeking did not affect experiences of fasting, and personality variables were not significant predictors of fasting responses. Conclusion. Even short-term fasting in healthy controls can lead to positive psychological experiences. This lends support to cognitive-behavioural and cognitive-interpersonal models of ANR, which suggest that dietary restriction is maintained through positive reinforcement. Levels of persistence, constraint, and novelty-seeking did not affect responses to fasting, suggesting that personality variables do not affect eating disorder pathology via responses to fasting.

Non-suicidal self-injury, more popularly referred to as ‘self-harm,’ has become a well established and somewhat haunting presence within late-modern western culture, however in marked contrast to the recent history of its cultural power and social presence, its clinical analysis and scientific exploration have proven confused, fragmented, and faltering. I argue here that these problems arise from a tendency to model self-harm as an individual psychopathological mechanism, an approach which tends to overlook the meanings and contexts which embed and pervade it as a cultural pattern, a social phenomenon, and a personal practice. By contrast I explore self-harm as a late-modern idiom of personal distress and emotional dysphoria, and argue that in order to make sense of it we must try to understand its meaning and not just its mechanism. I pursue this more situated exploration of self-harm through my research question: what are the discursive conditions of possibility which allow ‘self-harm’ to take on the meaning that it has in late-modern culture, and which allow it to exist as a meaningful category of action, and ‘the self-harmer’ to exist as a meaningful category of person. To help in this exploration I identify the key concepts and systems of meaning used to represent and understand self-harm across the multiple social sites in which discourse about it is produced. I do this through a cultural sociological approach especially influenced by Foucault’s archaeological method, and work with a hermeneutic analysis of a range of data, including non-structured interviews, psycho-medical texts which represent expert systems of knowledge governing understandings of self-harm, and popular representations in magazines, newspapers and other media. In this way I address the very conditions upon which self-harm can exist and work as a meaningful idiom in late-modern culture, or in other words: I seek to make self-harm make sense.

Background: Depressive disorders are highly prevalent and often take a persistent course. A considerable body of research shows that depression undermines interpersonal functioning and thereby increases stress, thus contributing to the maintenance of the disorder. However, relatively little is known about the cognitive mechanisms underlying this [interpersonal] stress generation. The present study investigated social perception in depression; in particular (1) whether depressed patients (DPs) are more prone to make spontaneous trait inferences (STIs; a tendency to spontaneously ascribe personality traits to others based on ambiguous information) than healthy controls (HCs); (2) whether the tendency to make such STIs predicts [interpersonal] daily hassles or, more broadly, depression severity; and (3) how this tendency relates to other vulnerability factors for depression such as overgeneral memory (OGM), childhood maltreatment, neuroticism and dysfunctional attitudes (DAs). Method: Twenty DPs and 20 age and gender matched HCs completed a novel experimental task to assess STIs, the autobiographical memory task to assess OGM, and a number of questionnaire measures assessing vulnerability factors. Participants then reported mood ratings and [interpersonal] daily hassles over a follow-up period of one week. Results: DPs showed significantly higher levels of STIs, OGM, an index of childhood maltreatment, neuroticism and dysfunctional attitudes. Within DPs, STIs correlated with indices of childhood maltreatment and depression severity. Across participants, but not within DPs, correlational analyses revealed significant positive relations between STIs and interpersonal daily hassles. Exploratory mediation analyses demonstrated that STIs accounted for relationships between childhood maltreatment / dysfunctional attitudes and concurrent depressive symptoms. OGM mediated the relationships between (1) vulnerability factors and depression severity, and (2) depression severity and daily hassles. Discussion: The findings suggest that DPs have an increased tendency to ascribe trait characteristics to other people which may, in parallel with depressive symptomatology, contribute to the elicitation of [interpersonal] daily hassles. Such difficulties are even more likely to occur in individuals who have suffered from childhood maltreatment. DPs may benefit from interventions aimed at elaborating person perception or reducing overgeneral memory.

Following years of disregarding and minimising the incidence and consequences of childhood adverse events, researchers and clinicians have recently established that a broad range of negative adverse experiences act as significant risk factors in the onset of mental health problems and particularly psychosis (Read & Bentall, 2012). However, within this complex trauma-psychosis paradigm the detrimental long term effects of sexual trauma have been consistently overlooked and disregarded as a risk factor in the etiology of psychological disorders. In addition, some evidence has suggested that sexual trauma in both childhood and adulthood leads to negative attributions and dissociation which may heighten vulnerability to the onset of psychotic-like symptomology (Copeland, Keeler, Angold, & Costello, 2007). In view of this, a retrospective cohort study was carried out in order to explore the mechanisms of a sequential process (sexual trauma-increased psychological distress-vulnerability to psychosis) in 269 sexual trauma survivors and 85 control participants. Results demonstrated that sexually traumatised participants had elevated levels of a broad range of psychological symptomology including dissociation, depression, anxiety and stress, with 65% of the sample meeting the DSM-IV diagnostic criteria for PTSD. In addition, it was found that these participants had increased early adverse experiences and a reduced sense of social status and rank in comparison to others. Finally it was found that sexual trauma was associated with the development of psychotic-like experiences (PLEs), particularly hallucinatory experiences and delusional ideation and dissociative depersonalisation was found to mediate this relationship. The research conclusions of this thesis demonstrate the need to go beyond conceptualising sexual trauma in isolation and to examine in more detail how other mediating variables may contribute to overall traumatology. Consistent with the findings from Fergusson et aI., (1996), sexual abuse cannot be regarded as an isolated factor but should be seen in the context of a large number of intervening variables that individually create small contributions to the risk of psychopathology but in combination crucially impact on individual adjustment. Research such as this, which emphasises the deleterious outcomes associated with sexual trauma should be instrumental in leading treatment and assessment formulation for survivors and to improve service provision and responses to sexual violence and childhood sexual abuse.

Autism spectrum disorder (ASD) is a neurodevelopmental condition with a reported prevalence of one in 100. Currently there is a paucity of literature describing fundamental visual process in children with ASD making evidence-based clinical management difficult for eye care professionals. Methods This study aimed to describe the impact of ASD on the visual system by investigation of visual measures in 131 children with ASD and 206 age-matched typically developing children. Visual measures assessed included visual acuity, refractive error, ocular posture and binocular functions. A second aim of the study was to investigate current eye care services for children with ASD in Northern Ireland. A qualitative study investigated opinions, attitudes and experiences of parents of children with ASD and professionals providing eye care services for children with ASD in Northern Ireland. Results and Conclusions Review of the questionnaires identified several key themes including the need for improved communication, better facilities, reduced waiting times and improved awareness of ASD. Assessment of vision and visual function identified: • No significant difference in visual acuity between the ASD and control group • Significantly greater magnitude of refractive astigmatism in the ASD group • A significantly higher prevalence of heterotropia in the ASD group • Significantly, but not clinically, reduced convergence and stereoacuity in the ASD group • A significantly higher prevalence of accommodative dysfunction in the ASD group. • Participants with ASD demonstrated a greater reduction in accommodative responses when blur was removed compared to the removal of disparity. • Investigation of CVI suggested that a sub-group of participants with ASD may have dorsal stream dysfunction . • Investigation of retinal thickness identified a trend towards a slightly thicker retina in participants with ASD.

This thesis focused on comparing paced (DTT) and free-operant (RB) teaching procedures commonly used in the education of children with ASD in ABA schools in Ireland. Investigations focused on comparing these teaching procedures in relation to specific learning outcomes of retention, endurance and application (R.E.A.), more often associated with RB procedures such as Precision Teaching (PT) and its applications (Johnson & Street, 2013). While DTT is the most commonly employed procedure in the context of these schools, there are a few schools employing RB strategies within the framework of PT in the education of children with ASD. Of interest to this investigation were the measurement criteria used by each to assess learning. Investigations involved comparison of indirect percent correct measures and direct measures of rate of response per minute in terms of the comprehensiveness of information provided to educators. This thesis also investigated one key factor that may act as a deterrent to the use of RB procedures with children with ASD, namely that these procedures may place unnecessary stress or anxiety on the learner since it is assumed that demand is increased when rate of responding is increased. Two other factors impOliant in the education of children with ASD were investigated. Alongside the central comparison of learning outcomes and differences in measurement criteria, the number and type of consequences provided to learners, as well as differences in the levels of aberrant behaviour occurring during teaching sessions in each condition were compared. Results from the three studies support the use of RB as a procedure in producing more accurate responding, as well as better retention of accurate responding after an extended period of no skill practice. DTT proved as effective when matched for practice opportunities, although took longer to deliver, required higher levels of reinforcement during sessions and overall, there were more occurrences of aberrant behaviour during the paced condition than free-operant condition. Results are presented and discussed in relation to limitations in the research and suggestions for future research.

The aim of this research is to explore the factors that are involved in the development and maintenance of disordered eating attitudes and behaviours. While major strides in research have provided an understanding into the complexity of these disorders, considerable gaps remain with little evidence existing for the effective prevention and treatment of these disorders. The theories of self-esteem, emotional intelligence and health literacy are considered as central themes to understanding the onset and maintenance of these disorders. This study aims to explore these onset and maintenance variables using a mixed methods sequential design. Phase one used a qualitative design conducting a series of semi-structured interviews, focus groups and personal narrative to explore the experiences of individuals with personal or professional experience of eating disorders (n=32). Phase two used a quantitative design to statistically test and model the findings within a large general sample (n=435). The results from this study provide an in-depth qualitative and quantitative exploration of the variables which motivate and maintain disordered eating. These results provide insights into the unique barriers and risk factors which are associated with disordered eating. The results indicate these three variables have considerable impact on the onset and maintenance of disordered eating, with interactions occurring between these variables, suggesting unique pathways towards clinical risk of eating disorder development. This indicates the need to develop holistic interventions that help target programs towards the barriers and factors which maintain an eating disorder. This study provides a unique contribution to the field of eating disorders as it offers new insights into the impact of low self-esteem, emotional intelligence and health literacy as key variables within disordered eating onset and maintenance. It is envisaged that the findings of this study can be used to inform and further develop intervention areas to promote positive, and timelier, interventions.

Pro-anorexia (or pro-ana) is an intertnet-based eating disorder (EiD) movement committed to supporting and encouraging or advising those who wish to initiate or maintain (Gavin et al. 2008) an ED, i.e. those who are not yet ready to recover (Dias 2003). The aim of this thesis is to explore interdiscursivity (ID) in pro-ana discourse, showing how members of the pro-ana community draw on the discourse of Evangelical Christianity in their online interactions. The analysis examines two bodies of data. The main focus is on the data taken from a proana website, comprising 219 message threads collected over a period of 47 days from a proana message board. The data taken from the discussion fora of several Christian websites serves as the evidence base, or empirical defence, for the study. By drawing on discursive psychology (DP) and the concept of ID, the analysis considers the way in which pro-ana site users display a marked orientation to each of the main aspects, or components, of Evangelical Christian discourse in their interactions on the website. Part of the thesis is also dedicated to reviewing current research in ID and explaining the rationale behind the use of both ID and c)'P. The primary analytical focus is on the construction of Ana as god(dess), and so the first empirical chapter considers orientations in the data to the notions of committing to Ana, following Ana and failing Ana with respect to the ways Christians orient to their relationship with God. It examines the construction of Ana's voice, and it deals with the contradictory depiction of Ana as both a loving and a cruel god(dess), drawing parallels with the orientation to the voice of God in the Christian discourse, and the construction of the Old Testament God of wrath and the New Testament God of love. It also accounts for potentially competing constructions of Ana, noting their place in the data and the impact they have on the construction of Ana the deity. The secondary analytical focus is on the construction of all the other religious components in the discourse, and so the second empirical chapter considers how speakers construct food as the devil, hunger or craving as temptation, and eating as sinning. It also explores the speakers' orientation to fat as punishment (or the wages of sin), and to cutting/selfharming, exercising, fasting and purging as penance (or atonement) for sin.