This study explored the difficulties dyslexic nursing students have in achieving clinical competence, what coping strategies they employ and how they may be supported in practice, thus enabling them to meet the standards to register as a nurse. A qualitative research study utilising case study methodology was chosen so that in addition to the personal experiences of individual dyslexic students, the wider social and cultural context that influences nurse education could be considered. All eleven students who participated had difficulty in clinical practice attributable to the nature and severity of their dyslexia. These difficulties involved dealing with verbal and written information, comprehension, constructing reports, remembering things, and being able to prioritise and organise their work within specific timeframes. There was evidence of tension felt by staff about upholding the rights of the dyslexic student seeking to become a registered nurse against the potential risk they thought the student posed to patients/clients. This tension influenced the relationships between staff and students. The diagnosis of dyslexia impacted negatively on the students' self-image, particularly affecting those diagnosed as adults. Timing and nature of the work in clinical placements either assisted or further challenged the dyslexic students in the achievement of clinical competence. The students identified a range of coping strategies, including the use of informal support networks. The students desired the formation of peer support groups. The relationship the students had with their mentors was key to the development of clinical competencies. It is recommended that all mentors receive preparation in supporting students with specific learning needs. Bronfenbrenner's (1979) Ecological Systems Theory was used as a framework to explain the implications of this study. The recommendations have relevance for policy makers, regulators and providers of nurse education, as well as for individual dyslexic nurses.

This study explores the experiences of five families as their children transfer from primary to secondary school, and is based on the words of the parents. The sample children live and attend school in different parts of Northern Ireland and each carries a medical diagnosis of dyspraxia and has been identified within school as having special educational needs. The study is based on the words of the parents. The research strategy employed was experiental case study. An emancipatory approach was followed using face-to-face unstructured interviews to generate data. Analysis began after the first data collection and was progressive. This facilitated the desire for depth as opposed to width and allowed for issues to emerge from the data. Analysis is from a Foucauldian perspective. Within the text I discuss the relevance of Foucault’s discourses to the construction of the identity. I describe how it is my understanding that both professionals and parents are limited by the identities inscribed on the political surface of their body by disciplinary power. This inscription tends individuals to conformity to the single truth of the dominant power through hierarchical observation, normalisation and the examination. I argue that power is weighted in favour of the professionals. However, I assert that this weighting is not because of professional expertise in its own right, but rather comes from the administrative role that professionals fulfil within the bureaucracy of the State. Finally, as I found Foucault’s philosophies wanting in terms of resistance to the inscription of identity, I turn to the writings of Deleuze and Guattari and their concept of ‘becoming other’ as a means to empowerment. The study is based in the area of parenUprofessiona1 partnership.

This report explores a range of underlying factors which appear to motivate the social behaviour of adults with severe learning difficulties. While there is ample evidence to suggest that these adults often behave in ways viewed as unacceptable by the wider population a skills deficit approach to the issue is frequently adopted. This dissertation argues that this view is both over-simplistic and inappropriately judgmental and that the behaviours demonstrated often serve an important purpose in the lives of the individuals concerned. This research is located within a number of theoretical perspectives related to inclusion and the politicisation of disability, the development of personal and social identity and the acquisition of emotional intelligence. The study is focused on a group of adults with severe learning difficulties who attend a further education college in Northern Ireland. Data were collected by observation and interviews with students, college staff, carers, volunteers and other professionals. A number of salient themes have emerged. The perceptions of the student group are at great variance with those of carers and professionals, which suggests major communication barriers and the need for on-going reality checks for the students themselves and for those working with them. In addition, there is little awareness among the non-disabled participants of the extent to which the students’ behaviours are a response to their own expectations and actions. Interestingly, too, those students viewed as demonstrating the most ‘undesirable’ behaviours are the students who most want to be included in mainstream life. Finally, where a need for skills development work is identified, it is argued that this should take account of recent developments in emotional intelligence and attribution theories. A social skills model, involving learned acceptance of set rules, is not seen as acceptable. In addition, teaching staff are encouraged to view the gaining of student perceptions as an integral, planned part of their own teaching. Challenging professional attitudes and approaches to the delivery of programmes is essential for the development of good practice within educational institutions.

This investigation explored social cognition and emotional processing in people with Anorexia Nervosa (AN). Social and emotional processing difficulties are increasingly recognised as maintaining factors for the disorder and as having potential as treatment targets. but as yet the specific foci to target are unknown. In addition, comparisons between AN and Autism Spectrum Disorder (ASD) have long been drawn, and have recently been empirically demonstrated in the domains of executive dysfunction and weak central coherence. Assessment of an overlap in the area of poor social cognition that is characteristic of ASD has been neglected to date. Following a systematic review of social cognition research in AN, a battery of tasks was chosen to assess emotion recognition and emotional Theory of Mind (the ability to infer emotion based on context and content: eToM). Poor eToM was observed in people with AN (n=40) relative to those with Chronic Fatigue Syndrome (n=45) and healthy controls (HC; n=47). These deficits were similar to those reported in the ASD literature. This finding led to further examination of whether such deficits represented traits or were restricted to the ill state.

This research applied ideas from the cognition-emotion literature to some of the theories in the OCD literature, and in so doing took'Va multi-dimensional approach to the understanding of OCD. The aim of the study was to explore the nature of 'emotionalcognitive profiles'^ of people with OCD,. and to compare these 'profiles' with those of people with other anxiety disorders and people from a non-clinical population. Participants from the three groups i.e. an OCD group, an anxiety group and a non-clinical group were asked to rate a number of appraisal dimensions, in response to four vignettes. There were 10 participants in each group (N=30). The vignettes were constructed to evoke feelings of anxiety, guilt, anger and pride. The responses of each group were then compared. The results showed that when anxiety is evoked, both people suffering with OCD and people suffering with other anxiety disorders, perceived more personal responsibility and more harm to self than the non-clinical group. The OCD group also seemed to perceive more personal responsiblity in the situation of guilt, which provoked discussion about the nature and role of guilt and responsibility in the aetiology and maintenance of this disorder. The results also led to some debate about the relationship between anxiety, depression and OCD and finally, a formulation of OCD was proposed. The formulation was an attempt to incorporate thinking from both cognitive and psychodynamic perspectives and to draw together some of the theories and models of OCD, which had been discussed in the study.

The self-concept can be separated into the physical self-concept (concerned with the self as a physical being) and the psychological self-concept (involving mental states, attitudes and beliefs). People with autism spectrum disorder (ASD) are thought to have an intact physical self-concept and an impaired psychological self-concept. Very little experimental work has previously been conducted directly comparing the physical and psychological self-concepts in ASD. This comparison is the primary aim of this thesis. Chapters 1-3 utilise a self-referencing paradigm to investigate the strength of the self-referencing effect in relation to the physical and psychological self-concepts. Chapter 1 demonstrates the presence of the self-reference effect in typically developing adults in both physical and psychological domains. Chapter 2 shows that adults with ASD display self-referencing effect in both domains, while chapter 3 demonstrates that children with ASD (aged 8 – 10) show the self-referencing effect in the physical domain only. Chapter 4 sought to verify the existence of an unimpaired physical self-concept in ASD using the rubber hand illusion. Children with ASD performed at the same level as a comparison group. Chapters 5 and 6 used an autobiographical memory interview and a self-description task respectively to compare and contrast the physical and psychological self-concepts in ASD. On both these tasks, participants with ASD displayed impairments in the psychological domain only. Chapter 7 concentrates on the psychological self-concept alone and investigates the ownership effect in ASD. It was found that participants with ASD were impaired on this task. Overall, the results presented here seem to support the idea that the psychological self-concept is impaired in ASD, while the physical self-concept remains intact. These are some of the first studies to directly compare the strength of the physical and psychological self-concept in ASD.

Background: This dissertation focuses on effective crisis management for people with borderline personality disorder. The dissertation reports a single-blind randomised controlled trial investigating the effectiveness of joint crisis plans (JCPs; a type of advance statement regarding future treatment preferences for people with mental health problems) compared with treatment as usual for community-dwelling adults meeting research diagnostic criteria for borderline personality disorder. Methods: During the developmental phase, three focus groups were held with mental health service users, clinicians and academics in order to adapt an existing joint crisis plan template, the utility of which was then tested in a small (N=13) pilot study. Participants in the resulting larger trial were recruited from community mental health teams in south London and randomised to receive either treatment as usual (TAU) or a joint crisis plan plus treatment as usual. Participants were assessed on a number of variables prior to randomisation and again at six-month follow-up and these included self-harm, engagement with services, therapeutic alliance and health-related quality of life. Results: Eighty-eight adults out of the 133 referred were eligible and consented before being randomised to receive a joint crisis plan in addition to treatment as usual (n = 46) or TAU alone (n = 42). This represented approximately 75% of the target sample size. Follow-up data were collected on 73 (83.0%) participants. A modified intention-to-treat analysis revealed no significant differences in the 6 proportion of participants who reported self-harming (odds ratio (OR) = 1.9, 95% CI: 0.53–6.5, P=0.33) or the frequency of self-harming behaviour (rate ratio (RR) = 0.74, 95% CI: 0.34–1.63, P=0.46) between the two groups at follow-up. No significant differences were observed between the two groups on any of the secondary outcome measures. JCPs were viewed favourably by participants, who reported referring to their JCPs both during and between crises. Approximately half of participants (47%) reported a greater sense of control over their mental health problems and an improved relationship with their mental health team when using a JCP. Conclusions: This dissertation expands the knowledge about effective crisis management for people with borderline personality disorder, a group who have traditionally been alienated from mainstream mental health services and are still perceived to be difficult to help. The study showed that it is possible to recruit and retain adult service users with borderline personality disorder to a trial of joint crisis plans. Although the intervention was not clinically effective, the findings suggest that the brief intervention was perceived as helpful to participants with borderline personality disorder. Future research - including a definitive trial with a more comprehensive process analysis - may provide further information about the potential benefits of JCPs to people with borderline personality disorder.

Body Dysmorphic Disorder (BDD) is a mental disorder characterised by an excessive preoccupation with a perceived defect in physical appearance, associated with significant distress and/or functional impairment as well as markedly high suicide rates. Its aetiology remains largely unknown, though believed to be related to a complex interplay of genetic, neurobiological, psychological and socio-­‐cultural factors. Despite the alarmingly high suicide rates and the severity of this illness, BDD is widely under-diagnosed and under-investigated compared to other psychiatric conditions. The distinct studies included in this PhD will address some core questions about the heritability of BDD and its etiological relation to Obsessive-Compulsive Disorder (OCD) and Related Disorders (OCRDs); the current thesis also aims to investigate holistic visual processing in BDD. Specifically, using twin modelling methods, Studies 1 to 4 aimed to examine the heritability of BDD symptoms and skin picking behaviours in a large twin sample and to estimate the extent to which BDD shares genetic and environmental risk factors with other OCRDs (i.e. OCD, Hoarding Disorder, Trichotillomania and Skin Picking Disorder). Clinical observations, neuropsychological and neuroimaging studies suggest a tendency of BDD patients to selectively attend to details and excessively focus on minor flaws in physical appearance. Hence, the aim of Study 5 was to investigate the integrity of holistic visual processes in 25 BDD, compared to 25 healthy controls, using the inversion, composite, and navon tasks. The results of Studies 1 to 4 showed that BDD and OCRDs symptoms are moderately heritable traits, sharing a complex genetic architecture. Study 5 provided converging evidence from three experimental paradigms to suggest intact global visual processing in BDD. The findings have important implications for guiding genetic research and the study of environmental risk factors for BDD and OCRDs as well as for encouraging further examination of visual processing in BDD.

‘For the convenience of the public’, declared the author of an 1889 article printed in Punch, ‘I would really suggest that the motto for ordinary busses should be, “Abandon fat, all ye who enter here!”’ Such pressing ‘abandonments’, as facetious as they might seem, were, in fact, patently central in shaping (meta)physical ideals, throughout much of the long nineteenth century. The ideological structures underpinning numerous cultural strands – from the social and sporting, to the scientific and sartorial – espoused a fierce anorexic logic. They placed more emphasis on (in)corporeal discipline, compulsive (non)consumption, and (dis)embodied panopticism than ever before. Through adhering to its own idyllic prescriptions, nineteenth-century culture implemented varying strains of the bodily disorder it sought to expel. The cultural and corporeal orderliness it pursued became itself disorderly. Of course, there already exists a substantial amount of research focused on (dis)ordering the too fat or too thin bodies of the nineteenth-century female. With fleshly embodiment and dis-embodiment being stereotypical female concerns, we often forget to ask about the fat-phobic dis-corporation of men. Surveying a variety of textual material, printed roughly between the years 1800 and 1910, this thesis intends to reconfigure man’s peripheral status in modern histories of diet, disorderly eating and fat shame. Dismissing the timeworn myth that fat is, and always has been, ‘a feminist issue’, it will explore how fat, body-image, and an intense desire to be slender became increasingly central to ideal constructions of the nineteenth-century male.

The characteristic EEG trait of patients with nocturnal idiopathic epilepsies during childhood is the spike and wave discharge. Cognitive dysfunction is prevalent among these patients and is thought to be linked to disturbances in memory consolidation processes that normally occur during slow wave sleep. Several genetic mutations of nicotinic receptor subunits have been linked to these disorders. However, there is little known about the underlying mechanisms or the spatiotemporal characteristics of this epileptiform activity within the neocortex. This thesis presents a rat in vitro model of the epileptiform activity synonymous with nocturnal childhood epilepsies, that allows for pharmacological manipulation of receptor subunits linked to these disorders. The application of DTC [10 M], a non-selective, competitive nicotinic acetylcholine receptor antagonist, to an in vitro model of the cortical delta rhythm induced two individual forms of paroxysm events - wave discharges and the conventional spike and wave discharges. Pharmacological manipulation of this model suggest that the epileptiform activity is mediated by excitatory currents which is consistent with the use of glutamate antagonists as anticonvulsants. A blanket blockade of inhibition by a GABAA antagonist resulted in severe discharges, hence hugely increasing excitatory response. Only partial disinhibition is suggested to be required to generate epileptiform activity as nicotinic acetylcholine receptors and 5-HT3 receptors are located on dendrite targeting interneurons. Mapping of unit activity revealed the di erence between the two paroxysm events was recruitment of super cial layers with simultaneous paroxysm events in delta frequency-generating Layer V pyramidal cells. It is proposed that the hyperexcitability responsible for the generation of the spike component of a spike and wave discharge is mediated by the lack of excitatory tone in 5-HT3 and nicotinic acetylecholine receptor expressing inhibitory interneuron subtypes. The disinhibition, spike generation and disruption of interplay between deep and super cial layers of the neocortex is thought to be associated with synaptic plastic changes.