Borderline Personality Disorder (BPD) is a distressing difficulty prevalent within UK secondary-care settings. Previous qualitative studies have examined individual experiences of long term Mentalization-Based Therapy (MBT) groups for people with BPD. However, the psychoeducational component of MBT has not yet been researched coherently. The current study explored lived experiences of manualised MBT-psychoeducation groups for people with BPD within NHS secondary care settings. Eight participants took part in interviews about their recent participation in these groups. Interpretative phenomenological analysis was used to interpret individual meaning-making of these experiences. While some accounts were characterised by contradictions, MBT-psychoeducation was generally viewed as a challenging but predominantly beneficial experience. Three main themes emerged, comprising eight sub-themes. These highlighted individuals’ attempts to manage complex group processes, strategies for personalising knowledge, and the power and fear of increased self-reflection. Participant’s felt the group had impacted their sense of self, their understanding of others and their impulsivity, particularly within interpersonal relationships. Research and clinical implications of these findings are discussed. Particular importance is given to the implications of some individual’s perceived need for additional support or coping, the desire for further MBT group therapy and the possibility that these findings support propositions that the groups provide a useful mechanism to stimulate mentalizing.

Objective: Research into how staff working in eating disorder setting may be affected by their work is still a reasonably new area, with many previous studies relying on homogenous groups for recruitment or utilising survey based methodologies. Therefore, this study used a grounded theory approach to construct a theory of changes to body image, perceptions of food and diet experienced by clinicians, how these changes are experiences or made sense of, and what factors may contribute to these changes. Method: Thirteen members of staff were interviewed about their body image and eating habits before and since working in eating disorder settings. Participants were drawn from a range of different staff groups. Interviews were analysed using grounded theory to develop a theoretical model of why changes to body image and eating habits may occur. Results: Three core categories were defined, and a theoretical model was postulated in which pre-existing body image and ideas of food, the work environment, access to support, the impact of patients themselves and promotion of chaotic eating through the work itself all interplay to create change. Individual differences in management and the “personalised meaning” ascribed to these changes media how these changes are labelled and managed. Implications for future research and clinical practice are discussed.

Objective: Clinicians working with individuals with eating disorders encounter unique emotional, cognitive and behavioural responses. Such responses may impact on clinician self-care and wellbeing, and are linked to clinician burnout and poor treatment outcomes. Supervision can protect against such deleterious consequences. At present there is limited theoretical literature and no empirical literature relating to the supervision of eating disorder clinicians. Method: A three round Delphi Methodology was employed to explore the experiences of clinicians from a range of professional backgrounds who work therapeutically with individuals with anorexia nervosa, along with the role of supervision and relevant key supervision requirements. Results: Positive experiences were more frequently reported than negative experiences. Key negative emotions comprised sadness, anxiety, frustration and inadequacy. The impact on clinicians thinking about food and their own body-image were divergent. A large number of statements reflecting the core elements of supervision including areas of discussion, reflection, outcomes, supervisor qualities, the supervisory relationship, barriers and facilitators reached consensus. No consensus was reached regarding discussing clinicians’ thoughts about food, body-image or personal eating disorder history. Discussion: Implications for clinical practice include using these findings to challenge persistent beliefs that individuals with anorexia nervosa are undesirable to treat, and to help identify appropriate support where challenging experiences arise. Results relating to supervision can form the basis of future supervision guidelines in this field. Study limitations and implications for future research are discussed.

Objectives The study aimed to explore which discourses staff in crisis services draw on when discussing people in crisis. Further questions were; how those with borderline personality disorder diagnosis are positioned by these discourses and what the subsequent consequences are for people in crisis. Design This study utilised a qualitative design. Individual interviews were conducted with participants to generate personal and reflective accounts. Method Twelve staff members from home treatment, day treatment or acute ward teams were interviewed. Questions related to their experiences of people in crisis. Foucauldian Discourse Analysis was used to highlight the discourses used when talking about those in crisis. Results Four main discourses were present in language used; ‘medical legal’, ‘personal responsibility’, ‘limited resources for the problem’, and ‘human experience and emotions’. People with a diagnosis of borderline personality disorder (BPD) were positioned differently to those with other diagnosis. Staff are positioned as experts needing to diagnose and cure distress. The discourse of human experience and emotions highlighted the emotional aspect of working with people in crisis, especially those with a BPD diagnosis. Conclusion The prevailing discourses within NHS crisis services remain those of the medical model, legitimising ideas of classic mental illness and practices of medication and control. This impacts the position of people with a BPD diagnosis. Further reflective spaces are required to highlight the flexibility of these discourses, practice, and the importance of emotions raised by those in distress.

There is a rich body of research on the impact of common mental health difficulties such as depression and anxiety. These concepts, formalised by Western-developed diagnostic frameworks, may be less relevant in non-Westernised cultures. Although depression and anxiety may be presented, they can be presented in different ways in non-English speaking populations. Cultural adaptation of interventions has therefore been advocated to enhance engagement and recovery. This thesis focuses on the mental health presentation and support of Chinese-speaking international students with low mood or anxiety. It aims to explore how they might present with symptoms of depression, how they would like to work/engage in treatment, modify and then test the feasibility of delivering an online life skills package aimed at such students as well as bringing together the evidence base around such interventions through a systematic review.

Autism, a lifelong developmental disability, can have a significant impact on parents, particularly mothers who are often the primary care takers of their children in countries in which understanding of and resources for young people with autism are limited. This study explores the lives of mothers of adolescent sons with autism in Bahrain and Saudi Arabia. I focus on the issues that arise in a strictly sex segregated society, Saudi Arabia, and ask how living in such a culture affects the capacity of mothers to support and care, and to be helped to support and care, for their sons. I consider the experiences of these mothers in contrast with those of mothers from Bahrain which, though still a traditional society, has a more progressive approach towards women who fully participate in society and have almost the same rights as men, at least in law. In a country like Saudi Arabia, mothers struggle with the complexities of autism in a society that often treats them as inferior simply because of their sex. In Bahrain, even though mothers struggle with autism and a lack of support, the social and political structures of the country are different. Bahraini mothers, for example, do not have to contend with male guardianship laws or a prohibition on driving, both of which, I argue here, extensively affect their capacity to care for their sons. In this thesis, I apply Nussbaum’s Capability Approach to questions of social justice for mothers of adolescents with autism. The Capability Approach is an evaluative framework that assesses individuals’ well-being, exploring what a person can actually do and be when given opportunity freedoms. In a just society, according to Nussbaum (2011), every individual is entitled to dignity and respect and should be provided with appropriate threshold levels of functioning in ten central human capabilities which include bodily integrity; senses imagination, and thought; emotions, and affiliation. By engaging in conversations with 17 mothers, 10 in Saudi Arabia and seven in Bahrain, this study starts to tell the stories of these seventeen mothers. In their own words2, the mothers I interviewed share their journeys with autism, discuss available social support, both formal and informal, and refer to and sometimes explicitly describe the cultural norms and regulations they encounter. To analyse the interview data, I use thematic analysis and Nussbaum’s Capability Approach to explore mothers’ experiences. While I acknowledge that this is a small-scale study and I make only limited claims to generalisability or representativeness, the results of 1 I discuss terminology in Chapter One but this term is taken from the UK National Autistic Society definition at http://www.autism.org.uk/about/what-is/asd.aspx 2 Translated from Arabic to English as explained in Chapter Four. iv my analysis indicate a significant lack of support, both informal from husbands, families and friends, and formal from hospitals and schools. Most mothers experienced difficulties dealing with autism, physically and/or emotionally. With respect to the Capability Approach, most Saudi mothers reported capability failure, largely because of the marginalisation of those with autism and gender discrimination. These capabilities are compromised because Saudi mothers live under laws which, I claim, promote inequality and injustice. With major gender inequality, mothers in Saudi, I argue, suffer greatly and their capabilities are jeopardised. By contrast, my data indicates that Bahraini mothers’ capability development is less inhibited by the social and political arrangements of their country than applies to women in Saudi Arabia. This study draws out the significant differences in the experiences of women in two countries that are geographically separated only by a bridge but whose norms and conventions are radically different. I argue that in order to promote social justice for women, it is important to see the situation through their eyes and to research their experiences in ways that allow a deep understanding of their struggles in their societies. I conclude that it is vital to acknowledge and value the roles of mothers caring for their children with autism within their communities, and to develop and ultimately implement policies that allow their own capabilities and those of their children to flourish.

Introduction: GBS has a highly diverse clinical course and outcome. Currently available literature suggests that despite treatment about 20 % of patients remain disabled at one year and about 5 % patients die. These data come from clinical trials conducted between 1984 and 2006. Most of these studies included severe GBS cases. We conducted a multicentre prospective observational study looking at clinical and biological determinants of prognosis of GBS. As part of this study, I had an opportunity to analyse the data collected from 15 UK centres; looking at clinical and treatment patterns, various outcomes including ability to walk at 12 months, pain and quality of life. We also analysed Electrophysiological data from our local centre (Glasgow); compared newly published electrophysiological diagnostic criteria with existing criteria to determine whether serial studies are required for final electrophysiological diagnosis. Finally, to identify the patients with poor prognosis early in the disease course, we attempted to validate the currently available clinical prognostic models. Method: We conducted a multicentre prospective observational study named IGOS (International GBS Outcome Study) with a web-based entry system. It aimed to study at least 1000 patients over 3 years. The study included two modules: 1) core module which consist of a) acute clinical data collection at 0, 1, 2, 4 weeks and follow up data at 6 and 12 months b) serum samples collection at each clinical data entry point c) electrophysiology studies within 2 weeks 2) optional modules included additional electrophysiology studies at 4 weeks, CSF studies and long term outcome data at 2 and 3 years. As the study still ongoing, I analysed the data of 122 GBS patients recruited from 15 UK centres between May 2012 and Jan 2015. Results: In our cohort about 20 % patients remained disabled at 1 year, 18% required mechanical ventilation (MV), 5 % died. Pain continued to remain a major disabling symptom in more than half of the patients however unable to perform usual activity was the most disabling QoL domain affected at 12 months and was an important contributing factor affecting quality of life. Intravenous immunoglobulin was the most commonly prescribed treatment followed by plasma exchange. Immunotherapy was not beneficial in mildly affected GBS patients. Currently available electro diagnostic criteria are not very sensitive in identifying final EP subtypes and newly published Rajabally's criteria potentially addresses this issue and should be used in clinical practice to establish final EP diagnosis. Existing prognostic models EGOS and mEGOS performed well in our cohort and showed good discriminatory capacity. Discussion: Despite wider availability of immunotherapy prognosis of GBS has not changed in last 20years, which highlights the urgent need of more effective treatments in these patients. However new therapy can be expensive and can be only beneficial if the patients with poor prognosis are identified early in course. This can only be achieved by developing good prognostic models. Our results show that existing available models EGOS/MEGOS validates well and provides a proof of the concept that prognostic model can be used to identify patients with poor prognosis when the treatment is most beneficial. GBS continues to remain a clinical diagnosis. While there are drawbacks of existing EP criteria, newly developed Rajabally's criteria are sufficient to establish final EP diagnosis.

Purpose: The aim of this research was to investigate perceptions of child sexual abuse (CSA), particularly the perceptions held by CSA perpetrators and the public. Given the influence perceptions can have on a CSA victim’s wellbeing and disclosure behaviour, and a CSA perpetrator’s sexual recidivism risk, gaining insight into these perceptions was considered important. Method: To facilitate this investigation, a multifaceted approach was adopted. This commenced with chapter one, a systematic literature review, which aimed to identify which factors influence English and Welsh perceptions of CSA victims. The second chapter comprised an empirical research project which aimed to investigate the influence of a victim’s abuse history, victim-perpetrator relationship and a perpetrator’s gender on British perceptions of CSA. These three factors were selected due to their hypothesised influence on perceptions and lack of investigation. Following this, chapter three was completed which involved a critique of the Gudjonsson Blame Attribution Inventory-Revised (GBAI-R). This was to assess the inventory’s suitability for chapter four and to inform practitioners of its utility. Finally, chapter four entailed a case study which aimed to investigate whether a CSA perpetrator’s offence-specific minimisation could be reduced. This was facilitated by completing a six-session intervention on an individual basis. Results: This thesis revealed various findings. Specifically, chapter one revealed respondent gender influences public perceptions of CSA victims as males perceived CSA victims more negatively than females. Regarding chapter two, a victim’s abuse history, victim-perpetrator relationship and a perpetrator’s gender were not found to influence British perceptions of CSA. However, similar to chapter one, females were significantly more pro-victim compared to males. In chapter three, the critique identified some evidence of the GBAI-R being psychometrically sound and utilising an efficient administration methodology. Despite this, some concerns were raised regarding the representativeness of its normative data and the inventory’s susceptibility to extreme scores. Finally, chapter four revealed some evidence of the intervention reducing the perpetrator’s offence-specific minimisation although it was not possible to firmly conclude this. Conclusion: The findings highlight the need for further research into perceptions of CSA. This should include investigations into why males are less pro-victim compared to females and the impact this might have on CSA. Research should also continue to investigate the influence of a victim’s abuse history, victim-perpetrator relationship and a perpetrator’s gender on perceptions of CSA. As part of this research a more representative sample should be recruited to enable the generalisation of findings. A more comprehensive critique of the GBAI-R should also be facilitated as well as further investigations into minimisation.

This thesis consists of three parts: a major literature review, an empirical study and a critical appraisal. In Part One, the literature review begins with a brief introduction which outlines the importance of the topic, in particular the disparity in diagnosis rates for autism spectrum disorder (ASD) in girls compared to boys and possible causes and consequences. This is followed by an overview of the development of the diagnostic criteria for ASD and a critical exploration of a range of explanations for this disparity, suggesting some under-identification of symptoms in girls. This is followed by an overview of research into the experiences of girls and their parents during the diagnostic journey, including evidence for a later and longer diagnostic process, the prevalence of comorbid psychiatric diagnoses and evidence for the impact on mothers particularly. Finally, the literature review is summarised in order to provide the rationale for this thesis and to lead into the research questions. In Part Two, following a brief overview of the literature, the empirical study provides a detailed account of the research undertaken. This includes an outline of the methodology and method and presents an interpretative phenomenological analysis of semi-structured interviews with five mothers of daughters with diagnoses of ASD, exploring their diagnostic journeys in the broadest sense. This analysis is explored in relation to psychological literature, particularly systemic thinking, before a discussion of the implications for future research and for educational psychology practice. Part Three, the critical appraisal, consists of two parts: firstly, a critical account of the research process is given from inception through to completion including ontological, epistemological and ethical considerations as well as difficulties encountered; secondly, a more detailed discussion of the findings is offered in relation to psychological literature and the contribution to knowledge and educational psychology practice.

Co-occurring borderline personality disorder and eating disorders confer a greater risk for self-harm and suicide attempts than either diagnosis alone. The nature of, and possible reasons for, the relationships between disordered eating, borderline personality disorder, and self-harm behaviour remains unclear. This study used a cross-sectional mixed methods approach to examine the prevalence of self-harm, suicide attempts, and eating disorder symptoms in borderline personality disorder; investigate the effect of psychological factors on these relationships; and to explore lived experiences of self-harm, suicidal behaviour, and disordered eating in borderline personality disorder. 52 individuals with borderline personality disorder in NHS Highland completed questionnaires assessing various psychological factors. A subset of these (n=7) took part in semi-structured interviews exploring experiences of self-harm/suicide attempts, and disordered eating, analysed using interpretative phenomenological analysis. Results demonstrated that self-harm and/or suicide attempts were reported by all participants, and the mean scores on the EDE-Q were high. Social perfectionism, emotional dysregulation, depression, and low resilience were associated with eating disorder severity; social perfectionism uniquely so. Three superordinate themes describing participants’ experiences of self-harm, suicide attempts and disordered eating emerged from the analysis: ‘self as defective’; ‘need for control’; and self-harm as ‘friend and foe’. These findings highlight that high rates of self-harm, suicide attempts, and disordered eating are reported by individuals with borderline personality disorder. Social perfectionism in particular appears to be a risk factor in those with co-occurring borderline personality disorder and disordered eating, alongside emotion dysregulation, depression, and low resilience. More attention needs to be given to assessing and treating eating disorder symptomatology and self-harm/suicide attempts in individuals with borderline personality disorder.