The question addressed in this review was whether or not the available empirical evidence suggested a significant association between childhood maltreatment and insecure attachment. In particular the focus was on the disorganised category of attachment insecurity as attachment theory considers this to be the most problematic attachment classification in terms of the links to later psychopathology (Carlson, 1998). The purpose of this paper was therefore to review the empirical evidence of an association between childhood maltreatment and attachment insecurity and, through a meta-analysis, calculate the odds ratios associated with a maltreated child being classified as having an insecure attachment style, in particular disorganised attachment. Following a literature search that yielded 84 citations, 12 studies were identified that met the inclusion criteria (see method section for details of the systematic search). The results of the meta-analysis showed that children who had been maltreated were at a significantly greater risk of having an insecure attachment pattern. In particular, the disorganised attachment classification showed a greater association than either the avoidant or preoccupied classifications. These findings support the theoretical link between childhood maltreatment and attachment insecurity and suggest that disorganisation of the attachment system is a possible mediator of the negative outcomes associated with childhood maltreatment. This would indicate the necessity for further examination of this association, with particular focus on the disorganised attachment category.

Contextualised by the proposed UK Government initiative to introduce expert information into rape trials, this review surveyed literature addressing the prevalence of rape, common psychological sequelae and how symptomology consistent with Posttraumatic Stress Disorder (PTSD) may impact rape narratives. It also explored research on the general public's understanding of these symptoms and their potential influence on judgements of witness credibility. A paucity of literature focussed the review on dissociation and shame, two common phenomena associated with PTSD and how cognitive, affective and behavioural markers may impact the content and style of a rape victim's statement. The literature suggested that some manifestations of both peritraumatic and posttraumatic dissociative experiences negatively influenced judgements. The review also found that many of the behavioural markers of shame were seen as indicative of deceit, thus further reducing perceived credibility. The findings are discussed in relation to the current legal system, with recommendations for further research made.

Objective: The purpose of this study was the identification of synaptic changes related to epileptogenesis in patients investigated with intracranial recordings during presurgical assessment. Hypothesis: The following hypotheses were tested: 1. Suppression, depression or facilitation is related to seizure onset area. 2. The removal of the cortex showing suppression, depression or facilitation is associated with better surgery outcome. Methods: A total of 79 patients with intractable focal epilepsy in whom intracranial electrodes were implanted for assessment prior to epilepsy surgery were analysed, using paired pulse electrical stimulation. The amplitude of the response elicited from the first pulse (1st response) was compared with the amplitude of the response elicited from the second pulse (2nd response). Depending on if the 2nd response was absent, of reduced, increased or similar amplitude to that of the 1st response four different conditions were emerged: a) suppression, b) depression, c) facilitation, or d) no change. Results: The following results were noted: a) Suppression showed better relation with SO lobe than depression and facilitation b) In patients with focal onset, suppression was observed in the area surrounding the focus and c) Resection of the suppressed areas was found to be an unreliable marker of surgical outcome. Discussion: The distribution of suppression in seizure onset lobe and more specifically in the area surrounding the focus can be of particular interest to identify the epileptogenic lobe and to study the pathophysiology of human focal epilepsy.

Generalised anxiety disorder is characterised by excessive, uncontrollable, worry. The current study tested the idea that the verbal nature of worry in GAD, due to its abstract nature, might self-maintain by generating a widespread attentional bias for threat. It was hypothesised that verbal worry would generate more of an attentional bias for threat than imagery-based worry which, due to its more concrete nature, was hypothesised to produce attentional bias only for stimuli specifically relating to worry content. Verbal worry was also hypothesised to give rise to more negative intrusions than imagery-based worry. In part one of the study, high-worriers were instructed to worry in either a verbal way (the Verbal group) or an imagery-based way (the Imagery group), before completing the dot probe task as a measure of attentional bias for threat-related words. In part two, the two groups worried in the same way as before and then completed the breathing focus task as a measure of the number of negative intrusions occurring after worry. The results provided support for the hypothesis that verbal worry produces more attentional bias to threat than imagery-based worry but did not support the hypothesis that imagery-based worry would produce attentional bias to stimuli specifically relating to worry content. The two groups were not found to differ in number of negative intrusions following worry. The results are interpreted in terms of verbal worry generating a "general threat detection mechanism", and a new theory of GAD is presented that incorporates this speculated mechanism. Clinical implications of the current study’s findings are discussed and consideration is also given to possible future avenues for research.

Autism Spectrum Disorder (ASD) is a life-long developmental disorder, which affects communication, social interaction, and flexible behaviour. Kanner’s and Asperger’s original descriptions suggested a hidden intelligence in Autism, reflected in islets of ability. However, for more than three decades it has been documented that ASD has a strong association with Intellectual Disability (ID) and low measured IQ: a high percentage of cases of ASD have intellectual disability, and risk of ASD increases with reduced IQ. The current study aimed to investigate the underlying cognitive potential in ASD, using a simple measure of processing efficiency. The thesis reports studies testing the notion that learning and acquisition of skills is hampered by poor social insight in ASD, which curtails ordinary social learning mechanisms. This general framework further predicts that the basic processing mechanism is not impaired in ASD, and that learning will proceed more efficiently through non-social than through social routes. The Inspection Time (IT) task was used to assess processing efficiency and speed of processing, free of social demands. ITs were predicted to be significantly better than expected from standard IQ in children with ASD and ID, but not in those with ID alone. A novel photograph version of a well-known receptive vocabulary test was developed, predicting that this less socio-communicative version would specifically aid children with ASD, compared to the traditional line drawing format (which may be more determined by the author’s own interpretation and/or drawing ability). Finally, learning in novel social and non-social odd-one-out tasks was tested in children with ID with and without ASD. Learning performance was examined in relation to performance on standard IQ tests, IT, Theory of Mind, and report of everyday life skills and deficits. Results showed that ASD individuals outperformed ID individuals in the IT task despite matched IQ. However, IT did not predict better non-social learning than IQ did. Implications of these results and future directions are further discussed.

Introduction: The rates of mental illness in United Kingdom military personnel have largely been stable since operations began in Iraq in 2003. However data is often gathered at one time point so cannot measure change over time and the one longitudinal study (Fear et al., 2010) which has examined this issue found a significant increase in PTSD symptoms over time. This highlighted the need for measurement of poor mental health symptomatology at more than one time point. The current research aimed to: a.compare rates of mental ill health among military personnel upon completion of deployment and at follow up; and b. to identify any factors associated with maladjustment. Method: 2580 personnel completed the baseline questionnaire and 586 consented to follow up. 296 provided follow up questionnaire responses, via internet,post, or site visit. Two follow up groups were compared; those assessed between three weeks to four months post homecoming; and those assessed between four to eight months post homecoming. Results: Symptoms of poor mental health increased from baseline to follow up, with no difference between follow up groups. There was a significant rise in PTSD symptomatology and the prevalence of functional impairment. Greater unit cohesion, leadership satisfaction and positive family relationships were predictive of better mental health. Stigmatising beliefs regarding seeking mental health treatment were associated with poor mental health. Conclusions: Bolstering modifiable areas of support, such as peer and family relationships, may help to buffer adverse deployment effects. Delivering the anti-stigma message to family, peers and commanders may help increase awareness of, and reduce stigma towards, help seeking for mental health difficulties. Continued follow up research is needed to monitor if symptoms of poor mental health continue to rise and reach clinical significance.

Background: Cognitive styles, emotional processing and behavioural traits are involved in the aetiology and maintenance of eating disorders. Some of these traits are present post recovery and in first-degree relatives suggesting that they may be endophenotypes. Aims: The aim of this study was to examine cognitive styles, emotional processing and behavioural traits in female twins with eating disorders in order to explore their genetic basis. Such investigations will increase our knowledge of the aetiological architecture that underlies eating disorders. Methods: In a sample of twins representative of the population (n=3338), the heritability of psychological symptoms thought to be related to eating disorders was estimated using structural equation modelling of questionnaire data. In a more in-depth face-to-face study, a smaller group of 114 clinical and control twins (n=53 met lifetime DSM-IV eating disorder criteria, n=19 non-eating disorder cotwins and n=42 controls) were assessed using a semi-structured interview and an objective assessment of cognitive styles, emotional processing and behavioural traits. To explore the heritability of these, within-pair-correlations were calculated and generalised estimating equations compared probands with non-eating disorder cotwins and controls. Results: In the population sample, the psychological symptoms related to eating disorders were found to be moderately heritable. In the clinical sample of twins, there appeared a genetic basis to the life course of the eating disorder. Childhood traits reflecting an obsessive compulsive personality and lifetime impulsive behaviours were found to be familial traits. Analysis of cognitive styles indicated they had a genetic and familial basis and emotional processing also showed a genetic and familial basis at trend level. There was some evidence of altered reward sensitivity in people with bulimic disorders, although less evidence of a substantial genetic basis. Conclusions: Psychological symptoms related to eating disorders were moderately heritable in the population twin sample. The clinical studies were exploratory, in part due to the limited sample size. Some elements of the findings lent support to cognitive and emotional processing traits being endophenotypes for eating disorders. However the relatively small sized differences between clinical and control samples as well as the differences between age groups and across the diagnostic spectrum, demonstrates that these particular measures may be restricted in their ability to inform the future diagnosis and taxonomy of eating disorders. Future studies with larger samples are required to confirm the present study’s findings.

This thesis describes a nested cross-sectional study of Iraq War veterans who deployed in the main war-fighting period of the war (TELIC 1) and those in the UK military during the Iraq War, but who did not deploy at that time. Participants were drawn from a large UK military cohort, stratified by deployment status and engagement type. Participants undertook a structured telephone interview including diagnostic instruments, measures of service utilisation, and barriers to care. The response rate was 76% (821 participants). The weighted prevalence of common mental health problems/PTSD symptoms was 27.2% and 4.8%. The most common diagnoses were alcohol abuse (18%) and neurotic disorders (13.5%). There was no health effect of deploying for regular personnel, but an increased risk of PTSD for reservists deployed to Iraq, and other recent deployments, compared to reservists who did not deploy. Less than a quarter of those with common mental health problems still serving in the military were receiving any form of medical professional help. Non-medical sources of help were widely used. The rates of help-seeking in this population were comparable with general population rates. The majority of those diagnosed were not receiving the best evidence based treatment. 44% of interviewees diagnosed on structured interview failed to recognise they were suffering from a mental health problem. The most common barriers to care reported related to the anticipated public stigma associated with consulting. In addition, participants reported barriers in the practicalities of consulting, e.g. scheduling an appointment. Stigma did not influence help-seeking, although negative attitudes | toward mental health care did. Those with mental health problems, such as PTSD, reported significantly more barriers to care than those without a diagnosis. Barriers to care appeared undiminished on leaving the services.

Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD) are highly comorbid and share deficits in working memory, motor inhibition and cognitive flexibility. Serotonin modulates these functions and Fluoxetine has positive clinical effects in these disorders. Functional magnetic resonance imaging was used to scan 22 ADHD and 22 ASD boys, under placebo or an acute dose of Fluoxetine, in a double-blind, placebo-controlled, randomised design, while they performed N-Back, Stop and reversal learning tasks. Repeated measures analyses within patients assessed drug effects. Patients under each drug condition were compared to 20 controls to test for normalisation effects. During the N-Back, under placebo, relative to controls, ADHD and ASD groups shared underactivation in right dorsolateral prefrontal cortex (DLPFC). ASD boys showed disorder-specific deactivation of posterior cingulate (PCC). Under Fluoxetine, DLPFC underactivation in ASD was significantly normalised and PCC deactivation was increased in ADHD, relative to controls. During the Stop task, under placebo, relative to controls, ASD boys showed disorder-specific overactivation in bilateral inferior frontal cortex while ADHD boys showed disorder-specific underactivation in ventrolateral prefrontal cortex. Under Fluoxetine, prefrontal dysfunctions were significantly normalised in both disorders, due to inverse up and downregulation effects of Fluoxetine in these regions, in each disorder. During reversal learning, under placebo, ASD boys exhibited disorder-specific underactivation in medial prefrontal cortex (mPFC), compared to controls and ADHD, while patients shared decreased activation in precuneus. Under Fluoxetine, mPFC activation was upregulated and normalised in ASD boys, but down-regulated in ADHD boys. Fluoxetine had disorder-dissociated, inverse effects on frontal brain function in ADHD and ASD during inhibition and reversal learning. During working memory Fluoxetine improved task-positive frontal activation in ASD and task-negative activation in ADHD. These inverse effects of Fluoxetine on frontal brain activation in the two disorders potentially reflect inverse baseline serotonin levels and may underlie its clinical effect.

Borderline personality disorder is a severe, psychologically and socially debilitating condition that tends to develop in people who have experienced multiple forms of adversity in their early lives. For a variety of reasons, most research into the aetiology of the disorder has focused on women. This research seeks to explore potential aetiological factors among men. There is evidence that known risk factors for BPD differ in incidence between men and women, and that responses to and interpretations of such experiences may also differ by gender. It is possible, then, that BPD may develop along different pathways for men and women, or may act on different vulnerabilities. These differences may be clinically significant, and could influence the way in which therapeutic interventions are conceptualised and delivered. The first section, a review paper, describes and critiques the existing research into risk factors for BPD, including aspects of childhood maltreatment and neurobiological markers of the disorder. It examines the literature on gender and BPD, exploring explanations for the apparent rarity of men in research and clinical settings. The review then evaluates the existing research specifically regarding men with BPD, and makes a case for a more inclusive programme of research, incorporating a consideration of gender-specific risk factors. The second section, an empirical paper, presents an analysis of the responses of 30 men, 19 meeting criteria for BPD and 11 forming a psychiatric control group, to questions exploring their childhood experiences of abuse, neglect and adversity, and their current symptomatology. Characteristics of the BPD group were described, and hypotheses regarding the nature and severity of experiences of maltreatment between the BPD and non-BPD group were tested. Then, the findings of this study were compared with those of two recent similar studies. Finally, the paper discusses the theoretical and clinical implications of the results, appraises their validity, and makes suggestions for further investigation. Third, a critical appraisal reflects on several salient issues in some depth. It examines criteria for BPD in the light of gender differences and patterns of responding in this study, and explores the validity of the diagnosis for men. Methodological debates regarding the use of retrospective data collection are detailed and the decisions made in the current study discussed. Finally, some observations are made regarding the research process, noting challenges endemic in research in this area, and specific points of learning.