Posttraumatic stress disorder (PTSD) is a trauma-related disorder that may develop in response to traumatic or stressful events. Dysfunction of the Hypothalamic-Pituitary-Adrenal (HPA) axis has been implicated in the disorder. Studies support such dysfunction as being a consequence of PTSD, rather than a precursor. However, most studies of the HPA are either cross-sectional or have been carried out in adults. The aim of the present study was to identify whether HPA dysregulation interacts with stressful experiences to increase the likelihood of developing PTSD symptoms in a community-recruited sample of healthy adolescent girls. Adolescent girls (N = 550) and one of their parents participated. Adolescents’ clinical symptoms were assessed at baseline and at a nine month follow-up. Saliva samples were collected from all adolescent participants at waking, 30 minutes after waking, and 8 pm on 3 consecutive days. Flattened diurnal slope of cortisol at baseline was associated with increased PTSD symptoms nine months later. Baseline cortisol awakening response (CAR) per se was not prospectively related to developing PTSD symptoms, but its interactions with stressful experience was associated with elevated PTSD symptoms at follow-up. Effects were small and need to be replicated in samples with more severe stressors, as well as more clinical levels of PTSD. Nevertheless, findings suggest that dysregulated basal HPA functioning may be involved in the development of PTSD symptoms.

This study aimed to assess the impact of an Mindfulness-based stress reduction (MBSR) intervention in a program serving women who survived Intimate partner violence (IPV). The biopsychosocial model, formulated by Engel, was the theoretical basis of this study. The impact of the MBSR intervention was assessed by qualitatively evaluating researcher notes and 5 participants' journals and reflections, and quantitatively evaluating 16 participants' self-reported stress, mindfulness, well-being, and optimism before and after the intervention. The themes that emerged from the qualitative data included participants' feelings of relaxation or balance, improved self-awareness, mindfulness exercises becoming easier over time, and improved intentionality. The Kentucky Inventory of Mindfulness Skills (KIMS) self-report inventory was used to assess participants' mindfulness. The KIMS instrument is composed of four subscales: observe, describe, act, and accept. There were significant improvements in the describe and accept dimensions of mindfulness from pretest to posttest, after Bonferroni adjustment. The subscale describe measures how well the participants report being able to describe, identify, or observe mental phenomena in a nonjudgmental manner. There were no significant differences from pre to posttest on stress, well-being, and optimism, a non-equivalent dependent variable not expected to change as a result of the intervention, as optimism is presumed to be a stable personality trait. This study may provide a valuable link to the development of coping and treatment strategies for IPV survivors that can be integrated into therapy programs and individual treatment.

Over the past 15 years, mental health professionals have seen an increasing number of Vietnam combat veterans suffering from stress disorders resulting from the trauma of combat and continued exposure to life threatening situations. Prior to 1980, professional repudiation of and hostility toward Vietnam veterans and toward a clinical reality of Post Traumatic Stress Disorder was common while nondiagnosis and nontreatment was prevalent

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A dissertation submitted in partial fulfilment of requirements for the degree of Master of Arts At the University of Witwatersrand Johannesburg 2016 / This study explored the subjective experiences of a population who appear to be at relatively high risk of potential violence and harm, specifically female university students who are compelled to commute by taxi on a daily basis. The study aimed to explore and document the psychological experiences of these female university students including their anxieties, levels of traumatic stress related responses, cognitions and fantasies, and conscious and unconscious adaptations to their circumstances. It was hoped that information gleaned would contribute to, and possibly expand the understanding of what the lived experience of Continuous Traumatic Stress (CTS) might entail. In order to investigate the research questions, ten students who were identified as being compelled to use minibus taxis as their primary mode of transport to and from university participated in semi-structured interviews on the topic of their experiences in this space and how they adapt to and survive in their circumstances. The study was located in the qualitative research tradition and the interview transcripts were analysed using critical thematic analysis. The main themes were identified and presented under four sections; exposure to traumatic events, the effects and impacts of these events, managing and coping, and gender related experiences in the taxi commuting space. Exposure to traumatic events included taxi driver aggression, motor vehicle accidents, crime and violence, xenophobic attacks and gender related trauma. The most prominent effects or impacts that were identified were firstly, anxiety, fear and preoccupation with danger and secondly, numbing, resignation and hopelessness. The tactics which were employed by participants in managing and coping with their circumstances included, prayer and observation and management of their commuting environment. It was through observation and self-management that participants practiced strategies that allowed them some measure of control in terms of how they conducted themselves in the taxi commuting space. Under the final section, participants revealed their gender related experiences reporting a sense of being exploited, being subject to sexual harassment, and the constant fear of rape or sexual violation. The links between these participants’ experience and the concept of CTS are presented and it is argued that many aspects of their experience appear consistent with CTS. / GR2017

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Experiencing early life adversity (ELA) increases the risk of anxiety disorders, such as generalized anxiety disorder and post-traumatic stress disorder, with disproportionally higher risk in women compared to men. Neurodevelopmental and behavioral outcomes following ELA are multifaceted and are influenced heavily by the type of adversity experienced and sex of the individual. A major contributor to emotional dysfunction and anxiety disorders resulting from ELA are changes in fear and threat circuitry. Children who experienced ELA have been reported to show an accelerated development of the amygdala, a region involved in processing threat, and greater cerebrospinal levels of corticotrophin releasing hormone (Crh), an orchestrator of neuroendocrine and behavioral responses to stress. Work in rodents have linked Crh signaling within the lateral central amygdala (CeAL) with processing and responding to threat, core features disrupted in anxiety-related disorders. Further, sex biases in risk and symptom presentation have been proposed to be related to sexual dimorphic signaling of Crh across the brain that differentially influence a variety of Crh-dependent behaviors. However, it remains unclear what properties of ELA portend differential neurobiological risk, what is the basis of sex-differences for negative outcomes, and how specific mechanistic changes give rise to certain endophenotypes. In this work, I use genetic, cellular, and behavioral approaches to explore the impact of ELA and sex on perinatal development in mice and the functional consequences of altered Crh neuron activity in the CeAL on threat responding in adulthood. In Chapter 1, I review how factors such as sex and type of ELA influence amygdala development and Crh. In Chapter 2, I assess the impact of two forms of ELA, maternal separation (MS) and limited bedding and nesting (LBN) on perinatal development and anxiety-like behavior. Both forms of ELA shifted the timing of somatic maturation and basal CORT levels and led to increased anxiety-like behaviors, but the degree of the impact depended on the sex and type of adversity experienced. In Chapter 3, I demonstrate that a distinguishing feature between types of ELA was the predictability of maternal care. The type of ELA also contributed to sex-differences in Crh related gene expression in the perinatal amygdala. Increased expression was primarily observed in males following MS and in females following LBN. In Chapter 4, I investigate the functional consequences of ELA in the form of LBN on the activity of CeALCrh+ neurons in vivo and their causal role in threat reactivity indexed by the startle response. LBN rearing led to sustained activity of CeALCrh+ in female mice but diminished in male mice. Persistent activity of this population was necessary for and predicted the magnitude of startle responding. In Chapter 5, I discuss important considerations when integrating new advancements in the study of ELA and the use of sex as a biological variable. Collectively, this work deepens our understanding of the neurobiological mechanisms impacted by sex and ELA and holds promise for future strategies that may consider the sex and specific experiences of the individual to target specific endophenotypes and address the underlying root causes of anxiety disorders.

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School-age children are at high risk of experiencing traumatic and stressful events that can negatively impact their academic, emotional, and behavior performance (Brock et al., 2016). Any stressful situation (i.e., natural disaster) or adverse childhood experience (ACE) can potentially become a traumatic event for a child or adolescent. The current literature indicates that 60% of children experience at least one ACE, putting them at high risk for a variety of health and social problems (Manyema et al., 2018). Natural disasters adversely impact children's life as they have the potential to destroy physical structures and injure the child or family members. According to Inoue and colleagues (2018) natural disasters can additionally be considered as an ACE. The purpose of this study was to explore the relationship between PTSD symptoms of students who have experienced a natural disaster (e.g., hurricane exposure) and students’ internalizing and externalizing behaviors. Participants included 75 students from elementary, middle, and high school in a school district in the Southeastern United States. Linear regression showed that PTSD symptoms are significantly correlated with internalizing and externalizing behaviors. However, moderation and interaction effects showed that he type of hurricane exposure did not significantly moderate the relationship between PTSD symptoms and students' internalizing and externalizing behaviors. Implications from these results suggest that trauma-informed strategies are needed for students that are exposed to a traumatic event.