M.A. / The prevalence of rape in the world and particularly in South Africa, calls for the understanding of the factors involved in rape. In particular, it is necessary to understand rape in terms of the victim, not just in terms of the prevalence, causes and social consequences of rape. The victim’s experience of rape is complicated and takes place over a journey that progresses from the assault, through her responses and psychological and social reactions to her recovery from the trauma. It is imperative that a clear understanding of previous research is gained in order to understand the existing epistemological picture of the rape victim’s experience. This dissertation has intended to achieve this understanding by reviewing the literature that has explored rape victim’s responses after the rape, the psychological and social impact the rape has had and the recovery process after the rape. In each of these instances the factors that are identified by research as influencing the rape victim’s experience are surveyed. The victim’s responses to rape are traumatic. It is therefore important to understand the nature of trauma and in particular Post Traumatic Stress Disorder (PTSD). Rape Trauma Syndrome (RTS) in particular describes the traumatic responses of a rape victim. There are factors that influence the extent that the victim experiences responses to a rape. These factors include the extent to which a victim is believed about the rape, the extent to which it is thought that the victim precipitated the assault. Her own attributions about the rape will also influence her responses, as well as the nature of the assault, the level of violence, prior victimisation, past psychological treatment or mental illness, poor social support and other life stresses experienced at the same time as the rape. The victim does not only respond to the traumatic experience after a rape, but may also experience the psychological impact a rape may have. Reactions such as fear, anxiety, anger, aggression, guilt, shame, doubt, depression and psychopathology may be experienced as psychological reactions to a rape. The victim may also experience the impact a rape can have on her social functioning. She may withdraw socially and experience problems in her sexual functioning. The research reviewed indicated that there are factors that influence the extent that these reactions may impact on the victim’s life, if at all. These factors include: participation in the justice system, social support received after the rape, 8 cognitive appraisals made by the victim and possible psychological problems prior to the assault. The final part of a victim’s journey is the recovery. Recovery can be described the psychological work that is required by the victim. As with the responses and reactions that a rape victim experiences, the recovery process is also a journey that is dependent on many influencing factors. The factors that are identified as influencing the recovery process of the victim, both by enhancing it and by hindering it, include: demographic variables of the victim, previous victimisation, functioning before the rape (including chronic life stress and family grief, the nature of the assault, the relationship of the victim to the assailant, social support received after the rape, and the meaning the victim gives to the ordeal. This study of the existing literature concerning the journey of the rape victim through the responses she has after the rape, to the impact of the rape on her psychological and social functioning, to her recovery has highlighted the importance of influencing factors on this journey. It has also been noted by this study that there is a lack of evidence that can shed light on the factors that may influence the South African rape victim’s experience.

M.A. / The literature indicates that journalists who experience work related traumatic situations, are at risk for the development of Posttraumatic Stress Disorder (PTSD) (Teegen & Grotwinkel, 2001). Moreover, some journalists who develop this disorder do so after covering a relatively minor traumatic story (Castle, 2001). Certain temperament traits have been implicated as vulnerabilities to the development of Posttraumatic Stress Disorder (PTSD) in police officers (Henning, 1999). Few research studies have investigated temperament and sense of coherence as mediating factors for occupational stress in journalists exposed to trauma. The aim of the present study was to address this dearth by investigating whether there are statistically significant differences in the experience of trauma, temperament traits and sense of coherence of journalists with varied responses to occupational stress and trauma. The Impact of Event Scale-Revised was used to divide journalists into three groups, namely those with minor reactions to trauma (n=10), moderate reactions (n=24) and severe reactions of clinical importance (n=16). The first group of hypotheses posed in the study pertains to group differences and postulates that the three groups will have statistically significant differences regarding trauma exposure. The second group of hypotheses deals with group differences and postulates that the three groups of journalists will differ regarding certain temperament dimensions. The third group of hypotheses formulated for the study proposes group differences regarding sense of coherence. Analysis of Variance followed by the Scheffé post hoc multiple comparisons technique indicated statistically significant differences between the three groups regarding experience of trauma as measured by the Trauma Questionnaire; certain temperament-personality traits as measured by the Personality Assessment Inventory and the Zuckerman-Kuhlman Personality Questionnaire; and sense of coherence as measured by The Sense of Coherence Questionnaire. The study revealed that the group with severe reactions to stress and trauma had been exposed to intense trauma involving people and that they report significant emotional reactions to the trauma. The Personality Assessment Inventory indicated that the severe reactions group has temperament profiles characterised by somatic complaints, anxiety, depression, paranoia, borderline features, aggression, suicidal ideation, stress and treatment rejection. This group also showed greater neuroticism-anxiety and aggression-hostility prone temperament types than the other two groups as well as lower comprehensibility and manageability as indicated by the Sense of Coherence Scale. The results of the present study exhibit support that there are various factors that could have an impact on how journalists deal with the traumatic stories they cover and what their personal outcomes are after covering these stories. Journalists who develop severe PTSD have different perceptions of the trauma, temperament profiles and sense of coherence that impact on their ways of coping with the traumatic situations they face daily. Criticism of the study deals mainly with gender, age, race and the subjects' pre-testing history, which were not controlled for. Another possible shortcoming of the research is that the journalists were sourced from main stream publications as well as community papers. This might have had an impact on the amount and type of trauma the journalists were exposed to. It would have been preferable to include a greater number of participants in the study to more efficiently address the many variables. Lastly, pre-trauma temperament traits were not controlled for, due to the complexity and ethical complications involved in the subject matter. It is recommended that age, gender, race, pre-testing history and pre-trauma traits is controlled. This will however require a large sample of journalists, which was not available for the present study. It would also be beneficial to compare frequency and type of trauma exposure, PTSD and temperament in a comparative study where community journalists are compared with main stream journalists. Lastly, the development of South African measures for temperament, PTSD and trauma would be highly advantageous to this field of research.

A dissertation submitted to the Faculty of Arts. University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the Degree of Master of Arts (Clinical Psycholoqy). Johannesburg, August 1996 / This study aims to explore the relationship between intrusion and avoidance symptoms as described in the diagnostic category in the DSM-IV (American Psychiatric Association, 1994) and frequency and level of exposure to traumatogenic events. The effects of lay counselling after the event were taken into account in the analysis, and the sample consisted of voluntary First National Bank employees, who were exposed to more than one bank robbery between December 1989 and 1992. The hypotheses of the study were that an increasing number of exposures to potentially traumatogenic events, and increasing levels of exposure to potentially traurnatoqenic events would be related to the development of avoidant and intrusion symptoms. Further, it was hypothesised that the interaction of these two variables would also be significantly related to the development of avoidant and intrusive symptoms and the nature of this interaction was explored. The scale used to measure the symptoms was the impact of Events Scale (Horowitz, 1979). Level of exposure was measured on a four point scale, which included extreme exposure with physical injury; direct threat and coafrontatlon: indirect contact with the perpetrators, and the fourth category was indirect exposure, or secondary victimisation. The results indicated that level of exposure had a significant relationship with the development of both intrusion and avoidance symptoms. Contrary to expectations, frequency of exposure was not found to be related to symptomology and it was speculated that this might have been because of the crudeness of the measure. In this regard it is of note that level of exposure as measured in this study included frequency of exposure. The results indicated further that post trauma counselling was not significantly related to symptomology. The implications of these findings were discussed in the light of the general literature in PTSD.

Worldwide there are several million war refugees, many of whom stay in the host countries for years. However, little is known about their long-term mental health. The current thesis examined the prevalence, course, and predictors of mental disorders and subjective quality of life (SQOL) in 854 war refugees from former Yugoslavia who had resettled in Germany, Italy and the United Kingdom 9.3 years previously. 215 interviewees with Posttraumatic Stress Disorder (PTSD) at baseline were reinterviewed one-year later. The participants were additionally assessed for use of social and health care interventions during the one-year follow-up period. Prevalence rates of mental disorders in the war refugees varied substantially across countries, with between 42.1% and 67.8% of refugees having a mental disorder. Warrelated factors explained most variance in rates of PTSD whereas post-migration factors explained most variance in mood, anxiety and substance use disorder rates. Risk factors for each disorder were consistent across host countries. At the end of the one-year follow-up period, a third of the sample no longer met the criteria for PTSD. Recovery was positively associated with employment and negatively associated with severity of war exposure, baseline PTSD symptom severity and use of mental health services. Despite the high rates of mental disorders, refugees felt reasonably satisfied with SQOL. Low SQOL was associated with poor post-migration living conditions and mental illness, but not with war trauma. In conclusion, mental disorders appeared to be highly prevalent in war refugees many years after resettlement. This increased risk may result from exposure not only to wartime trauma but also to post-migration socio-economic adversity. Policies promoting community integration and employment may be more effective than existing psychiatric and psychological interventions in improving mental health and quality of life in war refugees.

Background: People who experience physical trauma face a range of psychosocial outcomes. These may be overlooked by busy clinicians. While some risk factors are understood, our understanding of the psychological effects of violent injury remains limited. Furthermore, there has been little research on the effect of facial trauma. Although changes to appearance can be distressing, the effects of these have not been studied in traumatic injury patients. Aims: To establish the prevalence and persistence of psychological distress and appearance concerns following injury. To compare the psychological outcomes in i) violent and accidental injury and ii) facial and other injury, and iii) to identify explanatory risk factors for psychological distress. Methods: Participants were adults admitted to the Royal London Hospital with traumatic injuries. Two hundred and twenty five participants (225) completed questionnaires in hospital. Follow up was at three months (N = 100) and six months (N = 112). Standardised measures were used to assess symptoms of post-traumatic stress (PTSS) (Acute Stress Disorder Scale, PTSD Checklist), depression and anxiety (Hospital Anxiety and Depression Scale), and appearance concern (Derriford Appearance Scale). Explanatory measures were collected, including history of mental health. Data were analysed in logistic and linear regressions, using multilevel models. Results: PTSS and depressive symptoms affected 28% and 33% respectively at baseline. At six months, 27% and 31% respectively reported these symptoms. After adjusting for demographic factors, violent injury was associated with increased PTSS (OR 6.44, CI 1.75 to 23.75), depressive symptoms (OR 4.78, CI 1.41 to 16.18) and appearance concern (2.78, CI 0.09 to 5.47). A history of mental health problems increased distress. Conclusions: There were high levels of psychological distress in this sample. Violent injury was associated with a complex interaction of social and psychological factors. People vulnerable to distress may benefit from psychological support. Hospital admission provides a unique opportunity to engage them in interventions.

Researchers have agreed that most rape victims vii experience stress-related symptoms similar to post-traumatic stress disorder. There have also been numerous studies that have tried to predict the severity of those stress-related symptoms, but the literature is inconclusive. Lack of perceived control is consistently mentioned in the rape research literature as being present in rape victims, but no study has empirically examined the relationship between perceived control and a rape victim's stress-related symptoms. The purpose of this study was to empirically examine the relationship between perceived control and stress-related symptoms in rape victims. This was accomplished by comparing a group of 33 subjects who reported being victims of rape with a group of 50 subjects who did not report being victims of rape. Mean stress-related symptom scores were correlated with perceived control scores; also, factors, including group membership and the time elapsed since a rape, were regressed onto the subjects' stress-related symptom scores. The correlations between stress-related symptoms and perceived control in the rape victim group were statistically significant, but the relationship was not present for the nonvictim group. Also, nonsignificant results were obtained for joint effects between perceived control and group membership, along with perceived control and time since a victim had been raped. The results suggest that low perceived control is a good predictor for elevated stress-related symptoms. Further research may clarify the relationship between perceived control and stress-related symptoms in rape victims.

Current theories of PTSD propose that impaired retrieval of trauma memories may impede processing of these memories and subsequent trauma recovery. This thesis investigated memory retrieval processes in trauma survivors with and without symptoms of posttraumatic stress, and in non-traumatised individuals exposed to a highly arousing event. Study 1 examined deliberate avoidance of unwanted memories in recent trauma survivors. The results indicated that attempts to forget were associated with poorer recall of forgotten information, but the size of this effect did not depend on the presence or absence of Acute Stress Disorder (ASD). Study 2 investigated automatic retrieval inhibition in trauma survivors with or without Posttraumatic Stress Disorder (PTSD). The results suggested that repeated retrieval of trauma-related information by individuals with PTSD can cause inhibition of related, but unpractised information. Studies 3 and 4 examined the relationship between the vantage point of trauma memories, avoidance and posttraumatic stress symptomatology. The findings indicated that recalling a traumatic event from an observer perspective is associated with post trauma avoidance. They also showed that an observer vantage point in the initial few weeks after trauma is associated with poorer long-term post trauma adjustment. Studies 5, 6 and 7 were analogue studies which analysed the impact of heightened arousal on memory retrieval in novice skydivers. The results suggested that elevated arousal can interfere with retrieval of information related to the arousal-inducing event. Study 7 also indicated that autobiographical memory for the event may be impaired. Finally, Study 8 examined the qualities of trauma memories that were accessed via different modes of retrieval. The results provided evidence that intrusive memories were experienced as more realistic and with more intense affect than memories for the same event that were deliberately retrieved. Together, the findings of this program of research extend current theories of PTSD by highlighting the mechanisms through which retrieval of trauma memories may be impaired. The results suggest that the quality of trauma memories is affected by avoidance processes, elevated arousal and level of conscious control the individual exerts over retrieval.

Comorbidity between substance use disorders and post traumatic stress disorder (PTSD) is common. Despite evidence to suggest that people with heroin dependence are at particular risk of PTSD, there is a dearth of research focussing on the interrelationship between these disorders. The present thesis aims to identify the prevalence of PTSD among people with heroin dependence, the correlates of this comorbidity, and its impact on treatment outcomes, the utilisation of treatment services, and treatment costs. Study 1 examines the epidemiology of PTSD and heroin dependence among 10,641 Australian adults who participated in the National Survey of Mental Health and Wellbeing. The prevalence of PTSD was highest among people with heroin or other opioid use disorders compared with any other drug class (33.2%). Comorbid PTSD was associated with poorer occupational functioning, and poorer physical and mental health. While general population studies provide crucial population estimates they do not allow for a detailed examination of the relationship between highly disabling but low prevalence disorders. The remaining studies were undertaken using a sample of 615 treatment seeking and non-treatment seeking dependent heroin users. Study 2 examines the prevalence and correlates of this comorbidity. PTSD was common (lifetime 41%; current 31%) and was associated with a more severe clinical profile. Studies 3 and 4 were based on follow-up data on this large cohort. Study 3 is the first study to examine the impact of PTSD on 2 year treatment outcomes for heroin dependence. Across the 2 year period, those with current PTSD at baseline performed more poorly in terms of their occupational functioning, physical and mental health. Study 4 found that this did not equate to the greater use of treatment services or an increased cost to the health care system among those with PTSD. It is concluded that PTSD and heroin dependence are highly comorbid conditions, and that this comorbidity is associated with poorer functioning and poorer treatment outcomes. Individuals entering treatment for heroin dependence should be assessed for PTSD so that they may receive appropriate treatment and referral. Further research is also needed to determine how best to treat this comorbidity.

This thesis explores the ways in which a number of individuals survived their experiences of severe and perpetrated trauma. I theorise the participant’s survival adaptations in terms of hope which I positioned as being an active relational process. A case study method was used to collect data from intersubjective-psychoanalytically informed therapy sessions, from three participants who each received 12, 60 minute therapy sessions. I utilised a hermeneutic ontology from the work of Gadamer, who contended that the development of understanding and meanings results from an active intersubjective process. This ontology and design enabled the research to capture and interpret aspects of the dynamic development of personal meanings about the experiences of surviving traumas. Central to my notions of hope is the concept of intersubjectivity which is based upon the work of Winnicott, Fairbairn, Ferenczi, Meares, Stern and Bromberg. Using their ideas about relatedness and identification I argue that survivors expressed hopeful intentions and actions through their conscious and unconscious adaptive strategies. I explore the peritraumatic hopeful adaptations the survivors made such as identifying with the aggressor, the splitting of self, and the overt valuing of relatedness. I further argue that hopeful intentions can be seen in such actions as the survivor remembering their trauma rather than re-enacting it, in their efforts in narrating their trauma histories despite their fears, shame and difficulties in finding a listener. The thesis concludes by exploring some of the ramifications for society of hope, trauma and witnessing: foremost being the need to recognise the vulnerable in our communities and the difficulties we face in meeting the challenges of knowing their stories. / Doctor of Philosophy (PhD)

Environmental factors such as stress and hormones acting during embryogenesis, as well as early life experiences such as parental care have been clearly demonstrated in animal models to shape the individual's phenotypic gene expression, brain development, and behavioural repertoires ( Meaney, 2005 ). However, human studies have not assessed both prenatal mental health and the quality of postnatal parental care with the same sample of mothers. The current study sought to fill this gap by investigating the impact of women's experiences of trauma and posttraumatic stress disorder ( PTSD ) before pregnancy on the mother's ante - and postnatal mental health problems, parenting, and children developmental outcomes. The study reported here is the second phase of a longitudinal study that commenced in 2002. In phase one community based middle class women in their third trimester of pregnancy were recruited and followed during the early postnatal period ( Linke, 2002 ; Lowe 2003 ). The current study assessed forty four mother - infant dyads at three time points during the second postnatal year. The dyads were divided into one of three groups ( control, trauma control and PTSD ) depending on the mother's trauma experience and whether she met the lifetime diagnosis for PTSD. The assessments included the measure of the mother and infant's basal cortisol, the mother's lifetime and ongoing mental health problems, the quality of the mother - infant relationship, and the development of the infant's general cognitive abilities, emerging language skills and emotional and behavioural self regulation. The current study found infant morning cortisol levels measured at 13 months of age were significantly predicted by maternal trauma experience and the subsequent PTSD symptoms of hyperarousal supporting the research of Yehuda and colleagues ( 2005 ) and implicating an epigenetic transmission of environmental experience from the mother to her offspring possibly via in utero programming of the HPA axis. Overall, maternal trauma was found to impact on both child language and self regulation development. Unexpectedly, the trauma control or resilient mothers were found to be least engaged with their infants, and their infants had the lowest language development. However, poorer language development was not mediated through dyadic emotional availability or maternal sensitivity. Maternal PTSD was found to be related to poorer child emotional and behavioural outcomes which were mediated through maternal mental health problems. Overall, the findings of the current study suggest that maternal trauma experience is associated with a biologically based mechanism occurring in both the mother and the infant which is protective for both the mother and the child's emotional health, but comes at a cost of slower infant language development. Furthermore, this mechanism appears to have broken down in the presence of maternal PTSD for both the mother and the infant with subsequent associations with greater maternal mental health problems, more problematic infant emotional and behavioural problems, and disorganised attachment. These findings have clinical implications, particularly for early intervention programs. The results need to be interpreted with caution due to the small sample size. However, the findings have broad implications in relation to resilience to trauma and the development of psychopathology and warrant repetition. / Thesis (Ph.D.)--School of Medicine, 2007.