Despite a high proportion of the population experiencing traumatic events within their lifetime, the number of individuals who go on to develop posttraumatic stress disorder (PTSD) is comparatively small; herein highlighting the importance of individual differences in imparting risk and resilience towards the development and maintenance of PTSD. Existing literature illustrates that biological and ecological factors are important in predicting PTSD development, with pathological vulnerabilities excepting their effects at pre- peri- and post trauma stages. Whilst cognitive and emotion based models of PTSD account for the role of a minority of known pre-trauma risk factors, individual differences in peri- and post trauma processes are held as critical to the development of PTSD. The broad range of risk factors implicated in the empirical literature, and necessity of traumatic exposure to PTSD, implicates the utility of a diathesis-stress conceptualisation of PTSD development. The current thesis employed an analogue VR-trauma paradigm to investigate the respective importance of vulnerability factors at each stage, in the prediction of analogue PTSD symptoms (memory problems, startle responses, re-exposure fear habituation), whilst measuring affective and electrophysiological concomitance. Findings supported the importance of peri-traumatic responses in the prediction of PTSD, where present, showing increased predictive capacities over pre- and post-trauma factors. Biological and ecological factors also illustrated important predictive associations, with genetic SNPs implicated in reflex startle and cardiac responses towards intrusive memories. Moreover, peri-traumatic HR decelerations and accelerations mediated the association between pre-trauma factors and cued recall inaccuracy and intrusion severity respectively. Results support existing cognitive and emotional models in their emphasis on peri-traumatic processes but suggest the added utility of a diathesis stress conceptualisation of the development of PTSD, in highlighting the importance of pre-trauma biological and ecological risk and resilience factors.

In den Jahren 1992-1995 kamen ca. 35 Tausend bosnische Kriegsflüchtlinge nach Berlin und wurden vorübergehend geduldet. Nach Kriegsende 1995 sollten sie schnellstmöglich wieder zurückkehren. Traumatisierte und Ältere ohne Angehörige im Heimatland wurden weiterhin geduldet bis Bosnien-Herzegowina wieder aufgebaut ist. Doch der Wiederaufbau verlief schleppend. Mit dem Friedensvertrag von Dayton begannen nicht Frieden und Wiederaufbau, sondern die Konsolidierung der ethnischen Grenzen in demokratischen Strukturen. Deshalb sahen viele Flüchtlinge keine Möglichkeit in ihre Heimatorte zurückzukehren und versuchten ihre Rückkehr hinauszuschieben. Möglich war dies mithilfe der Attestierung einer kriegsbedingten Posttraumatischen Belastungsstörung und ihre psychotherapeutische Behandlung, die den Inhabenden und ihren Familienmitgliedern eine Aufenthaltsverlängerung ermöglichte und ab dem Jahr 2000 den Erhalt eines dauerhaften Aufenthaltstitels. Die Verbindung einer psychischen Krankheit und ihrer Psychotherapie mit einem Aufenthaltsrecht ist neu in der Geschichte des deutschen Ausländerrechts und obwohl Berliner Psychiater, Psychiaterinnen, Psychologinnen und Psychologen maßgeblich an der Schaffung der „Traumatisiertenregelung“ beteiligt waren, wurden ihre Atteste von der Berliner Verwaltung in Frage gestellt. In der Dissertation werden die Standpunkte der Flüchtlinge, Behandelnden und der Verwaltung dargelegt und ihre Interaktionen beschrieben.Die Rolle des Krankheitskonzeptes der Posttraumatischen Belastungsstörung wird als "boundary object" (Star/Griesemer 1989) untersucht. Der Schwerpunkt liegt auf den Lebenswelten und Taktiken der Flüchtlinge, sich in Berlin zurechtzufinden und Anerkennung und Verständnis für ihre Situation zu finden. Ihre Bedürfnisse wurden in einen psychotherapeutischen Bedarf übersetzt und damit den Berliner Psychotherapeutinnen und -therapeuten ein neues Betätigungs- und Professionalisierungfeld geboten, was kritisch hinterfragt wird. / From 1992 until 1995 about 35 thousand Bosnian war refugees fled to Berlin and were allowed to stay temporarily. After the end of the war in 1995 they were expected to leave as soon as possible. Traumatized persons and elderly without relatives in Bosnia had the possibility to prolong their visa until Bosnia is reconstructed. But the rebuilding process progressed only slowly. With the end of the war did not start the expected peace time and rebuilding but the consolidation of ethnic borders inside democratic structures. Therefore many refugees did not see a possibility to return to their property and tried to delay their return. This was possible with an medical statement certifying a war related posttraumatic stress disorder and their psychotherapeutic treatment. These medical statements ensured the extension of the visa for the concerned person and its family members. From 2000 onwards they could receive a permanent residence title. The connection of a mental illness and psychotherapy with residence entitlements is a novelty in the German aliens law. And despite the fact that psychiatrists and psychologists from Berlin were leading actors in the establishment of the „regularization of the traumatized“ their medical/psychological statements were impeached by the authorities. The dissertation describes the viewpoints of refugees, treating physicians and psychologists and the authorities and how they interact with each other. Additionally is the concept of posttraumatic stress disorder examined and discussed as „boundary object“ (Star/Griesemer 1989). An important aspect is the description of life worlds and tactics of the refugees to get along in Berlin, to gain respect and appreciation for their situation. Their needs were translated into a psychotherapeutic demand and this led to the invention of a new field of work and professionalization for psychotherapists in Berlin. This development is critically reflected.

Based on longitudinal ethnographic fieldwork in Bosnia and Herzegovina I trace ontologies of posttraumatic stress disorder (PTSD) and their enactments among veterans of the 1992-1995 war. My aim is to problematize and rethink social constructionists' approaches in medical anthropology that discuss war trauma and PTSD in relation to naturalistic models and treat them as constructed realities not determined by the nature of things. I argue that such a standpoint produces a particular epistemological/ontological side-effect: it allows medical anthropologists to craft a purely social ontology of trauma and PTSD by claiming that the realness of these "constructs" is a result of psychiatric discourse, moral economy of contemporary societies or Western (intellectual, political, and medical) hegemony. Considering the ontology of PTSD as an empirical question I analyze the enactments of PTSD in four settings: the ethnographic genre itself, the organization of war veterans with PTSD in the city of Tuzla, the veterans' welfare system in the Federation of Bosnia and Herzegovina, and Bosnian public arena. I argue that PTSD is practiced as a heterogeneous and multiple reality that cannot be situated solely either in the realm of human organism (and explained by naturalistic models) or society and culture (and...

Based on longitudinal ethnographic fieldwork in Bosnia and Herzegovina I trace ontologies of posttraumatic stress disorder (PTSD) and their enactments among veterans of the 1992-1995 war. My aim is to problematize and rethink social constructionists' approaches in medical anthropology that discuss war trauma and PTSD in relation to naturalistic models and treat them as constructed realities not determined by the nature of things. I argue that such a standpoint produces a particular epistemological/ontological side-effect: it allows medical anthropologists to craft a purely social ontology of trauma and PTSD by claiming that the realness of these "constructs" is a result of psychiatric discourse, moral economy of contemporary societies or Western (intellectual, political, and medical) hegemony. Considering the ontology of PTSD as an empirical question I analyze the enactments of PTSD in four settings: the ethnographic genre itself, the organization of war veterans with PTSD in the city of Tuzla, the veterans' welfare system in the Federation of Bosnia and Herzegovina, and Bosnian public arena. I argue that PTSD is practiced as a heterogeneous and multiple reality that cannot be situated solely either in the realm of human organism (and explained by naturalistic models) or society and culture (and...

<p>Psychiatric assistance dogs for military veterans with posttraumatic stress disorder (PTSD) currently make up over 19% of assistance dog partnerships globally. We conducted a systematic review of the literature relating to these partnerships, with specific aims to (1) summarize their characteristics, (2) evaluate the quality of existing evidence, and (3) summarize outcomes. A total of 432 records were independently screened (Cohen’s kappa=0.90). Of these, 41 articles (29 peer-reviewed publications and 12 unpublished dissertations) met inclusion criteria. Data extraction was conducted to address the research aims, including a meta-analysis (quantitative outcomes) and meta-synthesis (qualitative outcomes). All peer-reviewed publications on the topic of psychiatric assistance dogs for veterans with PTSD were published within the last five years. The majority of included articles were quantitative (53%), 41% were qualitative, and 6% employed mixed methods. Mean methodological rigor scores were 80% for peer reviewed articles and 71% for dissertations, where higher scores represent more rigorous methodology. Quantitative articles reported significant improvements in the domains of PTSD severity, mental health, and social health. Impacts on physical health and global quality of life appear inconclusive. Meta-analysis (9 articles) revealed that partnership with an assistance dog had a clinically meaningful, significant, and large effect on PTSD severity scores (<em>g</em>=−1.129; <em>p</em><0.0001). Qualitative meta-synthesis identified two third order constructs: (1) Impact on the individual: mental & physical health and (2) Impact beyond the individual: building relationships & connection. This synthesis of increasingly prevalent research on assistance dogs for veterans with PTSD provides support for the impact of this complementary and integrative health intervention on PTSD symptom severity, and signs of meaningful improvements in adjacent domains including mental and social health. Gaps between quantitative and qualitative findings, along with the need to report greater demographic detail, highlight key opportunities for future research.</p>