Includes bibliographical references / Objective: The main aim of this thesis is to analyze data from the South African Stress and Health (SASH) study and , for the first time, generate information on the epidemiology of traumatic event s (TEs) and posttraumatic stress disorder (PTSD), and on the association of TEs with other psychopathological and physical health outcomes. Methods: A literature review was done to provide information current knowledge in the field. Cross - tabulations, Chi - squared tests and logistic regression analyses were then conducted SASH data to determine the prevalence of the different types of trauma and PTSD and the associations between the sociodemographic variables and TEs and PTSD on the one hand, and TEs and PTSD, other psychopathology and chronic physical conditions on the other . Results: The most common traumatic events were the unexpected death of a loved one and witnessing trauma. Lifetime prevalence of PTSD was 2.3%, and the conditional prevalence of PTSD after trauma exposure was 3.5%. PTSD conditional risk and burden were both highest for witnessing trauma. Witnessing trauma was commonest among males and those with low - average education. There was statistically significant association between witnessing and PTSD, mood, and anxiety disorders. Exposure to any TE significantly increased the odds of all the physical conditions, and the odds of having a physical condition were directly related to the number of lifetime traumatic events. Sexual violence and unexpected death of a loved one significantly increased the odds of all the e physical conditions assessed, while war events were only associated with respiratory conditions. Apart from war events, accidents and witnessing trauma were associated with the fewest physical conditions. Conclusions: Consistent with the literature, trauma and PTSD in South Africa are not distributed according to the socio - demographic factors or trauma types observed in other countries. Witnessing trauma is common in South Africa and increases the risk of mood and anxiety disorders. Finally, TE exposure is associated with chronic physical conditions in a dose - response manner. Trauma interventions must therefore focus also on those not directly affected, and routine evaluation for chronic physical conditions is recommended for survivors of all trauma.

The purpose of the current study was to provide both additional evidence of the psychometric properties of the TIPSA by examining reliability and validity coefficients, and to add to the empirical evidence for the application of betrayal trauma theory outside the context of complex and/or historical trauma. It was hypothesized that internal-consistency coefficients for the TIPSA would exceed 0.70; the TIPSA and the PTSD Checklist for DSM 5 (PCL-5) would be significantly positively correlated; the TIPSA and the Composite Codependency Scale (CCS) would not be significantly correlated; and that neither Adverse Childhood Experiences (ACE) nor Benevolent Childhood Experiences (BCE) scores would be significantly correlated with, or have a significant effect on TIPSA or PCL-5 scores. This study was conducted using anonymous survey data from192 female participants who self-identified as partners of sex addicts. Participants completed the TIPSA, PCL-5, CCS, ACE, and BCE measures. All reliability estimates for the TIPSA were above 0.70, as were all total-scale reliability estimates for the additional measures. Correlation between the TIPSA and PCL-5 produced a Pearson's r of 0.851 (p = 5.541 E-55), which indicated a large effect size. Correlations with additional measures produced statistically significant, yet small to weak, effect sizes (CCS: r = 0.292; ACE: r = -0.173; BCE: r = 0.244). Based on study results, there appears to be sufficient evidence to establish convergent validity of the TIPSA as a measure of trauma symptoms. Moreover, statistical evidence indicates only a weak relationship between the TIPSA and the CCS, thus establishing divergent validity of the TIPSA. Finally, neither the BCE nor the ACE was strongly correlated with the TIPSA, which adds to the empirical evidence for utilizing betrayal trauma theory outside the context of complex trauma, and also serves to provide additional evidence for divergent validity of the TIPSA.

Bakgrund: Posttraumatiskt stressyndrom (PTSD) är en av de vanligaste psykiatriska följdsjukdomarna efter en traumatisk upplevelse. Många av de individer som har diagnostiserats med PTSD har samtidiga kroppsliga besvär och det finns forskning som tyder på att fysioterapeutiska interventioner skulle kunna vara betydelsefulla i behandlingen av PTSD. Trots att forskning på området fysioterapi vid PTSD har ökat i omfattning under de senaste åren är fysioterapeutprofessionen inte självklar i PTSD-teamet. En kvalitativ studie om hur fysioterapeuter upplever sin roll i behandlingen av patienter med PTSD skulle kunna bidra med värdefull information. Syfte: Syftet med studien var att beskriva fysioterapeuters upplevelser och erfarenheter av att arbeta med vuxna personer som har diagnostiserats med posttraumatiskt stressyndrom. Metod: Studien var en kvalitativ intervjustudie som baserades på fem semistrukturerade intervjuer med fysioterapeuter från Röda Korsets behandlingscenter i Sverige. Ett ändamålsenligt urval tillämpades i studien och datan analyserades utifrån en kvalitativ innehållsanalys. Resultat: Analysprocessen resulterade i 14 underkategorier och fyra kategorier. De fyra kategorierna var; Ett varierat och individanpassat fysioterapeutiskt arbetssätt vid PTSD, Fysioterapeutens betydelse och unika roll i PTSD-teamet, Variationsrika framgångsfaktorer inom vården av PTSD och Utmaningar som komplicerar vården vid PTSD. Konklusion: Fysioterapeuter har, i och med sin unika kompetens, en betydelsefull roll i PTSD-teamet och kan genom kroppsliga behandlingsmetoder göra en stor skillnad för patienter med PTSD. Utmaningarna för fysioterapeuter inom vården av PTSD var många och det fanns en önskan om mer forskning och utbildning. Vidare forskning på området fysioterapi vid PTSD behövs för att fylla de kunskapsluckor som finns inom området. / Background: Posttraumatic stress disorder (PTSD) is one of the most common psychiatric disorders following a traumatic event. Many of those who have been diagnosed with PTSD have bodily symptoms and research suggests that physiotherapeutic interventions may be meaningful in the treatment of PTSD. Even though research regarding physiotherapy and PTSD has grown over the last couple of years physiotherapists are not a natural part of the PTSD-team. A qualitative study regarding physiotherapists views on their role in the treatment of PTSD could provide valuable information. Purpose: The purpose of this study was to describe physiotherapists' views and experiences of working with adults who have been diagnosed with posttraumatic stress disorder.  Method: The study was a qualitative interview study which was based upon five semi-structured interviews with physiotherapists from the Red Cross treatment centers in Sweden. A purposive sampling was used and the data was analyzed using qualitative content analysis.   Results: The analysis resulted in 14 subcategories and four categories. The four categories were; A varied and personalized physiotherapeutic way of working with PTSD, The physiotherapists importance and unique role in the PTSD-team, Variating successful factors in the healthcare of PTSD and Challenges that complicates the healthcare of PTSD. Conclusion: Physiotherapists have, because of their unique competence, an important role in the PTSD-team and can make a big difference for their patients through physiotherapeutic interventions. There are many challenges in the healthcare of PTSD for physiotherapists and more research and education was requested. Further research regarding physiotherapy and PTSD is needed.

There is growing evidence to suggest an inverse association between physical activity and symptoms of posttraumatic stress disorder (PTSD). However, the mechanisms are not well understood and much of the research in this area stems from cross-sectional studies, thereby limiting what is known about these relationships at the intra-individual level. Chapter 1 of this dissertation is a systematic review examining the literature on the association between physical activity and PTSD in a variety of study designs (i.e., cross-sectional, longitudinal, and intervention). Chapters 2 and 3 used data from a 7-day diary study of 15 participants with a diagnosis of PTSD. In this study, participants completed twice daily surveys on mobile phones and wore Fitbit accelerometers measuring physical activity and sleep. Chapter 2 used multilevel modeling to examine the within-person and between-person associations between physical activity and symptoms of PTSD, sleep, positive and negative affect, and coping. Multiple operationalizations of physical activity were used (i.e., self-report and accelerometer-measured) in order to explore and better understand which metrics are most strongly related to psychosocial factors. Results from Chapter 2 add to the literature by providing evidence of within-person associations between physical activity and PTSD symptoms over the course of the day, such that on days when participants are more physically active than usual, they also report fewer symptoms of PTSD that evening. Chapter 3 discusses the utility of using N-of-1 study designs with an emphasis on the benefits of using frequent repeated measurements in clinical practice. Three case examples are presented to illustrate the intra-individual variability that is observed in symptoms of PTSD, affect, and health behaviours. These examples provide rationale for the use of intensive measurement designs in order to fully capture and understand how and when variables fluctuate over time. / Graduate

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With the advancement of protective gear and medical aid, soldiers are now surviving traumatic experiences that were once fatal. As a result, the prevalence of brain injury and posttraumatic stress disorder in military service members has grown. Those who have obtained brain injury are at risk of developing chronic traumatic encephalopathy, a neurodegenerative syndrome. To date, there is no cure, treatment, or diagnostic method (besides autopsy) for chronic traumatic encephalopathy. Because chronic traumatic encephalopathy and posttraumatic stress disorder present many of the same symptoms and have the possibility of deriving from the same traumatic experience, an investigation of a potential link is necessary. This study explores the possibility of chronic traumatic encephalopathy being misdiagnosed as posttraumatic stress disorder. This is done by analyzing the frequency of brain injury along with the comorbidity of posttraumatic stress disorder and brain injury. This thesis also proclaims the need for research that attempts to develop diagnostic criterion and treatment methods for chronic traumatic encephalopathy.

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Alcohol use disorder (AUD) and post-traumatic stress disorder (PTSD) are debilitating conditions that often co-occur, with an estimated 41-79% comorbidity rate. A major concern with the co-occurrence of these disorders is the tendency for one to exacerbate the other. Specifically, symptoms related to PTSD are a significant risk factor for the development of AUD, and alcohol abuse worsens PTSD symptoms. This cycle, along with a lack of effective pharmacological treatment options, leads to significant behavioral and physiological deficits. Additionally, remission for comorbid AUD and PTSD is much more difficult to attain due to exacerbated symptomology and a lack of FDA-approved medications. In recent years, cannabidiol (CBD), a non-psychoactive compound found in cannabis, has been a focus of study due to its therapeutic potential. Researchers have demonstrated the anxiolytic and anti-inflammatory effects of CBD in both humans and animals, showing its promise as a novel therapeutic agent in the treatment of psychiatric disorders. The purpose of this study is to investigate the hypothesis that CBD will reduce fear-related behaviors and neuroinflammation in a rat model of comorbid AUD and PTSD. Our AUD/PTSD model utilized restraint stress and chronic intermittent ethanol exposure procedures. To investigate changes in future stress sensitivity all animals were exposed to a contextual fear conditioning paradigm, which was used to train the animals to associate environmental and auditory cues (environment appearance and tone) with an aversive stimulus (mild foot-shock). 30 minutes prior to each conditioning session, rats received an intraperitoneal injection of CBD (20mg/kg) or 0.9% Saline. Once the animals learned to associate the cues with a shock, they were exposed to an extinction learning procedure that involved presentation of the cue alone (no shock). This procedure parallels exposure therapy in humans, allowing for the assessment adaptations to fear learning. The amount of time the rats remain still (freezing) during the tone represents fear-related behavior. Our current results indicate rats with a history of stress and alcohol exposure displayed significantly higher freezing behaviors and this effect was significantly decreased with CBD treatment. This suggests that when CBD is administered during fear learning, it is able to attenuate heightened stress sensitivity associated with AUD/PTSD. To evaluate how CBD mediates the neuroinflammatory response associated with AUD and PTSD, brains from the rats were extracted and analyzed for the inflammatory cytokine tumor necrosis factor a (TNF-a). Specific regions of interest included the medial prefrontal cortex and hippocampus, areas associated with anxiety, memory, and addiction. Neuroinflammation analyses are still ongoing, however it is predicted that rats who received CBD will show a reduction in inflammation in the medial prefrontal cortex and hippocampus. Taken together, the current results show promise for CBD to reduce enhanced fear-related behavior associated with comorbid AUD and PTSD.