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The material in current emergency medical services (EMS) curricula is insufficient to prepare prehospital emergency medical care personnel recognize the signs and symptoms of post-traumatic stress disorder (PTSD) within their workforce. Prehospital emergency textbooks focus on treating patients affected with PTSD, but there is very little included about how EMS professionals may also be affected. Moreover, supervisors and managers of EMS agencies receive very little education on workforce PTSD in their personnel. The purpose of this study was to understand the educational preparation of EMS supervisors in order to develop a PTSD-awareness course. The research question investigated the educational preparation that EMS supervisors receive. The conceptual framework of the study was Conti-O’Hare’s wounded healer theory. EMS professionals are wounded healers from frequent critical incident exposure. A qualitative approach featuring a case study design was used. The study included 9 participants. A focus group was used that consisted of three paramedics and three emergency medical technicians (EMTs). Separate interviews were conducted with three EMS supervisors. Data gained from the focus group and individual interviews were analyzed through coding with the goal of investigating the education received by EMS supervisors on PTSD. The themes that emerged were EMS supervisors do not receive enough education on workforce PTSD and a course specifically targeted on this subject is needed. Positive social change may be achieved through this study by enabling EMS managers to help paramedics and EMTs cope with a critical incident (CI) improving prehospital healthcare.

Cette recherche a étudié l’évolution psychique de neuf victimes directes des attentats qui ont touché Paris durant l’année 2015 et dont les symptômes étaient atypiques, voire, inexistants, a priori. Si les symptomatologies d’états de stress post traumatiques caractéristiques sont communément admises, tant par les soignants, que par les acteurs juridiques de la réparation en dommage corporel, les états de dissociation péri et post traumatiques, lorsqu’ils sont identifiés, ne sont, en revanche, jamais envisagés autrement que comme des temps de latences augurant de futurs états de stress post traumatiques sévères. A l’aide des contenus d’entretiens cliniques réalisés à trois mois puis dix-huit mois des attentats, accompagnés de deux passations d’une échelle d’évaluation des états de stress post traumatiques (PCL/S), l’évolution psychologique de neuf victimes directes, sans symptômes caractéristiques apparents, a ainsi été effectuée. Cette étude a permis de démontrer que chez certains sujets, la confrontation au Réel de la mort se fait dans une telle violence qu’elle engendre la mise en marche de mécanismes de défense archaïques tel le déni de l’effroi décrit par Lebigot (2005) puis le clivage, et non des tableaux caractéristiques d’état de stress post traumatiques. Chez deux tiers des sujets, il a été démontré que la réassociation par le langage et le retour aux processus de symbolisation étaient néanmoins possibles, sans effondrement pathologique, mais en respectant une progression lente vers l’élaboration du traumatisme, dans le cadre d’alliances thérapeutiques étayantes et ininterrompues. Chez un tiers des sujets, en revanche, la permanence de tels tableaux cliniques, c’est-à-dire asymptomatiques pour deux d’entre eux, ou caractérisé par une amnésie dissociative pour l’un d’entre eux, n’a pas permis de déterminer le caractère adaptatif et non pathologique de tels mécanismes dissociatifs. L’ensemble des résultats démontre néanmoins la nécessité d’accroître les connaissances sur le sens, le repérage et la fonction de tels mécanismes, qui ne sont pas toujours identifiés, du fait même de leur origine qui exclue toute capacité de verbalisation de la part des victimes, mais qui nécessitent cependant des proposition soins appropriées. / This research studied the psychological evolution of nine direct victims of the terrorist attacks that struck Paris in 2015 and whose symptoms were, at first glance, atypical, or even non-existent. While the symptomatologies of post-traumatic stress disorder are commonly recognised, both by carers and legal bodies involved in physical injury compensation, peri and post-traumatic dissociative disorders, when they are identified, are never perceived as anything other than periods of latency, predicting future severe post-traumatic stress disorder.The psychological evolution of the nine direct victims lacking apparent typical symptoms was thus studied based on the content of clinical interviews carried out three months and eighteen months after the attacks, backed by two assessments using the PCLS rating scale for post-traumatic stress disorder. This study has enabled us to show that with some subjects the confrontation with the real of death occurred in such violence that it triggered archaic defence mechanisms, such as denial of the dread as described by Lebigot (2005) then splitting, and not the typical presentations of post-traumatic stress disorder. With two-thirds of the subjects, it was shown that reassociation through language and a return to the process of symbolisation were still possible, without a pathologic breakdown, by respecting a slow progression towards the formulation of the trauma as part of continuous and substantiated therapeutic relationships. However, with one third of subjects the permanence of such clinical presentations, i.e. asymptomatic for two of them or characterised by dissociative amnesia for one of them, made it impossible to determine the adaptive and non-pathological character of such dissociative mechanisms. Nevertheless, the combined results show there is a need to learn more about the meaning, identification and function of these mechanisms which are not always identified, precisely because of their cause which excludes all ability on the part of victims to express themselves, but which nonetheless require that appropriate treatment be offered.

In March 2012, the Durban High Court found three accused guilty of murder on two of the accused’s parents. The Lotter case was covered extensively by the media, because of its unusual story: The two Lotter siblings claimed that they were brainwashed by the sister’s boyfriend as he had made them believe that he was the third son of God. As the siblings’ defences they decided to use the controversial defence of non-pathological criminal incapacity. This dissertation gives an extensive outline of case law that has covered this defence. While attempting to define this defence, the courts have limited its uses to such an extent, that it appears to be abolished. Viewpoints of academic authors have been considered to assist the reader in defining new borders for this defence. Redefinition is necessary in light of the Constitution of the Republic of South Africa. Concepts such as ‘coercive persuasion’ are explained in terms of psychological, psychiatric and legal backgrounds. Other countries have taken measures to restrict the use of coercive persuasion, specifically religious coercive persuasion. We therefore compare South Africa’s lack of legislation to those countries that have adopted anti-coercive persuasion legislation as the Constitution permits that foreign law may be taken into account when interpreting and developing the law. There is also a discussion on the role of expert evidence in a South African court, specifically the psychologist, as well as discussion on Post-Traumatic Stress Disorder and the Battered Partner/Spouse/ Wife syndrome in context of coercive persuasion. Coercive persuasion is viewed in terms of the defence of non-pathological criminal incapacity – as a prevailing factor that discredits the second (conative) leg of the capacity test: The ability to act in accordance with right and wrong. Defences such as automatism and private defence are also considered in context of coercive persuasion. By analysing the case of Cézanne Visser along with the other cases that considered the defence of non-pathological criminal incapacity, one is able to view that the Lotter case is not the first case that mentions a person coercively persuaded by her partner to commit crimes. After the discussion of the Lotter case (the facts and judgment are covered in detail), similarities are drawn between the two women that were coercively persuaded by their partners. An alternative judgment and sentence reveals that the Lotter case had an opportunity to develop the defence, in context of coercive persuasion, and in light of the Constitution, but failed to do so. The recommendations that follow are based on the defective dialogue that occurs between psychologists and psychiatrists, the unnecessary absence of expert evidence in court, the transformation of the defence of non-pathological criminal incapacity, a development of the term ‘coercive persuasion’ for purposes of the court when considering cases that deals with religious practices and the lack of legislative protection for women who murder their abusive husbands. / Dissertation (LLM)--University of Pretoria, 2012. / Public Law / unrestricted

This research explores the beliefs and behaviour of individuals who have suffered a traumatic experience, specifically the violent crimes of assault, motor vehicle hijackings and armed robbery. The researcher focuses on the occurrence of residual, subclinical symptoms of PTSD that individuals experience subsequent to the specified violent crimes. By identifying and describing trends in commonalities that exist between research participants’ accounts of such residual, subclinical symptoms the research aims to explore and describe these trends, enabling a common understanding and awareness of the longstanding effects that these experiences have on individuals. The qualitative research design allowed for an exploration aimed at understanding the meaning that individuals ascribe to specific events. Three case studies were examined. The researcher ensured the exclusion of individuals who met the criteria for PTSD by making use of the PCL-S. From this approach a thematic analysis was done using the transcriptions of audiotaped interviews with the participants. The three participants chosen for the study were aged twenty-nine (29), thirty (30) and thirty-one (31) independently. Two of the participants experienced an armed robbery, which were, independently, followed by non-violent crime of housebreaking and theft. A third participant experienced an armed robbery during her early childhood, and an additional crime of aggravated robbery in adulthood. The studied violent crimes had taken place between one year eleven months and six years prior to this study. None of the participants have received therapy following their traumatic experience. Five important findings were identified and discussed. Firstly, some individuals still meet the requirements for a diagnosis of PTSD, even years following their experiences with traumatic events. Secondly, following the experience of a violent crime some individual’s core cognitive schemas regarding themselves, their world and their relationships undergo various changes. Thirdly, some individuals experience numerous posttraumatic symptoms, which are not extensive enough to validate the diagnosis of PTSD, but that affect the individual’s life on a regular basis. Nine symptoms were identified in this study. Fourthly, some individuals may experience additional effects following exposure to violent crimes, e.g. physical illness, that is not classified as posttraumatic symptoms. Fifthly, a few individuals who have been the victim of more than one crime may experience cumulative or diminished effects when one explores the overall effects of revictimisation. Results also indicated that individuals may experiences similar posttraumatic symptoms, but that the presentation of these symptoms are unique and are influenced by an individual’s history, cognitive schemas and the characteristics of the crimes that they have experienced. Finally, these findings explored and described the phenomenon of partial posttraumatic stress disorder in order to expand the understanding of this occurrence. / Dissertation (MA)--University of Pretoria, 2014. / tm2015 / Psychology / MA / Unrestricted

Childhood and adolescent bullying victimization procures mental health issues and dysfunction. Using a longitudinal design from the McMaster Teen study dataset, a semi-parametric group- based trajectory analysis was used to identify distinct patterns of peer victimization across ages 10 to 18. A three-class solution of peer victimization was selected. Most individuals followed a low decreasing trajectory of peer victimization (71.3%). The next largest group followed a moderate decreasing peer victimization trajectory (25.2%), and the smallest group followed a high stable peer victimization trajectory (3.5%). These trajectory groups were used to predict Borderline Personality Disorder (BPD) symptoms and Post-Traumatic Stress Disorder (PTSD) in emerging adulthood (ages 19 to 22). Results indicated that the high stable and moderate decreasing groups differed from the low decreasing group on BPD symptoms; individuals who were bullied by their peers in childhood and adolescence were more likely to have elevated symptoms of BPD in adulthood. However, when controlling for gender and childhood maltreatment, this differentiation only held true for the high stable group. Results also indicated that children and adolescents who followed a high stable trajectory of bullying victimization were more likely to meet PTSD diagnostic criteria in emerging adulthood than those who followed a low decreasing or moderate decreasing trajectory. The implications of the positive associations of childhood and adolescent bullying victimization on BPD symptoms and PTSD are considered via a group socialization theory lens. High levels of bullying victimization are explained as a form of relational trauma. Results suggest that peer relations are powerful enough to lead to subsequent personality pathology, and implications of these associations are examined through a developmental trauma framework. Understanding the developmental impact of childhood and adolescent bullying on BPD symptoms and PTSD provides insight and supports prevention and intervention initiatives at the school level and in clinical practice.

About 4 % women in general population and up to 19 % women in at-risk population suffer from PTSD related to childbirth. The main risk factors for postpartum PTSD are negative birth experience and obstetric emergencies. However, the findings about risk factors and prevalence rates vary across studies, which is mainly due to the inconsistency in the diagnostics of postpartum PTSD. Researchers use various PTSD measures that differ in the number and type of symptoms monitored and many of these measures do not cover all DSM criteria for PTSD. Furthermore, the PTSD diagnostic criteria have been significantly modified in the new DSM-5 and the existing instruments need to be revised. The first part of the thesis presents the concept of PTSD related to childbirth. Special attention is paid to the risk factors identified in previous research and to the analysis of PTSD diagnostic and screening measures used in the postpartum context. The aim of the second part of the thesis is to evaluate the psychometric properties of the unpublished Childbirth-Related PTSD Questionnaire on a sample of 620 Czech women. The factor validity of the scale, the internal consistency of the total scale and the subscales resulting from the factor analysis; and the criterion validity of the instrument are verified. With regard to...

College students have an increased risk for cannabis use, trauma exposure, and posttraumatic stress disorder (PTSD). Cannabis use disorder (CUD) and PTSD comorbidity is high, and given the negative consequences of the comorbidity (e.g., poor academic outcomes), there is a need to understand comorbid CUD-PTSD etiology. Two primary etiologic models exist: self-medication (i.e., PTSD à CUD) and high-risk (i.e., CUD à PTSD) hypotheses. This study 1) examined the prevalence and predictors of cannabis use and interpersonal trauma (IPT) exposure; 2) investigated the relationship between cannabis use and IPT; and 3) examined cannabis use, IPT, and PTSD through mediational self-medication and high-risk hypotheses lenses in a large (n = 9,889) longitudinal study of college students. Aim 1 found the prevalence of lifetime problematic (i.e., use ≥ 6 times) and experimental (i.e., use 1-5 times) cannabis use was 28.3% and 17.4%, respectively. Aim 1 results also estimated that the prevalence of lifetime IPT exposure was 35.9%. Aim 2 results supported the self-medication hypothesis, but not the high-risk hypothesis. Overall model fit from Aim 3 was poor. Nonetheless, Aim 3 results did not support the self-medication or high-risk hypotheses. Given the poor model fit of Aim 3, results should be interpreted with caution. However, as a whole, these findings provide preliminary support for the self-medication hypothesis, indicating that those reporting IPT exposure and probable PTSD may be at risk for cannabis use. Implications of these findings, in light of study limitations, are discussed.

Posttraumatic stress disorder (PTSD) symptoms and substance use have been associated with increased suicide ideation, but have rarely been examined within a larger theoretical context of suicide risk. The interpersonal theory of suicide posits that feeling disconnected from others (i.e., thwarted belongingness) and feeling like a burden on others (i.e., perceived burdensomeness) are associated with increased suicide ideation. We hypothesized that perceived burdensomeness and thwarted belongingness would mediate the relation between PTSD symptoms and suicide ideation, and that using substances to cope would moderate these relations. Participants were 254 college students reporting exposure to potentially traumatic experiences. Findings from a moderated mediation analysis indicated that perceived burdensomeness, but not thwarted belongingness, mediated the relation between PTSD symptoms and suicide ideation, and using substances to cope moderated this relation. Therapeutic interventions aimed at reducing suicide ideation might benefit from decreasing perceived burdensomeness and the use of substances to cope.

In conducting this study, the ultimate goal was to determine whether parents and other caregivers of individuals with disabilities are experiencing higher levels of Posttraumatic Stress Disorder (PTSD) symptoms as compared to the general population. Individuals with Autism Spectrum Disorder (ASD), intellectual disabilities and other disabilities are more likely to engage in aggressive behaviors such as hitting, kicking, biting, screaming, and self-injurious behavior. Research has also shown that parents of children with special needs have higher levels of stress, and special education teachers are leaving the field due to burnout. In addition to comparing PTSD levels of these caregivers with the general population, results of parents in this sample size were compared with the results of other caregivers. Using the PTSD Checklist – Civilian version (PCL-C), a self-report questionnaire, PTSD total scores, the three subscale scores which included re-experiencing, avoidance/numbing, and hyperarousal were analyzed. In total PCL-C scores and the subscale scores, the respondents’ results were statistically significant, with a mean score of 46.7 as compared to 29 with the general population. In addition, results demonstrated that parents and other caregivers that worked with an individual with a disability who engaged in aggressive behavior had a higher mean score than those who didn’t among this population. When divided into two groups, parents had a higher mean than the other caregivers. Future research can be done on PTSD treatments for this specific population without having to remove them from their environments in order to help reduce burnout and attrition among caregivers of individuals with disabilities.