Objectives: The relationship between dissociation and PTSS was studied by examining the moderating role of prior trauma. The relationship between prior trauma and PTSS was studied by examining the mediating role of dissociation. The relationship between various coping styles, dissociation and prior trauma was also addressed. Study Design: The current study was a retrospective correlational between-subjects design. Subjects: The study included 90 subjects who were admitted into a level one trauma center following a traumatic physical injury. Results: Dissociation was most strongly and significantly related to PTSS (r = .583). Childhood sexual abuse, childhood physical abuse, and total prior trauma were also significantly related to PTSS (r = .249, r =.298, r = .295, respectively). The results of the study indicated that prior trauma did not moderate the relationship between dissociation and PTSS. The addition of the interaction term (prior trauma X dissociation) explained 3.5% additional variance in PTSS (F(3,82) = 1.10, p = .354). However, the relationship between prior trauma and PTSS was found to be partially mediated by dissociation. The effect of prior trauma on PTSS was reduced when dissociation was added into the regression equations for each of the prior trauma predictor variables including: childhood sexual abuse (b = 9.122 reduced to b = 2.050), childhood physical abuse (b = 1.011 reduced to b = .547), and total prior trauma (b = .114 reduced to b = .055). Dissociation was also found to be significantly related to maladaptive coping including: emotional venting (r = .373), denial (r = .213), and behavioral disengagement (r = .330). Prior trauma was not found to be related to maladaptive coping styles. Conclusions: The study findings suggest that the relationship between prior trauma and PTSS is partially due to the engagement in dissociation. However, those who have not experienced a prior trauma are also at risk for experiencing dissociation and subsequent PTSS. Additionally, dissociation was found to be related to maladaptive coping, while prior trauma was not significantly related to any coping styles. Therefore, the findings suggest that dissociation is related to more disruptive psychological sequelae, as compared to pre-trauma factors such as the experience of prior trauma.

<p>The purpose of this essay is to find out how two schools work with newly arrived children and to see how they differ. There is a lack of national directives for those who work with newly arrived children and teenagers; this makes the introduction very different between schools.</p><p>The study is qualitative, based on interviews with four teachers in two different compulsory schools. One school is situated in a suburb of Stockholm and the other one is situated in a minor community in Dalarna. One schools got a preparatory class for newly immigrated pupils and the other school doesn’t.</p><p>The theoretical frame that I have chosen to analyse these interviews are literature and research on Bilingualism, Children with PTSD, Intercultural Pedagogy and Special Pedagogy</p><p>My results also show that these schools work very differently, and that there is very little co-operation within the school and with the units around the school, regarding these children. Major parts of the work end up on the teachers and they feel insufficient. My results also show that it is very important for teachers in schools to have an intercultural sensibility when relating to the pupils and their families.</p>

The purpose of this essay is to find out how two schools work with newly arrived children and to see how they differ. There is a lack of national directives for those who work with newly arrived children and teenagers; this makes the introduction very different between schools. The study is qualitative, based on interviews with four teachers in two different compulsory schools. One school is situated in a suburb of Stockholm and the other one is situated in a minor community in Dalarna. One schools got a preparatory class for newly immigrated pupils and the other school doesn’t. The theoretical frame that I have chosen to analyse these interviews are literature and research on Bilingualism, Children with PTSD, Intercultural Pedagogy and Special Pedagogy My results also show that these schools work very differently, and that there is very little co-operation within the school and with the units around the school, regarding these children. Major parts of the work end up on the teachers and they feel insufficient. My results also show that it is very important for teachers in schools to have an intercultural sensibility when relating to the pupils and their families.

Kurt Vonnegut’s Slaughterhouse-Five focuses on Billy Pilgrim’s travels through time and his experiences during World War II. More than that, it is a story about the journey of a clearly troubled protagonist whose mental state, best described as broken, is never fully explored in the novel. The aim of this essay is to bring light to the intricacies of Billy’s curious mental state, and to explore the theory that the alien encounters as well as the time travelling that he experiences are the result of Post-Traumatic Stress Disorder that Billy suffers from. This is done by analyzing Billy’s experiences with time travel, emotional numbing, and Tralfamadorians and connecting it to known symptoms and causes of PTSD. The results show that Billy does indeed showcase strong signs of PTSD, which were most likely caused by a combination of childhood experiences and trauma during the war. This PTSD manifests itself through Billy’s time travelling and alien encounters, which are used as a coping mechanism. / Kurt Vonneguts Slakthus 5 fokuserar på Billy Pilgrims resor genom tiden och hans upplevelser under andra världskriget. Ännu mer än det så är det en berättelse om resan av en helt klart besvärad huvudperson vars mentala tillstånd, som bäst kan beskrivas som brutet, aldrig riktigt förklaras i romanen. Syftet med denna uppsats är att skapa en klarhet till förvecklingarna av Billys besynnerliga mentala tillstånd, och att undersöka teorin att utomjordingarna såväl som resorna genom tiden som han upplever är resultat av posttraumatisk stressyndrom som Billy lider av. Detta utförs genom att analysera Billys upplevelser av tidsresor, emotionellt bedövande och Tralfamadorer och ansluta dem till symtomer och orsaker till PTSD. Resultaten visar att Billy visar tydliga tecken på PTSD, som troligen orsakades av en kombination av barndomsupplevelser och trauma under sin tid som soldat. Denna PTSD manifisterar sig genom Billys tidsresor och möten med utomjordingar, som används som en coping mekanism.

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Over 200 railway suicides occur on the British Rail Network (BRN) every year. Research into the physical and psychological effects of this traumatic event on train drivers has been limited, and has focused very little on the mediating influence of personal factors. Kelly’s Personal Construct Psychology (PCP, 1955) was used in the current study to explore the relationship between train drivers’ views of themselves and others, and the psychological impact of witnessing a railway suicide. This was achieved through the use of repertory grid technique. Repertory grid measures of tightness of the overall construct system, level of elaboration of the self and others, construed distances between the self and others, conflict, extremity of ratings, and superordinacy were compared with participants’ scores on a measure of the psychological impact of the event (Impact of Event Scale Revised, IES-R, Weiss & Marmar, 1997). The fifteen participants in the study also completed a background information questionnaire. A content analysis of the constructs used in the repertory grids, and a thematic analysis of a follow up interview with two of the participants was also conducted. The findings indicated that most drivers experienced symptoms suggestive of a significant posttraumatic stress (PTS) reaction following the incident. For many this appeared to be short-lived, but for some the incident had longer lasting effects, and a third of the sample had been given an official diagnosis of Post-Traumatic Stress Disorder (PTSD). Possibly due to the small sample size, many of the correlations did not achieve statistical significance. However, discrepancy between the self and ideal self, and the number of moral constructs employed by participants, were both positively associated with reported levels of psychological distress. The superordinacy of the traumatised construct, and the number of emotional constructs employed by participants, were both negatively associated with reported levels of psychological distress. These findings therefore gave some support to Sewell and Cromwell’s (1990) PCP model of trauma, and to the importance of emotional processing of traumatic events. The thematic analyses added information about the nature of the changes experienced by train drivers following these events, and the impact of contextual factors. The repertory grid technique proved useful in measuring the influence of personal meaning making on the impact of traumatic events. The findings suggest that drivers can best be supported clinically by reducing the discrepancy between their self after the event and their ideal self, increasing their ability to emotionally process their experience, and by giving consideration to issues such as anger and blame. Limitations of the research are presented, as well as suggestions for further research.

Background The effects of prolonged, interpersonal trauma have long been recognised. Such traumatic events can lead to the development of post-traumatic stress disorder (PTSD), but are also associated with a range of other psychological difficulties. The forthcoming ICD-11 has proposed the inclusion of a new diagnostic category to cover such trauma reactions, named complex-PTSD (CPTSD). CPTSD is conceptualised as including the core elements of PTSD with additional difficulties with affect regulation, self-concept, interpersonal relationships. This thesis presents a systematic review of the research into the proposed CPTSD diagnosis. In addition, this thesis investigates the association between difficulties with emotional regulation, interpersonal problems and PTSD symptoms in a group of male prisoners, and a male community sample. Aims This project aims to investigate whether the proposed CPTSD diagnosis accurately describes the difficulties seen following complex trauma, and examines whether it is best to view CPTSD is different from exiting disorders, including PTSD and borderline personality disorder (BPD). In addition, it aims to investigate the association between difficulties with emotional regulation, interpersonal problems and PTSD among men in prison. Methods We systematically assessed and synthesised the available research regarding the proposed ICD-11 CPTSD diagnosis. In the second paper, data regarding PTSD, emotional regulation, and interpersonal problems were collected from HMP Glenochil, a male-only prison in Scotland (n=51), and matched to an existing community data set (n=46). Results The results of the systematic review provide partial support for the factorial validity of CPTSD. In addition, they indicate that CPTSD can be conceptualised as distinct from both PTSD and BPD, and that CPTSD is more closely related to prolonged interpersonal trauma than PTSD. However, there is overlap between PTSD and CPTSD in terms of both symptomology and aetiology. The results also indicate high levels of PTSD among male prisoners. In addition, PTSD was found to be strongly associated difficulties with emotional regulation, but not interpersonal problems, in the forensic sample. In the community sample emotional regulation was a less strong predictor of PTSD symptoms, and both emotional regulation, and interpersonal problems were associated with the severity of PTSD. Conclusions This thesis supports the inclusion of CPTSD as a distinct diagnostic entity. Inclusion of CPTSD may allow survivors a better understanding of the aetiology of their difficulties, and may initiate research into effective ways of working with individuals who have experienced complex-trauma. I addition, they demonstrate the need for trauma-informed prison services, which prioritise the development of emotional regulation strategies in recovery and rehabilitation.

Critical Review of the LiteratureCan Borderline Personality Disorder be treated effectively in forensic settings? A systematic reviewBorderline Personality Disorder (BPD) is a common diagnosis in forensic settings. Certain features of BPD, such as impulsivity and emotional dysregulation, can create a vulnerability to impulsive acts. The condition is also associated with poor mental and physical health, making the treatment of BPD and its clinical features an important goal in forensic settings. This paper reviews evidence for the effectiveness of treating BPD and its symptoms using psychological approaches in forensic settings. A systematic search found 2913 papers, of which 13 met the inclusion criteria. The papers reported nine separate studies (six controlled) that implemented four distinct interventions, often adapted for particular forensic settings. Improvements in overall BPD symptomatology and specific BPD symptoms were reported for all types of intervention, although few differences in outcome between intervention and control groups were found. There were also reported improvements in BPD-related behaviours, but data on offending behaviour were absent. Heterogeneity in study quality and design makes it challenging to draw any firm conclusions about the effectiveness of any one form of treatment over another, nor about which treatment may best suit a particular setting. Further randomised controlled trials are needed to answer these questions. Service Improvement ProjectEvaluation of a brief educational intervention for clinical staff aimed at promoting trauma-informed approaches to careThere is growing evidence that trauma plays an important role in the aetiology of severe and enduring mental health problems. Yet staff can be reluctant to ask patients about trauma for reasons such as anxiety about harming patients and limited access to training. Where services have adopted trauma-informed approaches (TIAs) to mental health care (i.e., considering the ways in which trauma affects individuals when planning and delivering services), improved clinical outcomes have been observed. With this in mind, a new educational video was developed for mental health staff at an NHS trust. The video was intended to be (a) brief (10 minutes); (b) contemporary and engaging; and (c) accessible using computers, smartphones and tablets. Forty-one multidisciplinary staff viewed the video. Quantitative and qualitative evaluation indicated improvements in self-reported knowledge and confidence with regard to trauma, and a decrease in worries with regard to asking patients about such experiences. Participants found the video to be enjoyable, understandable and informative. Importantly, many indicated that it spurred them to further action, such as further training and asking patients about possible trauma. These findings indicate that a video of this type can offer an important ‘taster’ of trauma-related learning, constituting an important step towards embedding trauma-informed ways of working at a service. Main Research ProjectThe Role of Intrusive Imagery in Hoarding DisorderThe cardinal feature of Hoarding Disorder (HD) is persistent difficulty discarding possessions, with the resulting clutter compromising the intended use of living areas. Within the dominant cognitive-behavioural model of hoarding (Frost & Hartl, 1996), hoarding behaviours are positively and negatively reinforced in the context of certain object-related beliefs. Available treatments for HD have so far yielded modest outcomes, indicating a need for new approaches. Intrusive imagery has so far been neglected in HD research, despite the frequency of trauma in the histories of people with the condition. To address this, 27 individuals who met the DSM-5 criteria for HD and 28 community controls (CCs) were interviewed about their everyday experiences of mental imagery. Participants were also asked about the images they experienced during two recent real-life examples of actual or attempted discard of (1) an object of low subjective value; and (2) an object of high subjective value. Everyday imagery in the HD group commonly reflected themes of illness, death and reminiscence. Imagery in HD participants tended to carry negative emotional valence in comparison with CCs, and was associated with greater interference in everyday life and attempts to avoid the imagery. HD participants reported more negative experiences of intrusive imagery in comparison with CCs during recent episodes of discarding objects of low subjective value. However, HD participants experienced positive imagery when discarding, or trying to discard, high value objects. These findings indicate that although people with HD frequently report traumatic histories, this is not reflected in the everyday imagery that they experience. There is some evidence to suggest that the negative and positive memories experienced in relation to low and high value objects may aid our understanding of discarding and saving behaviour in HD. The theoretical and clinical implications of these findings are further discussed.

Il presente elaborato descrive tre dimensioni quali lo stile d'attaccamento (Bowlby, 1969, 1973, 1980; Ainsworth e coll., 1978), la competenza emotiva (Frijda, 1990; Goleman, 1996, 1998; Grazzani Gavazzi, 2004) e la resilienza (Cyrulnik, 2002), analizzata partendo da un excursus storico del concetto di trauma, dalle prime teorie psicoanalitiche fino a giungere alla categoria diagnostica del DPTS disturbo post traumatico da stress. Viene quindi riportata una ricerca condotta in Sri Lanka su un campione di 70 bambine tra gli 8 e i 10 anni, che hanno avuto esperienza dello tsunami che ha colpito il sud est asiatico nel dicembre 2004. Lo studio ha previsto l'utilizzo del SAT (Separation Anxiety Test) (Attili, 2001) per individuare gli stili di attaccamento dei bambini; il disegno a tema, analizzato attraverso la griglia interpretativa ideata da Bombi e Pinto (1993, 2000) per individuare il grado di competenza emotiva e il test della memoria a breve termine della figura complessa di Rey (1967), volto ad indagare le capacità attentive, di concentrazione e di memoria a breve termine dei bambini. Le variabili prese in considerazione sono state quindi analizzate sia singolarmente sia in relazione tra loro. / This work describes three dimensions: the attachment style (Bowlby, 1969, 1973, 1980; Ainsworth e coll., 1978), the emotional competence (Frijda, 1990; Goleman, 1996, 1998; Grazzani Gavazzi, 2004) and the resilience (Cyrulnik, 2002), analyzed through the history of the trauma's concept, since the first psychoanalytic theory until the category of PTSD Post Traumatic Stress Disorder. Therefore, it is described a research in Sri Lanka about a sample of 70 female children between 8 and 10 years old, who had experience of Tsunami of December 2004 in the South East Asia. The research included the use of SAT (Separation Anxiety Test) (Attili, 2001) to find out the attachment styles of the children; the thematic painting, analyzed through the interpretative grate of Bombi e Pinto (1993, 2000) to analyze the grade of emotional competence and the Test of short-term memory of Complex Figure of Rey (1967), to describe the capability of attention, concentration and short-term memory of the children. The variables had been analyzed individually and in relation one to one.

Variables predicting the effects of surgery in patients with low back pain Abstract The theoretical part of the thesis summarizes the knowledge about pain and its types, especially chronic pain. Than we focus on low back pain and currently used approaches in the treatment of this syndrome. In this work we summarize the influence of central sensitization and adverse life experineces and posttraumatic stress disorder on pain (especially low back pain). In the practical part, we investigated the effect of central sensitization and adverse life events and posttraumatic stress disroder on the effect of spinal surgery in low back region. The results were obtained using Central Sensitization Inventory (CSI), PTSD Cecklist dor DSM-5 (PCL- 5) a Life Event Checklist (LEC-5 Standard), Short Form 36 Helth Survey Questionnaire (SF- 36), NASS Lumbar Spine Questionnaire. The obtained data were statistically evaluated and processed. Higher scores of CSI and LEC-5 (more adverse life events) were both statistically significantly correlated with worse low back surgery outcomes. At the same time, a statistically significant relationship between PCL-5 (checklist of PTSD symptoms) and CSI was confirmed. Keywords Pain, central sensitization, adverse life experiences, adverse life events, PTSD, posttraumatic stress disorder,...