Background: It is widely understood that survivors of childhood trauma (emotional abuse, physical abuse, sexual abuse and emotional, physical neglect) have poorer mental health outcomes than their non-abused counterparts; one of which is an increased risk of suicidality. The disclosure of childhood abuse is key to safeguarding against further victimization and promoting better psychosocial outcomes for survivors in the long-term. Aims: The aims of this thesis portfolio are twofold. Firstly, to review the published literature investigating the barriers and facilitators to disclosing sexual abuse as perceived by children and adolescents (Chapter 1). Secondly, to research the relationship between childhood trauma and suicidality in a cohort of socio-economically deprived men living in Scotland (Chapter 3). The bridging chapter (Chapter 2) discusses the main themes that connect chapters one and three, notably the possible negative impact of childhood trauma on adult psychosocial functioning. Method: An exploratory systematic review and meta-synthesis of the literature was carried out. Strict eligibility criteria were predefined and a comprehensive search strategy identified a total of thirteen studies for review. For the empirical study, a total of 86 adult men with past and/or present suicidality participated in a quantitative cohort study and completed measures on childhood trauma, emotion regulation, interpersonal difficulties and suicidal behaviour. Multiple mediation analysis was used to analyse the data and to answer the study’s research questions. Results: The exploratory review highlighted that existing research into child and adolescent disclosures of sexual abuse is still in its infancy and that robust, longitudinal studies with more sophisticated methodologies are required to replicate findings. The collective body of literature identified that limited support, perceived negative consequences and feelings of self-blame, shame and guilt serve as significant barriers to disclosure whilst being asked or prompted through the provision of developmentally appropriate information facilitates young people to tell. The empirical study found that emotion regulation and interpersonal difficulties mediate the relationship between childhood trauma and suicidality in a sample of adult men. Conclusion: Several important clinical implications were identified in both parts of the thesis portfolio. Firstly, the systematic review identified the need for family members, friends and frontline professionals to explicitly ask children about the possibility of sexual abuse. It was also considered imperative that recipients are supported in responding to disclosures in positive and supportive ways so as to reduce young peoples’ feelings of responsibility, self-blame, shame and guilt. The empirical study concluded that dysfunctional emotion regulation and interpersonal difficulties are implicated in the overall collateral and compounding psychosocial sequelae of childhood trauma. The provision of psychological interventions for men with past and/or present suicidality should support individuals to develop healthy social problem-solving and emotion regulation skills. Providing effective, trauma-informed interventions for these individuals will move their treatment beyond simple risk management and focus, instead, on instilling recovery and resilience.

Introduction: Borderline Personality Disorder (BPD) is characterised by deficits in affect and impulse regulation, along with interpersonal difficulties (Lieb et al., 2004). It is thought to develop through a complex relationship between adverse childhood events, such as childhood abuse and genetics. A recent developmental model of BPD and one that is gaining popularity focuses on mentalization. Following their exposition of the mentalizing model of BPD, Bateman and Fonagy developed the Mentalization Based Treatment (MBT) intervention for BPD (Bateman & Fonagy 2006). This intervention includes both group and individual therapy with the focus on the patient’s relationship with the therapist and other members of the group. Promising evidence that MBT interventions are effective for treating symptoms of BPD is beginning to emerge. Methods: First a systematic review examining the prevalence of childhood abuse in BPD patients was conducted. Second, an empirical study of the efficacy of a group-only adaptation of the MBT intervention for BPD, delivered in a routine health service setting. Finally, planned exploratory analyses were conducted in order to ascertain what factors might predict group completion. Results: The results of the systematic review suggested that that emotional abuse (mean prevalence 63%) and emotional neglect (mean prevalence 63.1%) are the most common forms of abuse reported by this population followed by physical neglect (mean prevalence 40.89%) , sexual abuse (mean prevalence 36.9%) and physical abuse (mean prevalence 32.49%). The results of the second study revealed that the HUB is an acceptable treatment to participants, with indicators of treatment efficacy in relation to reducing overall psychiatric symptoms along with specific symptoms including interpersonal sensitivities, depression, phobic anxiety and paranoid ideation. Finally, exploratory analyses suggested that patients who were older and with less histrionic symptoms (as defined by the Personality Disorder Questionnaire-4) were more likely to complete the HUB. Conclusions: These findings demonstrate that a group-only MBT intervention displays promising effectiveness in treating core symptoms of BPD and is acceptable to patients. Further it suggests that group-only MBT interventions are worth continued investigation both into their efficacies and the potential efficiencies associated a group-based intervention.

Magister Psychologiae - MPsych / The main aim of the current study is to examine the relationship between community violence exposure and the development of psychopathology and examine the relationship between community violence exposure and other types of trauma, that is, childhood trauma and stressful life events. It was hypothesised that exposure to community violence will have a high correlation with development of psychological disorders such as mood and anxiety and psychotic disorders. The main study employed a quantitative research design in order to determine the relationship between PTSD in children and adolescents. The current study used secondary data to measure the correlation between exposure to community violence and the development of psychopathology. The data for this study was collected from 132 consecutive referrals between the ages of 13 to 19 (mean age = 15.4, SD = 1.6) from a youth stress clinic at a university in the Western Cape. Findings indicated that community violence prevalence was higher than previous South African studies but lower compared to American studies. There was generally a high prevalence of PTSD and major depressive disorder (MDD) in this sample compared to previous South African studies. An unexpected outcome was that even though there was a high prevalence of PTSD, there was no relationship between community violence exposure and PTSD in this sample, rather, community violence exposure was related to MDD. Furthermore, MDD and not PTSD was related to experiences of childhood trauma. Stressful life events were related to acute stress disorder (ASD). / South Africa

Magister Psychologiae - MPsych / Increased rates of alcohol abuse and childhood trauma have been reported in previous studies of anxiety disorders, and social anxiety disorder (SAD) in particular. Yet the exact nature of this relationship remains unclear. This study aimed to assess whether SAD is a risk factor for later development of alcohol use disorders (AUD) and to investigate the association of childhood trauma with the prospective SAD-AUD comorbidity in adults with SAD. Data from fifty seven adult participants (N=57) with a primary diagnosis of SAD (mean age 36.7; 60% male) completed the self-rated Childhood Trauma Questionnaire (CTQ) as well as the Liebowitz Social Anxiety Scale (LSAS), a measure of SAD symptom severity. Alcohol abuse and dependence information were assessed with the Structured Clinical Interview for Axis I Disorders-Patient Version (SCID-I/P). Data from sixty two adult age and gender match controls were used as a comparison group. A Cognitive Behavioural Model and the Social Learning Model are the theoretical frameworks utilised in the conceptualisation of this research. The data is quantitative in nature and will be statistically analysed using descriptive statistics, logistic regression and ANOVA using the Statistical Package for the Social Sciences (SPSS) version 17.0. Informed consent was obtained in writing from all participants. The findings of the study were that 73.7% of the SAD sample met severity criteria for at least one type of childhood abuse or neglect as measured by the CTQ subscales using previously established thresholds. Physical neglect was found to be significantly associated with increased SAD symptom severity.17.5% of the SAD sample had a comorbid lifetime alcohol use disorder (AUD) and of those 80% reported experiencing childhood trauma. In conclusion there was a high rate of childhood trauma in individuals with SAD and there is a strong association between childhood trauma and comorbid AUDs in those with SAD.Thus screening for childhood trauma in SAD individuals is clinically prudent.

Magister Artium (Child and Family Studies) - MA(CFS) / Trauma exposure during childhood increases the risk of multitude complex post-trauma symptomology. Extensive research has been conducted on the effects of trauma exposure on adults, and the findings have been thereafter applied to children. This is problematic due to the developmental differences between adults and children. There is thus a need to understand the unique symptomology of children, who have been exposed to trauma, as understanding the effects of childhood trauma will certainly aid in the prevention and treatment of childhood trauma. This study incorporated a systematic review methodology to analyse the effects of exposure to childhood trauma on children’s mental health and wellbeing. Relevant literature from all the methodological paradigms that were published during the specified time period of this study (2000 – 2016) were considered for. Furthermore, the inclusion criteria also specified that only studies of which the participants were children were allowed to be included in the review; studies focusing on adults and their exposure were deliberately excluded. The initial search strategy yielded a total of 316 articles; after all duplicates had been removed and, the titles and abstracts of the remaining articles had been assessed, the number of relevant articles was reduced to 22. These 22 articles were thereafter assessed by means of a critical appraisal tool to evaluate whether they were suitable for inclusion. Several articles were excluded as the focus of the studies were on treatment modalities and the effects of child trauma in adulthood. This signifies a gap in the literature with regard to studies that investigate the effects of child trauma. Ultimately, only 13 of the 22 articles remained. These underwent full-text evaluation and data extraction. Results of this study provide insight into the effects of child trauma on child mental health and well-being. Based on thematic analysis, the results clearly show that children, who are traumatised, have a negative worldview. In addition, the symptoms they manifest are complex, which often lead to misdiagnosis. Moreover, these studies also explain the resilience processes involved when a child is exposed to trauma. In essence, this study provides parents, caregivers, researchers and mental health professionals with an all-inclusive understanding of the effects of childhood trauma based on a scientific body of literature.

Personality pathology, especially antisocial personality disorder (ASPD), often occurs in patients with methamphetamine use disorder (MAUD). However, little is known about potential risk factors for this dual diagnosis, and the impact of this comorbidity on both the severity of MAUD and levels of functional impairment. Casting light on such phenomena may aid in early identification of treatment targets, assist in the management of patients in this particular population, and contribute to development of treatment strategies. This crosssectional study described and compared sociodemographic, clinical and childhood trauma correlates in patients with a dual diagnosis of MAUD and ASPD (MAUD+ASPD) and those with MAUD without ASPD (MAUD-ASPD). The contribution of sociodemographic and childhood trauma variables in predicting membership of the MAUD+ASPD group was also investigated. A sample of 62 adult patients with a primary diagnosis of MAUD took part in the study. A sociodemographic questionnaire was completed and well established diagnostic measures of ASPD (The Mini-International Neuropsychiatric Interview; MINI) and MAUD (Structured Clinical Interview; SCID - 5) were used to determine diagnostic status. Illness severity was evaluated with the Yale-Brown Obsessive Compulsive scale (adapted for MAUD) (Y-BOCS-du) and functional impairment was assessed with the Sheehan Disability Scale (SDS). Histories of exposure and severity of childhood trauma (CT) were measured using the CTQ-SF. Of the 62 participants, 14 (23%) had MAUD and had MAUD+ASPD whereas 48 (77%) had MAUD without ASPD (MAUD-ASPD). Bivariate analyses found significant group differences in terms of gender (df =1) = 8.05; p =< 0.01), language (df = 2) = 7.12; p = 0.03), and level of physical neglect (F(1, 60) = 2.33; M = 9.85; SD = 4.23; p = 0.04). The MAUD+ASPD group members were mostly male (N = 9; 64%), English-speaking and with histories of increased physical neglect. Logistic regression suggested that male gender (beta = 1.08; OR = 8.65; p = 0.01) and English language (beta = 1.55; OR = 11.38; p = 0.03) significantly predicted ASPD comorbidity. There were no significant differences in clinical severity or functional impairment between the MAUD+ASPD and MAUD-ASPD groups. In conclusion, this study indicated that male gender and having English as a first language are associated with MAUD+ASPD but other sociodemographic variables, CT histories and clinical severity and impairment were not. Men who use MA are thus more prone to antisocial behaviour, which complicates their substance use condition. Treatment approaches for MAUD may benefit from developing adaptations that cater for challenges specific to comorbid ASPD. Additionally, the finding regarding first language warrants further investigation. Recommendations for future research are suggested.

Die vorliegende Arbeit untersucht Zusammenhänge zwischen verschiedenen Vulnerabilitätsfaktoren der Depression und deren Einflüsse auf den Krankheitsverlauf bei stationär behandelten, depressiven Patienten.

>Magister Scientiae - MSc / Anxiety, resilience and childhood trauma can be categorized as functional behavioural categories, with a wealth of research behind each. The research approach adopted for each, in most cases, is either from a genetic or neuropsychological standpoint, with few studies combining both to better understand all three functional behavioural categories as a multidimensional construct A number of candidate genes have been identified as markers for anxiety, resilience and childhood trauma, of which Catechol-methyl-transferase (COMT) and several respective single nucleotide polymorphisms (SNPs) are included. Although COMT SNPs have been linked to at least one of the functional categories, with a handful of haplotypes identified, to our knowledge no study has investigated the combination of SNPs selected for this study (rs6269, rs4818, rs4680, rs4633, rs737865, rs2075507) as a possible haplotype, specifically in a South African population. The use of SNaPshot for the genotyping of genes is an efficient and reliable means of identifying genotype frequencies and haplotypes in large sample groups, yet when selecting more than two SNPs of interest, the development of a multiplex assay is ideal. The first aim of the study was to design and optimize a multiplex assay to genotype several COMT SNPs. The primer design, multiplex optimization and SNaPshot conditions used showed good working parameters that can be utilized and further improved by optimization. Self-report measures are widely used to measure psychiatric disorders, such as anxiety, and has also been used for the measurement of resilience and childhood trauma. With each functional behavioural category well investigated in its respective domain, there is a need to investigate all three as a collective in a South African population due to the high rate of anxiety and childhood trauma exposure in communities. The second aim of the study was to investigate the prevalence of anxiety, resilience and childhood as functional behavioural categories in the full South African sample group; and the role of sex, through established self-report measures and respective normative data. Additionally, this carried over into investigating the correlation between anxiety, resilience and childhood trauma as a multidimensional construct in both the full South African sample and between sexes. There is a clear relationship which exists between all three functional behavioural categories, as they show a correlation in various dimensions independent of one another. Higher anxiety levels amongst females were reported, with no difference between sexes for resiliency. The empirical data collected from both COMT SNP and self-report measures for male and female where explored and reviewed against current literature for better understanding and insight into the association of COMT SNPs with anxiety, resilience and childhood trauma in a South African population. The results of this study to understand the complexity and association of all three functional behavioural categories as a multidimensional construct will be invaluable and may assist in the identification of possible risk factors which are essential for the promotion of better mental health in society.

Researchers have explored the effects of Adverse Childhood Experiences (ACEs) on academic performance from elementary years to young adulthood. In this study, we explored the relationship between ACEs and academic performance in high school and academic student self-perception, and the further role that community or high school extra-curricular involvement may play in this relationship. In this study, we hypothesize that participants with higher ACEs will have poorer academic performance than those with lower ACEs. Secondly, we hypothesize that students with higher ACEs will have a lower academic self-concept than students with lower ACEs. Thirdly, we hypothesize that community or extra-curricular involvement in high school will buffer the effect of ACEs on GPA. Finally, we hypothesize that this extra-curricular involvement will also buffer the effect of ACEs on academic self-concept. Using surveys through the REDCap platform, data was collected from 75 East Tennessee State University students above the age of 18. Using SPSS software, we ran correlations to determine the relationship between ACEs on both GPA and academic self-concept. There was no significant correlation between ACEs and GPA or ACEs and academic self-concept scores. Moderation was conducted through SPSS PROCESS to determine whether total involvement could moderate the effects of ACEs on GPA or academic self-concept. There was no significant moderation in the model predicting GPA. In the model predicting academic self-concept, however, ACEs did emerge as a significant predictor of academic self-concept, although extra-curricular involvement did not. Further, extra-curricular involvement did emerge as a significant moderator, such that the negative relationship between ACEs and academic self-concept was no longer significant at mean or high levels of extra-curricular involvement. In other words, ACE scores only predicted poorer academic self-concept for individuals with low levels of extra-curricular involvement. Results and limitations suggest future research on the relationship between ACEs on academic self-confidence and total extra-curricular involvement.

The relationship between childhood maltreatment and Borderline Personality Disorder (BPD) is a prominent issue in the etiological research on BPD. This study further explored the relationship between CSA and the development of borderline personality features while evaluating the moderating role of a primary social support source. The Inventory of Altered Self-Capacities (IASC) (Briere, 2000) was used to measure borderline features of participants in this study, a slightly modified version of the Early Sexual Experiences (ESE) questionnaire (Bartoi & Kinder, 1998) was used to evaluate childhood sexual abuse, and the Quality of Relationships Inventory (Pierce, Sarason, & Sarason, 1991) as well as the Unsupportive Social Interactions Inventory (Ingram, Betz, Mindes, Schmitt, & Smith, 2001) was used to measure social support variables. Consistent with previous research in this area, childhood sexual abuse and low social support were both positively correlated with borderline personality features. It was hypothesized that the presence of a supportive relationship at the time the abuse occurred would moderate the relationship between childhood sexual abuse and borderline features. This moderation hypothesis was not supported in the current study, but possible explanations for these findings are explained. Future research is needed in this area to continue and explore this relationship. It is suggested that longitudinal designs will be the next method of advancing the research in the development of borderline personality disorder and the prevention of the disorder.