Graduation Theses is focused on the problem of prostitution. The theoretical part deals with theoretical concept of prostitution, the characteristics of the prostitution-behaviour participants, the reasons of the existence of prostitution, prostitution in the Czech Republic, criminal activity, psycho-pathological phenomena and social-pathological phenomena associated with prostitution, the impacts of prostitution-behaviour and the prevention of prostitution. The practical part is focused on the interpretation of the in-depth interview. In this part there was given more space to the practical experiences with work with prostitution practicing persons and the comparison of practical knowledge and theoretical resources.

This dissertation critically investigates the current framework for psycholegal assessment of accused persons who are suspected or alleged to have lacked criminal incapacity at the time of committing an offence. This system must function as effectively as possible to ensure the interests of justice and the community are best served. Issues that impact how effectively the criminal justice system collaborates with psychologists and psychiatrists, who act as expert forensic mental health assessors, are identified and recommendations are made accordingly. The study first examines the theoretical base regarding the terminology surrounding criminal capacity, mental illness and automatism, with regard to how the understanding of concepts differ in law and psychology and psychiatry and how this negatively affects the process of assessment. The study then investigates the constitutional rights of accused persons admitted for observation, the effect this has on the patient and legal process, the accuracy and reliability of the diagnosis and the admissibility of expert evidence. Next a comparative study is made utilising English Law as a tool for analysis. The main findings are that lack of understanding and clarity are the main issues that hinder the collaboration between the legal and mental health care professions and that this may be remedied by a system of registration and education for forensic psycholegal assessors. An alternate and concurrent method of direct referral is also suggested as it may relieve some of the strain on the current system. / Dissertation (LLM)--University of Pretoria, 2011. / Public Law / unrestricted

Text in Afrikaans / The purpose of this study was to determine the nature, origin and negative consequences of perfectionism and to set guidelines for the therapeutic handling of perfectionism. Two literature studies were done to investigate the phenomenon and therapeutic techniques with regards to perfectionsim. A questionnaire was developed as aid to the therapist to identify negative perfectionism and associated problem areas. An empirical study was done to investigate the effectivity of the questionnaire and to compose a program and guidelines for the therapist and perfectionist. Results of the study indicated that negative perfectionism resulted in affective, cognitive, interpersonal and behavioural consequences for the client. It further showed that it is necessary to find the origin of the client's perfectionism and to give them insight in their problem to enable the therapist to succesfully apply cognitive behavioral therapy. / Educational Studies / M. Ed. (Voorligting)

Dissertation (DSc)-- Stellenbosch University, 2008. / ENGLISH ABSTRACT: The overall aim of these studies was to investigate selected aspects of psychopathology, neurobiological abnormalities and treatment in schizophrenia. The following topics were researched: 1. Psychopathology: We explored the symptom structure of schizophrenia by means of principal components and factor analysis in two separate samples. a. The first study investigated the nature of symptoms in patients with a first-episode of schizophrenia, in a large cohort of patients who were participating in a multinational clinical trial. We compared our findings with similar analyses previously conducted in multi-episode schizophrenia patients. b. We then assessed the influence of culture on the symptom structure of schizophrenia by conducting a principal components and factor analysis of the symptom ratings in a large sample of South African Xhosa patients with schizophrenia, and comparing the results with those in other parts of the world. c. We investigated the occurrence of co-morbid depressive and anxiety symptoms, and their demographic and clinical correlates. The sample for this study comprised acutely psychotic patients who were participants in clinical drug trials conducted at our centre. d. To explore the relationships between obsessive-compulsive disorder and schizophrenia, we conducted a review of the relevant literature. 2. Neurobiological abnormalities: a. We performed a series of studies to investigate disorders of water homeostasis and vasopressin secretion in schizophrenia. To test the hypothesis that acutely psychotic patients have disordered regulation of water homeostasis, we applied a dynamic suppression test - a water loading test, with assessment of excretory capacity (including arginine vasopressin assay) in acutely psychotic patients. To evaluate whether a subset of patients with schizophrenia and co-morbid disordered water homeostasis sustained cerebral damage as a consequence of water intoxication we did the following experiment: We identified a cohort of subjects with schizophrenia and disordered water homeostasis and compared them with patients with schizophrenia without disordered water homeostasis in terms of cerebral ventricular size and cognitive function. To assess the prevalence of disordered water homeostasis in a long-term inpatient sample of psychiatric patients we conducted serum sodium screening tests. Those subjects with dilutional hyponatraemia were then further investigated for dysregulation of water homeostatic mechanisms. b. We studied neurological soft signs in a sample of subjects with first-episode schizophrenia followed up over a two year period. We investigated their occurrence, relationships to psychiatric symptoms and medication effects, their temporal stability and their outcome correlates. We also investigated their potential to predict outcome in schizophrenia 3. Treatment aspects A great deal of our work has focussed on the pharmacological treatment of schizophrenia. The following aspects of treatment are included in this thesis: a. Treatment effects on psychiatric symptoms: i. To assess the effects of ethnicity on treatment outcome in schizophrenia we compared the acute response to antipsychotic treatment in 3 ethnic groups, namely blacks, coloureds and whites. We included patients in this analysis who had participated in clinical trials in our department as well as the Department of Psychiatry in the University of the Free Sate. Patients had been treated under blinded conditions over a 6-week period. ii. After discussions with the late Dr David Horrobin, who had pioneered possible applications of the omega-3 fatty acids in the treatment of various psychiatric disorders, we became interested in further investigating the potential of this group of compounds as an affordable adjunct to treating schizophrenia. We assessed the antipsychotic potential of the omega-3 fatty acid, ethyl-eicosapentaenoic-acid (e-EPA) supplementation versus placebo supplementation in a small sample of subjects with schizophrenia who had been only partially responsive to antipsychotic treatment previously. We also conducted a review of the literature to evaluate the evidence for efficacy for the omega-3 fatty acids in schizophrenia according to published studies. b. Treatment effects on neurological abnormalities: i. In a single-blinded controlled study we compared a new generation antipsychotic to a conventional antipsychotic in the treatment of tardive dyskinesia (TD). This was a long-term (1 yr) study in patients with chronic schizophrenia and established tardive dyskinesia. ii. We also assessed the effect of omega-3 fatty acid (e-EPA) supplementation in treating TD. This was conducted in a larger sample (n=84) of patients with chronic schizophrenia and established TD. The blinded, placebo-controlled phase was 12 weeks. This was followed by an open-label extension for 40 weeks. c. Conventional versus new generation antipsychotic agents. Several evidence-based literature reviews of the efficacy and tolerability of the new generation of antipsychotics compared to the conventional agents were conducted. Some multinational, randomised, controlled clinical trials in which the author was principal investigator, are included in this thesis. Also, studies addressing patients with partial treatment refractoriness are included, as well as studies of the effects of antipsychotics on depressive symptoms, body mass and glycaemic control. Finally, we have included a pharmacoeconomic study comparing a conventional antipsychotic (haloperidol) with a new generation antipsychotic (quetiapine) in partially refractory patients in a South African setting. Findings and conclusions: 1. Psychopathology: Our studies demonstrated that the factor structure for the symptoms of schizophrenia is replicable across samples, and is not greatly influenced by ethnic and cultural factors. However, changes in the factor structures do occur over time. There are symptom domains that are present in first-episode schizophrenia but disappear as a distinct entity as the illness becomes chronic. Particularly, a motor component is evident in untreated patients, but disappears after initiation of treatment. We found that depression and anxiety are common co-morbid symptoms in schizophrenia, and have important clinical and outcome correlates. Depressive symptoms in the acute psychotic phase of schizophrenia are associated with a favourable prognosis and diminish as the symptoms of psychosis improve in response to antipsychotic treatment. However, persistent depressive symptoms are associated with a poorer prognosis, and require additional therapeutic intervention. 2. Neurobiological abnormalities: We investigated the occurrence of disordered water regulation in a population of psychiatric inpatients, and conducted further investigations on those identified, in order to establish mechanisms involved. Polydipsia and the syndrome of inappropriate antidiuretic hormone secretion (SIADH) were found to occur in a subset of patients with schizophrenia, and are associated with acute psychosis, as well as with some psychotropic medications. These patients are characterised by more severe cognitive impairment and evidence of cerebral atrophy. The condition can become life-threatening in the presence of other factors impeding water excretion, particularly thiazide diuretics. Neurological soft signs were investigated in a sample of patients with a first-episode of schizophrenia. These soft signs appear to be trait-like (present early in the illness, and stable over time), except for a motor sequencing factor. Patients performing poorly on this latter group of tests have a longer duration of untreated psychosis, and are at significant risk for developing TD. 3. Treatment aspects: Our studies suggest that there are important ethnic differences in antipsychotic treatment response, but that these differences could be explained by a number of environmental and biological factors. As was found with many studies worldwide, we found that the new generation antipsychotics have important efficacy and safety advantages over their predecessors. Risperidone was as effective as haloperidol in first-episode psychosis, but with a more favourable side-effect profile in terms of reduced extrapyramidal symptoms. Quetiapine treatment in partially refractory patients resulted in more responders compared to haloperidol, and fewer extrapyramidal symptoms. However, evidence of a different side-effect profile is emerging. Of particular concern is the finding that some of the new antispychotics cause weight gain, glucose intolerance and dyslipidaemias. We found that one novel antipsychotic, quetiapine, was not associated with significantly more weight gain or disordered glucose metabolism that a conventional agent, haloperidol. The omega-3 fatty acids, particularly EPA may have a role in the treatment of various psychiatric disorders. Our studies provided mixed results – the first found a significant beneficial effect on psychotic symptoms and dyskinesia scores for EPA supplementation, while the second failed to demonstrate a beneficial effect on TD or psychotic symptoms. We explored the early treatment response in first-episode psychosis and found, unlike that reported in multi-episode patients, some patients took a long time to respond. We also found that early treatment response was a significant predictor of later remission, as was duration of untreated psychosis, educational level and baseline excitement factor scores. Finally, our pharmacoeconomic study conducted for South African circumstances in patients with a partial response to conventional antipsychotic treatment showed cost-neutrality or cost-benefits for quetiapine compared with haloperidol treatment for direct costs. / AFRIKAANSE OPSOMMING: Die oorkoepelende doel van hierdie studies was om geselekteerde aspekte van psigopatologie, neurobiologiese abnormaliteite en behandeling in skisofrenie te ondersoek. Die volgende onderwerpe is nagevors: 4. Psigopatologie: Ons het die simptoomstruktuur van skisofrenie ondersoek deur middel van hoofkomponent- en faktoranalise in twee aparte steekproewe. a. Die eerste studie het die aard van simptome in pasiënte, met ʼn eerste-episode van skisofrenie, ondersoek in ʼn groot kohort van pasiënte wat deelgeneem het aan ʼn multi-nasionale kliniese proefneming. Ons het ons bevindinge vergelyk met soortgelyke analises wat voorheen gedoen is in multi-eposode skisofrenie pasiënte. b. Hierna het ons die invloed van kultuur op die simptoom struktuur van skisofrenie geassesseer deur ʼn hoofkomponent- en faktoranalise van die simptoomtellings uit te voer in ʼn groot steekproef van Suid-Afrikaanse Xhosa pasiënte met skisofrenie en die resultate te vergelyk met bevindinge in ander dele van die wêreld. c. Ons het die voorkoms van ko-morbiede depressiewe en angssimptome ondersoek, asook hul demografiese en kliniese korrelate. Die steekproef vir hierdie studie het bestaan uit akute psigotiese pasiënte wat deelnemers was in ʼn kliniese geneesmiddel proef wat uitgevoer is by ons sentrum. d. Om die verband tussen obsessief-kompulsiewe steurnis en skisofrenie te verken, het ons ʼn oorsig van die relevante literatuur gedoen. 5. Neurobiologiese abnormaliteite: a. Ons het ʼn reeks studies uitgevoer om steurnisse in water homeostase en vasopressien sekresie in skisofrenie te ondersoek. Om die hipotese dat akute psigotiese pasiënte versteurde regulering van water homeostase het te ondersoek, het ons ʼn dinamiese onderdrukkingstoets toegepas – ʼn water ladingstoets, met assessering van ekskresiekapasiteit (insluitend arginien vasopressien essai) in akute psigotiese pasiënte. Om te evalueer of ʼn onderafdeling van skisofrenie pasiënte met ko-morbiede versteurde water homeostase serebrale skade opgedoen het as gevolg van water intoksikasie, het ons die volgende eksperiment uitgevoer: Ons het ʼn kohort deelnemers met skisofrenie en versteurde water homeostase geïdentifiseer en hulle vergelyk met skisofrenie pasiënte sonder versteurde water homeostase in terme van serebrale ventrikulêre grootte en kognitiewe funksionering. Om die voorkoms van versteurde water homeostase in ʼn langtermyn binne-pasiënt steekproef van psigiatriese pasiënte te bepaal, het ons serum natrium siftingstoetse uitgevoer. Deelnemers met hiponatremie is hierna verder ondersoek vir disregulering van water homeostatiese meganismes. b. Ons het neurologiese sagte tekens in ʼn steekproef van deelnemers met eersteepisode skisofrenie bestudeer en opgevolg oor ʼn twee jaar tydperk. Ons het hulle voorkoms, verwantskappe met psigiatriese simptome en medikasie effekte, hulle temporale stabiliteit en hul uitkoms korrelate ondersoek. Ons het ook hulle potensiaal om die uitkoms in skisofrenie te voorspel, ondersoek. 6. Behandelings aspekte ʼn Groot meerderheid van ons werk het gefokus op die farmakologiese behandeling van skisofrenie. Die volgende aspekte van behandeling is ingesluit in hierdie tesis: a. Behandelingseffekte op psigiatriese simptome: i. Om die effek van etnisiteit op behandelingsuitkoms in skisofrenie te assesseer, het ons die akute respons op anti-psigotiese behandeling in 3 etniese groepe vergelyk, naamlik swart, gekleurd, en wit. Ons het pasiënte wat deelgeneem het aan kliniese proefnemings in ons departement sowel as die Departement Psigiatrie van die Universiteit van die Vrystaan ingesluit in hierdie analise. Pasiënte is behadel onder geblinde toestande oor ʼn tydperk van 6 weke. ii. Na besprekings met wyle Dr David Horrobin, wie die moontlike toepassings van omega-3 vetsure in die behandeling van verskeie psigiatreise steurnisse gepionier het, het ons begin belangstel in verdere ondersoek na die potensiaal van hierdie groep samestellings as ʼn bekostigbare toevoeging in die behandeling van skisofrenie. Ons het die anti-psigotiese potensiaal van die omega-3 vetsuur, etieleikosapentanoësuur (e-EPA) supplementasie versus plasebo supplementasie ondersoek in ʼn klein steekproef van deelnemers met skisofrenie wat slegs gedeeltelik responsief was op anti-psigotiese behandeling in die verlede. Ons het ook ʼn literatuuroorsig gedoen om die bewyse vir die effektiwiteit vir die omega-3 vetsure in skisofrenie te evalueer volgens gepubliseerde studies. b. Behandelingseffekte op neurologiese abnormaliteite: i. In ʼn enkelblinde kontrole studie het ons ʼn nuwe generasie anti-psigotiese medikasie vergelyk met ʼn konvensionele anti-psigotiese medikasie in die behandeling van tardiewe diskinesie (TD). Hierdie was ʼn langtermyn (1- jaar) studie in pasiënte met chroniese skisofrenie en vasgestelde TD. ii. Ons het ook die effek van omega-3 vetsuur (e-EPA) suplementasie geassesseer in die behandeling van TD. Dit was gedoen in ʼn groter steekproef (n=84) van pasiënte met chroniese skisofrenie en vasgestelde TD. Die blinde, placebo kontrole fase was 12 weke. Dit is gevolg deur ʼn nie-geblinde ekstensie vir 40 weke. c. Konvensionele versus nuwe generasie anti-psigotiese agente. Verskeie bewys-gebaseerde literatuuroorsigte oor die effektiwiteit en toleransie van die nuwe generasie anti-psigotiese agente in vergelyking met die konvensionele agente, is gedoen. Sommige multi-nasionale, ewekansige, kontole kliniese proefnemings waarin die outeur die hoofnavorser was, is ingesluit in hierdie tesis. Verder, studies wat die pasiënte met gedeeltelike behandelingsweerstandigheid aanspreek, is ingesluit, sowel as studies oor die effekte van anti-psigotiese agente op depressiewe simptome, liggaamsmassa en glisemiese kontrole. Laastens, het ons a farmakoekonomiese studie ingesluit wat die konvensionele anti-psigotiese behandeling (haloperidol) met ʼn nuwe generasie anti-psigotiese behandeling (quetiapien) in gedeeltelik weerstandige pasiënte in ʼn Suid-Afrikaanse ligging vergelyk. Bevindinge en gevolgtrekkings: 4. Psigopatologie: Ons studies het gedemonstreer dat die faktor struktuur vir die simptome van skisofrenie herhaalbaar is oor steekproewe, en dat dit nie grootliks beïnvloed word deur etnisiteit en kulturele faktore nie. Veranderinge vind egter in die faktor strukture wel plaas met verloop van tyd. Daar is simptoom domeine wat teenwoordig is in eerste-episode skisofrenie, maar verdwyn as ʼn afsonderlike entiteit soos wat die toestand chronies word. Spesifiek, ʼn motoriese komponent is duidelik in onbehandelde pasiënte, maar verdwyn na die aanvang van behandeling. Ons het gevind dat depressie en angs algemene ko-morbiede simptome in skisofrenie is en het belangrike kliniese en uitkoms korrelate. Depressiewe simptome in die akute psigotiese fase van skisofrenie word geassosieer met ʼn gunstige prognose en verminder soos wat die simptome van psigose verbeter in repons op anti-psigotiese behandeling. Egter, volgehoue depressiewe simptome word geassosieer met ʼn swakker prognose en benodig addisionele terepeutiese intervensie. 5. Neurobiologiese abnormaliteite: Ons het die voorkoms van versteurde water regulering ondersoek in ʼn populasie van psigiatriese binne-pasiënte en verdere ondersoek ingestel op dié wie geïdentifiseer is, om die betrokke meganismes vas te stel. Polidipsie en en die sindroom van onvoldoende antidiuretiese hormoon sekresie (SIADH) is gevind om voor te kom in ʼn onderafdeling van pasiënte met skisofrenie, en word geassosieer met akute psigose sowel as met somige psigotropiese medikasie. Hierdie pasiënte word gekenmerk deur meer ernstige kognitiewe beperking en bewyse van serebrale atrofie. Die toestand kan lewensbedreigend raak in die teenwoordigheid van ander faktore wat water ekskresie hinder, veral tiasied diuretikums. Neurologiese sagte tekens is ondersoek in ʼn steekproef van pasiënte met eerste-episode skisofrenie. Hierdie sagte tekens blyk om kenmerkend (teenwoordig vroeg in die siekte, en stabiel oor tyd) te wees, behalwe vir ʼn motoriese volgorde faktor. Pasiënte wat swak vaar op die laasgenoemde groep toetse, het ʼn langer durasie van onbehandelde psigose, en het ʼn beduidende risko om TD te ontwikkel. 6. Behandeling aspekte: Ons studies stel voor dat daar ʼn belangrigke etniese verskil is in anti-psigotiese behandelingsrespons, maar dat hierdie verskille verduidelik kan word deur ʼn aantal omgewings- en biologiese faktore. Soos wat gevind was vir verskeie studies wêreldwyd, het ons gevind dat die nuwe generasie anti-psigotiese agente belangrike effektiwiteit- en veiligheidsvoordele het bo hulle voorgangers. Risperidoon was net so effektief as haloperidol in eerste-episode psigose, maar met ʼn meer gunstige newe-effkte profiel in terme van verminderde ekstrapirimidale simptome. Quetiapien behandeling in veral refraktêre pasiënte het gelei tot meer respondeerders vergeleke met haloperidol, en minder ekstra pirimidale simptome. Alhoewel, bewyse van ʼn verskillende newe-effekte profiel is besig om na vore te kom. Van spesifieke belang is die bevinding dat sommige van die nuwe anti-psigotiese agente gewigstoename, glukose intoleransie en dyslipidemie veroorsaak. Ons het gevind dat een nuwe anti-psigotiese agent, quetiapien, nie geassosieer was met enige beduidende meer gewigstoename of versteurde glukose metabolisme as ʼn konvensionele agent, haloperidol, nie. Die omega-3 vetsure, spesifiek EPA mag moontlik ʼn rol in die behandeling van verskeie psigiatriese versteurings hê. Ons studies het gemengde resultate voorsien – die eerste het ʼn beduidende voordelige effek op psigotiese simptome en diskinesie tellings vir EPA supplementasie gevind, terwyl die tweede nie ʼn voordelige effek op TD of psigotiese simptome gevind het nie. Ons het die vroeë behandelingsrespons ondersoek in eersteepisode pasiënte en het gevind, in teenstelling met dit wat gerapporteer word in multi-episode pasiënte, dat sommige pasiënte ʼn lang tyd geneem het om te reaggeer. Ons het ook gevind dat vroeë behandelingsrespons ʼn beduidende voorspeller was van latere remissie, so ook die durasie van onbehandelde psigose, opvoedingspeil, en basisvlak opwindings-faktor tellings. Laastens het ons farma-ekonomiese studie, wat uitgevoer is vir Suid-Afrikaanse omstandighede in pasiënte met ʼn gedeeltelike repons op konvensionele anti-psigotiese behandeling, koste-neutraliteit of koste-voordele aangetoon vir quetiapien vergeleke met haloperidol behandeling vir direkte onkostes.

Background: 'Neuromarketing' is a term that has often been used in the media in recent years. These public discussions have generally centered around potential ethical aspects and the public fear of negative consequences for society in general, and consumers in particular. However, positive contributions to the scientific discourse from developing a biological model that tries to explain context-situated human behavior such as consumption have often been neglected. We argue for a differentiated terminology, naming commercial applications of neuroscientific methods 'neuromarketing' and scientific ones 'consumer neuroscience'. While marketing scholars have eagerly integrated neuroscientific evidence into their theoretical framework, neurology has only recently started to draw its attention to the results of consumer neuroscience. Discussion: In this paper we address key research topics of consumer neuroscience that we think are of interest for neurologists; namely the reward system, trust and ethical issues. We argue that there are overlapping research topics in neurology and consumer neuroscience where both sides can profit from collaboration. Further, neurologists joining the public discussion of ethical issues surrounding neuromarketing and consumer neuroscience could contribute standards and experience gained in clinical research. Summary: We identify the following areas where consumer neuroscience could contribute to the field of neurology: First, studies using game paradigms could help to gain further insights into the underlying pathophysiology of pathological gambling in Parkinson's disease, frontotemporal dementia, epilepsy, and Huntington's disease. Second, we identify compulsive buying as a common interest in neurology and consumer neuroscience. Paradigms commonly used in consumer neuroscience could be applied to patients suffering from Parkinson's disease and frontotemporal dementia to advance knowledge of this important behavioral symptom. Third, trust research in the medical context lacks empirical behavioral and neuroscientific evidence. Neurologists entering this field of research could profit from the extensive knowledge of the biological foundation of trust that scientists in economically-orientated neurosciences have gained. Fourth, neurologists could contribute significantly to the ethical debate about invasive methods in neuromarketing and consumer neuroscience. Further, neurologists should investigate biological and behavioral reactions of neurological patients to marketing and advertising measures, as they could show special consumer vulnerability and be subject to target marketing. (authors' abstract)

Pathological gambling is a maladaptive behaviour associated with diminished self-control over persistent compulsive gambling behaviour despite negative consequences. A significant revision to the clinical perspective of pathological gambling is underway, and the disorder will likely be recognized as a behavioural addiction in the fifth edition of Diagnostic and Statistical Manual of Mental Disorders. However, the neurobiological, cognitive and behavioural processes that drive a ‘behavioural addiction’ are unclear. A series of five studies were conducted to investigate cognitive mechanisms associated with neural and behavioural substrates of addictive processes in disordered gambling. Studies 1 through 3 investigated neurobiological correlates of addiction in individuals with pathological gambling as compared to individuals with cocaine dependence, and as compared to non-addicted healthy controls. Study 1 investigated brain activity associated with anticipatory and consummatory reward processing during slot-machine gambling. Study 2 investigated executive control processes by examining functional brain networks associated with loss-chasing behaviour. Study 3 employed voxel-based morphometry (VBM) to explore alterations in grey-matter volumes in individuals with addictive disorders. Studies 4 and 5 investigated the behavioural substrates of addiction in regular gamblers utilizing emerging and novel research techniques. Study 4 examined continuous hand motion trajectories to explore approach biases and implicit processing. Study 5 employed an adaptive testing methodology to explore the influence of gaming machine preferences on cognitive processes and gambling behaviour. Research identified neurobiological and behavioural substrates of gambling-related beliefs and biases that indicate significant contributions of cognitive mechanisms to the development and persistence of a behavioural addiction. Results suggest addictive disorders may share some common features of anticipatory reward processing and brain structure (Studies 1 and 3), while neural signals associated losing outcomes and decision-making during gambling may be specific to disordered gambling (Studies 1 and 2). Furthermore, cognitive distortions in regular gamblers may influence reinforcement and executive control processes (Study 4), and individual preferences for gaming speed may influence cognitions and behaviour during machine gambling. As additional psychological disorders are being considered for classification as behavioural addictions, and clinicians will be faced with the challenges of treating individuals with these non-substance-related addictive disorders, a better understanding of behavioural addictions, through the study of disordered gambling, will be essential under the new diagnostic framework.

Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Both chronic trauma and shame, as well as the relation between them, are understudied phenomena. This is despite particularly high levels of both trauma- and shame-related psychopathology in South Africa (Edwards, 2005). I conducted a qualitative study exploring experiences of trauma, shame, post-traumatic reactions and coping mechanisms in single interviews with 19 South African survivors of chronic trauma (intimate partner violence) using narrative analysis. Results from the categorical content analysis indicated that all but one participant reported a history of physical violence perpetrated by her intimate partner. Sexual and emotional violence were also reported by the majority of the participants. The most significant reported mental health outcomes were persistent fear, depression and suicidality, dissociation and somatic complaints. Coping mechanisms included religion, support from family, counselling and substance misuse. Using smiling as a mask to conceal difficult feelings and keeping occupied were cited as the most effective defenses. Shame was viewed as a social emotion, and often described as humiliation (and sometimes embarrassment), which required the presence of a mocking, hostile audience. This was interpreted in socio-cultural terms. Eleven women presented with a split self – the authentic self who admitted to a great deal of shame when asked indirectly, and the false self who was described in surprisingly positive terms. I analysed this split using categorical content analysis and narrative analysis from a social constructivist point of view at individual (clinical) level, organisational (micro-cultural) level, and broader cultural level. I used Gee’s (1991) categorical form analysis to analyse five long complex shame and trauma narratives with the aim of determining if psychic fragmentation presents at linguistic level. I also analysed three short, compressed trauma and shame narratives. The structure of the short narratives tended to be circular, erratic, disjointed, and interrupted (Scarry, 1985; Simon, 2008). The three short, compressed trauma narratives were characterised by long pauses or silences, hesitations, avoiding eye contact, hunching over, covering the face with clothes, whispering, so making the narrative almost inaudible, crying, and defensive leaning in towards me, and laughing. These women were exceptions – most women expressed an urgency to talk about their experiences in great detail. Although the longer narratives are essentially fractured chaos narratives at linguistic level, they contain predominant trauma- and shame-related themes that are consistent throughout the narratives and that remain intact in spite of the signs of linguistic disruption and fragmentation. They are, in order of narratives, 1) shame/self-blame and deservedness; 2) truth/lies and bearing witness; 3) shame, humiliation and dissociation; 4) the concealed, shame-based self, including amnesiac-like disorientation of place and time; and 5) patterns of cyclical leave-return reflecting perpetrator-instilled abandonment terror, including disorientation of time. I have argued that although language, or narrative structure, continues to mimic and reflect narrative content (fractured narratives vs fractured selves) – there is also the intriguing possibility of a disconnection between form and content; and that thematic coherence or consistency and narrative fracturing can co-occur; co-exist. There are a number of clinical features in the narratives which are either related to, or comprise diagnostic criteria for chronic trauma syndromes such as chronic PTSD and DESNOS, and intersect with shame themes in the narratives I analysed. Consequently, I argue that there is a substantial intersection or co-occurrence between exposure to chronic trauma, and trauma-related clinical symptoms, including shame, which emerge from the narratives, which without exception, demonstrate significant linguistic fracturing. In conclusion, a number of gaps in the literature were identified. Future research should triangulate methods and chronic trauma prevalence and longitudinal studies are needed both internationally and locally. / AFRIKAANSE OPSOMMING: Sowel kroniese trauma as skaamte, en die verhouding tussen die twee, is tot dusver onvoldoende bestudeer – ondanks die besonder algemene voorkoms van trauma- en skaamte-verwante psigopatologie in Suid-Afrika (Edwards, 2005). Ek het ʼn kwalitatiewe studie onderneem en die ervaring van trauma, skaamte, post-traumatiese reaksies en oorlewingsmeganismes ondersoek in indiwiduele onderhoude met 19 Suid-Afrikaanse oorlewendes van kroniese trauma (geweld in intieme verhoudings). In my ondersoek het ek van narratiewe analise gebruik gemaak. Resultate van die kategoriese inhoudsanalise dui aan dat ál die vroue in die bestudeerde groep, behalwe een, ‘n geskiedenis van fisieke geweld gerapporteer het wat deur haar ‘partner’ gepleeg is. Seksuele en emosionele geweld is ook deur die meerderheid van die groep gerapporteer. Die mees betekenisvolle uitkomste in verband met psigiese gesondheid was voortdurende angs, depressie, selfmoordneigings, dissosiasie en somatiese klagtes. Oorlewingsmeganismes was onder andere godsdiens, berading en dwelms. Om ʼn glimlag te gebruik as masker vir die verberging van pynlike emosies, en om besig te bly, is genoem as die effektiefste verdedigingsmeganismes. Skaamte is gesien as ‘n sosiale emosie, en is dikwels ‘vernedering’ genoem (soms ʼn ‘verleentheid’), wat die teenwoordigheid van spottende, vyandige toeskouers impliseer. Skaamte is in die studie in sosio-kulturele terme geïnterpreteer. Elf vroue het 'n gesplete self vertoon – die outentieke self wat 'n groot hoeveelheid skaamte erken het wanneer hulle indirek daaroor uitgevra is, teenoor die valse self wat in verbasend positiewe terme beskryf is. Ek het hierdie gesplete self geanaliseer met gebruikmaking van kategoriale inhoudsanalise en ook van narratiewe analise uit 'n sosiaal-konstruktiewe perspektief – op 'n indiwiduele (kliniese), organisatoriese (mikro-kulturele) en ‘n breër kulturele vlak. Ek het Gee (1991) se kategoriale vorm-analise gebruik om vyf lang, komplekse skaamte- en traumanarratiewe te analiseer om te bepaal of psigiese fragmentering op 'n linguistiese vlak manifesteer. Ek het ook drie kort, gedronge trauma- en skaamtenarratiewe geanaliseer. Die struktuur van die kort narratiewe was geneig om sirkulêr, wisselvallig, onsamehangend en onderbroke te wees (Scarry, 1985; Simon, 2008). Die drie kort, gedronge traumanarratiewe is gekenmerk deur lang stiltes, aarseling, vermyding van oogkontak, vooroor buk, bedekking van die gesig met klere, fluistering (sodat die narratief byna onhoorbaar geword het), gehuil, defensiewe oorleun na my toe, en gelag. Hierdie drie vroue was uitsonderings – die meeste vroue het 'n dringende behoefte laat blyk om in fyn besonderhede oor hulle ervarings te praat. Alhoewel die langer narratiewe op 'n linguistiese vlak wesentlik gefragmenteerde chaos-narratiewe is, bevat hulle dominante trauma- en skaamte-temas wat konsekwent deur die verhale aanwesig bly ondanks die tekens van linguistiese disrupsie en fragmentering. Hulle is, in die volgorde van die narratiewe, 1) skaamte/selfblamering en verdiende loon; 2) waarheid/leuens en getuienis aflê; 3) skaamte, vernedering en dissosiasie; 4) bedekte, skaamte-gebaseerde self, insluitend die amnesieagtige disoriëntering van plek en tyd; en 5) patrone van sikliese vertrek en terugkeer, insluitend 'n disoriëntering van plek en tyd – 'n refleksie van die vrees om alleen gelaat te word, veroorsaak deur die gewelddadige optrede teen haar. Ek het geredeneer dat, alhoewel taal/ narratiewe struktuur geneig is om narratiewe inhoud na te boots en te reflekteer (gefragmenteerde narratiewe naas gefragmenteerde self) – is daar ook die interessante moontlikheid van 'n diskonneksie tussen vorm en inhoud; en dat tematiese samehang of konsekwentheid saam met narratiewe fragmentering kan voorkom. Daar is 'n aantal kliniese kenmerke in die narratiewe wat diagnostiese kriteria bevat vir kroniese trauma-sindrome soos kroniese PTSD en DESNOS, en wat verband hou met skaamtetemas in die betrokke narratiewe. Gevolglik redeneer ek dat daar 'n substansiële oorvleueling of saambestaan is van die blootstelling aan kroniese trauma en trauma-verwante kliniese simptome, insluitend skaamte. Dit kom na vore in die geanaliseerde narratiewe, wat sonder uitsondering deur linguistiese fragmentering gekenmerk word. Ten slotte is ‘n aantal leemtes in die literatuur geïdentifiseer. Toekomstige navorsing behoort metodes en algemeen-voorkomende kroniese trauma te trianguleer en longitudinale studies, plaaslik en internasionaal, word benodig.

This study explored three areas believed to play a central role in the pathogenesis and presenting clinical picture of the eating disorders, anorexia nervosa and bulimia. Measures of personal effectiveness, family dynamics, and traditional sex-role beliefs were assessed in groups of restricted anorexics, bulimic anorexics, normal weight bulimics and controls. Control subjects manifested the highest degree of psychological adjustment, resourcefulness, and self-direction, while restricting anorexics obtained the lowest score on this measure. Bulimics experienced the highest degree of personal effectiveness of the patient groups, with bulimic anorexics falling in-between restricting anorexics and bulimics. Control subjects also reported that they felt more independent, accepted and tolerated in their family than any of the eating disorder groups. Bulimic subjects scored closest to controls on this measure, with bulimic anorexics experiencing the least degree of acceptance, tolerance and independence of all groups. Finally, control subjects defined themselves in a more traditionally masculine role than did any of the eating disorder groups. Restricting anorexics were most likely to describe themselves as passive, submissive, constricted and sensitive; bulimic subjects were more likely to endorse such self-descriptive adjectives as assertive, uninhibited, self-confident and competitive. Bulimic anorexics perceived themselves to be less traditionally feminine than did restricting anorexics, but more than bulimics or controls. The results of this study support the theory that ego deficits contribute to the development of eating disorders.

Understanding the relation between personality characteristics, psychopathology, and sexual offenses can contribute to developing more effective treatment interventions. Previous research with sex offenders has focused on general personality traits or inconsistently classified sex offenders based on psychopathology. It was hypothesized that combining personality and psychopathological traits can assist in understanding sex offenders. The current study evaluated 88 male sex offenders in a court-mandated outpatient treatment program utilizing the NEO-PI-R and the MMPI-2. Three clusters of child molesters were examined for differences in personality characteristics and number of offenses. A second-order principle axis factor (PAF) analysis of personality and psychopathology traits revealed three factors: Psychological Distress, Excitement-Seeking, and Social Desirability. The potential clinical utility of these dimensions in predicting treatment compliance is examined.

Psychopaths constitute only an estimated 1% of the population, yet they are responsible for a disproportionately large number of violent and nonviolent crimes. The literature addressing this syndrome among male offenders is quite extensive. In contrast, psychopathy and its underlying factor structure remains understudied among female offenders. Research has suggested marked gender differences in the prevalence, clinical characteristics, and underlying dimensions of psychopathy. This study examined the dimensions of psychopathy in a female offender sample. The Psychopathy Checklist-Revised and the Self Report Psychopathy-II (SRP-II) were administered to 119 female inmates at Tarrant County Jail in Fort Worth, TX. Confirmatory factor analyses of the Psychopathy Checklist-Revised (PCL-R) did not support the use of the traditional two factor male model or a recently proposed two- factor female model. This thesis also addressed females' self-appraisal of PCL-R Factor 1 characteristics as well as the usefulness of the self-administered Self-Report Psychopathy-II as a screen for psychopathy.