Thesis (M.S.W.)--Smith College School for Social Work, Northampton, Mass., 2008. / Typescript. Includes bibliographical references (leaves 81-85).

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine.

We investigated the effects of the Gulf War on two groups of Kuwaiti children and youth. Those children experiencing war-related traumatic events and those who did not experience or witness a war-related traumatic event participated. Data were obtained from the mother of each child. Each mother completed a structured Interview which Included Child Traumatic Reaction Index, developed according to the DSM-IV (1994) criteria for Post Traumatic Stress Disorder (PTSD). The data indicated a significant interaction effect observed by mothers according to the child's gender, experience of war traumatic events, and PTSD. The results are discussed In terms of the diagnostic criteria for PTSD, the necessity of early Identification, and the difficulty associated with the diagnosing PTSD in children.

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

The breadth of interpersonal violence is continuously expanding. According to Broman-Fulks et al. (2006), current epidemiological studies estimate that between 50% and 70% of individuals in the United States have experienced some form of interpersonal violence during their lifetime. The occurrence of "traumatic incidents may create powerful affective responses in those who rescue, care for, and counsel the individuals directly affected" (Wilson & Lindy, 1994, p. 333). This emotional reactivity is especially prevalent among those that work with survivors of violent traumatic events (McCann & Pearlman, 1990). The variety of issues that mental health professionals encounter are multidimensional and include their work context, characteristics of their clients, and therapist variables. Due to such complexity, it is critical to consider the broad ramifications and scope of professional quality of life when addressing the outcomes of trauma work on mental health professionals. The purpose of this study was to analyze, through qualitative methodology, the professional quality of life of mental health professionals directly involved in the recovery efforts after the campus shootings that occurred at Virginia Tech on April 16th, 2007. A phenomenological research design was used to gather information regarding the experiences and perceptions of various mental health professionals. Two in-depth interviews were conducted to examine therapists' experiences regarding the vicarious exposure and growth potential involved in this work. Analysis from the data revealed two primary themes; changed perception due to shared traumatic exposure and the costs and benefits derived from trauma work. These themes depicted the professional consequences for mental health workers who have been directly affected by traumatic events and serve clients exposed to the same event. Findings indicate that self-awareness is a critical component to enhancing therapeutic lenses and professional and personal wellness. Further research considering the influence of shared exposure to trauma on mental health professionals could further our understanding of the professional and personal consequences of such work. This research could provide a guide for preparing current and future counselors and supervisors when working during times of crisis. / Ph. D.

Studies exploring the impact of work-related traumatic stress on law enforcement couples are limited. Such studies suggest that when work-related traumatic stress impacts law enforcement professionals, their spouses may experience secondary traumatic stress and serve in a supportive role following trauma exposure. Grounded in secondary traumatic stress theory, this study explored the impact of work-related traumatic stress on law enforcement couples. Semi-structured dyadic interviews were conducted with law enforcement couples (N = 7) using transcendental phenomenology. Three themes emerged within the data that captured the essence of law enforcement couple experiences of work-related traumatic stress: (1) the stressful nature of the law enforcement profession, (2) the impact of work-related traumatic stress on the couple relationship, and (3) resilient couple characteristics. The impact of work-related traumatic stress manifested in couple's communication, role responsibilities and parenting, and commitment to the relationship and the profession. Whereas the impact of work-related traumatic events differed for the law enforcement professional and their spouse based on the type of traumatic event, overall work-related traumatic stress led couples to engage in a meaning making process and activation of resilient couple coping characteristics. Given the significant impact that work-related traumatic stress has on the law enforcement couple dyad, couples therapy interventions are needed for law enforcement professionals and their spouses. / Master of Science / Law enforcement professionals often experience symptoms of traumatic stress as a result of repeated exposure to work-related traumatic events. Spouses of law enforcement professionals may also experience secondary traumatic stress and serve in a supportive role following work-related traumatic stress exposure. This study explored the impact of work-related traumatic stress on law enforcement couples. Semi-structured interviews were conducted with law enforcement couples (N = 7) using transcendental phenomenology. Couples experienced work-related stress related to the nature of the law enforcement professional's work outside of the instances of work-related traumatic events. Job demands and expectations of police culture contributed to work-related stress along with the stress of work-related traumatic events. Three themes emerged within the data that captured the essence of law enforcement couple experiences including: (1) the stressful nature of the law enforcement profession, (2) the impact of work-related traumatic stress on the couple relationship, and (3) resilient couple characteristics. The impact of work-related traumatic stress manifested in couple's communication, role responsibilities and parenting, and commitment to the relationship and the profession. While the impact of work-related traumatic events differed for the law enforcement professional and their spouse based on the type of traumatic event, overall work-related traumatic stress led couples to engage in a meaning making process and activation of resilient couple coping characteristics. Given the significant impact that work-related traumatic stress has on the law enforcement couple dyad, interventions are needed for law enforcement couples.

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Inledning: Sedan PTSD har blivit en diagnos i den psykiatriska diagnosmanualen DSM har forskningen i detta område ökat mycket. Samtidigt har man kunnat se att tidiga traumatiska upplevelser framför allt med anknytningspersoner ökar prevalensen för utveckling av psykiatriska och somatiska sjukdomar. Detta har lett till hypotesen att ett anknytningstrauma kan vara en predisponerande faktor för utveckling av PTSD eller att en trygg anknytning kan vara en skyddande sådan. Som kollektiv i studier valdes mest veteraner, våldäkts- eller brottsoffer. Denna pilot-studien väljer ett annat patientkollektiv. Frågeställning: Vilka anknytningsmönster som finns hos 10 patienter med exilbakgrund, vilka har varit utsatta för krig och/eller tortyr. Method: Undersökningen görs med hjälp av två skattningsinstrument, PCL-5, som undersöker graden av PTSD-symtom och ASQ, som undersöker anknytningsmönstret. Undersökningen görs med både kvalitativ metod genom att undersöka deltagarnas individuell anknytningsmönster genom utvärderingen och tolkningen av svaren i ASQ-testet och kvantitativ genom att utvärdera korrelationer mellan graden av PTSD-symtom och anknytningsmönstren. Resultat: I den kvalitativa delen visar det sig att nästan alla deltagare visar ett otryggt anknytningsmönster och i den kvantitativa delen ses det några intressanta tendenser, såsom att höga poäng på distansskalan har en stark korrelation till höga PTSD-score och en icke-signifikant negativ korrelation med tillits-skalan. I delgrupperna (män/kvinnor) ses tendenser som är signifikanta trots det låga deltagartalet. Diskussion: Undersökningen bekräftar hypotesen att patienter anknytningssystemet har drabbats hos patienter med PTSD och exilbakgrund. Resultatet ses som underlag till vidare forskning med en större population. / Introduction: Since PTSD has become a distinct diagnosis in the psychiatric manual of diagnoses (DSM) a lot of research has been done in this field. At the same time has research in the field of attachment produced evidence that early traumatic events, especially in relation to children´s attachment figures, rises the prevalence of psychiatric illness. This led to the hypothesis that attachmenttrauma could be a predisposing factor for development of PTSD or that a secure attachment could be a protective one. Most researchers chose veterans or violence/rape or crime-victims. This pilot-study chooses a different studypopulation. Issues: Which attachment patterns show patients with exile-background who became victims of war and/or torture. Method: The study uses two rating-scales for this, the PCL-5 to establish the participants PTSD-symptom-score and the ASQ to show the attachment pattern. In the qualitative part of the study the individual attachment patterns are established by evaluating and interpreting the answers in the ASQ-scale. The quantitative part of the study shows the correlations between the PTSD-totalscore and the attachment pattern. Results: The qualitative part shows that nearly all participants with a high PTSDsymptom-score show an insecure attachment. The quantitative part shows some interesting tendencies like a positive correlation between high PTSD-total-score and high score in the ASQ-dimension “discomfort with closeness” and a nonsignificant negative correlation between high PTSD-total-score and confidence. Discussion: The study confirms the hypothesis that PTSD-patient´s attachmentsystem is troubled. This result takes as a basis for more research with a bigger sample.