Chromosome 22q11.2 deletion syndrome (22q11DS) is characterised by a complex behavioural phenotype including anxiety, attention-deficit/hyperactivity disorder and psychosis. In the current study, we aimed at improving our understanding of the heterogeneity of behavioural characteristics in a group of 129 young people (aged 4¿22) with a confirmed 22q11.2 microdeletion and 116 age and gender matched typically developing controls. Half the participants with 22q11DS had behaviour characterised by emotion dysregulation. A cluster analyses, of the participants with 22q11DS, revealed four groups characterised by intact emotion regulation; predominantly internalizing problems; both internalizing and externalizing problems; and predominantly externalizing difficulties. Importantly, it was found that young people with 22q11DS¿whose emotion dysregulation was characterised by externalizing problems had the poorest levels of functioning. As our understanding of 22q11DS improves, it is becoming increasingly clear that we need a better understanding of how individual differences and psychosocial factors contribute to, and interact with one another, to result in the observable individual differences in the 22q11DS behavioural phenotype.

Individuals who experience complex traumatic events are potentially at risk of long-term psychological and emotional dysfunction. However, contemporary theories of posttraumatic growth, and the construct of positive psychology, reconceptualize traumatic exposure as a springboard for growth, as well as precursor to distress. Through a bibliometric analysis, the aim of this study was to assess the volume and characteristics of research output over time, inclusive of the constructs of complex trauma and posttraumatic growth. A descriptive repeat cross-sectional study of publications was conducted from the databases PsycINFO, MEDLINE, EMBASE, and Psychology and Behavioural Sciences across the timeperiods 1995¿1998, 2005¿2008, and 2015¿2018. Exclusion criteria included a lack of reference to both constructs. Authors jointly assessed article relevance for inclusion. For each study, classifications included database, country of research institution, country of participants, type of trauma experienced, and trauma terminology. A total of 141 articles met criteria for review. Findings included an increase in output of publications addressing complex trauma and posttraumatic growth across the selected time periods. Furthermore, research outcomes from the United States concerning war veterans dominated the field. Relative to descriptive studies, there were very few intervention studies. Despite a growing interest in the conceptualization of posttraumatic growth in the aftermath of complex trauma, cross-cultural trauma, and types of complex trauma, particularly interventional studies to inform therapy were found to be absent.

Objective: Attention deficit hyperactivity disorder (ADHD) is well recognised as a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with functioning or development; however, little is known about the subjective experience of ¿being ADHD¿. This phenomenological idiographic study explored how nine individuals with ADHD make sense of their life experiences, ability to function, and ideas about self in the context of ADHD. Method: Semi-structured interviews were used to collect data from nine participants aged 29 to 54. Audio recordings of interviews were then transcribed and analysed according to the protocols of interpretative phenomenological analysis (IPA). Results: Three themes emerged (1) otherness; (2) pixies, monkeys, and living in the moment; and (3) Challenging ¿broken¿. Themes encompass the experience of being different to others, mechanics of daily functioning, and advantages of being ADHD. Conclusion: A tendency to live in the moment was consistent across the nine participants in this study and aligns with quantitative research showing differences in the processing of temporal information in ADHD. The effects of this tendency on day-to-day functioning are linked to typical symptoms of ADHD, as well as perceived advantages. Participants attributed an uncommon degree of energy, optimism, adventurousness and curiosity, and novel problem-solving ability to their ADHD, adding to existing literature that suggests there are advantages to this unique mental architecture. Identifying positive aspects to ADHD offers clinicians and educators a pathway for mitigating the negative effects on self that flow from the challenges of ADHD.

Child sacrifice remains a horrific contemporary crime that masquerades as an old custom. Its revival in Uganda this century as a worldwide commercial enterprise, leaves those working to expose this violence, rescue, and care for the victims of child sacrifice, at psychological risk. This idiographic study sought subjective interpretations from 6 female carers working with a faith-based organization that rescues and cares for victims of child sacrifice/trafficking in Uganda. Semistructured interviews provided data for analysis using the protocols of interpretative phenomenological analysis. One superordinate theme, Cultural darkness, passion, purpose, and growth, overarched 5 subordinate themes: 1) Mission in life; 2) Dark society, dark future; 3) Cost to self; 4) Coming from a place of humility, openness, and learning; and 5) Healing children, healing life and healing society. Participants reflected on a strong ¿calling¿ or spiritual commitment to the high needs of others victimized by child sacrifice. This juxtaposed with inherent risks to personal safety, psychological distress, altruistic disruption, loss, and burnout. Skeptical of political will to eliminate corrupt practices, and shamed by cultural acceptance, the gratitude of child victims triggered humility, empathy, compassion, patience, and sense of purpose in the participants. Unexpectedly, carers spoke of overcoming the impossible through soothing and nurturing a renewed love of life and trust in the children, and seeking opportunities for psychological and spiritual growth for themselves out of merciless inhumanity. Culturally appropriate organizational trauma-management, and self-care protocols and procedures to protect carers¿ mental health and well-being, is a unique field of posttrauma recovery and growth that actively needs support.

Objective: Contextually embedded and sanctioned gender minimization and sexual abuse toward female personnel within the military appears widespread. Left unabated, mental health complications of female personnel will challenge care responsibilities for military organizations. Method: Interview data from six exmilitary women that sought positive and negative interpretations of gender minimization and sexual abuse while in the military was analyzed using interpretative phenomenological analysis. Results: Analysis revealed two superordinate themes: (a) Immature Culture, and (b) Ejection and Growth. These overarched four subordinate themes that explored fostered patriarchy and male privilege in the military. Participants expressed experiencing relentless belittling that eroded early adolescent goals of success and aborted their ability to thrive psychologically. By association, interpersonal violence compounded by organizational complicity triggered internalized shame and narcissistic defenses. Discharging from the military is remembered as a painful, isolated struggle for these participants as they sought to make sense of their fragmented identities as women. With time, all participants acknowledged pride in skills achieved during military life, and the strength to speak out against embedded organizational abuse. A persistent ruminative struggle to make sense of complex systemic biases against women that allowed organizational abuse to flourish facilitated posttraumatic growth. Conclusions: For these participants, personal experiences of gender minimization and sexual abuse in the military incubated a betrayal of hope and moral safety. As women, they felt violated at an organizational level seemingly orchestrated by male privilege and patriarchy. Clinical priorities include reparative validation and holistic trauma support underpinned by trauma and posttraumatic growth frameworks

Background and Objectives: Few studies explore both negative and positive perspectives of family members who relinquish home care of a family member with dementia for systemic aged care. Research Design and Methods: This phenomenological study sought the ¿lived¿ experience of relinquishing the role of home carer for a family member with mild to severe dementia to others within care home settings, by seeking to understand the impact of aged care on family members¿ psychological well-being. Using semi-structured interviews, positive and negative subjective interpretations from 17 families (27 individuals) provided data for analysis, following the protocols of interpretative phenomenological analysis. Results: One superordinate theme, mistrust/integrity, overarched oscillation between mistrust of the aged care system and a struggle for personal integrity in caring for these participants. Two sub-themes emerged: intrinsic trauma and extrinsic trauma. Intrinsic trauma explained feelings of helplessness and guilt, and internally directed responses that triggered a retreat into submission ultimately reducing the participant¿s role in advocacy. Extrinsic trauma represented externally directed responses such as anger and frustration, where family members became more engaged and watchful and recognised a need for vigilance and advocacy. Paradoxically oscillating between these personal struggles, participants exhibited growth, a third theme that defined assertive/advocacy utilised to nurture hope, gratitude, courage and change. Discussion and Implications: Family members experienced complex distress as they relinquished home care to others within systemic aged care for a member with dementia. By developing adaptive responses as appropriate, for example, advocating for their family member or accepting compliance with treatment, collaborative care between family and staff created better outcomes for the family member with dementia.

Children of veterans commonly join the armed forces, yet little research explores transgenerational exposure to combat trauma. This ideographic study sought positive and negative interpretations from veterans exposed vicariously as children to combat related trauma and primarily as personnel deployed to combat. Semistructured interviews provided the data for transcription and analysis using interpretative phenomenological analysis. One overarching superordinate theme, military family, moral dilemmas, reclaiming self, highlights a layered struggle for autonomy from a fractured relationship with a veteran father, the lack of preparedness for moral confrontation in combat from the larger military family, and a sense of betrayal from both father and organization in reconnecting with civilian life. Despite intermittent opportunities for shared connections between father and son, their fathers¿ resistance to sharing personal combat narratives brought distance and resentment. This was compounded by perceived organizational betrayal, where participants felt morally unprepared for the ¿cultural¿ threats of war. Feelings of shame and moral injury plagued ¿self¿ post service; however, purpose and meaning were expressed as a desire to parent differently from their own fathers. Importantly, though results are not generalizable, this study highlights the importance of postdeployment family education to reduce potential self-blame and self-doubt in male children of veterans exposed vicariously to the toxic masculinity of disengaged and brutal parenting styles following combat trauma. Second, this study reveals the importance of postdeployment reintegration training for restoration of moral integrity in life after the military.

Objective: Burnout is seen as an occupational phenomenon related to workplace stress. Professional groups within medical imaging and radiation science have been reported to suffer from burnout in the past, however research into the profession has been limited. This systematic review aims to evaluate literature measuring levels and prevalence of burnout in the professional groups within medical imaging and radiation science (MIRS). These being radiographers (radiological technologists), sonographers, radiation therapists (therapeutic radiographers) and nuclear medicine technologists. Methods: Electronic databases including Medline, Embase, Psycinfo and CINAHL were searched to locate studies published in English from 2000 that used a questionnaire/survey to measure burnout in the MIRS population. Also included were studies that measured burnout in a larger healthcare group that included MIRS professionals, as long as the MIRS professionals were reported as a separate group. Results: Sixteen articles met the inclusion criteria; two of these articles reported the same data and therefore were combined to leave 15 studies to review. Of the radiation therapy group, seven of the nine studies reported low or moderate burnout amongst their participants. One study reported high levels of burnout in the emotional exhaustion and depersonalisation domains, and another reported high emotional exhaustion levels. Within the other MIRS professions, five of the six studies reported moderate burnout. One group of sonographers had high levels of burnout in the emotional exhaustion domain. Conclusion: For the past 20 years, levels of burnout in MIRS professionals has remained relatively steady, with the majority of studies reporting moderate levels of burnout. However, more research is needed in radiographers, sonographers and nuclear medicine technologists. Implications for Practice: Even though the review indicates moderate level of burnout, this needs addressing on an organisational and individual level to ensure stress in the workplace is managed before burnout becomes a significant issue.

The 2014 Ebola epidemic in Sierra Leone, West Africa, was a public health crisis that triggered international fear, border shutdowns, and a declaration of an unprecedented international public health emergency. However, no known research has explored the subjective experience of international humanitarian health care workers deployed to provide on-the-ground support during the Ebola epidemic. This phenomenological study explored the subjective interpretations of 5 career-international Red Cross/Red Crescent health care delegates who deployed to the 2014 Ebola epidemic. Data were collected using semistructured interviews, transcribed, and analyzed using the protocols of interpretative phenomenological analysis. One superordinate theme: Beyond human fear and catastrophe: I can't save you, but I am here; overarched four subordinate themes: Calm amidst hysteria; Living in a pressure cooker; Journeying alone; Altruistic authenticity. These themes reflect the heavy burden felt by these participants in response to a strong altruistic call-"Who will go if I do not?" "Like no other" humanitarian deployment, unquestionable allegiance and trust among in-the-field colleagues were the only barriers against sudden and untreatable death. Official and societal criticism postdeployment precipitated social retreat wherein feelings of isolation and invalidation threatened psychological well-being. However, a strong sense of altruistic commitment remained unwavering and protective against psychological debilitation, as did positive support from the deploying organization. Despite daily confrontation with death, hypervigilance, and fear, altruistic purpose remained the beacon for professional and personal integrity in these participants. It counterbalanced the distress of isolation and invalidation from societal criticism. We recommended that strength-based predeployment humanitarian training is prioritized by deploying organizations.

Background: Previous studies have described inconsistent condom use in Chinese- and Thai-speaking female sex workers in Sydney, Australia. In the present study, we describe the demographics and safe sexual practices in the Chinese- and Thai-speaking female sex workers attending the Sydney Sexual Health Centre (SSHC) in 2014-15. Methods: A self-completed 60-item anonymous questionnaire, adapted from previous surveys conducted in 1993 and 2003, was translated into Chinese and Thai and administered to female sex workers attending the SSHC or seen on outreach. Results: In all, 488 surveys were distributed, of which 435 were returned; 43% in Chinese and 57% in Thai. Most women did not plan on sex work before their arrival in Australia. Compared with Chinese-speaking women, Thai-speaking women rated themselves higher on English language literacy, had better knowledge of the transmission of HIV and sexually transmissible infections (STIs) and were more likely to practice 100% condom use. Overall, 72% of the sex workers surveyed reported consistent condom use for vaginal sex at work. Conclusions: Consistent condom use for vaginal sex at work among Chinese- and Thai-speaking female sex workers has decreased slightly from that reported in a similar survey conducted by the SSHC in 2003, when 85% of sex workers reported consistent condom use. There are significant differences between Chinese- and Thai-speaking sex workers in terms of both knowledge and safer sex practices. Ongoing health promotion efforts should focus on providing culturally appropriate education around STIs and safe sex practices not only to workers, but also to parlour owners, managers and consumers.

The subjective voice of experiencing out-of-home care (OoHC) in the aftermath of removal from family of origin is poorly researched. This phenomenological study explored the "lived" experience of OoHC from the perspective of 4 adult care leavers reflecting on their childhood. Seeking both positive and negative interpretations, semistructured interviews were analyzed using interpretative phenomenological analysis. Two superordinate themes-unconditional is conditional and learning to walk with self- highlighted juxtaposed layers of complex traumatic distress and psychological growth for these participants. Conversely, as they navigated loss of family of origin and the expansive foster care system into which they were thrust, distress appeared to stimulate the emergence of self-reliance as a barrier to further traumatic loss. They spoke of nebulous and ambivalent commitment from new carers that repeatedly inhibited relational depth; however, the occasional glimmer of genuineness was remembered and appeared to facilitate doing "it" differently in adult life. Crucially this study highlights that foster parenting in OoHC has the potential to nurture healing from family of origin trauma but invariably contributes to cumulative distress on earlier childhood trauma. As such, foster parenting requires a unique ability to engage relationally with traumatized children. Poor remuneration and screening, and lack of training in healing and reparative support for childhood trauma, will continue to risk the future adult mental well-being of children placed in OoHC.

The psychopathological impact of parental mental ill-health on children is well known. However, little research explores positive and negative interpretations of such exposure in childhood, from the adult child's perspective. Using interpretative phenomenological Analysis this study sought subjective interpretations of the ¿lived¿ experiences of growing up in a family with parental mental ill-health. A purposive sample of seven adult children provided data for analysis through semi-structured interviews. One superordinate theme: A fractured journey of growth to adulthood, overarched six subordinate themes. Four themes captured stigma, shame, social isolation and betrayal. Juxtaposed with this, two themes captured purposeful redefinition of self and psychological growth. This study captures the chronicity of traumatic distress and sense of betrayal experienced by these participants in childhood through unrelenting exposure to parental mental ill-health. However, despite unpredictability, fear, and neglect in childhood, they identified the emergence of inner strengths in adult life: unexpected growth in empathy and compassion, high resourcefulness, and personal authenticity through higher education. Findings highlight that positively redefining ¿self¿ in adult life is possible in the aftermath of childhood trauma associated with parental mental ill-health. Implications for therapy include: (a) moving forward from childhood trauma and (b) managing ongoing family dynamics in adult-life.

How individuals experience reintegration postcombat and subsequent military discharge is a poorly explored phenomenon, though for many service personnel it is fraught with complex psychosocial hurdles. Therefore, seeking both positive and negative interpretations of this phenomenon, semistructured interviews explored the ¿lived¿ experience of 5 former military personnel. Using interpretative phenomenological analysis (IPA) 1 superordinate theme emerged: shaping and breaking: who am I now? and overarched 5 subordinate themes. Four themes encapsulated the search for post war identity in these former military personnel. As such, narratives revealed that each participant grappled to understand a destabilizing sense of betrayal beyond leadership malpractice. This was interpreted as an enduring organizational failure that was cumulative on core morality changes from exposure to war. Psychological injuries remained fresh and raw despite years since discharge. Memories of feeling discarded, lost, and alone rekindled the self-doubt, distrust, and depleted confidence that fostered an inability to readily reengage with civility, with loved ones, and society. Turning on self, intrinsic blame fueled either self-loathing or retreat into silence or rage. A fifth theme revealed tenuous insights where minimal acceptance, some redefining of altruistic identity, and hope could emerge. Findings are discussed in light of these results, particularly the role of organizations in providing immediate supportive validation of deployment experience where validation of moral distress and identity disruption are inclusive in reintegration programs nurturing recovery and psychological wellbeing.

The presentation of 22q11.2 deletion syndrome (22q11DS) is symptomatically variable, presenting diagnostic challenges for paediatricians and anxious uncertainty in parents. The ¿lived¿ experience of parenting a small child diagnosed with 22q11DS is unknown particularly how parents make sense, both positive and negative, of their role. A phenomenological study sought subjective interpretations from two fathers and four mothers of a young child (8¿36¿months) diagnosed with 22q11DS. Using interpretative phenomenological analysis, data were collected through semi-structured interviews and thematically analysed. Four themes embodied uncertainty and fear simultaneously experienced by these parents such as anticipatory traumatic distress, systemic stigma, confusion at professional smoke screens and ¿not knowing¿. This cacophony of distressing emotions plagued their unanswered fear, guilt, loss and grief. In seeking hope, their parenting journey was able to be redefined as one of intrapersonal and interpersonal growth from the adversity of 22q11DS. This study provides a lens into the experiences of parents struggling to make sense of their journey with 22q11DS in the early parenting years. It highlights the complex distress of parenting a small child whose development is fraught with uncertainly and where stigma and suspicion are often experienced when seeking support from social and health systems. However, a metamorphosis of personal strengths also emerged facilitated by hope. Healthcare professionals can best assist through open discussion that acknowledges often limited knowledge, using the guidelines for management of 22q11DS in guiding parents.

Background: Playback Theatre is applied theatre that draws on real-life stories from its audience to reflect the psychosocial needs of individuals and communities. Contemporarily it is being used to support those exposed to war/disaster; however, the impact of such work on its practitioners, is under researched. Methods: Using interpretative phenomenological analysis positive and negative subjective interpretations were sought from five Western Playback Theatre practitioners who taught in post-civil war Sri Lanka. Results: One superordinate theme, Naivety, Humility and Hope amongst the Rubble, encompassed five subordinate themes. These reveal an integral struggle experienced by Western practitioners unprepared for a culturally different lens. Conclusion: Teaching Playback Theatre in post-war Sri Lanka for these practitioners exposed the gap between the desire to help cross-culturally and their experienced reality. Over time, the collision of Western naivety with good intent facilitated an integral and humble search to be wiser humanitarians cross-culturally in these participants.

Objective: No known research explores the double-edged phenomenon of childhood trauma/adult mental health consumer. Therefore, whether receiving a psychiatric diagnosis in light of childhood trauma supports or impedes psychological wellbeing in adult life, is unknown. Method: Interpretative phenomenological analysis (IPA) provided the methodological framework. Data were collected through the use of semistructured interviews. Analysis sought thematic representation from subjective interpretations of the experienced phenomenon: childhood trauma survivor/mental health consumer. Results: Data revealed 1 superordinate theme, Childhood Betrayal, Identity, and Worthiness, that overarched 5 subordinate themes a) legacies, (b) the label, (c) putting the jigsaw together, (d) stigma, and (e) better than good enough self. Legacies of doubt that perpetuated "not good enough" delayed the development of an adult identity of worthiness in these participants. Importantly, the right diagnosis separated self as worthy-adult from self as traumatized child and facilitated positive change for breaking harmful cycles, self-valuing, and increased empathy, wisdom, and patience. Conclusions: Findings inform future research and therapeutic practice in regards to adult help seeking behaviors in light of childhood trauma, often postponed through fear of stigma associated with mental health diagnoses and services. Similarly, findings suggest that ameliorating wellbeing may be dependent on a therapeutic relationship in which accuracy or right fit of diagnosis provides a conduit for the client to disengage from self-blame, unworthiness, and "not good enough.

Objectives: 22q11.2 deletion syndrome (22q11DS), a complex genetic syndrome associated with more than 180 features, presents complex challenges for parents including gaining a diagnosis. This phenomenological study sought the "lived" interpretations of parents supporting an adult child with 22q11DS, a poorly researched area. Method: Interpretative phenomenological analysis informed a detailed and open exploration of parenting a child through to adult life with 22q11DS. Using in-depth semistructured interviews, 8 parents (2 male, 6 female) of adult children with 22q11DS were individually interviewed; providing the data set for transcription and thematic analysis. Results: Losing "I" Finding "self," overarched 6 subordinate themes that emerged from participants' articulated descriptions of psychological distress and psychological growth. Distress in parenting a child with 22q11DS was experienced through stigma, loss, grief, and guilt. Progressively, stigma undermined independence, friendships, and instinctual judgement. Ill-informed hierarchical structures experienced as layers of obstruction and lack of awareness of the syndrome triggered angry advocacy for their child. Diagnosis brought opposing relief and grief. In time, they came to value their unique "accomplishments," collected on their journey with 22q11DS, and in turn, consciously valued authentic "self" expressed through empathy, humility, gratitude, and pride. Conclusion: Parental distress through societal, educational, and health care invalidation persisted for decades for all participants. Conversely, distress facilitated psychological growth for redefining "self" and role as parents over time. Building on this phenomenological cameo, future research can educate against the plight of 22q11DS families. It can enlighten health care professionals in buffering against associated stigma, blame, and self-doubt, and in fostering psychological well-being.

Little research has included exploration of the interpreted experiences of a childhood overshadowed by a parent¿s distress from war. It is important to note that whether being parented by a combat veteran impacts psychological well-being both positively and negatively is unknown. In this phenomenological study, we sought positive and negative interpretations of childhood from the perspective of adult children of Vietnam veterans diagnosed with posttraumatic stress disorder (PTSD). Data were collected through semistructured interviews and analyzed using interpretative phenomenological analysis (IPA). One superordinate theme, making sense of the imposition of war, overarches (a) tragic and turbulent young years and (b) knowing, absolution, and posttraumatic growth. These subthemes encapsulate (i) the interpersonal blame and shame that tenaciously, undermined the ¿self¿ throughout their childhood, and (ii) the slow emergence of the self as not responsible, able to absolve, and psychologically grow out of their adversity. Youthful ignorance of a complex war left these participants not understanding why the heavy burden of responsibility became the child¿s remit for a father emotionally absent. The opportunity to reexamine childhood distress in adult life has revealed harmful patterns of relational engagement learned in childhood that have repeatedly dogged their adult lives. This honest reappraisal of self has allowed nonjudgmental self-regard to emerge. Forgiveness has been offered to fathers when true reparation was sought. However, nonabsolution did not preclude psychological growth, with positive self-regard replacing misplaced responsibility and self-blame. Therapy can support the coexistence of distress and growth in the aftermath of a father¿ child relationship irrevocably impacted by combatrelated trauma. In doing so, the ¿growthful¿ domain of self-acceptance may facilitate respectful choice in future adult relationships.

This study explored the dual phenomenon of experiencing a peer support residential trauma program from the perspective of (a) a client, and (b) a facilitator. It sought both positive and negative subjective interpretations. Participants were former clients and current facilitators of the program. Data were collected through a focus group, and analyzed using interpretative phenomenological analysis. One superordinate theme, altruistic growth, overarched 2 subordinate themes. The first, modeling through respect, included subthemes of respect and hope and empowerment. The second subordinate theme, reciprocal model of care, encapsulated personal challenges such as facing the mirror, old demons, and burnout and breaking points. Conversely, participants mused on these challenges as opportunities for further healing through opportunities for self-nurturing and gratitude. Implications for treatment of adult survivors of childhood trauma are discussed. For facilitators, the program was seen as offering further personal reflection and a giving forward that was interpreted as altruistic growth.

Minimal research explores the impact of dementia and a dementia diagnosis on families from the unique vantage of senior health professionals. The participants of this study, eight senior aged care professionals, provided unique interpretative insights into family dynamics and sense-making on the journey with dementia, and their own role in that journey. Both positive and negative perspectives were sought. Data from semi-structured interviews were analysed using Interpretative Phenomenological Analysis (IPA). One superordinate theme, Dementia naiveté; redefined intimacy, overarched Embarrassed shame; Maintaining hope; Redefining a model of intimacy; and Redefined relational intimacy and growth. Within these themes, the participants shed light on hurtful embarrassment and shame experienced by families associated with the diagnostic label given to a loved one. This label was perceived to either trigger separation, hurt and immobility through ignorance, or precipitate a frenzy of naive yet hopeful energy for seeking that elusive cure. The participants saw their role as one of enacting a new way of connecting what was with what could be. Thus, they modelled advocacy, integral care and relational intimacy. Validation came in witnessing a redefining of intimacy in many families who were able to embrace that holistic and empathic approach to the shifting presentation of dementia. Psychological well-being was observed to occur when families embraced growthful domains, e.g. acceptance, hope, relational closeness and altruistic concern for other families. Implications for future care models are discussed.

The potential for acute and cumulative exposure to traumatic events associated with policing is well recognized. However, research exploring the subjective impact of that trauma, particularly when it results in discharge with a diagnosis of posttraumatic stress disorder (PTSD), is significantly limited. Drawing on a phenomenological epistemological position, this study explores the subjective ¿lived¿ experience of 7 former police personnel medically discharged with PTSD. It sought both positive and negative interpretations of (a) their personal experience of policing; (b) consequential discharge with PTSD; and (c) life after discharge. Using interpretative phenomenological analysis (IPA), semistructured interviews provided the data for transcription and analysis. One superordinate theme: moral betrayal, silence, and hope in policing trauma; overarched 4 subordinate themes: eroded identity; moral betrayal; confronting the silence; learning to depend on me. These interpreted themes mirror multiple layers of complex policing trauma in these participants that over time eroded hope. They reveal a growing awareness of moral injury that only found voice, postdischarge. Chronic exposure to policing trauma was experienced as a domino effect slowly diminishing self-worth and consequently corroding their earlier sense of purpose as police personnel. Intrinsically, shame was interpreted as having failed. Discharge dissociated them from the collegial support necessary to reintegrate into their postdischarge lives. Instead, former altruistic selves became reclusive. These participants attributed ¿felt¿ distress as directly attributable to organizational factors that left them feeling invalidated, betrayed, and without support. Over time, some experienced a newfound appreciation of ¿self,¿ facilitated by hope. Implications for clinical practice and policy are discussed.

Minimal research explores the impact of a career in dementia care on senior health professionals. This study sought positive and negative subjective interpretations from seven senior health professionals regarding their experiences in dementia care. Data from semi-structured interviews were analysed using interpretative phenomenological analysis (IPA). One superordinate theme, Honouring stigmatised self, overarched four sub-themes: Systemic stigma, Invalidated, Self-respect and Moral integrity and Growth. Stigma was interpreted as systemically entrenched minimisation of aged care and the aged-care workforce, including poor remuneration and training. Participants experienced peer invalidation particularly when attempting to resolve complex professional and moral challenges in dementia care. These often occurred in the context of efforts to individualise care, constrained within a medical model. Paradoxically, external invalidation motivated a search for redefining ¿self¿ and moral integrity. By wisely acknowledging career experience, growthful domains of self-respect, optimism, humility and innovation defined professional practice and personal choices. Implications are discussed.

A paucity of research explores both negative and positive changes for family members supporting a loved one with dementia, especially when communication by speech and awareness of others diminishes. This qualitative study sought the views of family groups concerning their experiences over the past 10 years supporting a loved one with dementia. A focus group sought negative and positive subjective interpretations of this phenomenon. One superordinate theme: Synthesis of Meaning emerged from the data using interpretative phenomenological analysis. This overarched two subordinate themes: (a) Steps backward¿encompassing those times when relatives hovered uncertainly, missed opportunities to engage due to advancing dementia, and felt regret and (b) Steps forward¿encompassing moments of unexpected rewards, acceptance, self-forgiveness, and empathic connection with others on a similar journey. This study highlights that although often fraught with distress, positive aspects of the dementia journey are possible and offer opportunity for psychological growth and well-being.

There is minimal research investigating non-speech communication as a result of living with severe dementia. This phenomenological study explores retained awareness expressed through non-speech patterns of communication in a family member living with severe dementia. Further, it describes reciprocal efforts used by all family members to engage in alternative patterns of communication. Family interactions were filmed to observe speech and non-speech relational communication. Participants were four family groups each with a family member living with non-speech communication as a result of severe dementia. Overall there were 16 participants. Data were analysed using thematic analysis. One superordinate theme, Dance of Communication, describes the interactive patterns that were observed during family communication. Two subordinate themes emerged: (a) in-step; characterised by communication that indicated harmony, spontaneity and reciprocity, and; (b) out-of-step; characterised by communication that indicated disharmony, syncopation, and vulnerability. This study highlights that retained awareness can exist at levels previously unrecognised in those living with limited or absent speech as a result of severe dementia. A recommendation for the development of a communication program for caregivers of individuals living with dementia is presented. © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav.

The onset of an eating disorder in middle-age men is poorly researched as are eating disorders in men generally. Therefore, life events that influence eating disorders in men, including delayed onset of an eating disorder remains unknown. Given the limited understanding of males with eating disorders and limited access to large samples of men with eating disorders, an in-depth analysis of a single case of a male in middle age with an eating disorder was chosen to gain insight and understanding into this phenomenon. A Life History approach explored the case of Joseph (pseudonym), who was diagnosed at age 44 years with an Eating Disorder Not Otherwise Specified. Data were collected through (a) life course open-ended questioning through interviews, (b) written statements, and (c) comments on transcripts. Three themes emerged, loss and unworthiness, becoming bigger, and wanting to change reflecting eating behaviors associated with attachment disruption, loss and trauma, body dissatisfaction, and negative affect. Later in life, an emotional "tipping point" precipitated an eating disorder. Results indicate traumatic loss leading to early attachment disruption as influential in Joseph's delayed onset of an eating disorder. The value of thorough narrative life histories during therapy when eating disorders occur late in life is discussed as well as the significance for men. © The Author(s) 2013.

There is a paucity of research into the subjective experiences of humanitarian aid personnel exposed to modern global conflicts and disasters in the course of their work. In particular, little is known about how they make sense of any dual threat: (1) witnessing catastrophic and traumatic events perpetrated on those they seek to serve and (2) experiencing personal threat to self. This phenomenological study explores the idiographic interpretation of aid personnel working in complex humanitarian settings including exposure to genocide, and the impact of such exposure on reintegration processes postmission. Semi-structured interviews were conducted, and data were analyzed using interpretative phenomenological analysis (IPA). One theme: Complex humanitarian distress and growth overarched five subordinate themes. Four of the subordinate themes highlighted long term psychological distress including shame, moral doubt, betrayal, and narcissistic coping. The fifth theme, Reparation with 'self', describes a redefining of self-worth and altruistic identity over time despite earlier perceived moral failure and sense of rejection from organization and important others. Reparation with self, as a positive outcome from traumatic distress and lack of validating support from important others, is discussed in light of current posttraumatic growth literature. Implications for therapists and recruiting organizations are also discussed. © 2013 © 2013 Taylor & Francis.