Dr Tanya Hanstock

Background: The developmental consequences of childhood trauma for young children are extensive and impact a diverse range of areas. Young children require treatments that consider their developmental stage and are inclusive of caregiver involvement. Parent-Child Interaction Therapy (PCIT), with its dyadic focus and developmental sensitivity, is uniquely positioned to offer therapeutic support to young children and their families. Aim: The current study aimed to conduct a systematic review of the current literature on PCIT and trauma and determine treatment outcomes for children and caregivers. Method: A systematic review of five electronic databases was undertaken. Studies that utilized PCIT to treat a population who had experienced trauma were included in the review regardless of study design. Results: PCIT was used to treat a population who had experienced trauma in 40 studies. PCIT was an effective treatment in improving a variety of child and parent outcomes in this population including reduced parenting stress, child behavior problems, child trauma symptoms, parental mental health concerns, negative parenting strategies, and reducing potential risk of recidivism of abuse and neglect. These findings should be taken with caution given attrition rates and potential for bias in the study samples. Discussion: Clinicians should consider PCIT as a potential treatment for children who have experienced trauma and their families. Future research should incorporate corroborative sources of information, assessment of caregiver and child trauma symptoms, examination of permanency outcomes, and consider standardization of PCIT modifications for child trauma to determine treatment in this population of children.

Self-harm remains a major health issue, particularly for adolescents. This qualitative study explored the reflections of adults who had self-harmed during adolescence. Foci included reasons for commencing and ceasing self-harm, as well as the perceived meaning of the self-harm and advice they would provide to adolescents currently engaging in self-harm. Participants included 185 adults aged 18 to 61¿years, who had self-harmed at least once in adolescence. Participants responded to four qualitative questions that were part of a larger survey. Participants' responses were analyzed using either directed or conventional content analysis. Participants reported ambivalence about their self-harm with coexisting feelings of shame along with a recognition of the functions served by the behavior. The most frequently reported reasons for cessation included changes in personal relationships, frustration with shame, and receiving professional treatment. Most participants encouraged adolescents currently self-harming to seek help and to develop alternative coping mechanisms, although harm minimization also emerged as a theme. These findings are compared to international findings on reasons for initiation and cessation of self-harm as well as the advice for others. These insights may guide clinicians' understanding of motivations for adolescent self-harm and effective management of this behavior.

Enhanced Cognitive Behavioral Therapy (CBT-E) is an evidence-based treatment for bulimia nervosa (BN), which can be delivered individually or in a group format. This case study describes a young adult female's progress through a CBT-E group program at an Australian community outpatient eating disorder service. She completed 20 sessions over 10 weeks. The client was administered measures for eating disorder symptoms, depression, anxiety, stress, stage of change, and clinical impairment at pre- and posttreatment. She improved on global eating disorder symptoms, food restriction, eating concern, and her stage of change. Her weight and shape concerns remained unchanged. Her levels of depression, anxiety, and stress significantly increased after treatment, highlighting the need for concurrent treatment for these comorbidities. These results support the developing literature on the efficacy of CBT-E for BN and describe in detail the progress of an individual, including their progress and challenges within a group intervention.

Background Bipolar disorder (BD) phenomenology in children and adolescents remains contentious. The study investigated Australian children and adolescents with bipolar I disorder (BD-I), bipolar II disorder (BD-II), or BD not otherwise specified (BD-NOS). Methods Index episode demographics, symptomatology, functioning and diagnostic data were compared for 88 participants (63 female) aged 8-18 years (M=14.8, SD=2.5) meeting DSM-IV-TR criteria for BD-I (n=24), BD-II (n=13) or BD-NOS (n=51). Results BD-I had higher rates of previous episodes, psychotropic medication (compared to BD-II but not BD-NOS), rates of inpatient admissions (compared to BD-NOS), and number of inpatient admissions (compared to BD-II). BD-II had lower rates of lifetime depression and anxiety disorders, higher frequency of hypomania, shorter duration of illness, and fewer previous episodes. BD-NOS had younger age of onset, chronic course, irritability and mixed presentation. All BD subtypes had high rates of self-harm (69.3%), suicidal ideation (73.9%), suicide attempts (36.4%), psychiatric admission (55.7%), and psychosis (36.4%). Limitations There were relatively small numbers of BD-I and BD-II. Diagnoses were based on retrospective recall. Conclusions All BD subtypes had high levels of acuity and clinical risk. In accord with previous results, BD-I and BD-II participants' phenomenology was consistent with classical descriptions of these subtypes. BD-NOS participants were younger, with less euphoric mania but otherwise phenomenologically on a continuum with BD-I, suggesting that child and adolescent BD-NOS may be an early and less differentiated phase of illness of BD-I or BD-II and hence a target for early intervention.

Background: While self-talk has been argued to play a crucial role in the development and maintenance of eating disorders (EDs), it has received limited research attention. This study aimed to explore the relationship of ED self-talk with ED severity and symptomatology.Methods: Analysis of the existing literature, supplemented with a small-scale pilot study, identified 24 distinct categories of ED self-talk. The main study involved the completion of on-line questionnaires by 172 women aged 18-49, recruited through clinical services, ED websites, and the general population. Participants were assigned to clinical (n = 83) and non-clinical (n = 89) samples, using the Eating Disorder Examination Questionnaire to screen for ED psychopathology.Results: Substantial differences in the levels of ED self-talk were found between the clinical and non-clinical populations. Principal components analysis, conducted within the clinical sample, revealed ED self-talk to have a two-component structure. Self-talk reflecting an 'abusive relationship' between the sufferer and the ED strongly predicted overall severity and several aspects of symptomatology. 'Ascetic attitudes' towards thinness were linked with compulsive exercising and lower BMIs but not with overall severity.Conclusions: Close examination of the 'abusive relationship' component suggests a need to loosen the connection between negative appraisals of the abused self and the abusive voice of the ED so that the former can fulfil their potential as a force for change. Further, in seeking to counter the impact of the ED voice, it is suggested that the seducer and abuser roles require primary clinical focus. © 2014 Scott et al.; licensee BioMed Central Ltd.

Psychoform dissociation has been researched more than somatoform dissociation. The Somatoform Dissociation Questionnaire (SDQ-20), a commonly used adult measure of somatoform dissociation, is increasingly being used with adolescents internationally. We compared psychoform and somatoform dissociation in a mixed clinical adolescent sample. A total of 71 adolescents (12-18 years old) attending Australian community mental health and counseling services completed the SDQ-20 and the Adolescent Dissociative Experiences Scale, a commonly used measure of adolescent psychoform dissociation. The participants' treating clinicians provided participants' demographic details and mental health diagnoses. We found that 41% of participants reported high levels of psychoform dissociation and 21% reported high levels of somatoform dissociation. Both dissociation types were positively correlated. Neither was significantly related to participants' age, gender, or mental health diagnoses. Participants with more than 1 Axis I mental health diagnosis had higher levels of somatoform dissociation than participants with only 1 or no Axis I mental health diagnosis. This study is the first to examine somatoform dissociation in Australian adolescents and enables initial international comparisons. © 2014 Copyright Taylor and Francis Group, LLC.

Lactic acid accumulation in the caecum and colon resulting from the fermentation of carbohydrates can lead to deleterious effects in ruminant and monogastric animals, including humans. In the present study, we examined the behavioural effects of two types of commonly consumed foods: soluble and fermentable carbohydrates (FCs). Thirty-six male Wistar rats were fed either a commercial rat and mouse chow, a soluble carbohydrate (SC)-based diet or an FC-based diet. Social interaction, anxiety, aggression and locomotor activity were examined by employing a social interaction test and a light/dark emergence test, while physical parameters of hindgut fermentation were examined after sacrifice, either 3 or 21 h after feeding. Results showed that anxiety (spending less time in the light compartment during the light/dark emergence test) and aggression (increased fighting during the social interaction test) were increased following raised concentrations of fermentation end products, such as lactic acid and volatile fatty acids (VFAs) in the caecum of rats. These associations occurred regardless of dopamine and 5-HT concentrations in the prefrontal cortex (PFC) and provide evidence supporting a general effect of FCs on behaviour. Possible mechanisms of action along with similarities between a rat and human model of acidosis are discussed. © 2004 Elsevier Inc. All rights reserved.

Background: It is important that acne sufferers seek medical treatment to alleviate physical and possible psychological effects as early as possible. Treatment seeking behaviour amongst acne sufferers, however, is poorly understood. Objectives: To examine which type of personality variables can predict those who will seek medical treatment. To also examine what type of help seeking is associated with better acne related quality of life. Methods: Participants were 165 female students from an Australian University (82.5% response rate) aged between 17 and 28 years. All participants had their acne objectively rated as well as provided their own subjective rating. The General Health Questionnaire (GHQ-28), Acne Related Quality of Life Questionnaire (Acne QoL), The Multidimensional Perfectionism Scale (MPS) and The Dysmorphic Concerns Questionnaire (DCQ) were used to assess participants' general psychopathology, acne related quality of life, type and level of perfectionism and dysmorphic concerns, respectively. Results: Binomial logistic regression analysis revealed that a greater level of objective rated acne severity was associated with seeking treatment from non-medical help (p < 0.05). ANOVAs revealed (p < 0.01) that those participants seeking treatment from nonmedical professionals had less psychopathology, greater acne severity and a high level of socially prescribed perfectionism and dysmorphic concerns. Furthermore, ANOVA revealed that those participants who were currently seeking help from a medical professional had a greater acne quality of life (p < 0.01). Conclusions: Those young women experiencing more severe acne severity seek help from non-physicians. Less distress due to acne is associated with seeking medical help.

This study investigated the relationship between perfectionism and two aspects of appearance worry: acne-related concerns and dysmorphic concerns. One-hundred and sixty five female university students completed measures of three facets of perfectionism: self-oriented, other-oriented and socially prescribed [Hewitt, P. L., & Flett, G. L. (1991a). Perfectionism in the self and social contexts: conceptualization. assessment and association with psychopathology. Journal of Personality and Social Psychology, 60, 456-470], general psychopathology (GHQ-28), acne health related quality of life [Girman, C. J., Hartmaier, S., Thiboutot, D., Johnson, J., Barter, B., DeMunro-Mercon, & Waldstreicher, J. (1996). Evaluating health-related quality of life in patients with facial acne: development of a self-administered questionnaire for clinical trials. Quality of Life Research, 5, 481-490] and dysmorphic concerns [Oostuizen, P., Lambert, T., & Castle, D.J. (1998). Dysmorphic concern: prevalence and associations with clinical variables. Australian and New Zealand Journal of Psychiatry, 32, 129-132]. Multiple regression analyses showed that, after controlling for general psychopathology, a high level of socially prescribed perfectionism was associated with a greater tendency to be concerned about acne in particular and appearance in general. © 2002 Elsevier Science Ltd. All rights reserved.