Multi-type maltreatment : relationships between familial characteristics, maltreatment and adjustment of children and adults

This thesis examines the nature, extent and impact of multiple forms of maltreatment (multi-type maltreatment) from within a developmental victimological framework. The interrelationships between sexual abuse, physical abuse, psychological maltreatment, neglect, and witnessing family violence are assessed. The role of family variables in predicting maltreatment and the relative contribution of child maltreatment and family variables to adjustment are evaluated. Risk factors for multi-type maltreatment, and the relationship between multi-type maltreatment and adjustment are explored. The major theories of child development are reviewed. As well as exploring the relevance of developmental theories to understanding the impact of child maltreatment, factors influencing the emergence of child psychopathology are reviewed from a developmental psychopathology perspective. Ecological and developmental perspectives on how child maltreatment translates into the behavioural and emotional adjustment problems of children are integrated in the Child Maltreatment: Risk and Protection Model. After exploring some of the relevant conceptual issues, the literature on the prevalence and impact of each maltreatment type is reviewed, and the literature on multi-type maltreatment critiqued. Methodological and ethical concerns with the conduct of research in the field of child maltreatment using direct assessment of children led to the need for an instrument to assess parent perceptions of each of the types of abuse and neglect, as well as adult retrospective reports. Data are presented from two cross-sectional questionnaire-based studies using the Parent and Adult versions of the Family and Life Experiences Questionnaire which was designed to assess perceptions of children's experiences of sexual abuse, physical abuse, psychological maltreatment, neglect and witnessing family violence. Problems with the isolated focus of research on single forms of child maltreatment are addressed by the inclusion of each of these forms of child maltreatment within a single research design. Respondents for both studies were volunteers recruited from counselling agencies, medical, community health, child care and fitness centres and a first year psychology course. Parents (N=50) described their perceptions of primary school children's family characteristics, experiences of maltreatment and adjustment. Children's behavioural adjustment (internalising and externalising), sexual behaviours, emotions, self-esteem, gender identity, family adaptability and cohesion, parental traditionality, parental sexual punitiveness, interparental relationship satisfaction, and demographic characteristics are assessed in the study of Parents' perceptions. A large degree of overlap between the different types of abuse and neglect was found, with a high proportion of parents describing children's experiences of multiple forms of child maltreatment. Using both maltreatment and family characteristics to predict internalising behaviour problems, neglect and family cohesion were the only unique predictors. Family adaptability and cohesion were the only unique predictors of externalising behaviour problems. Physical and sexual abuse were not predicted from family characteristics; neglect was predicted, but no variables provided unique prediction. Unique predictors of psychological maltreatment were family cohesion, parental sexual punitiveness and divorce. Divorce was the only variable with significant unique prediction of the child witnessing family violence. Family background and family functioning were found to predict some forms of maltreatment, but to also be important factors mediating the adjustment of children, independent of maltreatment. The results are interpreted within an ecological framework, integrating risk factors for maltreatment with experiences of abuse and neglect and subsequent adjustment in childhood. Retrospective reports of adults' (N=175) own childhood family characteristics, experiences of maltreatment, and reports of their current adjustment are also studied. Included with the adult version of the FLEQ were the Trauma Symptom Checklist-40, Rosenberg's Self-esteem Scale, and the Family and Adaptability and Cohesion Evaluation Scale-II. Similar results were found in the in the Adult Study. As hypothesised, adult retrospective reports of the five different types of child maltreatment were found to be highly intercorrelated. Family characteristics predicted maltreatment and adjustment scores and discriminated between single and multi-type maltreatment. Maltreatment scores also predicted adult adjustment. As the number of maltreatment types increased, there was an increase in the number of adjustment problems reported. Alternate hypotheses regarding the possible operation of mediating and moderating processes in the relationships between family characteristics, maltreatment and the adjustment of adults were assessed. Finally, the results of these investigations are discussed and interpreted in the light of extant findings previously reviewed. Data from the two major empirical studies are used to demonstrate the overlap between different child maltreatment categories, and the extent and impact of multi-type maltreatment. The results show that children are vulnerable to more than one type of maltreatment. Individuals who experience a number of different forms of maltreatment had greater adjustment problems than those experiencing only one or two different types of abuse or neglect. Dysfunctional families place children at risk of child maltreatment. Negative family characteristics lead to adjustment problems in children and adults. The type of maltreatment having the most damaging effect on children was neglect, and in the long-term, sexual abuse. A multi-dimensional approach to prevention and intervention needs to be adopted, based on the co-morbidity of maltreatment types, and the likelihood of children experiencing further abuse or neglect of a different type. Dysfunctional family dynamics which place children at risk of multi-type maltreatment, and mediate the effects of maltreatment on adjustment, need to be specifically targeted with support and family intervention strategies. Risk-assessment measures used by Child Protection workers must include adequate knowledge of the inter-relationships between maltreatment types, and the particularly negative impact on adjustment of experiencing many forms of abuse or neglect. Suggestions for future clinical and research work in the area of child maltreatment are developed. The importance of assessing all forms of maltreatment when examining the relationships of maltreatment to adjustment is emphasised. It is recommended that prevention and intervention strategies acknowledge the interrelationships between maltreatment types.

Risk factors for chronic insomnia following hospitalisation

Aim. This paper reports a study whose purpose was to determine whether there is an increase in the incidence of chronic insomnia following hospitalization and, if so, to identify patients at risk.

Background. The consequences of difficulty sleeping in hospital have received scant attention from clinicians or researchers. Implicit in this lack of interest is the assumption that difficulty in sleeping is a transient reaction to hospitalization that will resolve on discharge, an assumption not empirically supported. It has been argued that in susceptible people this type of temporary disruption to sleep can be the catalyst for the development of chronic insomnia.

Method. Established sleep and depression rating instruments were used to monitor the sleep of 57 cardiac and 29 orthopaedic patients after elective surgery (n = 86), recruited through a hospital preadmission clinic.

Results. Preadmission chronic insomnia of 10% was consistent with general population prevalence estimates of 6–12%. Three months after discharge the incidence had almost doubled to 19%. Sixty-one per cent of this variance could be explained by hyperarousal, sleep hygiene issues, and dysfunctional cognitions about sleep. Depression was found to be a salient predictor but not an independent risk factor. Age, sex, and hospital-related data, such as score for difficulty sleeping in hospital, proved to be statistically insignificant.

Conclusions. The results support the role of hyperarousal and dysfunctional sleep attitudes and behaviours as stronger predictors of chronic insomnia than patient demographics or environmental issues. Given that most of the patients were ambivalent about how they slept in hospital, with high satisfaction (71%) in the presence of significant disruption (63%), preadmission sleep education given to these patients prior to admission potentially contributed to the development of more realistic expectations of the quality of in-hospital sleep.

Relationship between childhood abuse and psychosexual adjustment in adult women

Study 1 found that poor attachment relationships, dysfunctional family environments, re-victimisation experiences and poor coping skills contibute towards mental health problems as well as the child abuse experiences. Study 2 implemented a therapy program that demonstrated an improvement in the sexual response of women who experienced childhood sexual assault.

Maternal realms : an exegesis and novel

Combines a novel and exegesis. The fictional autobiography, "The wardrobe drawer", describes a girl's prepubescent experiences in a dysfunctional family. The exegesis explores the process of life writing and renegotiates terms for motherhood and femininity by drawing from feminism, autobiography, queer theory and psychanalytic theory.

Relationship factors in the development and maintenance of ED : implications for treatment effectiveness

Introduction. With the advent of effective medical treatments for erectile dysfunction (ED), there has been a reduced focus in recent years on the role of relationship in the development of this disorder.
Aim. This article examines the contribution of relationship factors to the success or otherwise of different treatment
approaches for ED.
Main Outcome Measures. The results of findings in the literature on the association between relationship factors and the development and maintenance of ED.
Methods. This article reviews and evaluates the literature that relates to the role of relationship factors in the development and maintenance of ED.
Results. The current review demonstrates that relationship dynamics are frequently dysfunctional among men with ED. Research demonstrates that addressing these problems is likely to improve the effectiveness of therapy. However, there have been limited studies conducted in this area; many of these studies are methodologically flawed, and so it is difficult to determine the effectiveness of these interventions.
Conclusions. There needs to be further research on the association between relationship factors and ED. Suggestions for future research that include combined medical and psychological interventions for ED are proposed.

Mirror neuron dysfunction in autism spectrum disorders

Autism spectrum disorders (ASDs) are developmental conditions characterized by deficits in social interaction, verbal and nonverbal communication and obsessive/stereotyped patterns of behaviour. Although there is no reliable neurophysiological marker associated with ASDs, dysfunction of the parieto-frontal mirror neuron system has been suggested as a disturbance linked to the disorder. Mirror neurons (MNs) are visuomotor neurons which discharge both when performing and observing a goal directed action. Research suggests MNs may have a role in imitation, empathy, theory of mind and language. Although the research base is small, evidence from functional MRI, transcranial magnetic stimulation, and an electroencephalographic component called the mu rhythm suggests MNs are dysfunctional in subjects with ASD. These deficits are more pronounced when ASD subjects complete tasks with social relevance, or that are emotional in nature. Promising research has identified that interventions targeting MN related functions such as imitation can improve social functioning in ASDs. Boosting the function of MNs may improve the prognosis of ASDs, and contribute to diagnostic clarity.

State–Chaebol relations in the post-crisis period

This article examines contemporary Korean capitalism via an analysis of state-chaebol relations in the post-crisis period. The Korean state played a prominent role in industrial and financial restructuring after the crisis. Some scholars argue that a 'new' state has emerged in Korea, with the activism during the financial crisis representing only a temporary diversion from the shift towards a 'competition state'. Others claim that the Korean state still seeks to directly shape economic outcomes: some policy instruments have changed, but strategic intent, defined here as the will to directly manage investment flows and shape economic structures, has not. The transition of Korean capitalism from the developmental state system towards neo-liberalism, this article argues, is far from complete. Emphasizing the situated choices of state elites and the challenging political context in which they find themselves, we presume a condition of mutual dependence between the state and chaebols. Given incidences of conflict in the post-crisis context, we argue that the state has not fully reasserted its will over the chaebols. The restructuring of chaebols ('Big Deals') are best understood as symbolic measures intended to garner external support for the Korean state rather than unfettered exercise of strategic intent. At the same time, we go beyond existing accounts of 'state decline' by highlighting the place of economic performance by the chaebols as the preeminent criteria for state support. The state and chaebols remain central to Korean capitalism, even in its current hybrid and somewhat dysfunctional form.

Maternal correlates of preschool child eating behaviours and body mass index : a cross-sectional study

To the authors’ knowledge, this is the first study to evaluate maternal child feeding practices, maternal parenting characteristics and mother-child interactions as cross-sectional predictors of child eating and/or weight within the one sample. Maternal pressure for her child to eat was a significant positive correlate of fussiness and a negative correlate of enjoyment. Maternal parenting warmth was associated negatively with child BMIz, while mother-child dysfunctional interaction was associated positively with child BMIz. Our findings suggest that childhood obesity research may be better informed by evaluating not just what mothers do (feeding practices) but also how they parent (parenting behaviours and interactions with their child). Longitudinal studies are needed to identify causal influences of parenting on preschool child eating and weight.

Development and psychometric properties of the Female Sexual Desire Questionnaire (FSDQ)

Introduction.  Sexual desire is often evaluated as part of a global assessment of female sexual function, which may not comprehensively evaluate the various facets of this experience. There currently exists a need to develop a psychometrically robust desire-specific measure for women.

Aim.  The aim of this study was to develop and validate a desire-specific, self-administered instrument that evaluates the multiple facets of sexual desire and factors influencing this experience for partnered heterosexual women, with or without sexual dysfunction.

Methods.  Preliminary items for inclusion in the Female Sexual Desire Questionnaire (FSDQ) were identified through a literature review and individual interviews with partnered heterosexual women, mostly from Australia. The resulting instrument was completed by a validation sample of 741 women, aged between 18 and 71 years, who were involved in a heterosexual relationship of between 3 months' and 49 years' duration.

Main Outcome Measures.  Exploratory factor analysis was used to refine the FSDQ item content and identify the underlying domain structure. The reliability (internal consistency) and validity (convergent validity) of the FSDQ were also evaluated.

Results.  The final version of the FSDQ consisted of 50 items organized into six domains that characterized the experience of, and factors influencing, sexual desire for heterosexual partnered women: Dyadic Desire, Solitary Desire, Resistance, Positive Relationship, Sexual Self-Image, and Concern. Each domain demonstrated high reliability, as did the overall measure. Evidence of construct validity was ascertained through convergence with the Sexual Desire Inventory and the Hurlbert Index of Sexual Desire. A short-form of the FSDQ, consisting of six items, was also developed.

Conclusions.  The FSDQ is a new reliable and valid multidimensional measure designed specifically for evaluating the facets of, and factors influencing, sexual desire among sexually functional and dysfunctional women who are involved in a heterosexual relationship.

HSP72 preserves muscle function and slows progression of severe muscular dystrophy

Duchenne muscular dystrophy (DMD) is a severe and progressive muscle wasting disorder caused by mutations in the dystrophin gene that result in the absence of the membrane-stabilizing protein dystrophin¹, ², ³. Dystrophin-deficient muscle fibres are fragile and susceptible to an influx of Ca²⁺, which activates inflammatory and muscle degenerative pathways⁴, ⁵, ⁶. At present there is no cure for DMD, and existing therapies are ineffective. Here we show that increasing the expression of intramuscular heat shock protein 72 (Hsp72) preserves muscle strength and ameliorates the dystrophic pathology in two mouse models of muscular dystrophy. Treatment with BGP-15 (a pharmacological inducer of Hsp72 currently in clinical trials for diabetes) improved muscle architecture, strength and contractile function in severely affected diaphragm muscles in mdx dystrophic mice. In dko mice, a phenocopy of DMD that results in severe spinal curvature (kyphosis), muscle weakness and premature death⁷, ⁸, BGP-15 decreased kyphosis, improved the dystrophic pathophysiology in limb and diaphragm muscles and extended lifespan. We found that the sarcoplasmic/endoplasmic reticulum Ca²⁺-ATPase (SERCA, the main protein responsible for the removal of intracellular Ca²⁺) is dysfunctional in severely affected muscles of mdx and dko mice, and that Hsp72 interacts with SERCA to preserve its function under conditions of stress, ultimately contributing to the decreased muscle degeneration seen with Hsp72 upregulation. Treatment with BGP-15 similarly increased SERCA activity in dystrophic skeletal muscles. Our results provide evidence that increasing the expression of Hsp72 in muscle (through the administration of BGP-15) has significant therapeutic potential for DMD and related conditions, either as a self-contained therapy or as an adjuvant with other potential treatments, including gene, cell and pharmacological therapies.

Association between the oxytocin receptor gene and amygdalar volume in healthy adults

Background: Recent studies have suggested that oxytocin affects social cognition and behavior mediated by the oxytocin receptor (OXTR) in amygdala in humans as well as in experimental animals. Genetic studies have revealed a link between the OXTR gene and the susceptibility to autism spectrum disorders (ASD), especially in the social dysfunctional feature of ASD.

Methods: We examined the relationship between amygdala volume measured with manual tracing methodology and seven single nucleotide polymorphisms and one haplotype-block in OXTR, which were previously reported to be associated with ASD, in 208 socially intact Japanese adults with no neuropsychiatric history or current diagnosis.

Results: The rs2254298A allele of OXTR was significantly associated with larger bilateral amygdala volume. The rs2254298A allele effect on amygdala volume varied in proportion to the dose of this allele. The larger the number of rs2254298A alleles an individual had, the larger their amygdala volume. Such an association was not observed with hippocampal volume or with global brain volumes, including whole gray, white matter, and cerebrospinal-fluid space. Furthermore, two three–single nucleotide polymorphism haplotypes, including rs2254298G allele, showed significant associations with the smaller bilateral amygdala volume.

Conclusions: The present results suggest that OXTR might be associated with the susceptibility to ASD, especially in its aspects of social interaction and communication mediated by a modulation of amygdala development, one of the most distributed brain regions with high density of OXTR. Furthermore, amygdala volume measured with magnetic resonance imaging could be a useful intermediate phenotype to uncover the complex link between OXTR and social dysfunction in ASD.

Effect of deep brain stimulation on nucleus accumbens dopamine in a preclinicla model of antidepressant treatment-resistance

Background / Purpose: To determine if clinically effective deep brain stimulation (DBS) of neurosurgical targets for treatment-resistant depression regulates transient mesoaccumbens dopamine release in control and antidepressant-resistant animals (rats).

Main conclusion: In control rats, DBS stimulation of either the nucleus accumbens or infralimbic cortex significantly attenuated transient mesoaccumbens dopamine efflux, with nucleus accumbens DBS inducing a greater attenuation than infralimbic DBS. High frequency DBS of both targets induced long-term depression of transient accumbens dopamine release, lasting > 2hr post DBS.

Conversely, in antidepressant-resistant rats, infralimbic DBS significantly potentiated transient mesoaccumbens dopamine efflux during stimulation, but failed to induce long-lasting changes in neurotransmission. This suggests that a key mechanism of DBS for treatment-resistant depression is the regulation of dysfunctional mesoaccumbens dopamine neurotransmission.

The Pharmaceutical Industry and Access to Medicines in India

Pharmaceutical policy in India as elsewhere is shaped by conflicting economic and social interests and opposing values and priorities. Tensions can be understood as revolving around the contradiction between use value and exchange value in the production of medicinal drugs as commodities, as per Marx’s original analysis. The use value of medicines – if safe and efficacious, of good quality, and prescribed and consumed appropriately – is the prevention, cure or alleviation of ill-health and disease. Health policy is – or should be – aimed at optimising the use value of medicines. For this purpose government agencies administer regulatory oversight of the manufacturing, marketing and distribution of medicines. Drugs made available to patients are expected to meet adequate safety, quality and efficacy standards, but regulation to ensure such standards is subject to controversy in most countries. This is a domain where definition and interpretation of scientific-technological principles and criteria is infused by partiality and bias grounded in social and material interests, as evidenced by recurrent debates about industry ‘capture’ of regulatory agencies, including the world’s most regulator, the US Food and Drug Administration (Angell 2005; Law 2006). In India, a Parliamentary Committee Report in 2012 depicted the Central Drugs Standard Control Organisation (CDSCO) as dysfunctional and influenced inappropriately by the exchange value perspective of manufacturers (Parliamentary Standing Committee on Health and Welfare 2012). The clash between use and exchange value perspectives is starkly illustrated by cases of products known to cause more harm than good, particularly common in poorly regulated markets such as India’s, as shown by Srinivasan & Phadke.

Collaborative care skills training workshops : helping carers cope with eating disorders from the UK to Australia

Purpose

The Collaborative Care Skills Training workshops, developed by Treasure and associates aim to improve the well-being, coping strategies and problem-solving skills of carers of someone with an eating disorder. Evidence has demonstrated the effectiveness of the workshops in the UK where it was developed. The aim of this pilot study was to examine whether conducting the workshops in different contexts by facilitators trained in its delivery could lead to similar impact.
Methods

The workshops were conducted with 15 carers in VIC, Australia and delivered by experienced health professionals trained in its content and delivery. A non-experimental research design with repeated measures was implemented. Quantitative data were collected at pre-and post-intervention and 8 weeks after completion of the workshops.
Results

Participation led to significant reductions in carers’ reported expressed emotion, dysfunctional coping, distress, burden and accommodation and enabling of the eating disorder behaviour, which were maintained at the 8-week follow-up.
Conclusion

Results suggest the workshops are effective in reducing carer distress and burden as well as modifying unhelpful emotional interactional styles when caring for family members with an eating disorder. The content of the workshops and its delivery, once experienced facilitators have received training, are transferable to other contexts.

Rangelands, conflicts, and society in the Upper Mustang Region, Nepal

Rangelands are considered critical ecosystems in the Nepal Himalayas and provide multiple ecosystem services that support local livelihoods. However, these rangelands are under threat from various anthropogenic stresses. This study analyzes an example of conflict over the use of rangeland, involving two villages in the Mustang district of Nepal. This prolonged conflict over the use of rangeland rests on how use rights are defined by the parties, that is, whether they are based on traditional use or property ownership. Traditionally, such conflicts in remote areas were managed under the Mukhiya (village chief) system, but this became dysfunctional after the political change of 1990. The continuing conflict suggests that excessive demand for limited rangelands motivates local villagers to gain absolute control of the resources. In such contexts, external support should focus on enhancing the management and production of forage resources locally, which requires the establishment of local common property institutions to facilitate sustainable rangeland management.