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How World War One Helped Us To Understand Posttraumatic Stress Disorder (PTSD).

world war one and PTSD

A vast number of troops were psychologically traumatized by their horrific experiences of trench warfare in World War One.

So-Called ‘War Neurosis’ :

In the British Army alone, 80,000 individuals were treated for such trauma (at the time it was – somewhat disparagingly – referred to as ‘war neurosis’) during the conflict and, additionally, 200,000 received pensions after the war was over for war-related ‘nerves’ (Young, 1995).

So-Called ‘Shell Shock’ :

Due to lack of knowledge about the psychological effects of trauma at the time, and the prevailing ‘stiff upper lip’ type culture, those in authority became worried that these traumatized individuals would make a large proportion of the Army appear ‘weak’ and ‘cowardly.’ This worry, coupled with the predominant medical model interpretation of illness at the time, led to these soldiers’ traumatized condition being referred to as ‘shell shock’.

According to the (incorrect) theory of ‘shell shock’, the soldiers’ traumatized state could be explained by concussion to the head, caused by exploding shells, adversely affecting the brain’s blood vessels. (In this way, the authorities could explain away the troops’ condition as having a physical cause, thus dispelling any notion that it had anything to do with ‘moral weakness’ or ‘cowardice’.)

world war one PTSD

However, it soon became apparent that a significant number of soldiers who were suffering from ‘war neurosis’ / ‘shell shock’ had NOT been exposed to exploding shells, nor had they been physically wounded ; therefore, another cause needed to be found.  In 1918, the psychiatrist, Rivers, who served in the Royal Army Medical Corps, proposed such a cause :

Rivers’ (1918) Explanation Of ‘War Neurosis’ – Overwhelming Fear Of Death.

Rivers’ explanation for the cause of ‘war neurosis’ was that it was due to the witnessing of the terrible horrors on the Western Front and an overwhelming fear of death – such intense fear, said Rivers, induced in the soldiers a sense of terror which they could not suppress (due to the instinct of self-preservation) and led to symptoms that were an involuntary response to such terror.

Rivers also stated that his hypothesis was supported by the fact that prisoners of war and the seriously wounded (who were, therefore, no longer able to fight) had a low incidence of ‘war neurosis’; he attributed this to the fact that their lives were no longer in danger.

Rivers’ interpretation of the causes of ‘war neurosis’ significantly helped people to understand that it was NOT a form of cowardice or moral weakness, but, instead, a disturbance to the instinct of self-preservation.

Conclusion :

River’s theory, based on his study of soldiers who fought in World War One, can be seen as a very significant step towards our modern-day, more enlightened and compassionate view of individuals suffering from posttraumatic stress disorder from which those diagnosed with ‘war neurosis’ or ‘shell shock’ in World War One were, in fact, suffering.

Tragically, this more enlightened view came too late for many.

306 British and Commonwealth Soldiers Were Shot For ‘Cowardice’ In World War One.



Resource :

childhood trauma and cptsd

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David Hosier BSc Hons; MSc; PGDE(FAHE).

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What Are The Effects Of Trauma On Young Children (0-6 Years)?


The possible effects of childhood trauma on children under the age of six years are extensive and can be divided into three main categories. These three categories are as follows :
  • COGNITIVE EFFECTS (i.e. effects on thinking and conscious mental processes)
  • PHYSIOLOGICAL EFFECTS (i.e. effects on physical health and biological processes)

Below, I list the possible effects of being exposed to prolonged and significant trauma on young children :








Regressive behavior

Extreme temper tantrums

Fear of adults connected to the traumatic experiences

Fear of separation from the parent / primary caregiver (see my article about separation anxiety)




Withdrawn behavior

Highly sensitive ‘startle response’

Prone to excessive screaming and crying


Memory impairment

Impairment of verbal skills


Sleep problems


Reduced appetite

Low weight

Problems with digestive system


What Are The Effects Of Trauma On Young Children?



Regressive behavior

Extreme temper tantrums

Fear of adults connected to the traumatic experiences

Fear of separation from the parent / primary caregiver (see my article about separation anxiety)




Withdrawn behavior

Highly sensitive ‘startle response’

Low self-confidence

Anxiety / Fearfulness

Avoidant behavior

Difficulty placing trust in others

Difficulties making friends

Self-blame in relation to traumatic experiences (e.g. blaming self for parental separation or believing physical abuse ‘deserved’ for being a bad person‘)

Acting out

Imitating the abusive behavior suffered (e.g. by bullying school peers)

Reenacting traumatic event

Verbal aggression


Memory impairment

Impairment of verbal skills

Problems with concentration and associated problems with learning


Sleep problems


Psychosomatic complaints such as headaches and stomach aches

Regressive behavior  (i.e. behaving in ways associated with an earlier period of development such as stress-related bed-wetting)


Read my associated article :

Signs An Adult Was Abused As A Child – click here.


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Body Dysmorphic Disorder : Its Link To Childhood Trauma

childhood trauma and body dysmorphic disorder

Studies (see below) suggest that those of us who suffered traumatic childhoods are significantly more likely to develop body dysmorphic disorder (BDD) than those who were fortunate enough to have experienced relatively stable and nurturing childhoods. I briefly summarize two of these studies below :

Study One :

A study conducted by Didie et al., 2006 involving 75 participants who had been given a diagnosis of body dysmorphic disorder (with an average age of 35 years) found that 78.7 % reported having experienced maltreatment during childhood ; and, more specifically, of these 78.7 % :

  • 68 % reported emotional neglect
  • 56 % reported emotional abuse
  • 34.7 % reported physical abuse
  • 33.3 % reported physical neglect
  • 28 % reported sexual abuse

(NOTE : the above figures add up to more than 100 % because some participants in the study had suffered from more than one type of childhood trauma.)

Study Two :

A study conducted by Semiz et al., 2007 compared 70 in-patients suffering from borderline personality disorder (BPD) with 70 matched, healthy controls.

Results showed that 54.3 % of those suffering from borderline personality disorder (BPD) (a disorder which itself is closely linked to childhood trauma) were also suffering from body dysmorphic disorder (BDD).

Further statistical analysis revealed that these individuals (i.e. who were suffering from both BPD and BDD) had experienced significantly more trauma in childhood than those without BDD and that traumatic experiences during childhood were a significant predictor of the comorbid diagnosis of BDD in BPD sufferers.

body dysmorphia disorder

What Is Body Dysmorphic Disorder (BDD) ?

BDD is the preoccupation with a specific ‘blemish’ of physical appearance in an individual who is, in fact, of normal appearance. It mostly occurs during adolescence and affects males and females equally.

As we saw above, it is linked to childhood trauma but can also be influenced by parental attitudes to appearance, the prevailing culture (e.g. general high value placed upon youth and beauty, especially in the media) and low self-esteem.

How Does Body Dysmorphic Disorder Make The Individual Suffering From It Feel?

Typically, the individual suffering from BDD perceives him/herself as ‘ugly’ and is obsessively concerned about some imagined physical ‘flaw.’ In order to be diagnosed with BDD, the individual’s concern with his/her appearance must be severe enough to negatively impact upon his/her daily functioning (including avoidance of social interaction due to self-consciousness in connection with the imagined physical ‘flaw.’

Can A Person Diagnosed As Having Body Dysmorphic Disorder Actually Have A Physical Defect?

Yes, but the individual exaggerates its significance in relation to his/her appearance.

Considerations Relating To Diagnosis :

For BDD to be diagnosed it must exist ‘in its own right’ and not be explained as a symptom of another disorder such as anorexia nervosa, social phobia, avoidant personality disorder, delusional disorder (somatic type), other somatization disorders or normal concerns about appearance.

Cognitive-Behavioral Therapy :

One of the main treatments for BDD is cognitive-behavioral therapy aimed at psychosocial functioning and body image.





David Hosier BSc Hons; MSc; PGDE(FAHE).


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Family Therapy And Adolescent BPD Sufferers

family therapy and adolescent BPD

Borderline Personality Disorder In Adolescents :

I have written elsewhere about why some mental health clinicians are reluctant to diagnose borderline personality disorder (BPD) in adolescents. However, when an adolescent is believed to be suffering from this extremely serious psychiatric condition, family therapy can be of potentially crucial importance.

What Is Family Therapy?

Quite simply, family therapy is a form of counseling that treats more than one member of the family in the same therapy sessions; this is predicated on the notion that the behavior of a specific individual within the family is intimately connected to how other family members interact with him/her. (Two related posts that I have previously published about this phenomenon are : ‘Did Your Dysfunctional Family Make You Identified Patient?’ and ‘The Dysfunctional Family’s Scapegoat’

How Does Family Therapy Help?

The aim of family therapy is to educate all its relevant members about :

  • how family dynamics influence and maintain the behaviors of individuals within it
  • communication within the family
  • how adaptive (desirable) behaviors can be reinforced
  • ways in which the family can collaborate (work together) to solve problems within the family

It is often the case that, prior to such therapeutic intervention, the adolescent, due to his/her acting out‘, was seen (by the other members of the family) as the source of the family problems but, as the therapy sessions unfold, it becomes apparent that, in fact, the collective dysfunction of the whole family is at the root of the issue.

It is also not infrequently the case that through the process of family therapy it is revealed that other members of the family, too, have serious psychological conditions which need addressing (e.g. many adolescent sufferers of BPD will have a parent with the same condition or a similar personality disorder such as narcissistic personality disorder). When this found to be the case, such parents can also be helped (assuming they are willing) by the therapist which can, in turn, help them to relate to their family in a healthier way, hopefully culminating in a less dysfunctional relationship between them and their adolescent child.

Another very important aspect of family therapy is the therapist’s close observation of non-verbal communication between the parents and the adolescent (e.g. body language, facial expressions, intonation etc). By carrying out such observations, the therapist can point out to the family when such non-verbal signals may be less than helpful.

Family therapy can also include group training in parenting skills which can provide parents with :

  • emotional support
  • advice on how to create less dysfunctional family environments
  • how to set their children good examples / be good role models
  • how to reinforce their child’s positive behaviors


Enhance Parenting Skills – click here for further information.

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David Hosier BSc Hons; MSc; PGDE(FAHE).

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Arrested Psychological Development and Age Regression

arrested psychological development

Arrested Psychological Development

Traumatic life events can cause the child to become ‘stuck’ at a particular level of psychological development for an extended period of time – s/he may, therefore, often seem immature as development was frozen at an earlier stage.

For example, an eleven year old child who was abandoned by his/her primary carer at age four may throw tantrums similar to those one might expect of a four year old when left with an unfamiliar baby-sitter. In other words, s/he may regress behaviorally to the developmental stage at which s/he became frozen. Such regressive behavior is a temporary reaction to real or perceived trauma.

age regression

Severe trauma can result in commensurately severe developmental delays. For example, a ten year old child who has experienced severe trauma may not yet have developed a conscience (even though a conscience usually develops around the of ages six to eight). This does NOT mean that the child is ‘bad’, it is just that s/he has not yet reached the relevant developmental stage. This can be rectified by the child identifying with a parent or carer and internalizing that identification.

It is vital to point out that if a child has never had the opportunity to identify with a safe and rational adult and has not, therefore, been able to internalize adult values, we cannot expect that child to have developed a conscience.

Indeed, if there has been little or no justice or predictability in the child’s life, and s/he is ill-treated for no discernible reason by adults in a position of trust, developing a conscience may not even have been in the child’s best interests. In extreme circumstances, for example, it may have been necessary for the child to lie, steal and cheat purely in order to survive; once s/he has learned such behaviors are necessary to his/her very survival, these same behaviors become extremely difficult to unlearn.

Below I list some of the main factors that may lead to arrested development.



– separation from the primary care-giver

– all forms of abuse

– foster care

– adoption

– neglect

– parental alcohol/drug misuse


One of the main traumas a child can suffer is a problematic early relationship with the primary care- giver; these problems can include the primary care-giver having a mental illness, abusing alcohol/drugs, or otherwise abusing or abandoning the child. In such cases, attachment disorder is likely to occur in the child – this disorder can impair or even cripple a child’s ability to trust and bond with others. In such cases, it is the child’s ability to attach to other human beings which is impaired by developmental delays.

Since such a child’s development has essentially become frozen in relation to his/her ability to bond with others, s/he will not ‘grow out’ of the problem behaviors associated with attachment disorder without a great deal of emotional ‘repair work.’



the main examples of these are listed below :

– little eye contact with parents

– lack of affection with parents

– telling extremely obvious lies

– stealing

– delays in learning

– poor relationships with peers

– cruelty to animals

– lack of conscience

– preoccupation with fire

– very little impulse control /hyperactivity

– abnormal speech patterns

– abnormal eating patterns

– inappropriate demanding behavior

inappropriate clingy behavior

David Hosier BSc Hons; MSc; PGDE(FAHE).

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3 Core Unmet Needs Underlying Emotional Pain

3 core unmet needs underlying emotional pain

Core Unmet Needs

Many of us who have suffered significant childhood trauma experience intense emotional pain as adults; such pain my present itself as severe anxiety, depression or anger, for example.

According to Timulak et al., 2012, three core unmet needs underlie such emotional suffering; these are :

  • unmet needs for safety and security
  • unmet needs for love and meaningful connection to others
  • unmet needs for acceptance, validation and recognition by others 

Sadly, such unmet needs frequently stem from growing up in a  dysfunctional family. (To read my previously published article : Dysfunctional Families : Types And Effects, click here).


Core Feelings Associated With Core Unmet Needs :

Timulak elaborates on the above by stating that these three core unmet needs are associated with corresponding core feelings as shown below :

  • unmet needs for safety and security are associated with feelings of fear and insecurity
  • unmet needs for love and meaningful connection to others are associated with feelings of sadness and loneliness
  • unmet needs for acceptance, validation and recognition by others are associated with feelings of shame and worthlessness

emotional pain

Secondary Distress And Obscured Core Unmet Needs And Feelings :

Timulak also alerts us to the fact that when individuals suffering from emotional pain present themselves to therapists, their core unmet needs and corresponding core feelings may be obscured and concealed because these are overlayed by surface, ‘secondary distress’ (i.e. distressing, surface feelings that have their roots in the underlying core unmet needs and associated core feelings).

Examples of such ‘secondary distress’ / ‘surface feelings’, Timulak states, include :

  • feelings of helplessness
  • feelings of hopelessness
  • feelings of depression
  • feelings of anger
  • feelings of anxiety
  • somatisation (e.g. insomnia, physical tension, exhaustion, teeth grinding, stomach pains, chest pains, loss of appetite, headaches, dizziness etc.)

Conclusion :

It is important for patients and therapists to consider the possible core issues that may lie beneath adverse surface feelings (secondary distress). Often, these core issues will have their roots in childhood trauma.

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David Hosier BSc Hons; MSc; PGDE(FAHE).


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Childhood Trauma Linked To Psychologically Damaging Time Perspective

childhood trauma and temporal theory

Based upon Zimbardo’s and Boyd’s (2008) Time Perspective Theory, a therapeutic technique known as Time Perspective Therapy (Zimbardo, Sword and Sword) was developed.

Time Perspective Therapy is predicated upon Zimbardo’s idea that the way in which we view and relate to the past, the present and the future strongly influences how we think, feel, behave and perceive events that are going on around us.  According to this theory, each individual may be represented, to a greater or lesser degree) by any of the following types.


time perspective therapy

Let’s look at each of these in turn :

  1. THE ‘PAST-NEGATIVE’ TYPE : this type of individual is preoccupied by the negative aspects of his/her personal past experiences
  2. THE ‘PAST-POSITIVE’ TYPE : this type of individual feels nostalgic about the past and might describe it with phrases like ‘the good old days
  3. THE ‘PRESENT-HEDONISTIC’ TYPE : this type of individual seeks immediate pleasure and has an impaired ability to delay gratification
  4. THE ‘PRESENT-FATALISTIC’ TYPE : this type of individual has a tendency to feel that making plans and decisions ‘now’ (i.e. in the present) is futile as the future is predetermined and beyond their control – in this way they may develop a kind of ‘whatever will be will be…‘ attitude.
  5. THE ‘FUTURE-ORIENTED’ TYPE : this type of person adopts an optimistic view of the future, is able to delay gratification for the sake of the longer-term good, makes confident plans for it, is ambitious and sets him/herself challenging goals.
  6. THE ‘FUTURE-TRANSCENDENT’ TYPE : this type of individual focuses on his/her belief that an ‘after-life’ exists.

The degree to which individuals can be represented by the above types can be measured by the Zimbardo Time Perspective Inventory (ZTPI).

Childhood Trauma And Time Perspective Type :

Individuals who have suffered severe and protracted childhood trauma and who have, perhaps, as a result, go on to develop conditions such as borderline personality disorder (BPD) or complex posttraumatic stress disorder (complex-PTSD) are prone to :

In terms of Zimbardo’s time perspective theory, therefore, such individuals tend to score highly on the following scales :

  • PAST NEGATIVE TYPE (e.g. obsessively dwelling on one’s past mistakes)
  • PRESENT HEDONISTIC TYPE  (e.g. frequent heavy drinking to ameliorate, in the short-term, mental pain)
  • PRESENT FATALISTIC  TYPE (e.g. feeling powerless to affect future)

It can be seen, then, that scoring highly on the three scales representing the above three types can suggest a poor state of psychological health.

Instead, it is more conducive to good mental health to :

  • make positive use of the past (e.g. remembering good things, learning from past mistakes etc)
  • learn to live more in the present but not in such a hedonistic way that it jeopardizes the future
  • learn to take a more optimistic view of the future and to plan for the future.

Time Perspective Therapy :

TIME PERSPECTIVE THERAPY (developed by Zimbardo, Sword and Sword), based upon cognitive behavioral therapy (CBT),  can help us develop healthier / more balanced time perspectives and this, in turn, can improve many areas of our lives including our relationships, our social lives and our careers

David Hosier BSc Hons; MSc; PGDE(FAHE).






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Dialectical Behavior Therapy (DBT) May Beneficially Change Brain Functioning

BPD, borderline personality disorder and reality testing

One of the most effective therapies for those suffering from borderline personality disorder (BPD) (as we have seen, BPD is closely linked to childhood trauma) is called dialectical behavior therapy (DBT).

What Is DBT?

DBT is based on the person’s need to change their behavior and their need to be accepted. The therapy was devised by Marsha Lineham, PhD.

What Does DBT Involve?

Typically, DBT involves :

  • individual psychotherapy (usually once per week), starting with changing the individual’s most concerning behaviors, then changing behaviors hindering therapy (e.g. missing appointments), and finally with ‘quality of life issues.’
  • skills training (within a group-therapy context). The four main skills that are taught are :

DBT changes brain

Research Suggests That DBT Can Beneficially Alter Brain Functioning :


Research conducted by Schnell and Herpertz (2006) involved looking at the effects of DBT (specifically, training in emotional regualation, see number 4, above) on female patients’ brain functioning (this was done by taking magnetic resonance images, or MRIs, a type of brain scan) after they had spent 12 weeks undergoing an inpatient treatment program.


The female, BPD patients who improved following the DBT / emotional regulation skills 12 week inpatient program were found (by analysis of their MRIs) to show:


Such a reduction of activity in these brain regions is associated with an increase in the individual’s abilty to prevent themselves from overreacting to stressful situations (overreacting to stressful situations, also known as impaired emotional regulation, is one of the hallmark features of BPD).

Conclusion :

The above can be interpreted as further evidence for the effectiveness of DBT for treating patients suffering from borderline personality disorder (BPD).








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David Hosier BSc Hons; MSc; PGDE(FAHE).

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Reality Testing And Borderline Personality Disorder (BPD)

BPD, borderline personality disorder and reality testing

What Is Meant By ‘Reality Testing’?

Reality testing, a concept originally introduced by Sigmund Freud (1856-1939), can be described as the capacity of an individual perceive the external events going on around him/her objectively, accurately and based on conventional interpretation rather than in a way distorted by internal mental factors. The Medical Dictionary defines it as : ‘The objective evaluation of the external world and differentiation between it and the ego or self.’

Impaired Reality Testing :

Reality testing is most obviously impaired in individuals, such as some schizophrenics, who are in the grip of florid psychotic symptoms such as hallucinations (e.g. ‘hearing voices’ or ‘seeing things that aren’t there’) and delusions (e.g. believing one’s thoughts are being broadcast / audible to others).

bpd reality testing, borderline personality disorder, childhood trauma

Borderline Personality Disorder, Brief Psychotic Episodes And Reality Testing :

Individuals with borderline personality disorder (BPD) generally do not have such dramatically impaired reality testing (although they can suffer from brief psychotic episodes when experiencing extreme stress). However, their reality testing can fluctuate to a significantly greater degree than is found in relatively ‘psychologically healthy’ individuals.

For example, particularly when experiencing significant levels of stress, individuals suffering from BPD may lapse into a paranoid style of thinking or experience an impaired ability to self-reflect in a realistic fashion.

Problems That May Arise As A Result Of Impaired Reality Testing :

An impaired ability to reality test can lead to various problems, including :

Improving Impaired Reality Testing :

Studies suggest that cognitive behavioral therapy (CBT) can be an effective means of improving a person’s ability to reality test.

eBook :

BPD eBook

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David Hosier BSc Hons; MSc; PGDE(FAHE)



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Splitting, Denial And Flooding : The Inter-relationship

childhood trauma, splitting, denial, flooding


This is an unconscious defense mechanism that involves us seeing things in extreme and exaggerated ways, either as ALL GOOD or ALL BAD ; this unconscious strategy is often seen in people suffering from borderline personality disorder (BPD). 

For example, those suffering from this disorder frequently vacillate between, at times, perceiving a friend or partner in an idealized way and then, at other times, often as a result of perceived rejection (which may frequently be a false perception), ‘demonizing’ this same individual.


However, in order for ‘splitting’ to take place, ‘denial’ must take place first. This is because, in reality, in order to see things (and, especially people) as ‘all good’ or ‘all bad’, or, to put it another way, in ‘black or white’, the grey areas must be kept out of conscious awareness – this process, which also occurs on an unconscious level, is known as ‘denial’ and causes our view of things to be skewed and distorted. In essence, denial prevents salient information about whatever (or whoever) it is that we are making a judgment about from permeating our consciousness ; this, in turn, prevents us from considering or taking into account factors that contradict our (unknown to us) biased view, often leading to dysfunctional decisions and reactions.

childhood trauma, splitting, denial and flooding

How ‘Splitting’ And ‘Denial’ Can Lead To ‘Flooding’ :

Paradoxically, although ‘splitting’ and ‘denial’ are, technically speaking, defense mechanisms, their combined effect can be to cause FLOODING, I explain what is meant by ‘flooding’, and how this happens, below :

When ‘splitting’ and ‘denial’ operate together our emotional experience is intensified and and this reaction, in turn, can trigger related, intense memories. This can lead to a sense of our consciousness being ‘flooded’ with copious intense emotions and recollections.

Research conducted by the psychologist Siegel suggests that this overwhelming process of splitting/denial/flooding can be triggered in less than half a minute ; in effect then, it can be like a lightning fast ‘hijack’ of our mental faculties.

If our views are skewed negatively, this can lead to irrational verbal outbursts and behaviors which we are likely to later regret. On the other hand, if they are skewed positively (e.g. idealizing an abusive partner) we are prone to making poor decisions (e.g. remaining in a relationship with an abusive partner).

Link :

Splitting : Effects Of The BPD Parent Seeing The Child In Terms Of ‘All Good’ Or ‘All Bad.’

eBook :

BPD eBook

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David Hosier BSc Hons; MSc; PGDE(FAHE).

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