Discovering new memories in psychotherapy--childhood revisited, fantasy, or both?

Phenomenological characteristics of recovered memory in nonclinical individuals

A central hypothesis of recovered memory is that the source of the memory may be misattributed, and the memory of an imagined event may be mistaken as the memory of the perceived event that was not remembered. The judgment of memory source depends upon phenomenological characteristics. Thus, the present study investigated characteristics of recovered memory. To exclude potential confounding effects of traumatic stress and acute mental illness, data on recovered memories of diverse valences in a nonclinical sample were collected. Self-report scales including a measure of memory characteristics were used to evaluate recovered memories and age-matched autobiographical memories that had been continuously remembered. The results showed that recovered memory was of lower clarity and contained less detailed sensory, contextual, and temporal information; additionally, it was associated with fewer thoughts and lower intensity of feelings. Participants also felt less confident regarding the veracity of recovered memory in comparison with continuous memory. In contrast to recovered trauma memory reported by clinical clients, vivid sensory details and intense affect did not characterize recovered memory in nonclinical individuals. The reduction in perceptual and contextual information, as well as cognitive operations, may increase the difficulty of judging the source of recovered memory.

Dissociative disorders in acute psychiatric inpatients in Taiwan

Dissociative disorders have been documented to be common psychiatric disorders which can be detected reliably with standardized diagnostic instruments in North American and European psychiatric inpatients and outpatients (20.6% and 18.4%, respectively). However, there are concerns about their cross-cultural manifestations as an apparently low prevalence rate has been reported in East Asian inpatients and outpatients (1.7% and 4.9%, respectively). It is unknown whether the clinical profile of dissociative disorders in terms of their core symptomatic clusters, associated comorbid disorders, and environmental risk factors that has emerged in western clinical populations can also be found in non-western clinical populations. A standardized structured interview for DSM-IV dissociative disorders, post-traumatic stress disorder, and a history of interpersonal victimization was administered in a sample of Taiwanese acute psychiatric inpatients. Our results showed that 19.5% of our participants met criteria for a DSM-IV dissociative disorder, mostly dissociative disorder not otherwise specified. More importantly, the western clinical profile of dissociative disorders also characterized our patients, including a poly-symptomatic presentation and a history of interpersonal trauma in both childhood and adulthood. Our results lend support to the conclusion that cross-cultural manifestations of dissociative pathology in East Asia are similar to those in North America and Europe.

Recovered memory experience in a nonclinical sample is associated with dissociation rather than with aversive experiences

Different hypotheses exist for the relationship among trauma, dissociation, and recovered memory. According to one view, recovered memory results from dissociation that a survivor adopts as a defense mechanism during a traumatizing event to avoid emotional pain. From this perspective, trauma is a necessary antecedent to relate dissociative symptoms with recovered memory. Another view emphasizes the characteristics of the victim, such as fantasy proneness and atypical cognitive operations. This alternate view holds that trauma is not necessary in relating dissociation to recovered memory. We tested these two hypotheses, measuring recovered memory, dissociative symptoms, childhood interpersonal adversity, and fantasy proneness in a nonclinical sample of college students. Our results showed a significant correlation between recovered memory and dissociative symptoms; the correlation cannot be accounted for by childhood interpersonal adversity, fantasy proneness, or absorption. Recovered events can be negative, neutral, or even positive. Trauma is not necessary in relating recovered memory to dissociative symptoms.

Psychoanalytic treatment of psychological addiction to alcohol (alcohol abuse)

The DSM-V Committee plans to abolish the distinction between Alcohol Abuse and Alcohol Dependence (dsm5.org). The author presents a case report as a proof of concept that this distinction should be retained. The author has asserted that Alcohol Abuse is a purely psychological addiction, while Alcohol Dependence involves capture of the ventral tegmental dopaminergic SEEKING system (Johnson, 2003). In psychological addiction the brain can be assumed to function normally, and ordinary psychoanalytic technique can be followed. For the patient described, transference interpretation was the fundamental key to recovery. Alcoholic drinking functioned to prevent this man from remembering overwhelming childhood events; events that were also lived out in his current relationships. Murders that occurred when he was a child were hidden in a screen memory. The patient had an obsessional style of relating where almost all feeling was left out of his associations. After he stopped drinking compulsively, he continued to work compulsively. The maternal transference had to be enacted and then interpreted in order for overwhelming memories to be allowed into conscious thought. After psychoanalysis, the patient resumed drinking and worked a normal schedule that allowed more fulfilling relationships. He had no further symptoms of distress from drinking over a 9-year followup. This case illustrates that Alcohol Abuse is a purely psychological illness, that it does not have the brain changes typical of Alcohol Dependence. Combining epidemiological, neurobiological, longitudinal, and psychoanalytic observations would allow multiple sources of information to be used in creating diagnostic categories. Losing details of human behavior by relying only on epidemiological studies is likely to cause errors in categorization of disorders. In turn, having faulty categories as the basis of further research is likely to impair identification of specific effective treatments.

Trauma-related dissociative (conversion) disorders in children and adolescents--an overview of assessment tools and treatment principles

A high proportion of patients in child and adolescent psychiatry with significant dissociative symptomatology after early childhood traumatization may go undiagnosed, be wrongly diagnosed and/or inappropriately treated. The diagnostics and treatment of dissociative disorders have been limited by lack of comprehensive, reliable and valid instruments and the ongoing polarization and fierce controversy regarding treatment. However, recent neurobiological findings of neurochemical, functional and structural cerebral consequences of early stressful childhood experiences point out a need for active, early and effective identification and treatment interventions. We present an update on assessment tools available in the Nordic countries, and an overview of different appropriate therapeutic intervention models for children and adolescents. A systematic overview of studies of dissociation in children and adolescent published over the last decade disclosed a total of 1019 references. The 465 papers describing aspects of assessment tools and/or treatment were studied in detail. Reliable and valid screening questionnaires and diagnostic interviews for children and adolescents now allow for effective early identification of dissociative disorders. A combination of individual psychotherapy, pharmacotherapy and family therapy are often required to handle dissociative disorders in children and adolescents. Cognitive-behavioural therapy, hypnotherapy, Eye-Movement Desensitization-Reprocessing (EMDR), psychodynamic therapy and an integrated approach are the main described psychotherapeutic approaches, but treatment of dissociation in children and adolescent does not require allegiance to any one particular treatment model. However, achievement of physical safety by providing a safe environment is a primary goal that supersedes any other therapeutic work. Assessments tools are now available, and appropriate therapeutic intervention models may hopefully contribute to reduce the risk of wrong diagnoses and inappropriate treatment of dissociative symptomatology in children and adolescents. However, controlled clinical trials of the various interventions and longitudinal outcome studies are needed.

Australian and New Zealand clinical practice guidelines for the management of adult deliberate self-harm

BACKGROUND

The Royal Australian and New Zealand College of Psychiatrists is co-ordinating the development of clinical practice guidelines (CPGs) in psychiatry, funded under the National Mental Health Strategy (Australia) and the New Zealand Health Funding Authority.

METHOD

For these guidelines, the CPG Team for Deliberate Self-harm reviewed the treatment outcome literature (including meta-analyses) and consulted with practitioners and patients.

TREATMENT RECOMMENDATIONS

(i) Organization of general hospital services to provide: emergency department admission; a safe environment; integrated medical and psychiatric management; risk assessment; identification of psychiatric morbidity, and adequate follow-up. (ii) Detection and treatment of any psychiatric disorder. (iii) Dialectical behaviour therapy, psychoanalytically orientated partial hospitalization or home-based interpersonal therapy (for certain patients) to reduce repetition of deliberate self-harm (DSH).

CONCLUSION

Deliberate self-harm is common and is costly in terms of both individual distress and service provision. General hospitals are often the first point of clinical contact, but may not be appropriately organized to care for these patients. Evidence for the effectiveness of psychological treatments is based on single RCTs without replication. The three recommended psychological treatments are not widely available in Australia and New Zealand, and the interventions that are, such as cognitive behaviour therapy, problem solving and 'green cards' (an agreement guaranteeing access to services), do not reduce repetition of DSH. The effect of follow-up in psychiatric hospitals or in the community is poorly understood. We need to develop and evaluate interventions that will reduce repetition of both fatal and non-fatal deliberate self-harm and improve the person's functioning and quality of life.

Surviving roots of trauma: prevalence of silent signs of sex abuse in patients who recover memories of childhood sex abuse as adults

Recent research suggests that victimization imagery is chronically accessible in sex-abused populations, which is helpful in distinguishing them from nonabused populations. Eight categories of victimization imagery were selectively activated by Rorschach stimuli. These 8 sex-abuse signs were replicated in a new sample of 36 patients with continuous memory of sex abuse. Classification accuracy was 83%. By contrast, these signs were present in only 4% (5 of 115) of the protocols of nonabused patients. Taken together, the 2 studies confirm reasonably high sensitivity of the 8 signs for sex-abused populations and high specificity for nonabused populations. The 8 signs were also differentially salient for patients who recovered memory of childhood sexual trauma as adults. The Rorschach protocols of 59 of 114 patients with delayed recall of sexual abuse possessed signs of sex abuse. There was no linkage between therapy and recovered-memory cases with and without sex-abuse signs. Emergence of trauma memories was not uniquely traceable to treatment. Memories arose outside of the context of therapy in over 56% of the cases. Implications for the false-memory debate are discussed.

Memory functioning in adult women traumatized by childhood sexual abuse

Memory impairment has been reported in some studies of patients with combat-related posttraumatic stress disorder (PTSD) and in rape victims with PTSD. The authors tested whether explicit memory impairment was evident in adult women who were traumatized by severe sexual abuse in childhood. The California Verbal Learning Test (Delis, Kramer, Kaplan, & Ober, 1987) and the Benton Visual Retention Task (Benton, 1974), were administered to 22 female adult survivors of childhood sexual trauma and to 20 demographically and educationally similar nonvictimized women. No evidence was found of explicit memory impairment in the abuse survivors. Furthermore, neither PTSD severity, dissociative symptom severity, nor extent of preexisting amnesia for childhood trauma contributed to the variance in memory functioning. Additional studies are needed to determine the extent to which impaired explicit memory functioning is a common feature of posttraumatic stress syndromes.

Attitudes toward DSM-IV dissociative disorders diagnoses among board-certified American psychiatrists

OBJECTIVE

The authors assessed the opinions of American psychiatrists regarding the diagnostic status and scientific validity of the DSM-IV categories of dissociative amnesia and dissociative identity disorder.

METHOD

A one-page questionnaire was mailed to a random national sample of 367 board-certified American psychiatrists.

RESULTS

Three hundred one responses were received-a rate of 82%. Only about one-third of respondents replied that dissociative amnesia and dissociative identity disorder should be included without reservations in DSM-IV; a larger proportion replied that these categories should be included only as proposed diagnoses. Only about one-quarter of respondents felt that diagnoses of dissociative amnesia and dissociative identity disorder were supported by strong evidence of scientific validity.

CONCLUSIONS

Among board-certified American psychiatrists, there currently appears to be little consensus regarding the diagnostic status or scientific validity of dissociative amnesia and dissociative identity disorder.

False attribution of suggestibility to explain recovered memory of childhood sexual abuse following extended amnesia

Suggestibility is central to arguments proffered by critics of recovered memory of childhood sexual abuse who believe that memories involving amnesia are false creations of treatment. The present study represents the first direct investigation of suggestibility among patients who report recovered memory. Suggestibility was measured in 44 patients who recovered memories and in a 31 patient comparison group without a history of sexual trauma using the Gudjonsson Suggestibility Scale. Results indicated that patients who recover memories were remarkably less suggestible than the clinical field has been led to believe by advocates of false memory. As a group, they scored low on suggestibility. Recovered Memory patients yielded to suggested prompts an average of 6.7 times per case. This compares to an average of 10.6 in the Psychiatric comparison group. Paradoxically, patients without a history of sex abuse were more at risk for altering memory to suggestive prompts. These findings appreciably challenge advocated theories of suggested memory.