Traumatic memories are not necessarily accurate memories

Myths of trauma memory: on the oversimplification of effects of attention narrowing under stress

The present article addresses claims commonly made by prosecution witnesses in sexual assault trials: that attention narrows under stress, and that these attended aspects of the event are encoded in a way that ensures accuracy and resistance to fading and distortion. We provide evidence to contradict such claims. Given that what is encoded is largely the gist of one's interpretation of experience, we discuss the way in which attention and emotion can bias the interpretation of experience. We illustrate with issues of memory reports in cases of acquaintance rape, where the primary issue is the presence or absence of consent. We provide some specific illustrations concerning effects of emotion on interpretation of sexual consent. Finally, based on what is known regarding priming effects on memory retrieval and judgment, we conclude with discussion of the potential of some "trauma-informed" interviewing strategies to promote false memories (such as FETI: Forensic Experiential Trauma Interview).

Neuropharmacology of memory consolidation and reconsolidation: Insights on central cholinergic mechanisms

Central cholinergic system is critically involved in all known memory processes. Endogenous acetylcholine release by cholinergic neurons is necessary for modulation of acquisition, encoding, consolidation, reconsolidation, extinction, retrieval and expression. Experiments from our laboratory are mainly focused on elucidating the mechanisms by which acetylcholine modulates memory processes. Blockade of hippocampal alpha-7-nicotinic receptors (α7-nAChRs) with the antagonist methyllycaconitine impairs memory reconsolidation. However, the administration of a α7-nAChR agonist (choline) produce a paradoxical modulation, causing memory enhancement in mice trained with a weak footshock, but memory impairment in animals trained with a strong footshock. All these effects are long-lasting, and depend on the age of the memory trace. This review summarizes and discusses some of our recent findings, particularly regarding the involvement of α7-nAChRs on memory reconsolidation.

Prevalence and correlates of child sexual abuse: a national study

BACKGROUND

This study examines the prevalence, correlates, and psychiatric disorders of adults with history of child sexual abuse (CSA).

METHODS

Data were derived from a large national sample of the US population. More than 34000 adults 18 years and older residing in households were interviewed face-to-face in a survey conducted during the 2004-2005 period. Diagnoses were based on the Alcohol Use Disorder and Associated Disabilities Interview Schedule-Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, version. Weighted means, frequencies, and odds ratios of sociodemographic correlates and prevalence of psychiatric disorders were computed. Logistic regression models were used to examine the strength of associations between CSA and psychiatric disorders, adjusted for sociodemographic characteristics, risk factors, and other Axis I psychiatric disorders.

RESULTS

The prevalence of CSA was 10.14% (24.8% in men and 75.2% in women). Child physical abuse, maltreatment, and neglect were more prevalent among individuals with CSA than among those without it. Adults with CSA history had significantly higher rates of any Axis I disorder and suicide attempts. The frequency, type, and number of CSA were significantly correlated with psychopathology.

CONCLUSIONS

The high correlation rates of CSA with psychopathology and increased risk for suicide attempts in adulthood suggest the need for a systematic assessment of psychiatric disorders and suicide risk in these individuals. The risk factors for CSA emphasize the need for health care initiatives geared toward increasing recognition and development of treatment approaches for the emotional sequelae CSA as well as early preventive approaches.

“Keeping Up a Front”: Narratives About Intimate Partner Violence, Pregnancy, and Antenatal Care

Nine women who had been subjected to severe intimate partner violence during pregnancy narrated their ambiguous and contradictory feelings and the various balancing strategies they used to overcome their complex and difficult situations. Because allowing anyone to come close posed a threat, the women mostly denied the situation and kept up a front to hide the violence from others. Three women disclosed ongoing violence to the midwives, but only one said such disclosure was helpful. This article highlights the complexity of being pregnant when living with an abusive partner and challenges antenatal care policies from the perspective of pregnant women.

Arresting and convicting the innocent: the potential role of an "inappropriate" emotional display in the accused

Research from both simulated and actual jurors has demonstrated that the defendant's emotional display can influence legal decisions. The purpose of this paper is to review the evidence regarding the influence of the defendant's emotional display, and to consider the potential role of suspect and defendant emotion in wrongful convictions. It is possible that the lack of "appropriate" emotion during questioning or interrogation may lead investigators to create a mind-set that the suspect is the guilty party; as a result, they may be less inclined to investigate other leads. During a trial, the defendant's perceived level of emotion can potentially mislead jurors (e.g. a defendant displaying a low level of emotion leading people to believe, inappropriately, that he is guilty). After a review of the pertinent literature and examples of relevant cases, reasons are provided regarding why one's emotional display may be of limited diagnostic value. Future research ideas are proposed in an effort to determine more definitively the impact of the emotional display of the accused on legal decisions.

The PTSD supremacy: Criterion F in three Voyager cases

OBJECTIVE

The aim is to consider whether the courts and experts in their application of Criterion F for posttraumatic stress disorder (PTSD) have applied it consistently in civil claims brought years after the event.

METHOD

Three cases for compensation relating to the Voyager disaster are considered.

RESULTS

It appears, from the cases considered in this paper, that while courts consider that Criterion F is crucial in making a diagnosis of PTSD, there are some inconsistencies in terms of understanding and applying this criterion, both by the courts and experts. This may be because of a lack of guidance in psychiatric texts as to how to apply Criterion F.

CONCLUSIONS

Criterion F is, after the satisfaction of Criterion A(1), arguably the most important of the criteria for PTSD for, while the symptoms referred to in Criteria B-D have been shown to be fairly easy to simulate, it is arguably harder to do this with Criterion F, particularly in cases that arise a long time after the event. It is important therefore that psychiatrists assessing persons so long after an event adhere rigorously to Criterion F, because it is based on facts open to objective corroboration, while criteria B, C and D tend to rely on subjective experiences which are the most sensitive to distortion. Thus, it is to be hoped that if DSM-V is to maintain a criterion of clinically significant distress or impairment in the majority of the disorders described therein, it will provide some assistance as to how this criteria should be applied.

Are memories for sexually traumatic events "special"? A within-subjects investigation of trauma and memory in a clinical sample

According to a long-standing clinical tradition, sexually traumatic experiences are processed and recalled differently from other experiences, often leading to memory impairment. In this study, we compared the characteristics of traumatic memories for sexual violence and two other types of emotional experiences. N=44 women recruited from a local sexual trauma agency were asked to recall and describe three autobiographical events: sexual abuse/assault, a non-sexual trauma, and a positive emotional event. The characteristics of the three memory types were compared on both subjective and objective measures. Further, the potential influences of level of traumatic impact and dissociation were assessed. Results indicated that memories for sexual trauma were not impaired or fragmented relative to other memories. Instead, memories for sexual trauma were associated with a remarkably high level of vividness, detail, and sensory components. Further, high levels of traumatic impact were not associated with memory impairment. Implications for the ongoing traumatic memory debate are discussed.

Traumata und Traumafolgestörungen bei Kindern und Jugendlichen - eine kritische Übersicht zu Klassifikation und diagnostischen Kriterien

Zusammenfassung: In den letzten Jahren werden der Traumabegriff und einzelne Kriterien der in ICD-10 und DSM-IV definierten Traumafolgestörungen kritisch diskutiert. Dabei wird die Kategorie der akuten Belastungsstörung vor allem wegen der Überbetonung dissoziativer Symptome und der Pathologisierung normaler Traumareaktionen gänzlich in Frage gestellt, während die Kriterien der posttraumatischen Belastungsstörung insbesondere für das Kindes- und Jugendalter der Revision bedürfen. Spezifische Kriterien für das Kindesalter wurden von Scheeringas Arbeitsgruppe definiert. Zudem schlägt die amerikanischen «Complex Trauma Taskforce» des National Child Traumatic Stress Network die Diagnosekategorie der Entwicklungstraumastörung vor, um die Probleme von früh und komplex traumatisierten Kindern besser zu erfassen.

Psychiatry's problem child: PTSD in the forensic context: (part 1)

OBJECTIVE

The aim of this paper was to consider some of the recent literature that has raised questions about the prevalence of, and problems with, post-traumatic stress disorder (PTSD) in the forensic context and whether it is a failure by experts to consider adequately Criterion A (1), which leads them into error and results in a skewed picture of the prevalence of PTSD in litigation.

METHOD

The nature of the stressor criterion for PTSD from DSM-III to DSM-IV-TR, and recent literature relating to problems with the manner in which that stressor criterion is applied in forensic contexts, are considered.

RESULTS

It becomes clear that, notwithstanding that the class of persons who can suffer PTSD after a particularly traumatic event has widened since it was included in the DSM-III, the nature of the stressor required before a diagnosis of PTSD can be made has remained fairly constant.

CONCLUSIONS

Whether it is because PTSD is commonly associated with receiving a benefit (e.g. through post-war disability benefits, victims of crime compensation or because of a desire to use it as an ideological weapon), PTSD has become a ubiquitous presence in the forensic context, notwithstanding objective (i.e. non-forensic) clinical studies which refer to its rarity. It is clear now that PTSD symptoms can be readily simulated when the simulator is seeking a benefit. It is also becoming clear that some psychiatrists are not being as rigorous in the forensic context as they might be in a clinical context. Thus, with discussion now underway regarding DSM-V, it may be timely to reconsider the utility of PTSD as a clinical condition.

Does Repression Exist? Memory, Pathogenic, Unconscious and Clinical Evidence

The current dispute regarding the existence of repression has mainly focused on whether people remember or forget trauma. Repression, however, is a multidimensional construct, which, in addition to the memory aspect, consists of pathogenic effects on adjustment and the unconscious. Accordingly, in order to arrive at a more accurate decision regarding the existence of repression, studies relevant to all three areas are reviewed. Moreover, since psychoanalysis regards repression as a key factor in accounting for the development and treatment of neurotic disorders, relevant research from these two domains are also taken into account. This comprehensive evaluation reveals little empirical justification for maintaining the psychoanalytic concept of repression.

Cross-examining dissociative identity disorder: neuroimaging and etiology on trial

Dissociative identity disorder (DID) is probably the most disputed of psychiatric diagnoses and of psychological forensic evaluations in the legal arena. The iatrogenic proponents assert that DID phenomena originate from psychotherapeutic treatment while traumagenic proponents state that DID develops after severe and chronic childhood trauma. In addition, DID that is simulated with malingering intentions, but not stimulated by psychotherapeutic treatment, may be called pseudogenic. With DID gaining more interest among the general public it can be expected that the number of pseudogenic cases will grow and the need to distinguish between traumagenic, iatrogenic or pseudogenic DID will increase accordingly. This paper discusses whether brain imaging studies can inform the judiciary and/or distinguish the etiology of DID.

The scars of memory: a prospective, longitudinal investigation of the consistency of traumatic and positive emotional memories in adulthood

We conducted a prospective study with individuals who first described their memories of both a recent traumatic and a highly positive emotional experience in 2001-2002. Of the 49 subjects interviewed after 3 months, 29 were re-interviewed after 3.45 to 5.0 years. Subjects answered questions from a 12-item consistency questionnaire (maximum possible score of 36), rated the qualities of their memories, and completed questionnaires concerning the impact of the trauma. Results indicated that traumatic memories (including memories for violence) were highly consistent (M= 28.04) over time relative to positive memories (M= 17.75). Ratings of vividness, overall quality, and sensory components declined markedly for positive memories but remained virtually unchanged for traumatic memories. The severity of traumatic symptoms diminished over time and was unrelated to memory consistency. These findings contribute to understanding of the impact of trauma on memory over long periods.

The temporal dynamics model of emotional memory processing: a synthesis on the neurobiological basis of stress-induced amnesia, flashbulb and traumatic memories, and the Yerkes-Dodson law

We have reviewed research on the effects of stress on LTP in the hippocampus, amygdala and prefrontal cortex (PFC) and present new findings which provide insight into how the attention and memory-related functions of these structures are influenced by strong emotionality. We have incorporated the stress-LTP findings into our "temporal dynamics" model, which provides a framework for understanding the neurobiological basis of flashbulb and traumatic memories, as well as stress-induced amnesia. An important feature of the model is the idea that endogenous mechanisms of plasticity in the hippocampus and amygdala are rapidly activated for a relatively short period of time by a strong emotional learning experience. Following this activational period, both structures undergo a state in which the induction of new plasticity is suppressed, which facilitates the memory consolidation process. We further propose that with the onset of strong emotionality, the hippocampus rapidly shifts from a "configural/cognitive map" mode to a "flashbulb memory" mode, which underlies the long-lasting, but fragmented, nature of traumatic memories. Finally, we have speculated on the significance of stress-LTP interactions in the context of the Yerkes-Dodson Law, a well-cited, but misunderstood, century-old principle which states that the relationship between arousal and behavioral performance can be linear or curvilinear, depending on the difficulty of the task.