Psychotic-Like Symptoms and the Temporal Lobe in Trauma-Related Disorders: Diagnosis, Treatment, and Assessment of Potential Malingering

Objective

To overview the phenomenology, etiology, assessment, and treatment of psychotic-like symptoms in trauma-related disorders focusing on the proposed role of temporal lobe dysfunction.

Method

We describe the literature pertaining to (i) psychotic-like symptoms and temporal lobe dysfunction in trauma-related disorders and (ii) psychological testing profiles in trauma-related disorders. We define trauma-related disorders as borderline personality disorder, post-traumatic stress disorder, and the dissociative disorders. Our search terms were dissociative disorders, temporal lobe, trauma, post-traumatic stress disorder, borderline personality disorder, psychosis, and malingering.

Results

Trauma-related psychotic-like symptoms are common and can differ in phenomenology from primary psychotic symptoms. Hallucinations consist of auditory and nonauditory content that may or may not relate to traumatic content. Child voices are highly suggestive of complex dissociative disorders. Critically, not only do these symptoms resemble those seen in temporal lobe epilepsy, but the temporal lobe is implicated in trauma-related disorders, thus providing a plausible neurobiological explanation. Despite such evidence, these symptoms are frequently considered atypical and misdiagnosed. Indeed, common structured psychological assessment tools categorize these symptoms as possible indicators of invalid testing profiles.

Conclusion

Psychotic-like symptoms are common in trauma-related disorders, may be related to temporal lobe dysfunction, and are frequently misinterpreted. This may lead to ineffective treatment and inappropriate determinations of malingering in the forensic system.

Complex partial epileptic signs as a continuum from normals to epileptics: normative data and clinical populations

Over a 10-year period, a total of 447 men and 624 women between 18 and 61 years of age were administered an inventory whose items describe experiences that are similar to those evoked by electrical stimulation of the temporal lobes. Empirically determined factors contained experiences of sensory enhancement, affective-dissociation, ego alien intrusions, and literary emphasis. Using this population as a reference, T scores for these clusters were calculated for special normal populations (poets, drama students, false pregnancies) and for clinical groups (post-traumatic stress, anxiety-depersonalization, exotic dissociations, and complex partial epilepsy). Whereas only mild elevations (50 < T < 65) in indicators of temporal lobe signs and symptoms were noted in the special groups, moderate (65 < T < 75) and severe (T > 79) elevations were noted in the clinical populations.

Left ear (right temporal lobe) suppressions during dichotic listening, ego-alien intrusion experiences and spiritualistic beliefs in normal women

Beliefs in spiritualism, a history of a sensed presence, and mental diplopia may share a common source of psychometric variance. We hypothesized that this variance should be specifically associated with right temporal-lobe function. Inferences of temporal lobe signs, hemisphericity (Vingiano's quotient) and self-esteem as well as dichotic listening measures were obtained for 26 university women. As predicted, the numbers of left-ear suppressions (right temporal-lobe function) but not of right-ear suppressions were specifically and moderately (rho = 0.64) correlated with the intensity of Tobacyk's spiritualistic beliefs and a history of sensed presences and ego-alien intrusions. However, the negative association (rhos about -0.45) between indices of left-right hemisphericity and self-esteem was related to a separate factor.

Neuropsychological profiles of adults who report "sudden remembering" of early childhood memories: implications for claims of sex abuse and alien visitation/abduction experiences

Six adults, who had recently experienced sudden recall of preschool memories of sex abuse or alien abduction/visitation, were given complete neuropsychological assessments. All experiences "emerged" when hypnosis was utilized within a context of sex abuse or New Age religion and were followed by reduction in anxiety. As a group, these subjects displayed significant (T greater than 70) elevations of childhood imaginings, complex partial epileptic-like signs, and suggestibility. Neuropsychological data indicated right frontotemporal anomalies and reduced access to the right parietal lobe. MMPI profiles were normal. The results support the hypothesis that enhanced imagery due to temporal lobe lability within specific contexts can facilitate the creation of memories; they are strengthened further if there is also reduction in anxiety.

Tobacyk's sex differences in the experiences of ego-alien intrusions

Tobacyk's Revised Paranormal Belief Scale and an inventory that infers temporal lobe signs were administered to 44 men and 54 women who were enrolled in first-year university courses. Women believed more in psi phenomena, witchcraft, and spiritualism than did men, who believed more in extraterrestrial life forms. Although complex partial epileptic-like signs were moderately (0.40) correlated with total beliefs for both sexes, these signs were dominated by experiences of ego-alien intrusions for women only. The results support the concept of greater interhemispheric coherence in women compared to men and emphasize the importance of limbic processes in the formation and maintenance of religious and paranormal beliefs.