Personality profiles, dissociation, and absorption in women reporting repressed, recovered, or continuous memories of childhood sexual abuse

The Return of Repression? Evidence From Cognitive Psychology

The controversy over alleged repressed and recovered memories of childhood sexual abuse (CSA) was among the most contentious ever to embroil psychology and psychiatry. Adapting paradigms from cognitive psychology, my research group tested hypotheses pertinent to repressed memory and false memory interpretations of recovered memories. We tested adults who: (1) report recovering memories of CSA after not having thought about their abuse for years; (2) report never having forgotten their CSA; (3) believe they harbor "repressed" memories of CSA; and (4) deny having been sexually abused. We tested hypotheses about mechanisms that might figure in the inability to recall memories of one's abuse and those that might render one susceptible to developing false memories of abuse. The purpose of this article is to summarize this work. Finally, I draw on the work of Lionel Penrose to speculate about why the popularity of the concept of repressed memories of trauma-or its synonym, dissociative amnesia for trauma-may be rising today.

Tilting at Windmills: Why Attacks on Repression Are Misguided

In the November 2019 issue of Perspectives, Otgaar et al. argued that the "memory wars" persist and that "the controversial issue of repressed memories is alive and well and may even be on the rise" (p. 1072). Their thesis overlooked the well-established consensus that recovered memories of trauma may be genuine, false, or a mixture of the two and instead focused on a disputed mechanism: unconscious repression. A formal cocitation analysis identified the major publications mentioning repressed memories, but none endorsed a theory of unconscious repression. Studies of beliefs about repressed memories by the general public and other groups do not support Otgaar et al.'s thesis either because these studies did not adequately assess the key ideas defining the theory of repression. Clinical evidence is consistent with recovered memories occurring in many different forms of therapy, including ones that do not use suggestive techniques or rely on the concept of repression. Thus, Otgaar et al. have proposed the existence of a problem for which little objective evidence can be found. Continuing theoretical uncertainties about the mechanisms responsible for forgetting are less important than the general recognition since the 1990s that suggestive therapy and attempts to exhume memories are hazardous and generally inappropriate.

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.

Recovering Memories of Trauma

The controversy over the validity of repressed and recovered memories of childhood sexual abuse (CSA) has been extraordinarily bitter. Yet data on cognitive functioning in people reporting repressed and recovered memories of trauma have been strikingly scarce. Recent laboratory studies have been designed to test hypotheses about cognitive mechanisms that ought to be operative if people can repress and recover memories of trauma or if they can form false memories of trauma. Contrary to clinical lore, these studies have shown that people reporting CSA histories are not characterized by a superior ability to forget trauma-related material. Other studies have shown that individuals reporting recovered memories of either CSA or abduction by space aliens are characterized by heightened proneness to form false memories in certain laboratory tasks. Although cognitive psychology methods cannot distinguish true memories from false ones, these methods can illuminate mechanisms for remembering and forgetting among people reporting histories of trauma.

Reactions to research participation in victims of childhood sexual abuse

We examined whether adults with a documented or self-reported history of childhood sexual abuse (CSA) report more emotional reactions and negative responses to research participation and whether psychiatric symptoms play a moderating role in their reactions. Using a prospective cohort design, individuals with documented histories of CSA and non-abused matched controls were followed up and interviewed in adulthood (n = 460). Reactions to research participation were measured with a brief questionnaire. Concurrent symptoms of depression, anxiety, and PTSD were assessed via standardized measures. Results showed that those with a history of CSA, documented or self-reported, experienced similar reactions compared to controls. Psychiatric symptoms predicted stronger emotional reactions and more negative responses, but also greater personal benefit, regardless of CSA history.

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.

Trauma severity and defensive emotion-regulation reactions as predictors of forgetting childhood trauma

Using a retrospective survey, we studied a sample of 1,679 college women to determine whether reports of prior forgetting of childhood sexual abuse, physical abuse, and other traumas could be explained by trauma severity and individual differences in the use of defensive emotion-regulation reactions (i.e., repressive coping, dissociation, and fantasy proneness). Among victims of physical abuse (but not sexual abuse or other types of trauma), those who experienced severe abuse and used defensive reactions were sometimes more likely to report temporary forgetting of abuse but other times less likely to report forgetting. We also found unanticipated main effects of trauma severity on temporary forgetting. Our results provide an understanding of victims' experiences of forgetting by demonstrating the importance of considering unique effects of trauma type, different aspects of trauma severity, and victims' defensive reactions to trauma.

Recalled peritraumatic reactions, self-reported PTSD, and the impact of malingering and fantasy proneness in victims of interpersonal violence who have applied for state compensation

The present study explores the associations between three types of peritraumatic reactions (dissociation, distress, and tonic immobility) and posttraumatic stress disorder (PTSD) symptoms in a sample of 125 victims of interpersonal violence who had applied for compensation with the Dutch Victim Compensation Fund (DCVF). In addition, the confounding roles of malingering and fantasy proneness are examined. Results indicate that tonic immobility did not predict PTSD symptom levels when adjusting for other forms of peritraumatic reactions, whereas peritraumatic dissociation and distress did. However, after the effects of malingering and fantasy proneness had been controlled for, malingering is the only factor associated with increased PTSD symptomatology. Implications for policy practice as well as study strengths and limitations are discussed.

Did My Brain Implant Make Me Do It? Questions Raised by DBS Regarding Psychological Continuity, Responsibility for Action and Mental Competence

Deep brain stimulation (DBS) is a well-accepted treatment for movement disorders and is currently explored as a treatment option for various neurological and psychiatric disorders. Several case studies suggest that DBS may, in some patients, influence mental states critical to personality to such an extent that it affects an individual's personal identity, i.e. the experience of psychological continuity, of persisting through time as the same person. Without questioning the usefulness of DBS as a treatment option for various serious and treatment refractory conditions, the potential of disruptions of psychological continuity raises a number of ethical and legal questions. An important question is that of legal responsibility if DBS induced changes in a patient's personality result in damage caused by undesirable or even deviant behavior. Disruptions in psychological continuity can in some cases also have an effect on an individual's mental competence. This capacity is necessary in order to obtain informed consent to start, continue or stop treatment, and it is therefore not only important from an ethical point of view but also has legal consequences. Taking the existing literature and the Dutch legal system as a starting point, the present paper discusses the implications of DBS induced disruptions in psychological continuity for a patient's responsibility for action and competence of decision and raises a number of questions that need further research.

Service patterns of adult survivors of childhood versus adult sexual assault/abuse

This analysis compared the characteristics and service patterns of adult survivors of childhood sexual assault/abuse and adult survivors of adult sexual assault/abuse. Utilizing data from sexual assault crisis centers serving survivors in a Midwestern state over a six year period and controlling for revictimization, we describe and compare the demographic characteristics, referral sources, and service patterns of the two groups. Results indicate that paths into service differ for the two groups. Furthermore, adult survivors of childhood sexual assault/abuse obtain significantly more hours of service and service contacts on average than adult survivors of adult sexual assault/abuse. Implications for policy and practice are discussed.

Symptom overreporting and recovered memories of childhood sexual abuse

The authenticity of recovered memories is a much debated issue. Surprisingly, no study has systematically looked at symptom overreporting in people claiming recovered memories of childhood sexual abuse (CSA). In a first sample we administered the Structured Inventory of Malingered Symptomatology (SIMS) to individuals who said they had recovered CSA memories (n=66), individuals who said their CSA had always been accessible (continuous CSA memory group; n=119), and controls who said they had no CSA experiences (n=83). In a second sample individuals reporting recovered (n=45) or continuous (n=45) CSA memories completed the Morel Emotional Numbing Test (MENT). Our aim was to compare these groups with regard to their tendency to overreport symptoms. The results indicate that people with recovered memories do not score higher on the SIMS and the MENT than other CSA survivors suggesting that symptom overreporting is not typical for people reporting recovered memories.

Recovered memory and the Daubert criteria: recovered memory as professionally tested, peer reviewed, and accepted in the relevant scientific community

Research during the past two decades has firmly established the reliability of the phenomenon of recovered memory. This review first highlights the strongest evidence for the phenomenon itself and discusses the survey, experimental, and biological evidence for the varying mechanisms that may underlie the phenomenon. Routes to traumatic amnesia from dissociative detachment (loss of emotional content leading to loss of factual content) and from dissociative compartmentalization (failure in integration) are discussed. Next, an argument is made that false memory is a largely orthogonal concept to recovered memory; the possibility of one phenomena is largely irrelevant to the potential for the other. Furthermore, some aspects of the false memory research offer supportive data for the recovered memory researcher. Finally, the issue of error rates in making the Daubert case is explored. It is concluded that the weight of the evidence should allow the recovered memory victim to come before the court.

Clinical characteristics of adults reporting repressed, recovered, or continuous memories of childhood sexual abuse

The authors assessed women and men who either reported continuous memories of their childhood sexual abuse (CSA, n = 92), reported recovering memories of CSA (n = 38), reported believing they harbored repressed memories of CSA (n = 42), or reported never having been sexually abused (n = 36). Men and women were indistinguishable on all clinical and psychometric measures. The 3 groups that reported abuse scored similarly on measures of anxiety, depression, dissociation, and absorption. These groups also scored higher than the control group. Inconsistent with betrayal trauma theory, recovered memory participants were not more likely to report abuse by a parent or stepparent than were continuous memory participants. Rates of depression and posttraumatic stress disorder did not differ between the continuous and recovered memory groups.

Sleep paralysis in adults reporting repressed, recovered, or continuous memories of childhood sexual abuse

Sleep paralysis typically occurs as individuals awaken from rapid eye movement sleep before motor paralysis wanes. Many episodes are accompanied by tactile and visual hallucinations, often of threatening intruders in the bedroom. Pendergrast [Victims of Memory: Incest Accusations and Shattered Lives, HarperCollins, London, 1996] proposed that individuals who report repressed or recovered memories of childhood sexual abuse (CSA) may misinterpret episodes of sleep paralysis as reemerging fragments of dissociated ("repressed") memories of CSA. To investigate this issue, we administered a sleep paralysis questionnaire to people reporting either repressed (n = 18), recovered (n = 14), or continuous (n = 36) memories of CSA, or to a control group reporting no history of CSA (n = 16). The prevalence of sleep paralysis was: repressed memory group (44%), recovered memory group (43%), continuous memory group (47%), and control group (13%). Among the six individuals in the recovered memory group who had experienced sleep paralysis, one interpreted it as related to sexual abuse (i.e., a rate of 17%). All other participants who had reported sleep paralysis embraced other interpretations (e.g., saw a ghost). Dissociation and depressive symptoms were more common among those who had experienced sleep paralysis than among those who denied having experienced it.

Reality monitoring in adults reporting repressed, recovered, or continuous memories of childhood sexual abuse

People who report either repressed or recovered memories of childhood sexual abuse (CSA) may have deficits in reality monitoring--the process whereby one discriminates memories of percepts from memories of images. Using signal detection methods, the authors found that adults reporting either repressed or recovered memories of CSA were less able to discriminate between words they had seen from words they had imagined seeing than were adults reporting either never having forgotten their CSA or adults reporting no history of CSA. Relative deficits in the ability to discriminate percepts from images (i.e., low d') were apparent on only some tests. The groups did not differ in their criterion--response bias--for affirming having seen versus imagined stimuli.

Sleep paralysis, sexual abuse, and space alien abduction

Sleep paralysis accompanied by hypnopompic ('upon awakening') hallucinations is an often-frightening manifestation of discordance between the cognitive/perceptual and motor aspects of rapid eye movement (REM) sleep. Awakening sleepers become aware of an inability to move, and sometimes experience intrusion of dream mentation into waking consciousness (e.g. seeing intruders in the bedroom). In this article, we summarize two studies. In the first study, we assessed 10 individuals who reported abduction by space aliens and whose claims were linked to apparent episodes of sleep paralysis during which hypnopompic hallucinations were interpreted as alien beings. In the second study, adults reporting repressed, recovered, or continuous memories of childhood sexual abuse more often reported sleep paralysis than did a control group. Among the 31 reporting sleep paralysis, only one person linked it to abuse memories. This person was among the six recovered memory participants who reported sleep paralysis (i.e. 17% rate of interpreting it as abuse-related). People rely on personally plausible cultural narratives to interpret these otherwise baffling sleep paralysis episodes.

From refusal to reconciliation: family relationships after an accusation based on recovered memories

In following families who reported to the False Memory Foundation between 1992 and 2001 that a member had charged them with incest, a survey questionnaire (with a 42% return rate) was sent to some 4,400 families. These data demonstrate that 99% of these accusers were white, 93% were female, 77% were graduates, 86% were in psychotherapy, and 82% accused their father. Such accusations were rare events before 1985 but then grew exponentially in frequency, peaking in the 2-year period from 1991 to 1992, with 579 accusations. Thereafter, such accusations steadily declined so that in 1999 and 2000, only 36 accusations occurred. The accusers can be differentiated in the manner with which they reconciled with the situation: 56% refused all family contact, 36% returned but did not discuss the accusation, and 8% retracted completely. These data give evidence of a time-limited craze of therapy-induced incest accusations that has now dissipated.

Child sexual abuse

Child sexual abuse is a worldwide concern. It is an insidious, persistent, and serious problem that, depending on the population studied and definition used, affects 2-62% of women and 3-16% of men as victims. Pain and tissue injury from child sexual abuse can completely heal in time, but psychological and medical consequences can persist through adulthood. Associated sexually transmitted diseases (such as HIV) and suicide attempts can be fatal. All physicians who treat children should be aware of the manifestations and consequences of child sexual abuse, and should be familiar with normal and abnormal genital and anal anatomy of children. This aim is best accomplished through training and routine examination of the anus and genitalia of children. Because as many as 96% of children assessed for suspected sexual abuse will have normal genital and anal examinations, a forensic interview by a trained professional must be relied on to document suspicion of abuse.

Progress and controversy in the study of posttraumatic stress disorder

Research on posttraumatic stress disorder (PTSD) has been notable for controversy as well as progress. This article concerns the evidence bearing on the most contentious issues in the field of traumatic stress: broadening of the definition of trauma, problems with the dose-response model of PTSD, distortion in the recollection of trauma, concerns about "phony combat vets," psychologically toxic guilt as a traumatic stressor, risk factors for PTSD, possible brain-damaging effects of stress hormones, recovered memories of childhood sexual abuse, and the politics of trauma.

Dissociative experiences of women child abuse survivors: a selective constructivist review

A selective literature review of dissociation in women abuse survivors was under-taken from a feminist, constructivist perspective. Dissociation has been conceptualized many ways historically. Current understandings of dissociative phenomena are diverse, as reflected in the research and treatment literature. Dissociation has been linked to physical and psychological problems, including major mental illnesses, pelvic pain, somatization disorders, and eating disorders. There has been a preoccupation with rare but fascinating extremes of dissociation, such as multiple personality disorder, with less emphasis on more frequently seen types of dissociation, such as depersonalization and derealization. Views of dissociation as it occurs in women child abuse survivors affect their autonomy and perceived credibility and determine treatment trajectories. Questions remain as to what aspects and types of dissociation are "pathological." There is evidence that dissociation may be a commonplace human experience in the general population. Implications for theory, research, and practice are included.

The development and psychometric evaluation of a new measure of dissociative activities

The psychometric properties of a new measure of dissociative behaviors, the Scale of Dissociative Activities (SODAS), were evaluated. Undergraduates (n = 533) completed the SODAS, 2 other established self-report measures of dissociative behaviors, and a measure of socially desirable responding. A randomly selected subset of participants (n = 100) also participated in an additional reliability and validity follow-up study. The SODAS was found to be internally consistent (a =.95) and temporally stable (r =.77) over an average 38-day interval. The validity of the SODAS was established by a moderately low negative correlation with social desirability, high correlations with other self-report measures of dissociation, and moderate to high correlations with samples of dissociative activities assessed in naturalistic environments with experience sampling methodology. Overall, the SODAS compared favorably to other existing self-report measures of dissociative behaviors. Directions for future research on the SODAS are discussed.

Memory distortion in people reporting abduction by aliens

False memory creation was examined in people who reported having recovered memories of traumatic events that are unlikely to have occurred: abduction by space aliens. A variant of the Deese/Roediger-McDermott paradigm (J. Deese. 1959; H. L. Roediger III & K. B. McDermott, 1995) was used to examine false recall and false recognition in 3 groups: people reporting recovered memories of alien abduction. people who believe they were abducted by aliens but have no memories, and people who deny having been abducted by aliens. Those reporting recovered and repressed memories of alien abduction were more prone than control participants to exhibit false recall and recognition. The groups did not differ in correct recall or recognition. Hypnotic suggestibility, depressive symptoms, and schizotypic features were significant predictors of false recall and false recognition.

Alters in dissociative identity disorder. Metaphors or genuine entities?

How should the different identities (i.e., alters) that are thought to be typical for dissociative identity disorder (DID) be interpreted? Are they just metaphors for different emotional states or are they truly autonomous entities that are capable of willful action? This issue is important because it has implications for the way in which courts may handle cases that involve DID patients. Referring to studies demonstrating that alters of DID patients differ in their memory performance or physiological profile, some authors have concluded that alters are more than just metaphors. We argue that such line of reasoning is highly problematic. There is little consensus among authors about the degree to which various types of memory information (implicit, explicit, procedural) may leak from one to the other alter. Without such theoretical accord, any given outcome of memory studies on DID may be taken as support for the assumption that alters are in some sense "real." As physiological studies on alter activity often lack proper control conditions, most of them are inconclusive as to the status of alters. To date, neither memory studies nor psychobiological studies have delivered compelling evidence that alters of DID patients exist in a factual sense. As a matter of fact, results of these studies are open to multiple interpretations and in no way refute an interpretation of alters in terms of metaphors for different emotional states.

On nonassociative fear emergence

Poulton and Menzies have articulated a nonassociative alternative to traditional conditioning theories of phobia emergence. Prompted by their essay, I address several issues including controversies about what counts as a conditioning event, difficulties establishing whether a fear functioned as an adaptation throughout evolutionary history, hazards of attempting to recover conditioning events in the histories of patients, and problems with the contingency view of associative learning.