Memory in Patients with Abuse Related PTSD

Empirical studies do show, however, that patients with early abuse and the diagnosis of PTSD or other stress-related mental disorders have a variety of memory problems (Buckley, Blanchard, & Neill, 2000; Elzinga & Bremner, 2002). Adults with early childhood abuse (Bremner et al., 1995) were found to have deficits in verbal declarative memory function based on neuropsychological testing (Wechsler Memory Scale and Selective Reminding Test); similar findings were found in traumatized children (Mo-radi, Doost, Taghavi, Yule, & Dalgleish, 1999). One study in adult women with a history of childhood sexual abuse-related PTSD (Bremner, Vermetten, Nafzal, & Vythilingam, 2004) showed that verbal declarative memories are specifically associated with PTSD and are not a nonspecific effect of trauma exposure. Another study of women with early childhood sexual abuse in which some, but not all, of the patients had PTSD showed no difference between abused and nonabused women (Stein, Hanna, Vaerum, & Koverola, 1999). Children with PTSD related to mixed causes had deficits in verbal IQ compared to controls (Saigh, Yasik, Oberfield, Halamandaris, & Bremner, 2006). Another study in Lebanese youth with war-related PTSD showed deficits in scholastic performance compared to traumatized non-PTSD and nontraumatized youth (Saigh, Mroweh, & Bremner, 1997). Other types of memory disturbances studies in PTSD include gaps in memory for everyday events (dissociative amnesia) (Bremner, Steinberg, Southwick, Johnson, & Charney, 1993) and an attentional bias for trauma-related material (Moradi, Taghavi, Neshat-Doost, Yule, & Dalgleish, 2000). These studies suggest that traumas such as early abuse with associated PTSD result in deficits in verbal declarative memory.

In the 1994 comment by Loftus and colleagues on the report of Will-liams about 38% forgetting childhood abuse, the authors, after dismissing "repression," took on "amnesia," which they described as "trying to puff up [forgetting] with a scientific name to make it appear exotic . . . an example of psychological 'spin-doctoring,' the merging of science and politics."

However, spin doctors were not responsible for the description of the diagnosis of dissociative amnesia, which is an official disorder of the Diagnostic and Statistical Manual of Mental Disorders. This is the most common dissociative presentation of patients with PTSD, involving patients who have gaps in memory that are not due to normal forgetting and which can go from minutes to hours to days (Bremner et al., 1993). These symptoms of dissociative amnesia can include a lack of memory for episodes of childhood abuse. Some have argued that dissociative amnesia cannot be empirically verified; however, the same argument could be made for hallucinations in schizophrenics. The gold standard for psychiatric diagnosis continues to be self-reporting of symptoms.

Two studies have specifically looked at false memory paradigms in women with a history of childhood sexual abuse. Clancy, Schacter, McNally, and Pitman (2000) found that women with a history of delayed recall of childhood sexual abuse had an increase in false recall of the critical lure in the Deese/Roediger-McDermott paradigm. Bremner, Shobe, & Kihlstrom (2000) found that women with early childhood sexual abuse-related PTSD had higher rates of false recall on the Deese/ Roediger- McDermott paradigm compared to abused non-PTSD women, nonabused non-PTSD women, and normal men. Given the range of memory problems in PTSD patients, one interpretation of these findings is that there is a tendency to "fill in" facts when concrete declarative memory fails, as seen in patients with, for instance, hepatic encephalopa-thy, who will confabulate when presented with a false start to an autobiographical story.

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