Post Traumatic Stress Disorder, Repressed Memories And Abnormalities In The Brain
Running head: POST-TRAUMATIC STRESS DISORDER, REPRESSED MEMORIES 1 Post-Traumatic Stress Disorder, Repressed Memories and Abnormalities in the Brain Elizabeth Wolf Lynn University
POST-TRAUMATIC STRESS DISORDER, REPRESSED MEMORIES 2 Abstract Post-Traumatic Stress Disorder, Repressed Memories and Abnormalities in the Brain Sufferers of post-traumatic stress disorder due to the trauma of deceptive memories, orfalse memories, can cause the patient great distress even though a real traumatic event did nothappen it doesn’t mean that those feelings of distress aren’t real to that person, in fact thosefeelings are very real. The participants of the perspective experiment are adult women who haverepressed, recovered, and continuous memories of being sexually abused as a child were dividedinto clinical, subclinical, and control groups. The participants must meet our definition of sexualabuse, “Sexual abuse involved physical sexual contact ranging from fondling to penetration (e.g.,anal, oral, vaginal) occurring prior to the participants sixteenth birthday. The perpetrator had tobe at least 5 years older than the participant” (McNally, 2006, 238). These participants wentthrough a vigorous process of questionnaires, interviews, the MMPI hysterics scale, and MRI’sto determine whether the same abnormalities in the brain would be present as a PTSD sufferer.More research is needed to determine if recovered memories and repressed memories areeventually going to be accepted by the APA.
POST-TRAUMATIC STRESS DISORDER, REPRESSED MEMORIES 3 Sexual abuse of children depicts a considerable problem in our society because, “womenwho had been abused as children, as compared to those who had not been abused as children,were more likely to present in the emergency room with problems involving drug abuse, sex,suicidal ideation, suicide attempts, and severe personality disorder, especially BorderlinePersonality Disorder” ( Reisner, 1996, 1). Neuropsychology and neuropsychiatry use brain scansas a tool to diagnosis and understand mental illnesses. But when they diagnosis an individualthey do not solely use the brain scan they do a clinical history and tests to make sure thateverything matches up, that’s why they call it a tool. The use of brain scans can help see if aPTSD patient is having abnormalities in the brain and maybe what they can do to counteract that. “Post-traumatic stress disorder, or PTSD, is an anxiety disorder that affects 7 percent to 8percent of the population in the United States. It develops after a person experiences a traumaticevent or witnesses something traumatic happening to someone else” (“PTSD”, n.d.). Theseevents are stressful and outside the normal range of human occurrence. Post-Traumatic StressDisorder is a multifaceted condition that involves flashbacks, hyper arousal symptoms, limitedaffect, avoidance of people/ places/ things that is a reminder of the event, cognitive impairmentswhich include trouble recalling certain aspects of the traumatic event, poor autobiographicalmemory for recall of positive events in their life, and poor working memory, signifying thedisturbance of some of their neural mechanisms distressing precise brain circuits. In 1980 theAPA officially added PTSD to the DSM, in order to get a diagnosis of PTSD specific criteria laidout in the DSM IV-TR must be met. According to the DSM IV- TR PTSD is present inindividuals, who present these symptoms and behaviors, “ Post-traumatic stress disorder: 309.81 A.) person has been exposed to traumatic event in which both are present:
POST-TRAUMATIC STRESS DISORDER, REPRESSED MEMORIES 4 1.) person witnessed, experienced, or confronted an event or events that involved actual or threatened death or serious injury or threat to physical integrity to self or others 2.) persons response involved intense fear, helplessness, or horror. B.) traumatic event is persistently reexperienced in one or more of the following ways: 1.) recurrent and distressing recollections of event ( images, thoughts, or perceptions) 2.) recurrent distressing dreams of event 3.) acting or feeling as if the traumatic event were recurring ( reliving theexperience, illusions, hallucinations, dissociative flashbacks 4.) internal psychological distress at exposure to internal and external cues that symbolize or resemble an aspect of the traumatic event 5.) physiological reactivity to exposure to internal or external cues to traumatic event C.) persistent avoidance of stimuli associated with trauma and general numbing responsiveness, indicated by 3 or more of the following: 1.) effort to avoid thoughts, feelings, or conversations associated with trauma 2.) avoid activities, places, or people that arouse recollections of trauma 3.) inability to recall an important aspect of trauma 4.) feeling of detachment from others 5.) diminished interest or participation in significant activities
POST-TRAUMATIC STRESS DISORDER, REPRESSED MEMORIES 5 6.) restricted range of affect 7.) sense of foreshortened future D.) persistent symptoms of increased arousal, indicated by 2 or more: 1.) difficulty falling or staying asleep 2.) irritability or outbursts of anger 3.) difficulty concentrating 4.) hypervigilance 5.) exaggerated startle response F.) duration of disturbance must last more than 1 month” (First, M. B., MD, 2000, 467-468).Some of the causes associated with PTSD are rape, sexual abuse, physical abuse, emotionalabuse, soldiers, people who have been assaulted, disasters and people in serious accidents; this isnot a exhausted list of all the possible causes of PTSD. No one exactly knows why some peopledevelop PTSD and others do not, there are risk factors that makes an individual more prone todeveloping this disorder, “Children and adolescents have a higher risk of PTSD than adults, thelonger a traumatic events duration, the higher the risk that a person will develop post-traumaticstress disorder, and women are twice as likely to develop post-traumatic stress disorder as men”(“PTSD”, n.d.). Symptoms of PTSD are physiological and psychological impairments that arethe direct consequence from trauma. Post-traumatic stress disorder is characterized by continualthinking and reliving of the traumatic experience. PTSD can produce nightmares and flashbackswhere the trauma is repetitively relived, and anxiety when encountered with events or objectsthat trigger memories of the event. Treatments for PTSD include Trauma-Focused Cognitive-Behavioral Therapy and Trauma Systems Therapy which integrates psychopharmacology with
POST-TRAUMATIC STRESS DISORDER, REPRESSED MEMORIES 6numerous psychotherapeutic techniques. Some medications include clonidine for emotionregulation and mirtazapine for sleep, but this is not an exhausted list. “Both of these treatments involve the acquisition of emotional and cognitive coping skills as well as trauma-processing techniques. The acquisition of coping skills is a necessary prerequisite for trauma processing, as these skills help to combat much of the physiological symptomatology in response to traumatic reminders and, over time, allow for less hesitancy with regard to approaching the trauma. Trauma-processing techniques, such as the writing of a trauma narrative, enable the adult to process thoughts and feelings associated with the trauma and begin to ascribe meaning to the traumatic event” ( Kaplow, 2006, 365). Repressed memories are a controversial issue in the field of psychology, due to the factthat many people have false memories of a traumatic event happening and then go on to sue thealleged perpetrator, when in fact these traumatic events never happened. The APA it is not ableto differentiate between true repressed memories from a false memory, without support fromother evidence, since there is not empirical evidence that repressed memories are in fact truememories. “A repressed memory is a theoretical concept used to describe a significant memory,usually of a traumatic nature, that has become unavailable for recall, in which a subject blocksout painful or traumatic times in ones life” (“Repressed memories”, n.d.). According to therepressed memory theory, repressed memories can be recovered years or decades after thesupposed event, but this is not always the case, repressed memories are unexpectedly, triggeredby a certain smell, taste, or other trigger correlated to the lost memory, this can happen throughsuggestion at some point in psychotherapy as well. Along these same lines is recovered memorytherapy, which is used to portray as a wide scope of psychotherapy modalities based on
POST-TRAUMATIC STRESS DISORDER, REPRESSED MEMORIES 7remembering memories of abuse that had been forgotten by the individual. Many psychologistsbelieve that these individuals are having false memories brought on by suggestion throughpsychotherapy. “Even when patients who decide that their recovered memories are false andretract their claims they can still suffer post-traumatic stress disorder due to the trauma of theillusory memories” (“Repressed memories”, n.d.). I hypothesize that, if a person with repressedmemories exhibits the same behaviors and symptoms as someone who has PTSD, according tothe DSM IV-TR, and remembers the event happening; then when the clinician does a brain scan,the clinician is going to see the same abnormalities in both brain scans of adults. The pathophsiology of PTSD are linked to genetics and the environment in which theindividual is immersed in. Reactions to acute stress involve a genetic tendency. Changes inspecific brain systems are directly correlated with early life stress in adult psychopathology.When childhood stresses are present there is a great chance that there will be long termalterations in stress reactivity and brain maturity. “Studies have also shown that long-termneurobiological changes associated with early stress may be influenced by familial/geneticfactors, quality of the subsequent caregiving environment, and pharmacological interventions.Early traumatic events can lead to a wide range of psychopathological manifestations as well asinto factors associated with vulnerability or resilience” (Jackowski, 2009,6). The corpus callosum, “contains interhemispheric projections from brain structuresinvolved in circuits that mediate the processing of emotional stimuli and various memory aspectscore disturbances associated with PTSD. There is a decrease in total white matter brain volumeand has also been reported in adults with chronic, severe PTSD” (Jackowski, 2009, 4). Thehippocampus is, “ gray matter structure of the limbic system that is involved in explicit(declarative) memory, working memory, and memory for episodic events. The hippocampus is
POST-TRAUMATIC STRESS DISORDER, REPRESSED MEMORIES 8rich in glucocorticoids receptors and is vulnerable to petrochemical changes. Chronic stress mayaffect the hippocampus through excess release of glucocorticoids, corticotropin-releasinghormone, and glutamate, inhibition of neurogenesis, impaired long-term potentiating induction,inhibition of brain-derived neurotrophic factor (BDNF), and alteration in serotonergic receptorfunction” ( Jackowski,2009, 3). Adults who have encountered sexual abuse as a child have areduced volume in their hippocampus. In cases of severe trauma stress hormones that damage thehippocampus and other correlated areas of the brain and over time patchy reminiscences of thetraumatic event appear. The Hippocampus size is positively linked with the age the trauma tookplace and psychopathology severity especially when it came to the externalizing of PosttraumaticStress Disorder behaviors or symptoms. These decreases can be seen in MRI scans ofindividuals who a sexual abuse history. When sexual abuse happens recurring times in childhood there is harm done to the braincomposition that helps coordinate memory. “According to Freyds (1996) betrayal trauma theory, children abused by a caretaker are more likely than those abused by a noncaretaker to experience amnesia for their CSA. Freyd has maintained that children abused by caretakers are confronted with a seemingly senseless situation: The perpetrators are the same individuals on whom they must rely for shelter, food, and clothing. To resolve this conflict, the children maintain the necessary bond to the perpetrators by blocking out memories of the abuse. If we assume that participants were more dependent for caregiving on parental perpetrators than on other perpetrators (e.g., priests, neighbors, uncles), then Freyds theory predicts that parents and stepparents should be
POST-TRAUMATIC STRESS DISORDER, REPRESSED MEMORIES 9 identified as perpetrators more often in the recovered memory group than in the continuous memory group” (McNally,2006, 238).When undergoing stress or trauma the declarative, explicit, and implicit memory systemsbecome unfasten, these memory systems are usually greatly coordinated. When this uncouplinghappens sensory and affective rudiments become dissociated from any rational semantic memorysystem. “The conscious result of this uncoupling is to feel a certain way without knowing why.Because these memories continue to exist, even in an unintegrated form, they continue toinfluence emotion and behavior. Situationally accessible memories cannot be accesseddeliberately, but resurface automatically when the individual is confronted with asituation/context that has physical features or meaning similar to those of the trauma” (Kaplow,2006, 369). These individuals that have undergone trauma use a defense mechanism of denial toblock out memory of the traumatizing event. “The defense mechanism of denial (keeping threatening external information from entering the conscious cognitive system) versus the defense mechanism of repression (banishing from consciousness information which has entered consciousness or which threatens to enter consciousness from the unconscious). This threatening information must first enter the cognitive system (probably at an unconscious level) in order to later be "denied." Whether perceptual defense operates primarily via denial or primarily through repression, in either case information which has entered the system has been kept from consciousness” (Reisner,1996,3).
POST-TRAUMATIC STRESS DISORDER, REPRESSED MEMORIES 10To keep these memories at bay trauma victims may dissociate where there is a change inconsciousness that is induced by panic, “absorption in ones thoughts to the exclusion of theexternal world, feelings of detachment from ones body or self, and memory lapses” (Bower,1995, 1). Empirical evidence has shown that long term memory is matter that is prone todistortions or alterations on the basis of experience. MethodParticipants: All participants were recruited from a women’s health clinic. Where the first requirementto participate in this experiment is that you must be a woman who has encountered abuse as achild or have memories of being abused, whether they are recovered memories does not matter.There will be a repressed memory group, recovered memory group, continuous memory group,and finally a control group. The repressed memory group encompassed women who have allegednon accessible memories of abuse, but still displayed symptoms and behaviors of PTSD. Therecovered memory groups are individuals who state recalling memories of abuse after a period oftime, and show symptoms and behaviors of PTSD. The continuous memory group are womenwho never forgot their abuse and display PTSD symptoms and behaviors, and the control groupencompass women who have never been abused.Materials: The materials that are needed for this experiment are as follows; - DissociativeExperiences Scale, which tapped dissociative symptoms, Absorption Scale, which tappedproneness to become engaged in imaginative experiences—a correlate of fantasy proneness,Vividness of Visual Imagery Questionnaire, which served as a measure of imagery ability, Beck
POST-TRAUMATIC STRESS DISORDER, REPRESSED MEMORIES 11Depression Inventory, which measured depressive symptoms, Short form of the ManifestAnxiety Scale, which measured trait anxiety, Shipley measures of verbal and nonverbal cognitiveability, and a magnetic resonance imaging (MRI) machine, to observe abnormalities in the brain.Procedure: Behavioral scientists will use questionnaires to assess psychological distress andpersonality. The second procedure will be a series of interviews to, “elucidate the character oftheir abuse memories (e.g., kind of abuse, relationship to perpetrator) and to determine whetherthey qualified for PTSD or depression” (McNally, 2006, 238). The interviews will be designedto see if they qualify for PTSD according to the DSM, the PTSD symptom scale Interview willbe used, a clinical Interview for DSM IV, and participants will be assessed for Axis I mentaldisorders. After going through the questionnaires and the interviews the participants who meetall criteria will be given an MRI to determine if they have abnormalities in their brain. Predicted results Structural MRI has been successfully used to study the neural basis of PTSD”(Jackowski, 2009, 5). MRI’s have referred to the fact that contact with severe emotional traumacan cause changes in brain structure. This suggests that women who have the smallesthippocampal volume tend to score higher on the standard dissociation scale. When comparingwomen who have repressed memories, recovered memories, and continuous memories thewomen who have never forgotten their abuse were identical to women who had never beenabused on depression, posttraumatic stress, dissociation, personality, and who are negativeemotionally. Although the repressed memory group will tend to state more distress and score
POST-TRAUMATIC STRESS DISORDER, REPRESSED MEMORIES 12higher than the recovered memory group and the continuous memory group. The repressedmemory group will also state more anxiety and dissociative symptoms and depression than theother groups. Although the continuous, recovered, and repressed groups scored higher onamnesia, absorption, derealization, and depersonalization than the control group did on all thesefactors. The “False memory perspective implies that participants reporting either repressed or recovered memories of CSA should score higher than those reporting continuous memories on measures empirically or theoretically linked to false memory formation, but , inconsistent with the prediction that the repressed and recovered memory groups would score higher than the continuous memory group on absorption (related to fantasy proneness), all three of these groups were statistically indistinguishable; however, they did score higher than the control group” (McNally, 2006, 240). Behavioral neuroscientists have revealed that a release of stress hormones throughout extremely negative emotional events can reinforce memory for the experience, and this course may cause the memorability of the trauma. Discussion The participants in this study might skew the results due to the fact that, “individuals whomeet researcher-defined criteria for having been sexually abused may reject the label of sexualabuse survivor because they regard it as stigmatizing. However, members of our repressedmemory group embraced the label of abuse survivor despite not having any memories of abuse.
POST-TRAUMATIC STRESS DISORDER, REPRESSED MEMORIES 13Finally, rejection of the victim identity may signify psychological resilience rather than stigmaavoidance” (McNally, 2006, 241).And even though the controversy of false memories and repressed memories is about the factthat, “those experienced as overwhelmingly terrifying and perceived as life threatening—areseldom forgotten by victims” (McNally, 2006, 237). It doesn’t matter unless the individual whois having the false memories is bringing the perpetrator to court for alleged abuse. Once theseindividuals, who have repressed memories, have memories of abuse the stress hormone will stillbe released and decrease the size of the hippocampus leaving them vulnerable to PTSDsymptoms, just like individuals who meet the DSM IV-TR criteria for PTSD. Individuals whohave repressed memories still experience PTSD symptoms, therefore those memories are veryreal to them and the symptoms they experience are as well. Even though the memories of theseindividuals might be false, physicians shouldn’t deny them of a PTSD diagnosis, because to theindividual it is very real and distressing in every aspect of their life.
POST-TRAUMATIC STRESS DISORDER, REPRESSED MEMORIES 14 ReferencesBower, B. (1995). Child sex abuse leaves mark on brain. Science News, 147(22), 340. Retrieved from Academic Search Premier database.First, M. B., MD., et al. (2000). Posttraumatic Stress Disorder. In Anxiety Disorders (Vol. DSM IV-TR, pp. 463-468). Arlington, VA: American Psychiatric Publishing.Jackowski, A., de Araújo, C., de Lacerda, A., de Jesus Mari, J., & Kaufman, J. (2009). Neurostructural imaging findings in children with post-traumatic stress disorder: Brief review. Psychiatry & Clinical Neurosciences, 63(1),1-8. doi:10.1111/ j.1440-1819.2008.01906.x.Kaplow, J., Saxe, G., Putnam, F., Pynoos, R., & Lieberman, A. (2006). The Long-Term Consequences of Early Childhood Trauma: A Case Study and Discussion. Psychiatry: Interpersonal & Biological Processes 69(4), 362-375. Retrieved from Academic Search Premier database.McNally, R., Perlman, C., Ristuccia, C., & Clancy, S. (2006). Clinical characteristics of adults reporting repressed, recovered, or continuous memories of childhood sexual abuse. Journal of Consulting and Clinical Psychology, 74(2), 237-242. doi:10.1037/0022-006X.74.2.237.Post-traumatic stress disorder (PTSD) (n.d.). Retrieved on May. 11, 2010 from www.psychiatric-disorders.comRepressed memories (n.d.). Retrieved on May. 18, 2010 from
POST-TRAUMATIC STRESS DISORDER, REPRESSED MEMORIES 15 http://en.wikipedia.org/wiki/Repressed_memoryReisner, A. (1996). Repressed memories: True and false. Psychological Record, 46(4), 563. Retrieved from Academic Search Premier database.