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Remembered
A Report on the Current Scientific
Knowledge Base and its Applications
Childhood Trauma
Remembered
A Report on the Current Scientific
Knowledge Base and its Applications
Chief Editors:
Susan Roth, PhD
Duke University, Durham, NC
Matthew J. Friedman,MD, PhD
National Center for PTSD, Veteran’s Affairs Medical Center, White River Junction, VT
Dartmouth Medical School, Hanover, NH
This document is endorsed by the International Society for Traumatic Stress Studies,
and was prepared with the help of headquarters staff, ISTSS Immediate Past President
Terence Keane, PhD, and Journal of Traumatic Stress past and present editors,
Bonnie Green, PhD and Dean Kilpatrick, PhD.
For reprint requests or additional copies, contact ISTSS at 60 Revere Drive, Suite 500, Northbrook,
IL 60062; telephone:847/480-9028; fax:847/480-9282;e-mail: istss@istss.org.
Cover art: Beebe’s Birthday© 1993 by Ami Simms. This wall quilt features over 180 photographs and other
images that have been transferred to fabric. Simms made the quilt for her mother’s 70th birthday. It is featured with
other photo-quilts in Simms’ book, Creating Scrapbook Quilts (Mallery Press, 1993). For more information about
Simms’ quilts, books, or Photos-To-Fabric TM transfer paper, please call 800/278-4824, or write to Mallery Press at
4206 Sheraton Drive, Flint, MI 48532-3557.
INTRODUCTION
ver the past several years, the topic of memories of childhood trau-
The initiative for this report comes from the leadership of the International
Society for Traumatic Stress Studies, with strong support from its member-
ship. The Society (ISTSS) is perhaps uniquely prepared to take on the task
of gathering the expertise necessary to present the state of the art in scien-
tific understanding about memories of childhood trauma.ISTSS is a pro-
fessional organization of worldwide influence which is dedicated to the dis-
covery and dissemination of knowledge and to the stimulation of policy,
program and service initiatives that relate to the occurrence and conse-
quences of traumatic stress. For the present document, we have received
input from some of the most distinguished clinical researchers and scholars
on traumatic memory in order to provide you with the best available
knowledge and its most thoughtful practical application.
American Psychiatric
This report represents and incorporates the work of a diverse group of
Association. Statement on
Memories of Sexual Abuse scholars with expertise in a variety of different topic areas and professional
approved by the Board of contexts. It is a statement of the state-of-the-science that is expected to
Trustees of the American evolve as new information becomes available. Finally, this effort is in keep-
Psychiatric Association on ing with what has been produced by other professional organizations (see
December 12,1993. reports at left), and is in the spirit of finding middle ground and a conver-
gence of various points of view and areas of expertise.
Hammond,D.C. et al.(1994).
Clinical hypnosis and memory:
Guidelines for clinicians and for This report is not meant to be a comprehensive research review, but rather
forensic hypnosis.American an overall summary of the major issues involved in the recall of childhood
Society of Clinical Hypnosis Press. trauma. Therefore, instead of the usual format of citing specific references
for each issue, representative references and suggested readings are listed as
Recovered memories. The a sidebar for each section.
Report of the Working Party of
the British Psychological Society
(1996). In Pezdek,K.& Banks,
W. (Eds.), The recovered memo-
ry/false memory debate. New
York: The Academic Press.
We do not know the exact number of children who experience serious trau-
ma, but given the variety of forms it can take, the number is not small. In
recent years, many efforts have been made to estimate the occurrence of 3
particular kinds of childhood trauma. Sexual abuse is the type of trauma
that has received the greatest amount of study. The estimate that 20% of
girls and 5-10% of boys experience such unwanted sexual contact and
molestation while growing up is based on a large number of community
epidemiological studies that have interviewed adults about their child-
hoods. It appears that only a fraction of these cases get disclosed to authori-
ties while they are occurring, which accounts in part for why only approxi-
mately 300,000 cases get reported to U.S. child welfare authorities each year.
Both science and personal experience tell us that these childhood events some-
times leave scars that last until adulthood and interfere with healthy adult func-
tioning. It is one of the most consistent scientific research findings that traumas
and adversities in childhood tend to put an individual at risk for a large variety
of later difficulties. This is true for all kinds of early traumas, including acci-
dents, disasters and the observation of violence. But we know it to be especially
true for victims of child abuse and neglect, who have been the subject of a par-
ticularly large amount of research. Those who were severely abused as children
are two to five times more likely to experience a mental illness as an adult than
those who were not. They are more likely to suffer from low self-esteem and
difficulties in social, academic and occupational performance. Children who
were abused or neglected are also more likely to get caught up in patterns of
later delinquent and criminal behavior, violence, alcohol and drug abuse.
pp. 181-197.
women and men, found that 20% of the 116 people in the
sample who reported a history of childhood sexual abuse said
This paper provides evidence that that there was a period of time when they had no memory of
individuals can be made to believe the event. Complete to partial forgetting was reported after
that they had unusual childhood every form of traumatic experience, with child sexual abuse,
experiences that did not actually witnessing a murder of a family member and combat exposure
occur. After a third suggestive yielding the highest rates.
■ Williams (1994), and Williams & Banyard (1997) followed up
interview, 25% of the subjects
women and men who, in the early 1970s, were seen in a hospital
claimed to recall events that had
emergency room for child sexual abuse. They found that at the
not occurred.
time of their study, which was 17 years later, 38% of the women
6 and 55% of the men did not recall the documented abuse. Of
Hyman,L.E.& Pentland, J. the women who did recall the abuse, 16% stated that there was a
(1996). The role of mental time in the past when they did not remember that it had hap-
imagery in the creation of false pened to them.
childhood memories. Journal of ■ Widom & Morris (1997) found that 32% to 60% of women and
Memory and Language, 35, 58% to 100% of men with court-substantiated reports of child
pp. 101-117. sexual victimization did not report such abuse on reinterview
some 20 years later.
This article provides evidence that
individuals who are asked to form It should be noted that the above findings have been challenged in a
a mental image of an event and to number of critiques that address methodological concerns with the
describe it to an interviewer were retrospective studies as well as with the Williams study (see Pope &
more likely to create a false event. Hudson, 1995).
They were also more likely to
Sources: Herman, J. L., & Schatzow, E.(1987). Recovery and verification of memo-
recover memories of a previously ries of childhood sexual trauma. Psychoanalytic Psychology, 4, pp. 1-14; Briere, J. &
unavailable true event. Conte, J. (1993). Self-reported amnesia for abuse in adults molested as children.
Journal of Traumatic Stress, 6, pp. 21-31; Loftus, E., Polonsky, S. & Fullilove, M. T.
(1994). Memories of childhood sexual abuse: Remembering and repressing.
Psychology of Women Quarterly, 18, pp. 67-84; Elliot, D. M.(1997). Traumatic
events: Prevalence and delayed recall in the general population. Journal of
Consulting and Clinical Psychology, 65, pp. 811-820; Williams, L.M.(1994). Recall
of childhood trauma: A prospective study of women’s memories of child sexual
abuse. Journal of Consulting and Clinical Psychology, 62, pp. 1167-1176; Williams, L.
M.(1995). Recovered memories of abuse in women with documented child sexual
victimization histories. Journal of Traumatic Stress, 8, pp. 649-675; Williams, L .M . &
Banyard,V. L.(1997). Gender and recall of child sexual abuse: A prospective study.
In Read, J. D. & Lindsay, D. S .( Eds.), Recollections of traum a :S c ientific evidence and
clinical practice, pp. 371-377. New York: Plenum Press; Widom ,C .S . , & Morris, S.
(1997). Accuracy of adult recollections of childhood victimization: Part 2:
Childhood sexual abuse. Psychological Assessment, 9, pp. 34-36.
Regarding the accuracy of recovered memories, several cases in the public This article provides a thoughtful
record of reported delayed recall of childhood abuse that were corroborated methodological analysis of the lim-
provide evidence for accuracy, as do preliminary studies of recovered mem- itations of studies concerning for-
ories of documented traumatic events that occurred in childhood. In the getting of childhood sexual abuse
research project mentioned above, for example, Williams was able to com- and constructive suggestions for
the design of future studies.
pare women’s current accounts of their abuse with the details of the abuse
that had been recorded in the 1970s. She found that the women who report-
Scheflin ,A . W. & Brown, D. (1996).
ed prior periods of forgetting and the experience of having recovered mem- Repressed memory of dissociative
ories, and those who had always remembered had the same number of dis- amnesia: What the science says.
crepancies when their accounts of the abuse were compared to the reports Journal of Psychiatry and Law, 24
from 17 years earlier. This evidence suggests that memories of childhood (2), pp. 143-188.
trauma can become accessible after periods of forgetting. A summary and This paper presents a summary and
synthesis of more than two dozen studies on trauma-related forgetting is synthesis of more than two dozen
described in Scheflin and Brown. studies on trauma-related forgetting.
3. Memory is not a perfect representation like a photograph. This paper provides a thoughtful
11
The human capacity to remember and retrieve past events is largely accurate, review of the evolution of models
of memory processes from
but it is not perfect. Memory is a selective process which prioritizes informa-
ancient times to the present.
tion thought to be most important at the time it first occurred. Although
most errors in retrieved memory will be small, sometimes they can be quite Schacter, D. L.(1996). Searching
large. Some common errors in remembering that people make are: for memory: The brain, the mind
• People sometimes are unable to recall vast portions of their past and the past. New York: Basic
experiences. Books.
• People sometimes fail to accurately identify the source of their memories. This is the authoritative book on
• People may mistake memories of imagined events for memories of real brain mechanisms and memory.
events.
• People are suggestible; social influence may generally affect the memory Shobe, K.K.& Kihlstrom, J. F.
retrieval process, and recall of an event may be influenced by misinformation. (1997). Is traumatic memory
special? Current Directions in
4. There are two basic forms of memory: explicit and implicit memory. Psychological Science, 6, pp. 70-
Explicit memory, also referred to as the declarative memory system, records 74.
consciously available information about past experiences. Implicit memory,
This article provides a thoughtful
also referred to as the nondeclarative memory system, is information that is
critique of claims that traumatic
not consciously available. Skills or attitudes that are “second nature” and memory is special, and a careful
relatively automatic are examples of implicit memories. Implicit memory analysis of data on which those
may also contribute to strong emotional memories. Currently available claims are based.
information about these two basic forms of memory is useful for an under-
standing of traumatic memories:
This chapter provides a compre- 5. Traumatic memories may be different than ordinary memories.
hensive review of data suggesting There are a variety of points of view or emphasis among researchers and
that the processing of traumatic scholars with regard to the memory of traumatic vs. nontraumatic events.
memories is different than for
Some researchers believe that the same basic memory processes can
other memories.
account for the forgetting of both traumatic and nontraumatic memories.
Also suggested are four chapters Others, however, believe that while traumatic and nontraumatic memories
from: Yehuda, R. & McFarlane, may share many similarities, there may also be important differences
A.C.(Eds.).(1997). Psychobiology between these two types of memories in certain aspects of encoding, con-
12 of posttraumatic stress disorder. solidation and retrieval. Some researchers propose that memories of trau-
Annals of the New York Academy matic events are less distorted, longer-lasting and less susceptible to inaccu-
of Sciences, 821. New York:
rate recall, suggestibility or social influence. This is because traumatic stress
Academy of Sciences:
van der Kolk, B. A.,
activates both explicit and implicit memory to a much greater extent than is
Burbridge, J. A.& Suzuki, J. The the case for nontraumatic events. Emotional arousal associated with trau-
psychobiology of traumatic matic events may also be accompanied by elevations in stress hormones
memory: Clinical implications and neuromodulators that facilitate memory formation. The amount of
of neuroimaging studies, pp. 99- arousal that occurs during a traumatic event, however, may influence the
113. quality of memory formation. Some researchers argue that moderate levels
Cahill ,L . The neurobiology of
of arousal will lead to more reliable memories, but that extreme levels of
emotionally influenced memory:
Implications for understanding
arousal may limit attention so much that little memory of the event will be
traumatic memory, pp. 238-246. retained. Still others propose that highly charged traumatic memories may
Roozendaal, B., Quirarte, G. sometimes mobilize active efforts to forget a memory. One such theoretical
& McGaugh, J. L. Stress-activat- mechanism (among others) that has been widely discussed is called
ed hormonal systems and the “repression,” which prevents conscious recall of such memories. Repression
regulation of memory storage, is a concept, originally postulated in psychoanalytic theory, that has not
pp. 247-258.
been empirically demonstrated in the laboratory.
Armony, J. L.& LeDoux, J. E.
How the brain processes emo-
tional information, pp. 259-270. These different views about memory for traumatic vs. nontraumatic events
continue to stimulate a great deal of exciting research. In spite of our gaps
in knowledge and differences in opinion, it is generally accepted that the
memory of both childhood and adult traumatic events may sometimes
become irretrievable (“forgotten”) after exposure. There has also been a
6. There are a number of as yet unproven mechanisms that might explain how
traumatic memories are “forgotten.”
It is not currently known how traumatic memories are forgotten, and differ-
ent mechanisms may operate under different circumstances. These questions
are of great interest to researchers, and we can expect a rapid growth in
information in this area over the next decade. Among explanatory mecha-
nisms that have been proposed to account for “forgetting” are the following:
• Failure to encode: a failure to create a memory at the time of the event.
• Dissociation: an altered cognitive state which sometimes occurs during a
traumatic event and which may interfere with the normal processes for
remembering (encoding, consolidation or retrieval) of such events.
• Simple forgetting: the fading of a memory over time (a normal phenome-
non with non-traumatic memories).
• Repression: a theoretical psychological process hypothesized to actively
prevent conscious retrieval of memories.
• Conditioned extinction: a laboratory phenomenon by which certain con- 13
ditions can activate inhibition (or reduce the availability) of previously
learned behavior.
• State dependent learning: a mechanism that would explain why traumatic
memories can be retrieved only when the individual is in the same emo-
tional, environmental and neurobiological state that was present during
the original traumatic event.
• Long-term depression: a cellular mechanism which suppresses the trans-
mission of data from certain nerve cells to others; this could theoretically
impair the retrieval of previously accessible information.
Dalenberg, C.& Carlson,E.(in Clients sometimes consider taking certain actions with accused offenders
press). Ethical issues in the and/or family members during the course of therapy for childhood abuse.
treatment of the recovered These actions may include confronting offenders, informing others about
memory trauma victims and the abuse, restricting, and in some cases severing family relationships, or
patients with false memories of taking legal action against an alleged perpetrator. It is appropriate for thera-
trauma. In S. Buckey (Ed.).
pists to explore with clients the potential positive and negative impacts that
The comprehensive textbook of
ethics and law in the practice of
different choices may have on psychological and social functioning. It is not
psychology. New York: Plenum. appropriate for therapists to instruct or pressure clients to take a particular
course of action.
This chapter describes the vari-
ous clinical situations where
memory or lack of memory for Therapists treating clients who have suffered trauma or report a trauma
trauma becomes an issue. It iden- history have a duty to promote a therapeutic environment that is support-
tifies the various and complex ive regarding the trauma, but acknowledges that memory is imperfect.
dilemmas that clinicians face, Clients must not be discouraged from revealing and talking about traumat-
and suggests therapeutic ic experiences because of therapist discomfort with the traumatic material
approaches in light of these
or because of undue skepticism about client reports. However, it may be
dilemmas.
advisable, especially with delayed recall of memories for events that
occurred in the remote past, that therapists convey information about the
reconstructive nature of memory.
22