ABSTRACT The present study explored whether cognitive factors specified in the Ehlers and Clark model of PTSD predict chronic PTSD in children who had experienced a road traffic accident. Children were assessed at 2 weeks, 3 months, and 6 months after the accident. Data-driven processing during the accident, negative interpretation of intrusive memories, alienation from other people, anger, rumination, thought suppression, and persistent dissociation at initial assessment predicted PTSD symptom severity at 3 and 6 months. On the basis of sex and stressor severity variables, 14 percent of the variance of PTSD symptoms at 6 months could be explained. The accuracy of the prediction increased to 49 percent or 53 percent when the cognitive variables measured at initial assessment or 3 months, respectively, were taken into account.

ABSTRACT An interview study of 81 former political prisoners investigated whether posttraumatic stress disorder (PTSD) is related to the way individuals process the prison experience. In contrast to participants without PTSD, those with chronic or remitted PTSD were more likely to perceive mental defeat and an overall feeling of alienation from other people. Chronic PTSD was also related to perceived negative and permanent change in their personalities or life aspirations. The groups did not differ in their attempts to gain control during imprisonment. Evidence for a relationship between political commitment and PTSD was mixed. The results suggest that mental defeat, alienation, and permanent change are related to PTSD after interpersonal trauma and may need to be addressed in treatment.

ABSTRACT Some memories are linked to a specific time and place, allowing one to re-experience the original event, whereas others are accompanied only by a feeling of familiarity. To uncover the distinct neural bases for these two types of memory, we measured brain activity during memory retrieval using event-related functional magnetic resonance imaging. We show that activity in the hippocampus increased only when retrieval was accompanied by conscious recollection of the learning episode. Hippocampal activity did not increase for items recognized based on familiarity or for unrecognized items. These results indicate that the hippocampus selectively supports the retrieval of episodic memories.

Elliott, Kathy J. PhD (1999)
The 'Inner Critic' as a key element in working with adults who have experienced childhood sexual abuse
Bulletin of the Menninger Clinic, Vol. 63, No. 2, pp. 240-253, Spring 1999

Ellison JM, Chu JA, Henry ME (2000)
Transient dissociative identity disorder after electroconvulsive therapy.
Bulletin of the Menninger Clinic, Vol. 63, No. 2, pp. 240-253, Spring 1999

Elsass, Peter. (2001)
Department of Psychology, University of Copenhagen, Copenhagen, Denmark.
Individual and collective traumatic memories: a qualitative study of post-traumatic stress disorder symptoms in two Latin American localities. .
Transcultural Psychiatry (ISSN: 1363-4615), v. 38, no. 3, pp. 306-316 (September 2001).

ABSTRACT A qualitative analysis of material from a number of field trips to Peru and Colombia shows the diagnosis of PTSD to be culture related. When a local community consists of collective, functional units, as in some Peruvian villages, people have a tendency to not react solely with conventional PTSD symptoms, or to have the attitude that traumatic memory should be treated with crisis intervention. This is in contrast to some villages in Colombia where people are more individualistically oriented and reactions to trauma are more concerned with guilt and shame. In Peru, psychosocial work is carried out mostly by strengthening the construction of the local community, whereas in Colombia, individual, psychological interventions are more widely used and accepted. The study demonstrates that the concept of traumatic memory should be considered in both collective and individual aspects, depending on the nature of the underlying organisation of society and culture.

Elzinga BM, Schmahl CG, Vermetten E, van Dyck R, Bremner JD (2003)
Section of Clinical and Health Psychology, Leiden University, The Netherlands. elzinga@fsw.leidenuniv.nl
Higher cortisol levels following exposure to traumatic reminders in abuse-related PTSD.
Neuropsychopharmacology. 2003 Sep;28(9):1656-65

ABSTRACT Animal studies have found that prior stressful events can result in increased reactivity in the HPA-axis. However, baseline function of the HPA-axis has typically been normal or decreased in post-traumatic stress disorder (PTSD). The first purpose of this study was to assess cortisol responsivity to traumatic reminders in women with PTSD related to childhood abuse. The second aim was to assess the relationship between stress-induced cortisol levels and neutral and emotional memory. Salivary cortisol levels were measured before, during and after exposure to personalized trauma scripts in abused women with (N=12) and without current PTSD (N=12). Memory for neutral and emotional material was assessed immediately after trauma scripts exposure and 3 days later. PTSD patients had 122% higher cortisol levels during script exposure, 69% higher cortisol levels during recovery, and 60% higher levels in the period leading up to the script exposure compared to controls. PTSD symptoms were highly predictive of cortisol levels during trauma script exposure (r=0.70), but not during periods of rest. Both in PTSD patients and controls, memory consolidation after the trauma scripts was impaired relative to baseline (P<0.001), with no differences between the two groups on memory performance. There was no association between memory performance and cortisol levels. These results are consistent with higher cortisol levels following exposure to traumatic stressors in PTSD

Elzinga, Bernet M.; Phaf, R. Hans; Ardon, Angelique M.; van Dyck, Richard (2003)
Directed forgetting between, but not within, dissociative personality states.
Journal of Abnormal Psychology. 2003 May Vol 112(2) 237-243

ABSTRACT To investigate amnesia between identities in dissociative identity disorder (DID), the authors assessed explicit and implicit memory performance on a directed-forgetting task in 12 DID patients who switched from one state to an "amnesic" state between presentation and memory testing. DID patients were instructed either to remember or to forget neutral and emotional words. Besides an overall decrease in explicit memory, patients demonstrated selective forgetting of to-be-forgotten, but not of to-be-remembered words in the amnesic state. Patients did not exhibit any directed forgetting within the same state. Implicit memory was fully preserved across states. Independent of state, patients recalled more emotional than neutral information. These results may extend the conceptualization of memory processes in DID, suggesting an important role for retrieval inhibition.

Elzinga BM, Bermond B, van Dyck R. (2002)
The relationship between dissociative proneness and alexithymia.
Psychother Psychosom. 2002 Mar-Apr;71(2):104-11.

ABSTRACT BACKGROUND: Dissociative reactions and alexithymia are two strategies that have been put forward as coping mechanisms to alleviate painful emotions. It is the clinical impression that dissociation is related to certain alexithymia features. In line with the coping hypothesis, it was predicted that the relationship between dissociative tendencies and alexithymia would be partly mediated by current levels of stress and/or by past traumatic experiences. Furthermore, dissociation may also be related to enhanced fantasizing, although alexithymia has traditionally been associated with an incapacity to fantasize. METHODS: Data were obtained from 833 nonclinical participants on dissociative tendencies, alexithymia, childhood abuse, current stress and socially desirable behavior. Correlation analyses followed by multiple regression were performed. RESULTS: Dissociative tendencies appeared to be especially related to one alexithymic feature: a difficulty in identifying feelings. This relationship was partially mediated by levels of current stress. A history of trauma did not predict dissociation measures. Furthermore, highly dissociative participants were more fantasy prone than low-dissociative participants. CONCLUSIONS: The results of this study support the idea that in a nonclinical group dissociation may provide a way to cope with current stressful events, and that this is associated with a difficulty in identifying feelings. It is argued that two types of dissociation may exist, one trait-like type of dissociation that is associated with fantasy proneness and other related factors, and a trauma-related type of dissociation that is more apparent within the clinical range.

Elzinga, Bernet M; De Beurs, Edwin; Sergeant, Joseph A; Van Dyck, Richard; Phaf, R Hans. (2000)
Psychiatry Department, Vrije Universiteit, Amsterdam, The Netherlands; Clinical Psychology Department, University of Amsterdam, Amsterdam, the Netherlands.
Dissociative style and directed forgetting.
Cognitive Therapy and Research (ISSN: 0147-5916), v. 24, no. 3, pp. 279-295 (June 2000).

ABSTRACT Dissociative style may correspond to an enhanced ability to avoid conscious recollection of traumatic experiences, which may, however, remain dormant in nonconscious memory. This hypothesis was tested in two "directed-forgetting" experiments with affectively neutral words (experiment 1) and sex and threat words (experiment 2) employing students high and low in dissociative style, and dissociation patients. Conscious and nonconscious memory were separated with the process dissociation procedure. Instruction to forget was expected to reduce conscious but to enhance nonconscious memory performance in subjects with a high dissociative ability. Results were opposite to predictions. Particularly for sex words, the instruction to forget raised the overall (conscious and nonconscious) memory performance of the patients. An alternative construction hypothesis is proposed that identifies dissociative style with enhanced skills of constructing conscious experiences. [Author Abstract] KEY WORDS: dissociation; memory; directed forgetting

Elzinga, Bernet M., Richard van Dyck, Philip Spinhoven (1998)
Three controversies about dissociative identity disorder
Clinical Psychology & Psychotherapy Volume 5, Issue 1 , Pages 13 - 23

ABSTRACT Three controversies about Dissociative Identity Disorder are discussed. First, is DID an artefact due to iatrogenic influences? The empirical evidence does not support such a conclusion, although iatrogenic influences may play a considerable part in the presentation of this disorder. Second, how adequate are the present diagnostic criteria? It is argued that the DSM-IV may elicit overdiagnosis and that the use of structured clinical interviews is mandatory. The third controversy concerns memory processes of DID patients. Does psychogenic amnesia for sexual abuse exist, or are the so-called repressed memories of sexual abuse false memories (unintentionally) induced by overzealous therapists? Clinical data and experimental laboratory findings do not converge in this. The massive amnesia for traumatic events that is clinically reported in dissociative disorders, has not been replicated in laboratory studies, whereas memory research has shown that some false memories can be created in the laboratory.

Engle, P. (1997)
Art therapy and dissociative disorders.
Art Therapy, 14, 246-254.

ABSTRACT Dissociative disorders are characterized by disturbances of identity and memory exacerbated by childhood trauma. Although much has been written in the last decade about the treatment and etiology of these disorders, studies show that they are frequently misdiagnosed and do not receive effective treatment. Most dissociative clients who come for counseling are not aware of either the trauma or their dissociative response. Once a dissociative disorder is identified, useful treatment can present time and resource conundrums for private practitioners and their clients. By accessing traumatic material and giving expression to hidden aspects of the personality, art therapy offers a unique way to help clients understand and begin working with the traumatic influences that shaped their lives. This paper demonstrates how art therapy helped a woman begin to address her identity and memory difficulties and still manage her daily activities. The process helped validate for the client that there were traumatic events in her history and provided a starting point for addressing her internal conflicts. For the therapist, the artwork served as access to and communication with unconscious (dissociated) states.

Engum A, Bjoro T, Mykletun A, Dahl AA. (2002)
Department of Psychiatry, Innherred Hospital, Levanger, Norway. an-engum@online.no
An association between depression, anxiety and thyroid function--a clinical fact or an artefact?
Acta Psychiatr Scand. 2002 Jul;106(1):27-34.

ABSTRACT OBJECTIVE: The aim of the study was to examine the association between depression, anxiety and thyroid dysfunction. METHOD: The study is part of the HUNT-study. Individuals aged 40-89 years (n = 30,589) with thyroid assays, and self-rating of depression and anxiety--Hospital Anxiety and Depression Scale (HADS)--were divided in six categories according to thyroid function. Relations were investigated with logistic regression analysis. RESULTS: The group with biochemical hypothyroidism had significantly lower risk for depression and anxiety compared with the reference group with normal thyroid function. Subclinical hypothyroidism, and latent and overt biochemical hyperthyroidism were not risk factors for depression or anxiety. When individuals with former known thyroid disease were excluded from the analyses, the results were essentially identical, but this group had an increased risk of both anxiety and depression, independent of thyroid function. CONCLUSION: In this large, unselected population, we found no statistical association between thyroid dysfunction, and the presence of depression or anxiety disorder.

Epstein MA, Bottoms BL. (2002)
Explaining the forgetting and recovery of abuse and trauma memories: possible mechanisms.
Child Maltreat 2002 Aug;7(3):210-25

ABSTRACT Much attention has been focused on memories of abuse that are allegedly forgotten or repressed then recovered. By retrospectively surveying more than 1,400 college women, the authors investigated (a) the frequency with which temporary forgetting is reported for child sexual abuse experiences as opposed to other childhood abuse and traumas and (b) exactly how victims characterize their forgetting experiences in terms of various competing cognitive mechanisms. Rates of forgetting were similar among victims who experienced sexual abuse, physical abuse, and multiple types of traumas. Victims of other types of childhood traumas (e.g., car accidents) reported less forgetting than victims of childhood sexual abuse or multiple types of trauma. Most victims' characterizations of their forgetting experiences were not indicative of repression in the classic Freudian sense but instead suggested other more common mechanisms, such as directed forgetting and relabeling. The implications of these findings for psychological theory, clinical practice, and law are discussed.

Eustache F, Desgranges B, Laville P, Guillery B, Lalevee C, Schaeffer S, de la Sayette V, Iglesias S, Baron JC, Viader F (1999)
INSERM U320 and Services de Neurologie, CHU Cote de Nane, Caen, France.
Episodic memory in transient global amnesia: encoding, storage, or retrieval deficit?   
J Neurol Neurosurg Psychiatry 1999 Feb;66(2):148-54

ABSTRACT OBJECTIVES: To assess episodic memory (especially anterograde amnesia) during the acute phase of transient global amnesia to differentiate an encoding, a storage, or a retrieval deficit. METHODS: In three patients, whose amnestic episode fulfilled all current criteria for transient global amnesia, a neuropsychological protocol was administered which included a word learning task derived from the Grober and Buschke's procedure. RESULTS: In one patient, the results suggested an encoding deficit, and in two others, a storage deficit. CONCLUSIONS: The encoding/storage impairment concerning anterograde amnesia documented in our patients stands in clear contrast with the impairment in retrieval which must underly the retrograde amnesia that also characterises transient global amnesia. This dissociation in turn favours the idea of a functional independence among the cognitive mechanisms that subserve episodic memory.

Evans, J.R., & Claycomb, S. (1999)
Abnormal QEEG patterns associated with dissociation and violence.
Journal of Neurotherapy, 3, 21-27.

ABSTRACT A group of 10 men with histories of violent behaviors and who reported dissociative type experiences were found to have specific quantitative EEG (QEEG) abnormalities. In 6 cases there was abnormally excessive relative power at frontal (and sometimes anterior temporal) sites in the alpha frequency band. These men either strongly denied awareness that they had engaged in specific violent behaviors, seemed only vaguely aware, or were aware, but perceived having been controlled by an external force. This is discussed in terms of earlier reports of a correlation of hypnotizability (and, by inference, self hypnotizability and dissociation) with high amplitude alpha. In 4 cases paroxysmal delta waves were observed in the raw EEG primarily at site F8, but occasionally also involving other frontal and right temporal sites. In all 4 cases the men had histories of behaviors which had no cause apparent to them or others, sometimes accompanied by violence or delusions. The possibility of this raw EEG abnormality being a marker for 1 type of intermittent explosive disorder is discussed. These findings may have relevance to forensic situations and to the application of neurofeedback procedures in the prevention and treatment of some types of violence.

Everest P (1999)
The multiple self: working with dissociation and trauma.
J Anal Psychol 1999 Oct;44(4):443-63

ABSTRACT This paper describes a patient who appears to have a chronic dissociative personality disorder. Renewed clinical interest in dissociative disorders had arisen in North America in the 1980s, in part due to the influence of the Women's Movement which had highlighted the incidence of child sexual abuse. The early psychological observations of Janet, Freud and Jung on hysterical patients who displayed dissociative phenomena were similar to those displayed by the patient. consideration is given to theoretical understanding of the condition, taking into account the views of the earlier theorists and object-relations theory. The possibility of trauma, in particular childhood sexual abuse, as a causative factor in dissociative disorders is discussed.Comments: Comment in: J Anal Psychol 1999 Oct;44(4):465-74