ABSTRACT Dissociative symptoms are frequently present in trauma survivors with posttraumatic stress disorder (PTSD). However, the possibility that dissociative symptoms may comprise a risk factor for the development of PTSD has not been examined. The current research investigates this possibility by evaluating dissociative symptoms in a group of adult offspring of Holocaust survivors, whom we have previously shown to be at increased risk of PTSD. Eighty-seven Holocaust survivor offspring and 39 comparison participants completed the Dissociative Experiences Scale, and assessments of trauma exposure, psychopathology, and parental PTSD. Dissociative symptoms were elevated in individuals with current PTSD, but not in those with past PTSD or with the risk factor of parental PTSD. Dissociative symptoms were also associated with forms of psychopathology other than PTSD. The results suggest that dissociative symptoms are related to current psychiatric symptomatology, including PTSD, rather than representing an enduring trait or preexisting risk factor for the development of PTSD.

Philosophy, Psychiatry, and Psychology 5 (1998), 283-297

ABSTRACT My central argument is that the theoretical presuppositions of psychology serve to obscure the debate over false memory. Psychologists have failed to recognize that the reliability of personal memory is a presupposition human knowledge; we have to adopt a non-neutral stance to personal memory-claims as testimony. Memory may not be "reproductive," but it is not "reconstructive" either, in the sense defended for instance by Elizabeth Loftus in The Myth of Repressed Memories. Philosophical accounts of personal memory emphasize the distinction between personal and merely factual memory of one's own past, which tends to be neglected in psychology. This is a datum, not a result of theorizing. I elucidate the distinction, and contrast direct and indirect realist theories of memory, defending the former as emphasizing the spontaneous, authoritative nature of personal memory-claims. The "reconstructive" conception of "memory as narrative" assumed by psychologists such as Loftus disparages reliability and spontaneity. It claims that I integrate my personal memories with less direct sources of knowledge into a "narrative" that appears consistent to myself now. This view has not been much discussed in the philosophical literature. I argue that the "memory as narrative" conception is mistaken, and serves to confuse the debate over false memory. I also argue that the debate is unlikely to be undermined by Ian Hacking's argument that past human actions are to a certain extent indeterminate. My points of disagreement with Loftus concern: (1) Her mis-assimilation of false memory with ordinary memory-errors. Where memories are mistaken, they are almost invariably "false-in-detail". "Completely-false" memories are necessarily rare. Loftus and other psychologists tend to gloss over this vital distinction. The results of therapeutic suggestion are not part of a general pattern of "reconstruction" of the past through personal memory, as the narrative conception suggests. (2) Her wholesale rejection of repression. However, she may be right in arguing that there is a distinct and questionable category of "robust repression." (3) Her conviction that scientific theory can make us change our ordinary methods of assessing the reliability of testimony. There are strict limits to such change. I conclude by examining the tension between repression and the paradigm of a spontaneous memory-judgment.

Kathleen Hanley (2001)
Case Study: Narrative Of A Psychotherapeutic Treatment Of Dissociative Identity Disorder In An Adolescent
Southern African Journal of Child and Adolescent Mental Health, Volume 13, Number 1, 2001

ABSTRACT Over the last three decades, significant developments have been made in the areas of dissociative disorders research and clinical practice. Dissociative Identity Disorder (DID) (formerly Multiple Personality Disorder) is generally regarded as the most controversial of the dissociative disorder diagnoses, and yet is considered by those working with the disorder to be fundamental to the dissociation paradigm. Countering its image as a bizarre and intractable disorder, clinicians have built up a substantial body of literature which indicates that it is in fact eminently understandable and treatable. Specific theoretical principles and techniques have been developed for psychotherapeutic treatment of this group of patients with integration as the ultimate - but not exclusive - goal. The dual purpose of this case study is to describe patient symptoms and dynamics, and to illustrate the progression of an individual psychotherapeutic treatment of DID in an adolescent over a 14-month period in both inpatient and outpatient settings. The primary orientation of this case study is accordingly descriptive rather than analytic.

Hariri AR, Mattay VS, Tessitore A, Kolachana B, Fera F, Goldman D, Egan MF, Weinberger DR (2001)
Serotonin transporter genetic variation and the response of the human amygdala.
Science. 2002 Jul 19;297(5580):319.

ABSTRACT A functional polymorphism in the promoter region of the human serotonin transporter gene (SLC6A4) has been associated with several dimensions of neuroticism and psychopathology, especially anxiety traits, but the predictive value of this genotype against these complex behaviors has been inconsistent. Serotonin [5- hydroxytryptamine, (5-HT)] function influences normal fear as well as pathological anxiety, behaviors critically dependent on the amygdala in animal models and in clinical studies. We now report that individuals with one or two copies of the short allele of the serotonin transporter (5-HTT) promoter polymorphism, which has been associated with reduced 5-HTT expression and function and increased fear and anxiety-related behaviors, exhibit greater amygdala neuronal activity, as assessed by BOLD functional magnetic resonance imaging, in response to fearful stimuli compared with individuals homozygous for the long allele. These results demonstrate genetically driven variation in the response of brain regions underlying human emotional behavior and suggest that differential excitability of the amygdala to emotional stimuli may contribute to the increased fear and anxiety typically associated with the short SLC6A4 allele.

O. van der Hart , Hilde Bolt MA, Bessel van der Kolk MD (2005)
Memory Fragmentation in Dissociative Identity Disorder
Journal of Trauma & Dissociation Volume: 6 Issue: 1- 55 - 70, DOI: 10.1300/J229v06n01_04

ABSTRACT Objective: Imprecise conceptualizations of dissociation hinder understanding of trauma-related dissociation. An heuristic resolution for research and clinical practice is proposed. Method: Current conceptualizations of dissociation are critically examined. They are compared with a new theory that incorporates classical views on dissociation with other contemporary theories related to traumatization, viewing dissociation as a lack of integration among psychobiological systems that constitute personality, that is, as a structural dissociation of the personality. Results: Most current views of dissociation are overinclusive and underinclusive. They embrace non-dissociative phenomena - rigid alterations in the level and field of consciousness - prevalent in non-traumatized populations, and which do not require structural dissociation. These views also largely disregard somatoform and positive symptoms of dissociation and underestimate integrative deficiencies, while emphasizing the psychological defensive function of dissociation. They do not offer a common psychobiological pathway for the spectrum of trauma-related disorders. Structural dissociation of the personality likely involves divisions among at least two psychobiological systems, each including a more or less distinct apperceptive centre, that is, a dissociative part of the personality. Three prototypical levels of structural dissociation are postulated to correlate with particular trauma-related disorders. Conclusions: Limitation of the concept of dissociation to structural dividedness of the personality sets it apart from related but non-dissociative phenomena and provides a taxonomy of dissociative symptoms. It postulates a common psychobiological pathway for all trauma-related disorders. Trauma-related dissociation is maintained by integrative deficits and phobic avoidance. This conceptualization advances diagnosis, classification, treatment and research of trauma-related disorders.

O. van der Hart Nijenhuis, E., Steele, K., & Brown, D. (2004)
Trauma-related dissociation: conceptual clarity lost and found.
Australian and New Zealand Journal of Psychiatry, 38, 906-914.

ABSTRACT Objective: Imprecise conceptualizations of dissociation hinder understanding of trauma-related dissociation. An heuristic resolution for research and clinical practice is proposed. Method: Current conceptualizations of dissociation are critically examined. They are compared with a new theory that incorporates classical views on dissociation with other contemporary theories related to traumatization, viewing dissociation as a lack of integration among psychobiological systems that constitute personality, that is, as a structural dissociation of the personality. Results: Most current views of dissociation are overinclusive and underinclusive. They embrace non-dissociative phenomena - rigid alterations in the level and field of consciousness - prevalent in non-traumatized populations, and which do not require structural dissociation. These views also largely disregard somatoform and positive symptoms of dissociation and underestimate integrative deficiencies, while emphasizing the psychological defensive function of dissociation. They do not offer a common psychobiological pathway for the spectrum of trauma-related disorders. Structural dissociation of the personality likely involves divisions among at least two psychobiological systems, each including a more or less distinct apperceptive centre, that is, a dissociative part of the personality. Three prototypical levels of structural dissociation are postulated to correlate with particular trauma-related disorders. Conclusions: Limitation of the concept of dissociation to structural dividedness of the personality sets it apart from related but non-dissociative phenomena and provides a taxonomy of dissociative symptoms. It postulates a common psychobiological pathway for all trauma-related disorders. Trauma-related dissociation is maintained by integrative deficits and phobic avoidance. This conceptualization advances diagnosis, classification, treatment and research of trauma-related disorders.

O. van der Hart Nijenhuis E. (2001)
Department of Clinical Psychology, Utrecht University, Heidelberglaan 1, 3584 CS Utrecht, the Netherlands
Generalized dissociative amnesia: episodic, semantic and procedural memories lost and found.
Aust N Z J Psychiatry 2001 Oct;35(5):589-600

ABSTRACT OBJECTIVE: This review tests Ribot's classic twofold categorization of generalized amnesia (GA) into Type I, total loss of episodic memory, and Type II, additional more or less extensive loss of semantic and/or procedural memory. It also explores his law of regression, according to which, cast in modern terms, recovery of lost procedural and semantic memories precedes recovery of episodic memory, as well as reported aetiological factors. METHOD: Clinically and formally assessed cases of GA, published since 1845, were surveyed and further analysed. RESULTS: Over and above authentic episodic memory loss, cases differed widely in the extent of impairment of semantic and procedural memory. Recovery of semantic and procedural memory often preceded recovery of episodic memory. This particularly applied to authenticated trauma memories. To an extent, lost memories affected current functioning, and in some cases were associated with alternating dissociative personalities. Severe memory distortions upon memory recovery were not reported. Most cases were trauma or stress related, while in some cases the aetiology remained unknown. CONCLUSIONS: Contrary to the view expressed in DSM-IV, which states that dissociative amnesia pertains to an inability to recall personal information, GA may also involve loss and recovery of semantic and procedural memories. Since the loss of various memory types in GA is dimensional rather than categorical, Ribot's typological distinction does not hold. Some of the reviewed cases suggest a trauma-related aetiology. Generalized amnesia of varying degrees of severity can involve delayed retrieval of trauma memories, as well as the loss and delayed retrieval of the premorbid personality.

O. van der Hart, ; Annemieke van Dijke, MA Maarten van Son, PhD Kathy Steele, RN, MS, CS (2000)
Somatoform Dissociation in Traumatized World War I Combat Soldiers: A Neglected Clinical Heritage
Journal of Trauma & Dissociation, Vol. 1(4) 2000

ABSTRACT The massive traumatization of World War I combat sol-diers led to an unprecedented incidence of somatoform dissociative disorders and symptoms, usually diagnosed as hysterical disorders dur-ing the war years. Following a brief overview of the scope of the suffering during this Great War, attention is given to British army psychiatrist Charles S. Myers’ (1940) observations of the alternation between a so-called ‘‘emotional’’ personality and an ‘‘apparently nor-mal’’ personality in traumatized combat soldiers. Somatoform dissoci-ation, further categorized into positive and negative symptoms, is re-lated to this structural dissociation, and to fixation in the trauma and avoidance of the trauma, and may be part of a more encompassing symptomatology. Next, a short overview of diagnostic issues is given. We argue that the DSM-IV category of ‘‘conversion disorder’’ is incor-rect. Rather, the findings revealed here support Janet’s classic and Ni-jenhuis’ more recent views on somatoform dissociation. Finally, treat-ment issues are briefly presented.

O. van der Hart, ; Brown, P.,  Graafland, M. (1999)
Trauma-induced dissociative amnesia in World War I combat soldiers.
Australian & New Zealand Journal of Psychiatry, 33, 37-46.

ABSTRACT This study relates trauma-induced dissociative amnesia reported in WWI studies of war trauma to contemporary findings of dissociative amnesia in victims of childhood sexual abuse. Key diagnostic studies of post-traumatic amnesia in WWI combatants are surveyed. These cover phenomenology and the psychological dynamics of dissociation vis-a-vis repression. Descriptive evidence is cited for war trauma-induced dissociative amnesia. The authors conclude that posttraumatic amnesia extends beyond the experience of sexual and combat trauma and is a protean symptom, which reflects responses to the gamut of traumatic events.

O. van der Hart, ;  Nijenhuis, E.R.S. (1999)
Bearing witness to uncorroborated trauma: The clinician's development of reflective belief
Professional Psychology - Research & Practice, 30, 37-44.

ABSTRACT Clinicians should not reflexively accept or reject as fact a client's initial report of uncorroborated abuse. However, by maintaining a neutral stance, clinicians may fall short of therapeutic honesty and transparency, may fail to promote reality testing, and may not perform the necessary step of bearing witness to the client's victimization. Using a case of dissociative identity disorder, this article proposes the careful development and sharing of the clinician's reflective belief in the (in)validity of reported trauma. This process may assist clients in (a) reclaiming a sense of integrated personal narrative memory and identity, (b) correcting cognitive distortions, or (c) both.

O. van der Hart, v.d.; P. Brown (1998)
Memories of sexual abuse: Janet's critique of Freud, a balanced approach
Psychological Reports = ISSN 0033-2941: Vol. 82 (1998), no. 2-1 (jun), pag. 1027-1043.

ABSTRACT Since the late nineteenth century explanations of sexual trauma have invoked unconscious mental mechanisms of forgetting. Memories have been seen as submerged only to be therapeutically recovered. Explanations and related therapies have tended to be either hotly advocated or decried, not the least were those of Janet and Freud. Once again there is a vigorous debate surrounding the status of recovered memories. This paper was undertaken to contribute to reasoned and balanced dialogue by exploring an historical dimension. There is a renaissance of interest in the oeuvre of Janet. In this article Janetian sources are examined in which he criticised Freud's views on sexual trauma and elaborated his own position, a position which is yet significant today.

O. van der Hart, ; Madelon L. Peters, Seger A. Uyterlinde, John Consemulder (1998)
Department of Clinical and Health Psychology, Utrecht University, The Netherlands
Apparent Amnesia on Experimental Memory Tests in Dissociative Identity Disorder: An Exploratory Study  
Consciousness and Cognition Vol. 7, No. 1, March 1998 ISSN: 1053-8100

ABSTRACT Dissociative identity disorder (DID; called multiple personality disorder in DSMIII-R) is a psychiatric condition in which two or more identity states recurrently take control of the person's behavior. A characteristic feature of DID is the occurrence of apparently severe amnestic symptoms. This paper is concerned with experimental research of memory function in DID and focuses on between-identity transfer of newly learned neutral material. Previous studies on this subject are reviewed and a pilot study with four subjects is described. This study is specifically concerned with the question whether self-reported asymmetries in between-identity transfer can be replicated on experimental memory tests. A secondary aim was to examine whether, in the absence of explicit transfer, implicit transfer of information would occur. The results showed that the apparent amnestic asymmetry for explicit information was substantiated in the laboratory, although at least some leakage was present between the apparently amnestic identities. No evidence was found for better performance on implicit than on explicit memory tests in the apparently amnestic identities. In the discussion, parallels between apparent amnesia in DID and state-dependent memory are drawn, and the question of simulated amnesia is addressed.

O. van der Hart, ; Nijenhuis, E.R.S. (1998)
Recovered memories of abuse and dissociative identity disorder
British Journal of Psychiatry, 173, 537-538.

ABSTRACT Comments on the article by S. Brandon et al (see record 1998-01837-002) claiming that there is no evidence for delayed recall of authentic childhood trauma, implying that this recall involves pseudo-memories. The present author argues that studies have found evidence consistent with the hypothesis that a proportion of cases retrieve delayed memories of authentic trauma. Implications for the prevalence of dissociative identity disorder among this population are discussed. A commentary reply is included.

Hartman, D; Crisp, A H; Sedgwick, P; Borrow, S. (2001)
Is there a dissociative process in sleepwalking and night terrors?
British Journal of Psychiatry, 173, 537-538.

ABSTRACT The enduring and contentious hypothesis that sleepwalking and night terrors are symptomatic of a protective dissociative mechanism is examined. This is mobilised when intolerable impulses, feelings, and memories escape, within sleep, the diminished control of mental defence mechanisms. They then erupt but in a limited motoric or affective form with restricted awareness and subsequent amnesia for the event. It has also been suggested that such processes are more likely when the patient has a history of major psychological trauma. In a group of 22 adult patients, referred to a tertiary sleep disorders service with possible sleepwalking/night terrors, diagnosis was confirmed both clinically and polysomnographically, and only 6 patients had a history of such trauma. More commonly these described sleepwalking/night terrors are associated with vivid dream-like experiences or behaviour related to flight from attack. Two such cases, suggestive of a dissociative process, are described in more detail. The results of this study are presented largely on account of the negative findings. Scores on the dissociation questionnaire (DIS-Q) were normal, although generally higher in the small "trauma" subgroup. These were similar to scores characterising individuals with PTSD. This "trauma" group also scored particularly highly on the anxiety, phobic, and depression scales of the Crown-Crisp experiential index. In contrast the "no trauma" group scored more specifically highly on the anxiety scale, along with major trends to high depression and hysteria scale scores. Two cases are presented which illustrate exceptional occurrence of later onset of sleepwalking/night terrors with accompanying post-traumatic symptoms during wakefulness. It is concluded that a history of major psychological trauma exists in only a minority of adult patients presenting with sleepwalking/night terror syndrome. In this subgroup trauma appears to dictate the subsequent content of the attacks. However, the symptoms express themselves within the form of the sleepwalking/night terror syndrome rather than as rapid eye movement sleep related nightmares. The main group of subjects with the syndrome and with no history of major psychological trauma show no clinical or DIS-Q evidence of dissociation during wakefulness. The proposition that, within the character structure of this group, the mechanism still operates but exclusively within sleep remains a possibility.

Harvey, A.G. ; Bryant, R.A. (2001)   
Reconstructing trauma memories: a prospective study of "amnesic" trauma survivors.
Journal of Traumatic Stress (ISSN: 0894-9867), v. 14, no. 2, pp. 277-282 (April 2001).

ABSTRACT The purpose of this study was to investigate memory for trauma in patients who were initially amnesic of the trauma as a result of mild traumatic brain injury (MTBI). Motor vehicle accident survivors who sustained a MTBI were assessed for their memory within 1-month posttrauma (n = 79) and again at 2-years posttrauma (n = 50). Consistent with their brain injury, all patients reported significant amnesia of their accident at initial assessment. At 2-years posttrauma, 40 percent were able to remember their accident. Reporting memory for the trauma was associated with shorter duration of posttraumatic amnesia. These findings suggest that people reconstruct memories of trauma in the absence of complete encoding of the experience. Possible mechanisms for memory reconstruction are considered. KEY WORDS: acute stress disorder, PTSD, memory, amnesia

Harvey, A.G. ; Bryant, R.A. (1999)   
A qualitative investigation of the organization of traumatic memories
British Journal of Clinical Psychology, 38, 401-405.

ABSTRACT The present study aimed to evaluate the qualitative features of memory organization, dissociation and perception of threat in traumatic memories recalled by individuals with and without acute stress disorder (ASD). Survivors of motor vehicle accidents (MVA) with either ASD (N = 14) or no ASD (N = 15) participated in a study on traumatic memories within 12 days of the MVA. Participants' audiotaped recollections of their memories of the MVA were coded in terms of disorganized structure, dissociative content, and perception of threat. The recollections of ASD participants were characterized by disorganization and dissociation more than those of non-ASD participants. The current findings suggest that disorganized memory structure may be one process that impedes access to, and modification of, trauma-related cognitive schema.

Harvey AG ; Bryant RA (1999)   
Department of Experimental Psychology, University of Oxford, UK.
Dissociative symptoms in acute stress disorder.
J. Trauma Stress 1999 Oct;12(4):673-80

ABSTRACT This study provides a profile of symptoms, and particularly dissociative symptoms, in the diagnosis of acute stress disorder (ASD) following motor vehicle accidents (MVAs). Consecutive adult non-brain-injured admissions to a major trauma hospital (N = 92) were assessed between 2 days and 4 weeks following an MVA. Presence of ASD was determined by a structured clinical interview. The occurrence of full and subsyndromal ASD was approximately 13% and 21%, respectively. The majority of those who met criteria for subsyndromal ASD did not meet the ASD criteria for dissociation. At least 80% of individuals who reported derealization also reported reduced awareness and depersonalization. This significant overlap between dissociative symptoms questions the discriminatory power and conceptual independence of the dissociative criteria. These findings suggest the need for a more refined conceptual and operational understanding of dissociative symptoms in the acute trauma stage.

J Cogn Neurosci 1999 Nov;11(6):682-97

ABSTRACT We present a longitudinal neuropsychological study (31 examinations over a period of 18 months) of patient DE DF demonstrated bilateral atrophy of the hippocampal formation and globus pallidus resulting from carbon monoxide poisoning. Eighteen months after the event, the volume of the hippocampal formation was reduced by 42% on the left side and 28% on the right. The patient initially presented with a severe global amnesia. Then, he showed a gradual, yet selective recovery of episodic memory function. Verbal free recall and spatial memory performance remained reduced, whereas immediate word recall and recognition memory, as well as picture learning and memory, improved to levels at the lower range of normal performance. Interestingly, nonspatial associative learning was never much impaired and recovered completely by the end of testing. These data are taken as evidence that the human hippocampal formation does not equally support different forms of episodic memory.

ABSTRACT PRIMARY OBJECTIVES: To determine the frequency and nature of post-TBI personality disorders (PDs) in a community-based sample of individuals with TBI. RESEARCH DESIGN: One hundred individuals with TBI were administered a structural clinical interview to determine Axis II psychopathology. METHODS OF PROCEDURES: The Structured Clinical Interview for DSM-IV Personality Disorders, Clinician Version (SCID II) was used to determine 12 Axis II personality disorders. SCID II questions were modified so that symptom onset could be rated as occurring pre-injury vs. post-TBI. Data were analysed using student T-tests, chi-square analysis and one way analyses of variance. OUTCOMES AND RESULTS: Pre-TBI PDs were diagnosed in 24% of the sample; antisocial PD and obsessive-compulsive PD were the most common diagnoses. Post-TBI, 66% of the sample met criteria for at least one PD, with PDs independent of TBI severity, age at injury, and time since injury. The most common post-TBI PDs were: borderline, avoidant, paranoid, obsessive-compulsive and narcissistic. Men were more likely to be diagnosed with antisocial PD and narcissistic PD. Individuals with pre-TBI PDs were at greater risk of acquiring additional psychopathology post-TBI. Personality traits endorsed by more than 30% of the sample post-TBI reflected loss of self-confidence, attempts to cope with cognitive and interpersonal failures and negative affect. CONCLUSION: These findings argue against a specific TBI personality syndrome, but rather a diversity of personality disorders reflective of the persistent challenges and compensatory coping strategies developed by individuals post-TBI. Prospective need for clinical assessment, pro-active education and focused treatment approaches are discussed.

BMJ 2002;324:324-327 ( 9 February )

ABSTRACT Objective: To investigate the consistency of autobiographical memory of people seeking asylum, in light of the assumption that discrepancies in asylum seekers' accounts of persecution mean that they are fabricating their stories. Design: Repeated interviews. Setting: England, 1999 and 2000. Participants: Community sample of 27 Kosovan and 12 Bosnian refugees. Main outcome measures: Discrepancies in repeated descriptions of one traumatic and one non-traumatic event, including specific details, rated as central or peripheral to the event. Self report measures of post-traumatic stress disorder and depression. Results: Discrepancies between an individual's accounts were common. For participants with high levels of post-traumatic stress, the number of discrepancies increased with length of time between interviews. More discrepancies occurred in details peripheral to the account than in details that were central to the account. Conclusion: The assumption that inconsistency of recall means that accounts have poor credibility is questionable. Discrepancies are likely to occur in repeated interviews. For refugees showing symptoms of high levels of post-traumatic stress, the length of the application process may also affect the number of discrepancies. Recall of details rated by the interviewee as peripheral to the account is more likely to be inconsistent than recall of details that are central to the account. Thus, such inconsistencies should not be relied on as indicating a lack of credibility. What is already known on this topic Discrepancies between accounts of an event are often used to judge the credibility of asylum seekers What this study adds Discrepancies arise between two accounts of the same event even when there is no reason for fabrication Refugees with high levels of post-traumatic stress are more likely to give inconsistent accounts if they have a long time to wait between interviews Interviewees are more likely to be inconsistent in details that they rate as peripheral to their experiences than details they consider to be central Inconsistent recall does not necessarily imply that asylum seekers are fabricating their accounts

Biol Psychiatry 2001 Aug 15;50(4):292-8

ABSTRACT BACKGROUND: Intense and rapidly changing mood states are a major feature of borderline personality disorder (BPD); however, there have only been a few studies investigating affective processing in BPD, and in particular no neurofunctional correlates of abnormal emotional processing have been identified so far. METHODS: Six female BPD patients without additional major psychiatric disorder and six age-matched female control subjects underwent functional magnetic resonance imaging (fMRI) to measure regional cerebral hemodynamic changes following brain activity when viewing 12 standardized emotionally aversive slides compared to 12 neutral slides, which were presented in random order. RESULTS: Our main finding was that BPD subjects but not control subjects were characterized by an elevated blood oxygenation level dependent fMRI signal in the amygdala on both sides. In addition, activation of the medial and inferolateral prefrontal cortex was seen in BPD patients. Both groups showed activation in the temporo-occipital cortex including the fusiform gyrus in BPD subjects but not in control subjects. CONCLUSIONS: Enhanced amygdala activation in BPD is suggested to reflect the intense and slowly subsiding emotions commonly observed in response to even low-level stressors. Borderline subjects' perceptual cortex may be modulated through the amygdala leading to increased attention to emotionally relevant environmental stimuli.

ABSTRACT OBJECTIVE: The aim of the study was to investigate affective responses to emotional stimuli in subjects with borderline personality disorder. METHOD: Twenty-four female patients with borderline personality disorder and 27 normal female comparison subjects were examined. The test stimuli were a set of standardized photographic slides with pleasant, neutral, or unpleasant emotional valence. In addition to self-reports, emotional reactions to the slides were measured by heart rate, skin conductance, and startle response. Psychometric tests for various aspects of impulsiveness were also completed. RESULTS: Neither self-report nor physiological data gave any evidence that the borderline patients showed more intense affective responses than did the normal subjects. The borderline subjects did not produce higher levels of startle amplitude, and while viewing unpleasant slides, they showed a startle potentiation effect that was largely similar to that of the comparison group. In fact, the borderline patients showed low electrodermal responses to all three stimulus categories, which points to physiological underarousal. CONCLUSIONS: The results do not agree with the hypothesis that there is a fundamental, biologically based affective hyperresponsiveness in borderline personality disorder, as is suggested by current theories of affect dysregulation in the disorder. Autonomic underarousal may seriously interfere with a flexible adaptation to environmental stimuli.

Infant Mental Health Journal, 20, 42-59.

ABSTRACT This case report summarizes in detail the clinical course of twins referred for intervention after maltreatment at 19 months of age, who were followed to 36 months of age. Data from comprehensive assessment of parent-child relationships in these cases are reviewed and this material is considered in light of numerous family and systems factors that impacted the twins' clinical course. Diagnostic considerations pertaining to Reactive Attachment Disorder and the post-traumatic symptom of dissociation are presented. Links between recent research models of brain development and symptom presentation are discussed.

ABSTRACT This review aims to clarify the use of the term 'dissociation' in theory, research and clinical practice. Current psychiatric definitions of dissociation are contrasted with recent conceptualizations that have converged on a dichotomy between two qualitatively different phenomena: 'detachment' and 'compartmentalization'. We review some evidence for this distinction within the domains of phenomenology, factor analysis of self-report scales and experimental research. Available evidence supports the distinction but more controlled evaluations are needed. We conclude with recommendations for future research and clinical practice, proposing that using this dichotomy can lead to clearer case formulation and an improved choice of treatment strategy. Examples are provided within Depersonalization Disorder, Conversion Disorder and Posttraumatic Stress Disorder (PTSD).

ABSTRACT Three experiments indexed the effect of various concurrent tasks, while watching a traumatic film, on intrusive memory development. Hypotheses were based on the dual-representation theory of posttraumatic stress disorder (C. R. Brewin, T. Dalgleish, & S. Joseph, 1996). Nonclinical participants viewed a trauma film under various encoding conditions and recorded any spontaneous intrusive memories of the film over the following week in a diary. Changes in state dissociation, heart rate, and mood were also measured. As predicted, performing a visuospatial pattern tapping task at encoding significantly reduced the frequency of later intrusions, whereas a verbal distraction task increased them. Intrusive memories were largely unrelated to recall and recognition measures. Increases in dissociation and decreases in heart rate during the film were also associated with later intrusions.

ABSTRACT This is the first study to apply EEG coherence analysis to the study of Dissociative Identity Disorder (DID). EEG coherence is argued to be an objective measure of cortical connectivity. 5 DID patients were compared to 5 controls, who were professional actors. 15 dissociated DID alter states were studied, as were 15 "alters" simulated by the actor control participants. Comparisons of EEG coherence were made between DID participants and controls. Significant differences in EEG coherence were found in comparing DID host and alter personalities, with coherence found to be lower in the alter personalities. No significant differences were found in comparing DID host personalities and controls. The acted alters matched for age and gender, showed no significant differences in coherence compared to DID alter personalities. The results indicate that EEG coherence may be an objective measure of the neuronal cortical connectivity associated with DID. KEY WORDS: DID, EEG coherence, dissociation, trauma

Journal of Aggr., Maltreatment and Trauma (ISSN: 1092-6771), v. 4, no. 2, pp. 33-71 (2001).

ABSTRACT The study of traumatic memories is still an emerging field, both methodologically and theoretically. Previous questionnaire and interview methods for studying traumatic memories have been limited in their ability to evoke and assess remembrances with the characteristics long observed by clinicians. In this article, we introduce a new standardized method that incorporates a laboratory procedure for retrieving memories of traumatic events and a clinically informed measure for assessing these memories' characteristics. We present three case studies to demonstrate the data yielded by script-driven remembering and the Traumatic Memory Inventory - Post-Script Version (TMI-PS). We then discuss subjects' script-driven remembrances in terms of methodology, theoretical classification of traumatic memories, and the interplay between the two. Finally, we critique our method in detail and offer suggestions for future research. If validated as a method for evoking and assessing traumatic memories, and shown to yield reliable data, this integrative method shows great promise for advancing both clinical and cognitive research on traumatic memories. [Author Summary] KEY WORDS: traumatic memories, autobiographical memory, PTSD, research methodology

ABSTRACTDepersonalisation (DP) and derealisation (DR) are subjective experiences of unreality in, respectively, one's sense of self and the outside world. These experiences occur on a continuum from transient episodes that are frequently reported in healthy individuals under certain situational conditions to a chronic psychiatric disorder that causes considerable distress (Depersonalisation Disorder: DPD). Despite the relatively high rates of reporting these symptoms, little research has been conducted into psychological treatments for this disorder. We suggest that there is compelling evidence to link DPD with the anxiety disorders, particularly panic. This paper proposes that it is the catastrophic appraisal of the normally transient symptoms of DP/DR that results in the development of a chronic disorder. We suggest that if DP/DR symptoms are misinterpreted as indicative of severe mental illness or brain dysfunction, a vicious cycle of increasing anxiety and consequently increased DP/DR symptoms will result. Moreover, cognitive and behavioural responses to symptoms such as specific avoidances, 'safety behaviours' and cognitive biases serve to maintain the disorder by increasing awareness of the symptoms, heightening the perceived threat and preventing disconfirmation of the catastrophic misinterpretations. A coherent model facilitates the development of potentially effective cognitive andbehavioural interventions.

Journal of Abnormal Psychology. 2003 May Vol 112(2) 290-297

ABSTRACT Interidentity amnesia is considered a hallmark of dissociative identity disorder (DID) in clinical practice. In this study, objective methods of testing episodic memory transfer between identities were used. Tests of both recall (interference paradigm) and recognition were used. A sample of 31 DID patients was included. Additionally, 50 control subjects participated, half functioning as normal controls and the other half simulating interidentity amnesia. Twenty-one patients subjectively reported complete one-way amnesia for the learning episode. However, objectively, neither recall nor recognition scores of patients were different from those of normal controls. It is suggested that clinical models of amnesia in DID may be specified to exclude episodic memory impairments for emotionally neutral material. (PsycINFO Database Record (c) 2003 APA, all rights reserved)

ABSTRACT AB: Examined implicit memory transfer in patients with dissociative identity disorder (DID). To determine priming impairments in DID, the authors included both several perceptual priming tasks and a conceptual printing task using neutral material. The authors tested a large sample of DID 31 female patients (mean age 38.48 yrs), in addition to 25 controls (mean age 37.72 yrs) and 25 DID simulators (mean age 32.48 yrs), comparable on sex, age, and education. Controls replicated conceptual priming results of E. R. Vriezen, M. Moscovitch, and S. A. Bellos (1995) by showing that conceptual priming seems to require the formation of domain-specific semantic representations, denoting either sensory or functional object attributes. The authors extended a study performed by D. L. Schacter, L. A. Cooper, and S. M. Delaney (1990) by demonstrating priming for impossible objects using the sensitive priming index of response times. The simulators in the study were not able to simulate interidentity amnesia on the implicit memory tasks employed. Partly in contrast to participants in previous studies, DID patients showed evidence of perceptual priming as well as conceptual priming comparable to that of controls. DID patients thus displayed normal implicit memory performance.

ABSTRACT We used a free-recall paradigm to establish a behavioral index of the retrograde and anterograde interference of emotion with episodic memory encoding. In two experiments involving 78 subjects, we show that negatively valenced items elicit retrograde amnesia, whereas positively valenced items elicit retrograde hypermnesia. These data indicate item valence is critical in determining retrograde amnesia and retrograde hypermnesia. In contrast, we show that item arousal induces an anterograde amnesic effect, consistent with the idea that a valence-evoked arousal mechanism compromises anterograde episodic encoding. Randomized double-blind administration of the beta-adrenoceptor antagonist propranolol compared with the selective norepinephrine (NE) reuptake-inhibitor reboxetine, and placebo, demonstrated that the magnitude of this emotional amnesia and hypermnesia can be upregulated and downregulated as a function of emotional arousal and central NE signaling. We conclude that a differential processing of emotional arousal and valence influences how the brain remembers and forgets.