Clinical Implications
When providing treatment to foster children most clinicians in current practice rely on psychopharmacological and talking therapies that seek to neurobiologically stabilize and enhance ongoing problem solving skills, respectively. Because little attempt is made to help each child reexamine previously experienced trauma in a safe environment to promote psychological healing, breaches in drug adherence often yield profound unfortunate suffering after discharge from foster placement.
During clinical practice with foster children with histories of early severe physical and sexual abuse children present profound memory gaps for previously experienced traumatic events from their early childhood. Many of these children have experienced profound and sustained traumas during a time of rapid brain and central nervous system development. Loss of memory is also associated with compulsive preoccupation of aspects reminiscent of traumas (e.g. guns, fighting, (perpetrator related) monsters, etc.) (clinical observations), vivid hyperarousal in reexperiencing, avoidance, and, identification with trauma related material (Rothbaum, Foa, Murdock, Riggs, & Walsh, 1992; Berntsen & Rubin, 2006) and aggression, and sensitivity to aggressive responses to ongoing benign triggers (clinical observations). Apparently, the earlier the traumatic insult, the greater the likelihood for later recall deficits into adulthood (Terr, 1988).
Alterations in the ability for recalling early childhood traumatic experience are more common than one would expect. A prospective longitudinal study documented that as many as over 1/3 of a sample of 129 women at initial inquiry had amnesia “at some time” in adult life for previous hospital recorded childhood sexual abuse (Williams, 1994). Moreover with subsequent inquiry sixteen percent of 75 and seventeen percent 142 sampled adults, respectively, cited a time when they lacked total or partial memory for childhood sexual abuse, despite previously reported hospital and/or legal documentation or prosecutorial involvement (Goodman, Ghetti, Quas, Edelstein, Alexander, Redlich, et al., 2003; Williams, 1995). The tenuous nature of traumatic recall has been further supported by another study of twelve women who noted with initial inquiry “that there were time periods during which they had not recalled their abuse.” Interestingly with further inquiry into prior sexual abuse these same women noted that “they had never forgotten their (early childhood sexual abuse) experiences” (Fivush & Edwards, 2004, p. 6). The transient nature of memory from one moment to the next can explain these apparent contradictions. In contrast traumatized adults without memory deficits tend to report increased opportunity for sharing their trauma narratives with others on or around the trauma. Those without this opportunity present later recall deficits (Mechanic, Resick, & Griffin, 1998).
The following sections will examine the neurobiological nature of such deficits by examining lesioning effects of certain brain regions in both the human and the rodent and neuroimaging studies on asymptomatic and symptomatic trauma victims. Findings suggest a role for expressing traumatic emotion in mediating resilience to trauma’s effects.
References
Berntsen, D. & Rubin, D.C. (2006). Flashbulb memories and posttraumatic stress reactions across the life span: age-related effects of the German occupation of Denmark during World War II. Psychology and Aging, 21(1), 127-139.
Fivush, R., & Edwards, V.J. (2004). Remembering and forgetting childhood sexual abuse. Journal of Child Sexual Abuse, 13(2), 1-19.
Goodman, G.S., Ghetti, S., Quas, J.A., Edelstein, R.S., Alexander, K.W., Redlich, A.D., Cordon, I.M., & Jones, D.P. (2003). A prospective study of memory for child sexual abuse: new findings relevant to the repressed-memory controversy. Psychological Science, 14(2), 113-118.
Mechanic, M.B., Resick, P.A., & Griffin, M.G. (1998). A comparison of normal forgetting, psychopathology, and information-processing models of reported amnesia for recent sexual trauma. Journal of Consulting and Clinical Psychology, 66(6), 948-957.
Rothbaum, B.O., Foa, E.B., Murdock, T., Riggs, D., & Walsh, W. (1992). A prospective examination of post-traumatic stress disorder in rape victims. Journal of Traumatic Stress, 5, 455-475.
Terr, L. (1988). What happens to early memories of trauma? A study of twenty children under age five at the time of documented traumatic events. Journal of American Academy of Child and Adolescent Psychiatry, 27 (1), 96-104.
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(6), 1167-1176.
Williams, L.M. (1995). Recovered memories of abuse in women with documented child sexual victimization histories. Journal of Traumatic Stress, 8(4), 649-673.