PTSD & Traumatic Recall
A personal narrative is a sensory and spatial autobiographical map (of time, place, and event) to which personal meaning via emotion and emotionally laden cognition of self in interaction has been cumulatively attributed. A traumatic experience normally disrupts autobiographical memory’s processing and development as well as the social connections mediating its development (Wigren, 1994). Trauma survivors’ early development of trauma narratives is individualized and unpredictable (Tuval-Mashiach, Freedman, Bargai, Hadar, & Shalev, 2004). Some victims’ early trauma narratives are broken and incoherent. Their trauma narratives spontaneously develop and progress toward gaining coherence and meaning over the succeeding initial months. These trauma survivors and those with initially coherent trauma narratives do not go on to develop later PTSD symptoms. Their trauma narratives are temporally sequenced, detailed, coherent and embedded with personal meaning.
On the other hand according to these authors (Tuval-Mashiach et al., 2004) trauma survivors, who go on to develop later PTSD symptoms, throughout the post-trauma period tend to develop narratives that tend to avoid 1.) peripheral details of the most horrifying painful aspects of the trauma and 2.) perceptions of self in interaction experienced during and after the trauma. Their narratives tend to lack coherence, accurate chronological sequencing and personal meaning. Individuals who go onto to develop PTSD symptoms tend to have trauma narratives that have been characterized as having short, fast sentences, unfinished thoughts and speech fillers, and repetitious ideas. These findings are supported by others, who reference that PTSD narrative incoherence is reflective of disruptions in thought and memory (Foa, Molnar, & Cashman, 1995; Hembree & Foa, 2000). At three months post-trauma the lack of narrative articulation has also been associated with PTSD’s intensity of anxiety (Amir, Stafford, Freshman, & Foa, 1998) and with the later emergence of PTSD symptoms at six months (Halligan, Michael, Clark, & Ehlers, 2003).
PTSD traumatic memory recall has been accompanied by memory loss for peripheral details, which are necessary for the formation of an accurate detailed reconstruction of a traumatic event (Herlihy, Scragg, & Turner, 2002).* According to one interesting prospective study conducted by Yovel and researchers (2003), memory gaps that are persistent, “?consistent, circumscribed, and stable” (p. 684) and limited to brief moments on the most horrifying moments of the insult or assault are common among many trauma victims. Accordingly brief and delineated memory gaps do not impair the development of a relatively complete coherent, personally meaningful trauma report. However trauma survivors, who go onto develop PTSD symptoms from 30 days onward, present memory losses that enlarge well beyond the most horrifying traumatic perceptions. They found that PTSD associated memory loss to be progressive and persistent. PTSD trauma narratives often lacked temporal sequencing, were vague and diffuse in the amount of trauma detail provided, as well as embedded with a good deal of survivor guilt. For instance on day 120, one participant, who went on to develop later PTSD symptoms, had difficulty recognizing and recalling peripheral traumatic details recalled earlier despite rigorous cuing. Although certain loss of peripheral details of a traumatic event’s more horrifying extent is normal, progressive and expanded loss of memory details seem to be associated with PTSD symptom expression.
Tuval-Mashiach and colleagues (2004) stress that a traumatic event narrative, as with other meaningful memories and narratives of one’s life, normally needs continuity, coherence, individual meaning, and self-evaluation. These authors have identified two processes that enhance the construction of a detailed, coherent, chronologically accurate trauma story. First engaging and sharing one’s trauma story with another helps sensory details about the trauma narrative emerge and consolidate. Sharing one’s traumatic experience helps the trauma survivor to resolve areas of ambiguity and disorganization as to what had happened. Second as the survivor attributes meaning to the narrative one applies, incorporates, and assimilates the trauma into one’s autobiographical history. Though anxiety provoking trauma retrieval helps the survivor regain control and master trauma’s impact on the self. The interplay between both processes eventually facilitates the development of a “shorter, more coherent, well-constructed narrative,” which is less preoccupied with questions of meaning and explanation.
How is memory for the traumatic narrative that previously had been spontaneously generated and verbally narrated just 60 days before be partially forgotten? How is the loss for peripheral details linked with later PTSD symptoms? Why is it that patients with PTSD often present increased tendency for inappropriately displacing trauma related emotion into behaviors during future social interactions (Novaco & Chentob, 2002)? This site will seek to answer these questions in subsequent discussion.
References
Amir, N., Stafford, J., Freshman, M.S., & Foa, E.B. (1998). Relationship between trauma narratives and trauma pathology. Journal of Traumatic Stress, 11(2), 385-392.
Foa, E.B., Molnar, C., & Cashman, L. (1995). Change in rape narratives during exposure therapy for posttraumatic stress disorder. Journal of Traumatic Stress, 8(4), 675-690.
Halligan, S.L., Michael, T., Clark, D.M., & Ehlers, A. (2003). Posttraumatic stress disorder following assault: the role of cognitive processing, trauma memory, and appraisals. Journal of Consulting and Clinical Psychology, 71(3), 419-431.
Hembree, E.A., & Foa, E.B. (2000). Posttraumatic stress disorder: Psychological factors and psychosocial interventions. Journal of Clinical Psychiatry, 61 Supplement 7, 33-39.
Herlihy, J., Scragg, P., & Turner, S. (2002). Discrepancies in autobiographical memories-implications for the assessment of asylum seekers: repeated interviews study. BMJ, 324(7333), 324-7.
Novaco, R.W., & Chemtob, C.M. (2002). Anger and combat-related posttraumatic stress disorder. Journal of Traumatic Stress, 15(2), 123-132.
Tuval-Mashiach, R., Freedman, S., Bargai, N., Boker, R., Hadar, H., & Shalev, A.Y. (2004). Coping with trauma: narrative and cognitive perspectives. Psychiatry, 67(3), 280-293.
Wigren, J. (1994). Narrative completion in the treatment of trauma. Psychotherapy, 31(3), 415-423.
Yovell, Y., Bannett, Y., & Shalev, A.Y. (2003). Amnesia for traumatic events among recent survivors: a pilot study. CNS Spectrums, 8(9), 676-680, 683-685.* It should be noted at this point in time the research studying the eliciting of trauma detail from survivors is characterized by variability and methodological flaws. Prospective studies are most effective at correcting these methodological problems because they can ensure accurate documentation of traumatic narrative change over time rather than freeze findings at one particular point in time.