Child sexual abuse: sensory recall ... and treating survivors.

Impassioned debate currently surrounds claims by adults who describe memories of childhood sexual abuse that emerge years or decades after the fact. Much research indicates that conscious recall of most experiences gets distorted over time by a variety of influences, leading to skepticism about the accuracy of recovered sexual abuse memories (SN: 9/18/93, p. 184).

However, the terror that accompanies actual instances of such trauma may interfere with the brain's conscious recall system while leaving intact conditioned fear responses stored as visual images or physical sensations in other brain regions, asserts Bessel A. van der Kolk of Massachusetts General Hospital in Boston. He and his coworkers find that adult memories of confirmed childhood sexual abuse invariably appear first in perceptual fragments that get woven into a coherent story over weeks, months, or even years.

Early, prolonged sexual abuse produces the most fragmented perceptual memories of trauma, a process facilitated by a stress-induced disruption of consciousness known as dissociation, van der Kolk contends.

His group has conducted intensive interviews with 43 adults -- mostly women -- who responded to a newspaper ad seeking survivors of severe trauma in childhood or later. Of that number, 29 cited periods of extensive or moderate amnesia for their traumatic experiences. A total of 37 individuals obtained evidence supporting their memories, such as a sibling's confirmation that childhood sexual abuse had occurred or police and medical records of a devastating car accident.

All participants reported remembering traumatic incidents in perceptual ways first and developing verbal accounts as time passed, van der Kolk argues. For instance, one woman had panic attacks, feelings of being smothered, and sensations of genital rubbing prior to remembering her sexual molestation by her mother and uncle.

Amnesia usually lifted in response to a changed relationship with the perpetrator (or that person's death), involvement in romantic relationships, or exposure to trauma-related sights or sensations. About one-quarter of the volunteers initially regained traumatic memories during psychotherapy.

Post-traumatic stress disorder, a cluster of debilitating symptoms, occurred only in the six persons who could not make a coherent story out of perceptual elements. "Unfortunately, people seem to need to remember the details of their trauma to deal with it effectively," van der Kolk holds.

...and treating survivors

Many clinicians assume that psychotherapy can best serve victims of childhood sexual abuse by directly addressing their traumatic memories and associated feelings of powerlessness and confusion. However, a pilot prospective study finds that "trauma-focused" and "present-focused" group therapy work about equally well for incest victims, reports David Spiegel of Stanford University.

Spiegel and his coworkers randomly assigned 18 women who had experienced incest as children to one of the two therapies. The trauma-focused group employed self-hypnosis and group discussion to elicit traumatic memories and explore feelings and behaviors spurred by abuse. Members of the present-focused group looked primarily at their current problems in dealing with others and discussed how to improve relationships.

After 6 months of weekly therapy sessions, depression decreased equally in the two groups. Dissociation symptoms fell more sharply in trauma-focused therapy, while anxiety showed a greater decline in present-focused treatment.

"Both these groups helped incest victims, although there was no clear therapeutic difference between them," Spiegel says. "We'll need a larger sample to make definitive conclusions."