Dissociation and the Fragmentary
Nature of Traumatic memories:
Overview and Exploratory Study.
Bessel A. van der Kolk
& Rita Fisler
HRI Trauma Center
227 Babcock Streeet
Brookline, MA 02146
Harvard Medical School
Department of Psychiatry
Tel (617) 731-3200
Fax(617) 731- 4917
The authors wish to acknowledge the contributions
of Michael Rater, Roslin Moore, Nan Herron, Ann
Hostetler, Joseph Rodriguez, Danja Vardi and Aminadav
Zakai in the collection of the data for this study,
and Jennifer Burbridge and Joji Suzuki for their he
lp in preparing this manuscript.
Since trauma is an inescapably stressful event
that overwhelms people's coping mechanisms it is
uncertain to what degree the results of laboratory
studies of ordinary events have relevance to the
understanding of traumatic memories. This paper first
revie ws the literature on the differences between
recollections of stressful and of traumatic events.
It then reviews the evidence implicating dissociative
processes as the central pathogenic mechanisms that
give rise to PTSD. We present the results of a syste
matic exploratory study of 46 subjects with PTSD
which indicates that traumatic memories are retrieved,
at least initially, in the form of dissociated mental
imprints of sensory and affective elements of the
traumatic experience: as visual, olfactory, aff
ective, auditory and kinesthetic experiences. Over
time, subjects reported the gradual emergence of a
personal narrative that can be properly referred to
as "explicit memory". The implications of
these findings for understanding the nature of
traumatic me mories is discussed.
Key words: Trauma, memory, dissociation
Dissociation and the Fragmentary
Nature of Traumatic Memories:
Overview and Exploratory Study.
Bessel A. van der Kolk
The nature and reliability of
traumatic memories has been a controversial issue in
psychiatry for over a century. Traumatic memories are
difficult to study, since the profoundly upsetting
emotional experiences that give rise to PTSD cannot
be approximate d in a laboratory setting: even
viewing a movie depicting actual executions fails to
precipitate post-traumatic symptoms in normal college
students (Pitman, personal communication,1994). If
trauma is defined as an inescapably stressful event
that overwh elms people's existing coping mechanisms,
it is questionable whether findings of memory
distortions in normal subjects exposed to videotaped
stresses in the laboratory can serve as a meaningful
guides to understanding traumatic memories. Clearly,
there is little similarity between viewing a
simulated car accident on a TV screen, and being the
responsible driver in a car crash in which one's own
children are killed. While stress evokes homeostatic
mechanisms that lead to self-conservation and
resource-re- allocation (e.g. Selye, 1956), PTSD
involves a unique combination of learned conditioning,
problems modulating arousal, and shattered meaning
propositions. Shalev (1995) has proposed that this
complexity is best understood as the co-occurrence of
several interlocking pathogenic processes including (a)
an alteration of neurobiological processes affecting
stimulus discrimination (expressed as increased
arousal and decreased attention), (b) the acquisition
of conditioned fear responses to trauma-related stim
uli, and (c) altered cognitive schemata and social
Without the option of inflicting actual trauma in
the laboratory, there are only limited options for
the exploration of traumatic memories: 1) collecting
retrospective reports from traumatized individuals, 2)
post-hoc observations, or 3) provoking of tr aumatic
memories and flashbacks in people with PTSD.
Surprisingly, since the early part of this century,
there have been very few published systematic studies
that explore the nature of traumatic memories based
on detailed patient reports. Provocation stu dies of
traumatic memories have been done in psychophyisology
laboratories (e.g. Pitman, Orr, Forgue, de Jong,
& Claiborn, 1987; Rauch et al., 1995), and in
tests where patients with PTSD are given drugs that
alter neurotransmitter function that seem to p romote
access to trauma-related memories (Rainey et al.,
1987; Southwick, et al., 1993).
This paper first will review the studies that have
collected data on people's memories of highly
stressful and of traumatic experiences, and examine
the differences between recollections of stressful
and traumatic events.We will then review the evidence
implicating dissociation as the central pathogenic
mechanism that gives rise to PTSD and present
evidence that traumatic memories are retrieved, at
least initially, in the form of dissociated mental
imprints of sensory and affective elements of the
traum atic experience by presenting the results of a
systematic exploratory study of 46 subjects who
reported on their memories of childhood or adult
The Stability and Accuracy of
Memories of Stressful Events
At least since 1889, when Pierre Janet (1889)
first wrote about the relationship between trauma and
memory, it has been widely accepted that what is now
called declarative, or explicit memory is an active
and constructive process. What a person remembe rs
depends on existing mental schemata: once an event or
a particular bit of information is integrated into
existing mental schemes it is no longer be available
as a separate, immutable entity, but is liable to
become distorted both by associated experie nces,
demand characteristics and the emotional state at the
time of recall (Janet, 1889; van der Kolk & van
der Hart, 1991). As Schachtel (1947) defined it:
"Memory as a function of the living personality
can be understood as a capacity for the organiza tion
and reconstruction of past experiences and
impressions in the service of present needs, fears,
However, accuracy of memory is affected by the the
emotional valence of an experience: studies of people's
subjective reports of personally highly significant
events generally find that their memories are
unusually accurate, and that they tend to remain
stable over time (Bohannon, 1990; Christianson, 1992;
Pillemer, 1984; Yuille & Cutshall, 1986). It
appears that evolution favors the consolidation of
personally relevant information. For example, Yuille
and Cutshall (1989) interviewed 13 out of 22 witnes
ses to a murder 4-5 months after the event. All
witnesses had provided information to the police
within two days after the murder. These witnesses
were found to have very accurate recall, with little
apparent decline over time. The authors concluded
that emotional memories of such shocking events are
"detailed, accurate and persistent" (p.181).
They suggested that witnessing real "traumas"
leads to "quantitatively different memories than
innocuous laboratory events".
Researchers also have studied the accuracy of
memories for culturally significant events, such as
the murder of President Kennedy and the space shuttle
Challenger. Brown and Kulik (1977) first called
memories for such events "flashbulb memories".
While p eople report that these experiences are
etched accurately in their minds, research has shown
that even those memories are subject to some
distortion and disintegration over time. For example,
Neisser and Harsch (1990) found that people changed
their reco llections of the space shuttle Challenger
disaster considerably after a number of years.
However, these investigators did not measure the
personal significance that their subjects attached to
this event. Clinical observations of people who
suffer from PTS D suggest that there are salient
differences between flashbulb memories and the post-traumatic
perceptions characteristic of PTSD. As of early 1995,
we could find no scientific literature that had
demonstrated that intrusive recollections of
traumatic ev ents in patients suffering from PTSD
become distorted over time.
The Complexity of Memory Systems
Contemporary memory research has demonstrated the
existence of a great complexity of memory systems,
with multiple components, most of which are outside
of conscious awareness. Each one of these memory
functions seems to operate with a relative degree o f
independence from the others. To summarize: 1)
declarative, (also known as explicit) memory refers
to conscious awareness of facts or events that have
happened to the individual (Squire & Zola Morgan,
1991). This form of memory functioning is seriously
affected by lesions of the frontal lobe and of the
hippocampus, which also have been implicated in the
neurobiology of PTSD (van der Kolk, 1994). 2) Non-declarative,
implicit, or procedural memory refers to memories of
skills and habits, emotional respo nses, reflexive
actions, and classically conditioned responses. Each
of these implicit memory systems is associated with
particular areas in the Central Nervous System (Squire,
1994). Schacter (1987) has referred to the
descriptions of traumatic memories made by Pierre
Janet as examples of implicit memory.
The Apparent Uniqueness of Traumatic Memories
The DSM definition of PTSD recognizes that trauma
can lead to extremes of retention and forgetting:
terrifying experiences may be remembered with extreme
vividness, or totally resist integration. In many
instances, traumatized individuals report a combin
ation of both. While people seem to easily assimilate
familiar and expectable experiences and while
memories of ordinary events disintegrate in clarity
over time, some aspects of traumatic events appear to
get fixed in the mind, unaltered by the passage o f
time or by the intervention of subsequent experience.
For example, in our own studies on post traumatic
nightmares, subjects claimed that they saw the same
traumatic scenes over and over again without
modification over a fifteen year period (van der Kol
k, Blitz, Burr & Hartmann, 1984). For the past
century, many students of trauma have noted that the
imprints of traumatic experiences seem to be
qualitatively different from memories of ordinary
events. Starting with Janet, accounts of the memories
of tr aumatized patients consistently mention that
emotional and perceptual elements tend to be more
prominent than declarative components (e.g. Grinker
& Spiegel, 1946; Kardiner, 1941; Terr, 1993).
These recurrent observations about the nature of
traumatic mem ories have given rise to the notion
that traumatic memories may be encoded differently
than memories for ordinary events, perhaps via
alterations in attentional focusing, perhaps because
of extreme emotional arousal interferes with
hippocampal memory fun ctions (Christianson, 1992;
Heuer & Rausberg, 1992; Janet, 1889; LeDoux, 1992;
McGaugh, 1992; Nillson & Archer, 1992; Pitman,
Orr, & Shalev, 1993; van der Kolk, 1994).
Amnesias and the Return of Traumatic Memories.
Trauma can affect a wide variety of memory
functions For convenience sake, we will categorize
these into four different sets of functional
distubances: a) traumatic amnesia, b) global memory
impairment, c) dissociative processes, and d) the
sensorimotor organization of traumatic memories
A. Traumatic amnesia. While the vivid
intrusions of traumatic images and sensations are the
most dramatic expressions of PTSD, the loss of
recollections for traumatic experiences, followed be
subsequent retrieval is well documented in the
literature. Amnesias for some, or all , aspects of
the trauma have consistently been noted in a wide
variety of traumatized patients, starting with Pierre
Janet (1889). Amnesia for the traumatic experience,
with later return of memories for all, or parts of
the trauma, has been noted follow ing natural
disasters and accidents (Janet, 1889; Madakasira
& O'Brian, 1987; van der Kolk & Kadish, 1987;
Wilkinson, 1983). Sargeant and Slater (1941) observed
the presence of significant amnesia in 144 out of
1000 consecutively admitted combat soldiers to the
Sutton Emergency Hospital during the second World War.Similar
findings have been reported in other studies of
combat soldiers (Archibald & Tuddenham, 1956;
Grinker & Spiegel, 1945; Hendin, Haas, &
Singer, 1984; Kardiner, 1941;Kubie, 1943; Myers, 19
15; Sonnenberg, Blank, & Talbott, 1985; Southard,
1919; Thom & Fenton, 1920), in victims of
kidnapping, torture and concentration camp
experiences (Goldfield, Mollica, Pesavento, &
Faraone, 1988; Kinzie, 1993; Niederland, 1968), in
victims of physical an d sexual abuse (Briere &
Conte, 1993; Janet, 1893; Loftus, Polensky, &
Fullilove, 1994; Williams, 1992), and in people who
have committed murder (Schacter, 1986). A recent
general population study of 485 subjects by Elliot
and Briere (unpublished) reporte d significant
degrees of traumatic amnesia after virtually every
form traumatic experience, with childhood sexual
abuse, witnessing domestic violence as a child, and
combat exposure yielding the highest rates. Traumatic
amnesias are age- and dose-related : the younger the
age at the time of the trauma, and the more prolonged
the traumatic event, the greater the likelihood of
significant amnesia (Briere & Conte, 1993; Herman
& Shatzow, 1987; van der Kolk, Roth, Pelcovitz
& Mandel, 1993).
Amnesia for these traumatic events may last for
hours, weeks, or years. Generally, recall is
triggered by exposure to sensory or affective stimuli
that match sensory or affective elements associated
with the trauma. It is generally accepted that the
memo ry system is made up of networks of related
information: activation of one aspect facilitates the
recall of associated memories (Collins & Loftus,
1975; Leichtman, Ceci, & Ornstein, 1992). Affect
seems to be a critical cue for the retrieval of
informati on along these associative pathways. This
means that the affective valence of any particular
experience plays a major role in determining what
cognitive schemes will be activated. In this regard,
it is relevant that many people with trauma histories,
suc h as rape, spouse battering and child abuse, seem
to function quite well, as long as feelings related
to traumatic memories are not stirred up. However,
under particular conditions, they may feel, or act as
if they were traumatized all over again. Fear i s not
the only trigger for such recall: any affect related
to a particular traumatic experience may serve as a
cue for the retrieval of trauma-related sensations,
including longing, intimacy and sexual arousal.
B . Global memory impairment. While
amnesias following adult trauma have been well-documented,
the mechanisms for such memory impairment remains
insufficiently understood. This issue is even more
complicated when it concerns childhood trauma, since
children have fewer mental capacitie s to construct a
coherent narrative out of traumatic events. More
research is needed to explore the consistent clinical
observation that adults who were chronically
traumatized as children suffer from generalized
impairment of memories for both cultural a nd
autobiographical events. It is likely that the
combination of autobiographical memory gaps and
continued reliance on dissociation makes it very hard
for these patients to reconstruct a precise account
of both their past and current reality (Cole &
Putn am, 1992). The combination of lack of
autobiographical memory, continued dissociation and
of meaning schemes that include victimization,
helplessness and betrayal, is likely to make these
individuals vulnerable to suggestion and to the
construction of e xplanations for their trauma-related
affects that may bear little relationship to the
actual realities of their lives.
C. Trauma and dissociation. Recent research
has shown that having dissociative experiences at the
moment of the trauma (peritraumatic dissociation) is
the most important long term predictor for the
ultimate development of PTSD (Holen, 1993; Marmar, et
al., 1994; Spiegel, 1991). Brem ner et al. (1992)
found that Vietnam veterans with PTSD reported having
experienced higher levels of dissociative symptoms
during combat than men who did not develop PTSD.
Koopman, Classen and Spiegel (1994) found that
dissociative symptoms early in the course of a
natural disaster predicted PTSD symptoms seven months
later. A prospective study of 51 injured trauma
survivors in Israel (Shalev, Orr, & Pitman, 1994)
found that peri-traumatic dissociation explained 30%
of the variance in the six months fo llow-up PTSD
symptoms, over and above the effects of gender,
education, age, event-severity, and intrusion,
avoidance anxiety and depression that followed the
event. Peri-traumatic dissociation was the strongest
predictor of PTSD status six months after the event.
Dissociation refers to a compartmentalization of
experience: elements of the experience are not
integrated into a unitary whole, but are stored in
memory as isolated fragments and stored as sensory
perceptions, affective states or as behavioral
reenactme nts (Nemiah, 1995, van der Kolk & van
der Hart, 1989, 1991). While dissociation may
temporarily serve an adaptive function, in the long
range, lack of integration of traumatic memories
seems to be the critical element that leads to the
development of the complex biobehavioral change that
we call Post Traumatic Stress Disorder. Intense
arousal seems to interfere with proper information
processing and the storage of information into
narrative (explicit) memory. This observation was
first made by Pierre Ja net, and is confirmed by a
subsequent century of clinical and research data.
Christianson (1982) has described how, when people
feel threatened, they experience a significant
narrowing of consciousness, and remain merely
focussed on the central perceptual details. As people
are being traumatized, this narrowing of
consciousness s ometimes evolves into amnesia for
parts of the event, or for the entire experience.
Students of traumatized individuals have repeatedly
noted that during conditions of high arousal "explicit
memory" may fail. The individual is left in a
state of "speech less terror" in which the
person lacks words to describe what has happened (van
der Kolk, 1987). However, while traumatized
individuals may be unable to givea coherent narrative
of the incident, there may be no interference with
implicit memory: they may "know" the
emotional valence of a stimulus and be aware of
associated perceptions, without being able to
articulate the reasons for feeling or behaving in a
More than eighty years ago, Janet observed: "Forgetting
the event which precipitated the emotion ... has
frequently been found to accompany intense emotional
experiences in the form of continuous and retrograde
amnesia" (Janet, 1909b, p. 1607). He clai med
that when people experience intense emotions,
memories cannot be transformed into a neutral
narrative: a person is "unable to make the
recital which we call narrative memory, and yet he
remains confronted by (the) difficult situation"
(Janet 1919/1925 , p. 660). This results in "a
phobia of memory" (p. 661) that prevents the
integration ("synthesis") of traumatic
events and splits off the traumatic memories from
ordinary consciousness. Janet claimed that the memory
traces of the trauma linger as what he called "unconscious
fixed ideas" that cannot be "liquidated"
as long as they have not been translated into a
personal narrative. Failure to organize the memory
into a narrative leads to the intrusion of elements
of the trauma into consciousness: as te rrifying
perceptions, obsessional preoccupations and as
somatic re-experiences such as anxiety reactions (Janet,
1909b, van der Kolk & van der Hart, 1991).
Similar observations have been made by other
clinicians treating traumatized individuals. For
example, in 1945 Grinker and Spiegel noted that some
combat soldiers developed excessive responses under
stress which they thought to be responsible for the
dev elopment of a permanent disorder: "Fear and
anger in small doses are stimulating and alert the
ego, increasing efficacy. But, when stimulated by
repeated psychological trauma the intensity of the
emotion heightens until a point is reached at which
the eg o loses its effectiveness and may become
altogether crippled. ..." (p. 82). Grinker and
Spiegel described traumatic amnesias in these
soldiers, accompanied by confusion, mutism and stupor.
Kardiner, in describing the "Traumatic Neuroses
of War (1941) not ed that when patients develop
amnesia for the trauma, it tends to generalize to a
large variety of symptomatic expressions: "(t)he
subject acts as if the original traumatic situation
were still in existence and engages in protective
devices which failed o n the original occasion"(p.
82). Kardiner noted that fixation occurs in
disscociative fugue states: triggered by a sensory
stimulus, a patient might lash out, employing
language suggestive of his trying to defend himself
during a military assault. He note d that many
patients, while riding a subway train that entered a
tunnel, had flashbacks to being back in the trenches.
Kardiner also viewed panic attacks and hysterical
paralyses as the re-experiencing of fragments of the
trauma. Piaget (1962) claimed tha t dissociation
occurs when an active failure of semantic memory
leads to the organization of memory on somatosensory
or iconic levels. He pointed out: "It is
precisely because there is no immediate accommodation
that there is complete dissociation of the inner
activity from the external world. As the external
world is solely represented by images, it is
assimilated without resistance (i.e. unattached to
other memories) to the unconscious ego".
The realization of the role of dissociation in the
processing of traumatic memories was revived for
contemporary psychiatry when Horowitz described an “acute
catastrophic stress reaction” in civilian trauma
victims, characterized by panic, cognitive diso
rganization, disorientation and dissociation (1976) .
Such dissociative processing of traumatic experience
complicates the capacity to communicate about the
trauma. In some people the memories of trauma may
have no verbal (explicit) component at all: the
memory may be entirely organized on an implicit or
perceptual level, without an accompanying narrative
about what happened. Recent symptom provocation
neuroimaging studies of people with PTSD support that
clinical observation: during the provocation of t
raumatic memories there was decreased activation of
Broca's area, the part of the CNS most centrally
involved in the transformation of subjective
experience into speech. Simultaneously, the areas in
the right hemisphere that are thought to process
intense emotions and visual images had significantly
increased activation (Rauch et al., 1995). . Ongoing
dissociation in traumatized people.
People who have learned to cope with trauma by
dissociating are vulnerable to continue to do so in
response to minor stresses. The continued use of
dissociation as a way of coping with stress
interferes with the capacity to fully attend to life's
ongoing challenges. The severity of ongoing
dissociative processes (often measured with the
Dissociative Experiences Scale (DES)- Bernstein &
Putnam, 1986) has been correlated with a large
variety of psychopathological conditions that are
thought to be associat ed with histories of trauma
and neglect: severity of sexual abuse in adolescents
(Sanders & Giolas, 1991), somatization (Saxe et
al.,1994), bulimia (Demitrack et al, 1990), self-mutilation
(van der Kolk, Perry, & Herman, 1991) and
borderline personality d isorder (Herman, Perry,
& van der Kolk, 1989). The most extreme example
of this ongoing dissociation occurs in people who
suffer from dissociative identity disorder (multiple
personality disorder), who have the highest DES
scores of all populations studi ed and in whom
separate identities seem to contain the memories
related to different traumatic incidents (Putnam,
D. The sensori-motor organization of traumatic
experience. Numerous authors on trauma, for
example Janet (1889; van der Kolk & van der Hart,
1991), Kardiner (1941) and Terr (1993), have observed
that trauma is organized in memory on sensori-motor
and affective levels. Having listened to the
narratives of traumati c experiences from hundreds of
traumatized children and adults over the past twenty
years, we frequently have heard both adults and
children describe how traumatic experiences initially
are organized without semantic representations.
Clinical experience a nd reading a century of
observations by clincians dealing with a variety of
traumatized populations led us to postulate that
"memories" of the trauma tend to, at least
initially, be predominantly experienced as fragments
of the sensory components of the e vent: as visual
images, olfactory, auditory, or kinesthetic
sensations, or intense waves of feelings (which
patients usually claim to be representations of
elements of the original traumatic event). What is
intriguing is that patients consistently claim that
their perceptions are exact representations of
sensations at the time of the trauma. For example,
when Southwick and his group injected yohimbine into
Vietnam veterans with PTSD, half of their subjects
reported flashbacks that they claimed to be "jus
t like it was" [in Vietnam] (Southwick et al,
In the present study we designed a methodology for
examining traumatic and non-traumatic memories in
individuals with PTSD, in order to record whether,
and how, memories of traumatic experiences are
retrieved differently from memories of personlly
signif icant, non-traumatic events. In order to
examine the retrieval of traumatic memories in a
systematic way, we designed an instrument, the
Traumatic Memory Inventory (TMI) that specifically
inquires about sensory, affective and narrative ways
of remembering , about triggers for unbidden
recollections of traumatic memories, and ways of
mastering unwanted intrusions of traumatic memories
in subjects' lives.
Subjects Subjects were recruited in the
local newspapers from advertisements that invited
people who were haunted by memories of terrible life
experiences to submit to a two hour interview about
these memories. Subjects were paid $10.00 for their
participation.Su bjects were screened by telephone,
and again in one-on-one interviews for exclusion
criteria of organic mental disorders, schizophrenia,
bipolar illness, substance abuse and alcoholism. All
subjects met DSM III-R diagnostic criteria for PTSD,
as measured on the CAPS. Ten of the subjects were men,
36 were women. Average age at time of the interview
was 42.0 years (range 18-67).
Instruments Subjects were asked to sign an
informed consent and filled out self-rated
questionnaires, after which they participated in the
interview. The instruments used were:
- Traumatic Antecedents Questionnaire (self-rating
version) (TAQ [S]), a 78 item questionnaire
to identify exposure to taumatic life events
(self-rated version of the TAQ, Herman, Perry
& van der Kolk, 1989, van der Kolk, Perry
& Herman, 1991) and
- The Dissociative Experiences Scale (DES-
Bernstein & Putnam, 1986).
- The interviewer and subject then together
made an Inventory of Traumatic Experiences
which systematically asked them about the
circumstances and specifics of their trauma(s).
After finishing these interviews, subjects
were asked to indicate which par ticular
traumatic experience that had had most effect
on their lives, and to identify an intense,
but non-traumatic experience, that was used
as the "control" experience.
- Subjects were then given the Traumatic Memory
Inventory, a 60 item structured interview
that systematically collects data about the
circumstances and means of memory retrieval
of a traumatic memory, comparing those with
the subjects' memories of a personally highly
emotionally significant, but non-traumatic
event. The TMI describes 1) nature of trauma(s),
2) duration, 3) whether subject has always
been aware that trauma happened, and if not,
when and where subject became conscious of
trauma, 4) ci rcumstances under which subject
first experienced intrusive memories; and
circumstances under which they occur
presently, 5) sensory modalities in which
memories were experienced a) as a story b) as
an image (what did you see ?) c) in sounds (what
did you hear ?), d) as a smell (what did you
smell ?), e) as feelings in your body (what
did you feel ? where?), f) as emotions (what
did you feel, what was it like ?),. These
data were collected for how subjects
remembered the trauma a) initially, b)
whilesubj ect was most bothered by them, and
c) currently. The interview also asked about
6) nature of flashbacks, 7) nature of
nightmares, 8) precipitants of flashbacks and
nightmares, 9) ways of mastering intrusive
recollections(e.g. by eating, working, taking
drugs or alcohol, cleaning, etc. 10)
Confirmation: records: court or hospital,
direct witness, relative went through same
All information was collected first for traumatic
events, then for a non-traumatic event, like a
wedding, vacation, graduation, the birth of a child,
or an accomplishment in school or at work.
The interviews took about 2 hours and were
conducted by staff of the Trauma Center. Information
gathered from the TMI was presented to the members of
the Trauma Center memory research group who came to a
consensus about the scoring of each item of the
interviews. We were unable to establish a meaningful
way for the raters to be blind to whether they were
scoring the answers to traumatic or non-traumatic
Data Analysis Data analysis was conducted
by means of cross-tabulation and Kendall's tau
computation for ordinal by categorical variables.
Student two tailed t-tests were used to compare
ordinal data. Chi-Squared analyses were used to
compare nominal data. General lin ear models
procedure for step-wise linear regression with
posthoc analysis for comparison of means was used for
continuous variables. Pearson correlation
coefficients were calculated for bivariate
We interviewed 46 adults. Of these, 35 had
experienced their most significant traumas in
childhood, while 11 had their first traumatic
experience after age 18. The traumas they had
experienced are listed in Table 1. Several subjects
had experienced more than one type of trauma. Age of
onset ranged from 1- 56, (average 12.4). Only 11
subjects had their traumas start after age 18 (Adult
Trauma - AT). DES scores ranged from 1- 99; 14
subjects scored 10 and under. The average DES score
of the overall sample was 21.8; of the people who
were first traumatized as adults the average was 30.9.
Non-traumatic Memory Subjects considered
most questions related to the non-traumatic memory
non-sensical: none had olfactory, visual, auditory,
kinesthetic re-living experiences related to such
events as high school graduations, birthdays,
weddings, or births of their childr en. They denied
having vivid dreams or flashbacks about these events.
The subjects claimed not to have periods in their
lives when they had amnesias for any of these events;
none claimed to have photographic recollections of
any of these events. Environme ntal triggers did not
suddenly bring back vivid and detailed memories of
these events, and none of the subjects felt a need to
make special efforts to suppress memories of these
Table 1: Type of Trauma
* Note: Several subjects had
more than one type of trauma.
|Witnessing death of someone
|Industrial or transportation
Table 2: Traumatic and Narrative
|Images, sensations, affective and
||Narrative: semantic and symbolic
|Invariable -- does not change over time
||Social and adaptive
|Highly state-dependent. Cannot be evoked
Automatically evoked in special circumstances
|Evoked at will by narrator
|No condensation in time
||Can be condensed or expanded depending on
Modalities Table 2 presents the sensory
modalities which the subjects reported first having
experienced when they first became aware of the
trauma (whether they had always been aware of the
trauma, or recovered the memory after a period of
amnesia) . No subject rep orted having a narrative
for the traumatic event as their initial mode of
awareness (they claimed not having been able to tell
a story about what had happened), regardless of
whether they had continuous awareness of what had
happened , or whether there ha d been a period of
amnesia. There were no statistically significant
differences between the subjects with childhood (CT)
vs adult trauma (AT) in terms of the sensory
modalities first experienced, although there was a
trend towards more visual intrusions in the adult
trauma group. Figure 1 indicate that all subjects,
regardless of age a which the first trauma occurred,
reported that they initially "remembered"
the trauma in the form of somatosensory or emotional
flashback experiences. At the peak of the ir
intrusive recollections all sensory modalities were
enhanced, and a narrative memory started to emerge.
Currently, most subjects continued to experience
their trauma in sensorimotor modes, but while 41 (89)%
were able to narrate a satisfactory story ab out what
happened to them, 5 subjects (11%-all CT) continued
to be unable to tell a coherent narrative, with a
beginning, middle and end, even though all of them
had outside confirmation of the reality of their
trauma, i.e. a mother who knew, a prepetrat or who
confessed, hospital or court records.
Figure 1: Sensory modalities
reported when subjects first became aware of the
trauma, when the recollections of the trauma were
most intense, and currently.
Dissociation The DES score was
significantly correlated with the following event-related
variables: 1) duration of the trauma (r =.52 , p<.01),
2) presence of physical abuse (r= .56, p<.01), and
3) presence of neglect (r=.38; p<.05). Also,
dissociation was correlated with 1) affective
reliving (r= .54, p<.01), kinesthetic reliving (r=.40,
p<.05), lack of current narrative memory (r=.54, p<.01)
and with self-destructive self-soothing behaviors:
bingeing and purging (X2=7.41., df =1, p<. 01);
use of alcohol and drugs ( X2=2.75, df = 1, p<.10);
self-mutilation (X2=3.95, df.=1, p< .05), and
sexual activity (X2= 3.0, df= 1, p<.05).
Dissociation was not correlated with the following
self-soothing behaviors: talking things over, working,
cleaning, sleeping or turning to reli gion).
Nightmares and Flashbacks Of the total
sample, 36 (78%) reported current nightmares. Two (18%)
of the 11 AT and 15 (42%) of the 35 CT reported that
their nightmares were dreams: they included illogical
combinations and aspects of non-trauma-related
material (X2=11.0, df= 4, p=.0 2). Four (36%) of the
AT and 11(35%) of the CT reported having nightmares
that were identical to their flashbacks: they were
life-like presentations of the entire trauma, or
fragments thereof, without intermixture of other
Confirmation Of the 35 subjects with
childhood trauma, 15 (43%) had suffered significant,
or total amnesia for their trauma at some time of
their lives. Twenty seven of the 35 subjects with
childhood trauma (77%) reported confirmation of their
childhood trauma- from a mother, sibling, or other
source who knew about the abuse, from court or
hospital records, or from confessions or convictions
of the perpetrator(s). We did not ask them to produce
records to prove that this confirmation actually
Our study suggests that there are critical
differences between the ways people experience
traumatic memories versus other significant personal
events. The study supports the idea that it is in the
very nature of traumatic memory to be dissociated,
and t o be initially stored as sensory fragments
without a coherent semantic component. All of the
subjects in our study claimed that they only came to
develop a narrative of their trauma over time. Five
of the subjects who claimed to have been abused as
child ren were even as adults unable to tell a
complete narrative of what had happened to them. They
merely had fragmentary memories that supported other
people's stories, and their own intuitive feelings,
that they had been abused.
All these subjects, regardless of the age at which
the trauma occurred, claimed that they initially
"remembered" the trauma in the form of
somatosensory flashback experiences. These flashbacks
occurred in a variety of modalities: visual,
olfactory, aff ective, auditory and kinesthetic, but
initially these sensory modalities did not occur
together. As the trauma came into consciousness with
greater intensity, more sensory modalities came into
awareness: initially the traumatic experiences were
not conden sed into a narrative. It appears that, as
people become aware of more and more elements of the
traumatic experience, they construct a narrative that
"explains" what happened to them. This
transcription of the intrusive sensory elements of
the trauma into a personal narrative does not
necesarily have a one-to-one correspondence with what
actually happened. This process of weaving a
narrative out of the disparate sensory elements of an
experience is probably not dissimilar from how people
construct anarrati ve under ordinary conditions.
However, when people have day-to-day, non-traumatic
experiences, the sensory elements of the experience
are non registered separately in consciousness, but
are automatically integrated into the personal
This study supports Piaget's notion that when
memories cannot be integrated on a semantic/linguistic
level, they tend to be organized more primitively: as
visual images or somatic sensations. Even after
considerable periods of time, and even after acquir
ing a personal narrative for the traumartic
experience, most subjects reported that these
experiences continued to be come back as sensory
perceptions and as affective states. The persistence
of intrusive sensations related to the trauma after
the constru ction of a narrative contradicts the
notion that learning to put the traumatic experience
into words will reliably help abolish the occurrence
There were some interesting trends between the
adult onset trauma (AT) group and the childhood onset
(CT) group. There were non-significant differences in
the modalities in which the trauma was experienced,
which a larger sample size might clarify furthe r:
the subjects first traumatized as children tended to
first remember their abuse in the form of olfactory
images and kinesthetic sensations. The CT group had
significantly more pathological self-soothing
behaviors than the adult group, including self-mu
tilation and bingeing. This supports the notion that
childhood trauma gives rise to more pervasive
biological disregulation, and that patients with
childhood trauma have greater difficulty regulating
internal states than patients first traumatized as
adul ts (van der Kolk & Fisler, 1994). Another
interesting difference between the adult and the
child group was that the AT group had nightmares that
they reported to be exact replicas of the traumatic
experience more often than did the CT group.
It was striking that some subjects, particularly
those who never were able to construct a satisfactory
narrative of their trauma, did not have visual
flashbacks. Intuitively, it would appear to be
difficult to construct a satisfactory narration that
allo ws for the proper placement of the trauma in
time and space if an individual cannot visualize what
has happened. We are currently studying the mental
organization of traumatic experiences in blind
children and adults.
When people receive sensory input, they generally
automatically synthesize this incoming information
into narrative form, without conscious awareness of
the processes that translate sensory impressions into
a personal story . Our research shows that trau matic
experiences initially are imprinted as sensations or
feeling states that are not immediately transcribed
into personal narratives, in contrast with the way
people seem to process ordinary information. This
failure of information processing on a symb olic
level, in which it is categorized and integrated with
other experiences, is at the very core of the
pathology of PTSD (van der Kolk & Ducey, 1989).
Recently we collaborated in a neuroimaging symptom
provocation study of some of the subjects who were
part of the memory study reported here. When these
subjects had their flashbacks in the laboratory,
there was a significantly increased activity in the
areas in the right hemisphere that are associated
with the processing of emotional experiences, as well
as in the right visual association cortex. At the
same time, there was significantly decreased activity
in Broca's area, in the left hemisphere (Rauch et al.
1995). These findings are in line with the results of
this study: that traumatic "memories"
consist of emotional and sensory states, with little
verbal representation. In other work we have
hypothesized that, under conditions of extreme stress,
th e hippocampally based memory categorization system
fails, leaving memories to be stored as affective and
perceptual states (van der Kolk, 1994). This
hypothesis proposes that excessive arousal at the
moment of the trauma interferes with the effective
memo ry processing of the experience. The resulting
"speechess terror" leaves memory traces
that may remain unmodified by the passage of time,
and by further experience.
We (van der Kolk & van der Hart, 1991) have
earlier writen about Janet's clear distinctions
between traumatic and ordinary memory. According to
Janet, traumatic memory consists of images,
sensations, affective and behavioral states, that are
invariable a nd do not change over time. He suggested
that these memories are highly state-dependent and
cannot be evoked at will. Finally, they are not
condensed in order to fit social expectations. In
contrast, according to Janet, narrative (explicit)
memory is sema ntic and symbolic, it is social, and
adapted to the needs of both the narrator and the
listener and can be expanded or contracted, according
to social demands.
The question whether the sensory perceptions
reported by our subjects are accurate representations
of the sensory imprints at the time of the trauma is
intriguing. The study of flashbulb memories has shown
that the relationship between emotionality, vivi
dness and confidence is very complex, and does not
necessarily reflect accuracy. While it is possible
that these imprints are, in fact, reflections of the
sensations experienced at the moment of the trauma,
an alternative explanation is that increased ac
tivity of the amygdala at the moment of recall may be
responsible for the subjective assignment of accuracy
and personal significance. Once these sensations are
transcribed into a personal narrative, they are
subject to the laws that govern explicit memor y:
they become a socially communicable story that is
subject to condensation, embellishment and
contamination. While trauma may leave indelible
sensory and affective imprints, once these are
incorporated into a personal narrative this semantic
memory, lik e all explicit memory, is subject to
varying degrees of distortion, .
In this study we have merely confirmed Janet's
century-old clinical observations. The time now seems
ripe for more detailed investigations. These should
include careful follow-up of both traumatized
children and adults to check for memory distortions
ov er time, as well as the use of sophisticated
techniques, such as brain imaging, to gain further
understanding about the ways the central nervous
system processes traumatic memories. There clearly is
a need for further studies of dissociative processes
and their relationship to the develpment and
maintenance of PTSD. However, in the process of
trying to gain a deeper understanding of traumatic
memories, great caution should be excercised against
making careless generalizations that infer how
traumatic memo ries are stored and retrieved from
laboratory experiments that do not overwhelm people's
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