Janet E. Osterman

Exploring the nature of traumatic memory: Combining clinical knowledge with laboratory methods

Summary For over 100 years clinicians have observed and described the unusual nature of traumatic memories. It has been repeatedly and consistently observed that these memories are characterized by fragmentary and intense sensations and affects, often with little or no verbal narrative content. Yet, possibly because traumatic memories cannot be precipitated under laboratory conditions, the organization of traumatic memories has received little systematic scientific investigation. In our laboratory we have developed an instrument, the Traumatic Memory Inventory (TMI), which systematically assesses the ways that memories of traumatic experience are organized and retrieved over time. In this article we report findings from our third study using the TMI, of 16 subjects who had the traumatic experience of awakening from general anesthesia during surgery. We assessed changes in traumatic memory characteristics over time and differences between memories of subjects with and without current Post-Traumatic Stress Disorder. Our findings suggest the need for more rigorous methods for the assessment of the evolution of traumatic memories. In order to develop a comprehensive and integrated understanding of the nature of traumatic memory, we need to combine careful clinical observations with repli-cable laboratory methods, including those of cognitive science and neuroscience.

Awareness during anesthesia and posttraumatic stress disorder

It has been estimated that approximately 30,000 patients a year suffer awareness or consciousness during anesthesia. This paper reviews existing knowledge of the psychological impact and psychiatric sequelae of awareness during anesthesia. Literature on awareness and memory during anesthesia, traumatic memory, and posttraumatic stress disorder (PTSD) was reviewed using computer searches, books, and referenced articles. Few case reports of awareness have identified the accompanying psychological trauma and resulting PTSD. Five published cases illustrating relevant material were selected for inclusion. Waking up during anesthesia, especially if the patient experienced pain, is a traumatic event which places the patient at risk for developing PTSD. Awareness-induced PTSD must be considered for patients who present for mental health treatment following surgery. The advantages of light anesthesia must be balanced against the risk of awareness-induced PTSD.

Pain flashbacks in posttraumatic stress disorder

ObjectivesSurgical patients who regain consciousness while under general anesthesia may develop symptoms of Posttraumatic Stress Disorder (PTSD). One common PTSD symptom is the experiencing of abnormal perceptions during which the patient feels as if the trauma is recurring. The objective of this report is to document the re-occurrence of pain as part of the PTSD sequelae. ResultsWe present two patients who developed PTSD following an episode of awareness under anesthesia. In both cases, posttraumatic sequelae persisted for years and included pain symptoms that resembled, in quality and location, pain experienced during surgery. In addition to their similarity to the original pain, these pain symptoms were triggered by stimuli associated with the traumatic situation, suggesting that they were flashbacks to the episode of awareness under anesthesia. DiscussionThe similarity between the patients’ pain symptoms and pain experienced during trauma, the triggering by traumatic cues, and the associated emotional arousal and avoidance suggest the involvement of a somatosensory memory mechanism.

Antidepressant Treatments in PTSD

Posttraumatic stress disorder (PTSD) is a clinical syndrome with a high degree of morbidity that may follow a traumatic event. PTSD is characterized by three symptom clusters: (1) reexperiencing of the traumatic event; (2) avoidance of reminders of the traumatic event and emotional numbing; and (3) hyperarousal symptoms (1). PTSD results in significant distress and morbidity. For example, following an assault a person may experience intrusive thoughts of the assault, suffer from nightmares of threat or assault, or experience flashbacks of all or some portions of the assault. Avoidance of reminders is common and may include, for example, avoidance of the site of the assault or similar places, avoidance of people who are similar to the perpetrator, or avoidance of conversations about community or domestic violence. Following a traumatic event, emotional numbing such as a sense of being unable to have loving feelings, feeling detached from others, or having decreased interest may occur. Difficulty falling asleep, being easily startled, irritability, and hypervigilance are common hyperarousal symptoms (see DSM-IV for criteria) (1).

Antidepressant Treatments in Posttraumatic Stress Disorder

Posttraumatic stress disorder (PTSD) is clinical syndrome that may follow a traumatic event. This disorder is characterized by three symptom clusters: (a) re-experiencing the traumatic event; (b) avoiding reminders of the traumatic event and emotional numbing; and (c) hyperarousal (1). PTSD can result in significant distress and morbidity. For example, following an assault, a person may experience intrusive thoughts of the assault, nightmares of a threat or assault, or flashbacks of all or some portions of the assault. Avoidance of reminders is common and may include avoidance of the site of the assault or similar places, avoidance of people who are similar to the perpetrator, or avoidance of conversations about community or domestic violence. Following a traumatic event, emotional numbing may occur, which may be characterized by a sense of being unable to have loving feelings, feeling detached from others, or having decreased interest in normal activities.