The Influence of Posttraumatic Stress on Memory Complaints in Neuropsychological Settings

Objective: Memory problems are a frequent complaint in neuropsychological settings, particularly among individuals in mid-to-late adulthood and those who have experienced neurological insult (e.g., head trauma; Bay et al., 2012; Lezak et al., 2004; Wammes et al., 2017). Neuropsychiatric comorbidities that influence cognitive functioning (e.g., depression, anxiety, posttraumatic stress) are also common among neuropsychological patients, which can challenge interpreting etiology and predicting prognosis (Campbell et al., 2009; Reischies & Neu, 2000). Prolonged trauma exposure is associated with brain abnormalities in regions that subserve memory and executive functions (Daniels et al., 2016; Woon et al., 2010). Furthermore, a subgroup of individuals with trauma exposure experience dissociative symptoms, which can also interfere with memory and performing goal-directed behaviors (Bergouignan et al., 2014; Brewin et al., 2013; Özdemir et al., 2015). Method: In this article, we focus on symptoms that are consistent with dissociation and present three case studies of trauma-exposed women who were referred for neuropsychological testing following complaints of memory decline. Results: Formal neuropsychological testing did not fully support the degree of amnestic symptoms reported. Based upon the complex pattern of results, we propose a potential hypothesis for consideration: the dissociative interference hypothesis. Conclusions: For all three women presented, dissociation was a common symptom that may have contributed to an exacerbation of memory failures and amnestic experiences. Thus, interventions targeted at increasing awareness, rather than withdrawal, during times of stress may lead to a reduction in their memory complaints. Clinical Impact Statement This article highlights the need for trauma-informed assessment to improve diagnostic accuracy, cognitive test interpretation, and treatment in neuropsychological settings with trauma-exposed patients. We provide real-world clinical examples of discrepancies between objective and subjective memory performance among trauma-exposed women, and propose dissociation as an important-but often overlooked-mechanism. This has potential to inform neuropsychological care by modifying traditional testing procedures.