Dissociative Amnesia & Supportive Relationships Moderate Ties Between Aces & Mental Health

Abstract
Purpose
Dissociative amnesia stemming from adverse childhood experiences (ACEs) can present in different forms, including trauma-specific amnesia and childhood autobiographical memory loss (CAML; missing large gaps of early life memory that extend beyond trauma-specific experiences). Dissociative amnesia has been linked to a variety of mental health symptoms including suicidality and psychotic, anxiety, somatoform, and mood-related symptoms. Researchers have found equivocal results regarding the effects of distinct forms of dissociative amnesia on mental health outcomes. This distinction is important; trauma-specific memory loss is believed to have a better prognosis for treatment compared to CAML. Supportive interpersonal relationships are recognized protective factors that also help improve prognosis following childhood adversity. We sought to determine if the association between ACEs (both childhood sexual abuse [CSA] and cumulative ACEs) and adult mental health outcomes varied by distinct dissociative amnesia type (i.e., trauma-specific amnesia and CAML) and supportive interpersonal relationships.

Methods
Using data from an online survey administered as part of a larger, national, cross-sectional study of trauma and well-being, we employed moderated moderation analysis using the SPSS PROCESS macro to examine:

1) if distinct dissociative amnesia types moderated the association between ACEs and co-occurring adult mental health outcomes (simple moderation) and
2) whether that moderated association varied according to participants’ acknowledgement of supportive relationships (moderated moderation).
The simple moderation and moderated moderation models were used to examine this association. Participants (N=347) were primarily White (83%) adults (55% female) between 20–70 years old (M=40, SD=11.7).

Findings
Simple moderation: CAML significantly moderated the association between ACEs and symptoms of depression, as well as the association between CSA and overall mental health problems and symptoms of mania, somatic problems, and suicidal ideation, such that these respective mental health symptoms were worse for those with CAML. Trauma-specific amnesia significantly moderated the association between ACEs and CSA and psychotic symptoms, such that psychotic symptoms were stronger for those with trauma-specific amnesia.

Moderated moderation: Having a supportive person contributed to fewer overall mental health problems, symptoms of depression, mania, anxiety, psychosis, somatic symptoms, repetitive thoughts, and personality issues among people reporting ACEs and CAML, and attenuated symptoms of mania and anxiety for people reporting CSA and CAML. Among those who experienced trauma-specific amnesia, a supportive person led to fewer anxiety symptoms for people reporting ACEs, and fewer symptoms of mania and less suicidal ideation for people with a history of CSA.

Conclusion
Our results provide novel insights into how distinct forms of dissociative amnesia contribute to different co-occurring mental health outcomes among adults reporting histories of ACEs and/or CSA. Distinguishing between these forms of memory alterations when dissociative amnesia is suspected could lead to a more accurate prognosis and personalized treatment recommendations. These findings further support the literature wherein having a supportive person is a robust predictor of resilience among those exposed to childhood adversity. We review the changing emphasis on memory retrieval over time as interventions for dissociative disorders have evolved, and discuss implications of our results for contemporary trauma- and dissociation-informed treatment approaches for people with dissociative amnesia.

Additional Authors: Nicole M. Fava, PhD and Versha Rai Reejhwani, PsyD