Dissociative Amnesia and Supportive Relationships Moderate the Connection between Childhood Adversity and Adult Mental Health

Background and Purpose: Childhood adversity can have long-lasting negative consequences, including traumatic alterations in memory, such as dissociative amnesia. Dissociative amnesia 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 abusive 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 childhood adversity (i.e., childhood sexual abuse [CSA] and cumulative adverse childhood experiences [ACEs]) and adult mental health varied by distinct dissociative amnesia type (i.e., trauma-specific amnesia and CAML) and supportive 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 if distinct dissociative amnesia types moderated the association between childhood adversity and adult mental health and whether or not that moderated association varied according to whether or not participants reported having supportive relationships. The simple moderation (Model 1) and moderated moderation models (Model 3) 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).

Results: 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, repetitive thoughts, and suicidal ideation, such that mental health was worse for those with CAML. Trauma-specific amnesia significantly moderated the association between ACEs and CSA and psychosis symptoms, such that psychosis 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, personality issues, and suicidal ideation among people reporting ACEs and CAML, and attenuated symptoms of mania and anxiety for people exposed to CSA who had 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.

Conclusions and Implications: Our results provide novel insights into how distinct forms of dissociative amnesia contribute to different mental health outcomes among people reporting 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 encourage clinical social workers to prioritize supportive relationships for clients with dissociative amnesia.