ADULT SURVIVORS OF CHILDHOOD SEXUAL ABUSE: FORGETTING AND
REMEMBERING.

By
Leigh Hodder-Fleming
BSocSc (Hons) (Psych)

A thesis submitted in fulfilment of the requirements for the Degree of Doctor of
Philosophy at Queensland University of Technology
March 2004


PANEL DECLARATION


CSA Adult Survivor Memory

iii

Statement of Original Authorship

The work contained in this thesis has not been previously submitted for a degree or
diploma at any other higher education institution. To the best of my knowledge and
belief, the thesis contains no material previously published or written by another
person except where due reference is made.

Name:

Leigh Hodder-Fleming

Signed: ……………………………………..

Date:

…………….……………………….


CSA Adult Survivor Memory

iv

I, Leigh Ann Hodder-Fleming a candidate for the degree of Doctor of Philosophy at
Queensland University of Technology, have not been enrolled for another tertiary
award during the term of my PhD candidature without the knowledge and approval
of the University’s Research Degrees Committee.

_______________________________________
Candidate’s Signature

Date

/

/


CSA Adult Survivor Memory
KEYWORDS

Childhood Sexual Abuse; Forgetting; Remembering; Adult Survivors; Trauma;
Memory; Post-Traumatic Stress Disorder; Dissociation.


v


CSA Adult Survivor Memory

vi

ABSTRACT

Past research on adult memory for childhood sexual abuse (CSA) has provided
support for the phenomenon of forgetting and subsequent recovery of the memories,
after a period of time. This phenomenon, however, remains a source of debate and is
still not fully understood by researchers and psychological and legal practitioners.
The research has provided conflicting evidence about the factors which are thought
to lead to CSA forgetting for extensive periods of time, in addition to the processes
involved in forgetting, triggering and later remembering of the abuse memories by
adult survivors.

This study utilised a mixed method to investigate and explore the factors and
processes associated with CSA forgetting, triggering and later remembering, in a
sample of Australian adult CSA survivors (N = 77). Participants were asked to
complete a test booklet, containing the Traumatic Events Questionnaire (TEQ),
Symptom Checklist-90-Revised (SCL-90-R), Dissociative Experiences Scale II
(DES II), Impact of Events Scale – Revised (IES-R), a scale designed to measure
persistence of memory (Loftus), and a scale designed to measure emotional intensity
at the time of the abuse and now (Williams). Participants were then asked to
participate in a semi-structured interview. Seventy-one participants completed the
interview process. Five separate analyses were conducted on the data.

Methodological issues, such as the use of retrospective data and corroboration of the

abuse were outlined. All participants were asked to provide details about any
corroboration they had received that the abuse had occurred.
The participants were streamed into one of three categories of forgetting (Always
Remembered, n = 28; Partial Forgetting, n = 16; and Extensive Forgetting, n = 33).
The first analysis (Stage One Analysis One) examined the factors thought to be
associated with CSA forgetting, such as abuse parameters (TEQ), current
psychological functioning (SCL-90-R), persistence of memory (Loftus), emotional
intensity at the time of the abuse and now (Williams), the trauma response
experienced at the time of the abuse (IES-R), and current dissociation (DES II), to
determine the significant differences between the three groups.


CSA Adult Survivor Memory

vii

A significant difference was found regarding the age at which the abuse commenced,
with the Extensive Forgetting group reporting an earlier age at which the abuse
commenced. Significant differences were found on the variable that related to being
abused by an aunt or uncle, and on the current experience of hostility (SCL-90-R
sub-scale), and on the current levels of anger (Williams Emotional Intensity)
experienced by the participants. Significant differences between the groups were
also found on two of the Persistence of Memory items, namely clarity of memory
and participants’ memory of the tastes related to the abuse. Finally, a significant
difference was found on the participants’ current dissociation levels, with the
Extensive Forgetting group reporting higher levels of current dissociation than the
other two groups. Statistical profiles for each of the three groups were constructed,
based on the mean scores of the SCL-90-R, IES-R and DES II, for use in the Stage
Two, Analysis Two, profile comparison.


Stage Two, Analysis One, provided a qualitative analysis relating to the experience
of always remembering the abuse. The aim of this analysis was to provide a deeper
understanding of why some participants (n = 23) did not forget about their abuse,
when other participants reported being able to forget for a period of time. The results
indicated that participants’ responses formed clusters, such as older age at abuse
onset, failed dissociative mechanisms, constant reminders, and others.

Stage Two, Analysis Two, presented and compared each participant’s profile against
the statistical profiles constructed in Stage One. The participant’s profiles included a
summary of their TEQ responses and interview responses, in addition to their Stage
One test booklet scores. The comparison was made, firstly, on a specific basis
against the mean scores obtained by each category of forgetting, and secondly, on a
broader basis, against the score range for each measure of the statistical profile. This
was done to determine if there was a “typical” member of each category of forgetting
and to investigate the within-group differences. The specific profile comparison
demonstrated that there was no “typical” member of any of the three groups, with
participants varying widely in their scores and patterns of scores. However, when
the profile comparison was broadened to include score ranges, 61% of participants,
who always remembered the abuse, 44% of participants who partially forgot the


CSA Adult Survivor Memory

viii

abuse, and 47% of participants who extensively forgot their abuse, matched the
profile of a “typical” member of their relevant category of forgetting.

Stage Two, Analysis Three, provided an in-depth qualitative exploration on the
process involved in CSA forgetting, triggering and later remembering, for a selection

of participants who reported partially forgetting the abuse (n = 6), and extensively
forgetting the abuse (n = 10). Participants’ interview responses were transcribed
verbatim and analysed, using Interview Analysis. This analysis explored the
differences between participants, from the two categories of forgetting, on their
experiences of CSA forgetting, triggering and later remembering, in addition to
exploring how these participants were able to forget about the abuse; what events
triggered their abuse memories; and how the initial memories returned. Issues of
memory recovery, while in therapy or under hypnosis, were also explored.

Stage Two, Analysis Four, presented the case study of a participant, who had been
identified as an “outlier”, due to her high score on the DES II, claims of being able to
remember abuse incidents that occurred prior to the age of two years, diagnosis of
DID, and the substantiated conviction and sentencing of her abuser, based on her
recovered memories of the abuse and corroboration from her sister and mother. Her
case was examined against some of the criticisms often made by false memory
supporters.

This thesis found that some CSA survivors forgot about their abuse, either partially
or extensively. The thesis also found support for some, but not all, of the factors that
previous researchers have identified as being associated with CSA forgetting by adult
survivors, specifically the individual’s age at the time the abuse commenced and the
individual’s ability to dissociate from the abuse. The research then explored, indepth, the issues of: CSA remembering, CSA survivor profiling, and the “how” of
CSA forgetting, triggering and later remembering, by adult survivors.


CSA Adult Survivor Memory

ix

TABLE OF CONTENTS

Title page

i

University Panel Declaration

ii

Statement of Original Authorship

iii

Enrolment Declaration

iv

Keywords

v

Abstract

vi

Table of Contents

ix

List of Figures


xix

List of Tables

xx

Acknowledgements

1

xxii

Chapter One: Trauma and Memory

3

1.1

Research Aim

4

1.2

Thesis Organisation & Theoretical Model

4

1.3


The Theoretical Context

7

1.3.1

1.3.2

1.4

Trauma defined: Can Childhood Sexual Abuse
be defined as trauma?

7

The long-term effects of childhood sexual abuse

9

1.3.2.1 Studies 1988-1999

13

1.3.2.2 Studies 2000-2002

18

1.3.3

Positive mediating factors


21

1.3.4

Section summary

22

DSM-IV and CSA: The Trauma Response

24

1.4.1

DSM-IV 308.3 Acute Stress Disorder

24

1.4.2

DSM-IV 309.81 Post Traumatic Stress Disorder

25


CSA Adult Survivor Memory
1.4.3
1.5


1.6

1.7

The relationship between CSA, ASD and PTSD

x
27

What is the type of memory under investigation by
this study?

29

1.5.1

32

Section summary

The Effect of Trauma on Memory

34

1.6.1

40

Section summary


The Dissociative Mechanism

41

1.7.1

DSM-IV and dissociation

41

1.7.1.1 DSM-IV 300.12 Dissociative Amnesia

41

1.7.1.2 DSM-IV 300.6 Depersonalisation Disorder

42

1.7.1.3 DSM-IV 300.15 Dissociative Disorder
Not Otherwise Specified (DDNOS)

1.8

2

1.7.2 Dissociation theory

42

1.7.3


46

Section summary

Chapter Conclusion

CSA Forgetting and Remembering
2.1

47

52

Prevalence and Demographics of Australian CSA
Survivors

2.2

42

52

Forgetting and Remembering of Childhood Sexual
Abuse

55

2.2.1


Studies conducted between 1987 and 1996

57

2.2.2

Studies conducted between 1997 and 2003

63

2.3

Chapter Conclusion

71

2.4

Research Questions and Hypotheses

73


CSA Adult Survivor Memory
3

xi

Methodological Issues, Research Design and Stage One Method


79

3.1

Methodology Issue: Retrospective Data and Corroboration

79

3.1.1

Retrospective data

80

3.1.2

Corroboration of CSA

81

3.2

Section Summary

87

3.3

Research Design


88

3.3.1

88

3.4

Deductive and Inductive Thinking

3.3.2 The Mixed Method

90

3.3.3

91

Recruitment Protocols

3.3.4 Research Structure

92

Stage One Analysis One Method

98

3.4.1


98

Participants

3.4.2 Materials

100

3.4.2.1 Traumatic Events Questionnaire (TEQ)

101

3.4.2.2 Dissociative Experiences Scale II (DES II)

101

3.4.2.3 Symptom Checklist 90 Revised (SCL-90-R)

103

3.4.2.4 Impact of Events Scale - Revised (IES-R)

106

3.4.2.5 Persistence of Memory survey

108

3.4.2.6 Emotional Intensity survey


109

3.4.3 Procedure

110

3.4.3.1 Recruitment process

110

3.4.3.2 Definition of childhood sexual abuse

111

3.4.3.3 Categories of forgetting definition

111

3.4.3.4 First period of contact

112

3.4.3.5 Second period of contact

114


CSA Adult Survivor Memory
3.5


4

5

xii

Chapter Summary

115

Stage One Analysis One

118

4.1

Data Analysis

118

4.1.1 Data Input and Screening

118

4.1.2 Analysis Techniques

118

4.2


Hypothesis One Results

119

4.3

Hypothesis Two Results

127

4.3.1

127

Analysis

4.3.2 Hypothesis 2.1 Results

128

4.3.3 Hypothesis 2.2 Results

128

4.3.4 Hypothesis 2.3 Results

128

4.3.5 Hypothesis 2.4 Results


128

4.3.6 Hypothesis 2.5 Results

128

4.3.7 Hypothesis 2.6 Results

129

4.4

Discussion

130

4.5

Stage One Implications, Limitations and Future Directions

135

4.5.1

General Implications of the Findings

135

4.5.2


General Limitations of the Findings

136

4.5.3

General Future Directions

136

4.6

Statistical Profiles

138

4.7

Chapter Summary

140

Stage Two Analysis One

143

5.1

Stage Two Method


145

5.1.1

145

Participants


CSA Adult Survivor Memory

5.2

5.3

5.1.2 Materials

145

5.1.3 Procedure

148

Stage Two: Analysis One

150

5.2.1 Rationale

150


5.2.2

Method

150

5.2.2.1 Participants

150

5.2.2.2 Materials

150

5.2.2.3 Procedure

151

Results and Discussions

152

5.3.1

Age of onset

152

5.3.2


Discussion

153

5.3.3

Failed dissociative mechanisms

154

5.3.4

Discussion

155

5.3.5

Constant reminders

155

5.3.6

Discussion

156

5.3.7 Other


156

5.3.8

Discussion

157

Chapter Summary

159

5.4

6

xiii

Stage Two Analysis Two: Profiling

162

6.1

Rationale

163

6.2


Psychological Profiling

164

6.3

Method

166

6.3.1

166

Participants

6.3.2 Materials

166

6.3.3 Procedure

167


CSA Adult Survivor Memory
6.4

Results and Sub-Section Discussions


168

6.4.1

168

Always Remembered Statistical Profile

6.4.2 Always Remembered Profile Comparisons
6.4.3

169

Discussion: Profiles for Participants who Always
Remembered

178

6.4.4

Partial Forgetting Statistical Profiles

179

6.4.5

Partial Forgetting Profile Comparisons

180


6.4.6

Discussion: Profiles for Participants who Partially Forgot 186

6.4.7

Extensive Forgetting Statistical Profile

187

6.4.8

Extensive Forgetting Profile Comparisons

188

6.4.9

Discussion: Profiles for Participants who Extensively
Forgot

6.5

xiv

200

Stage Two Analysis Two General Discussion


201

6.6
Chapter Summary

7

204

Stage Two Analysis Three: Forgetting, Triggering and
Remembering of CSA Memories

208

7.1

Processes and Mechanisms of Forgetting

210

7.2

Triggers

213

7.3

Processes of Remembering


218

7.4

Method

221

7.4.1

Participants

221

7.4.1.1 Demographic characteristics (N = 16)

221

7.4.1.2 Demographic characteristics for the Partial

222


CSA Adult Survivor Memory

xv

Forgetting cases
7.4.1.3 Demographic characteristics for the Extensive


223

Forgetting cases

7.5

7.4.2 Materials

223

7.4.3

223

Data Analysis Procedures

Results and Discussions

225

7.5.1

The Processes of Forgetting

226

7.5.1.1 How long after the abuse started did you begin

226


to forget the abuse?
7.5.1.2 Discussion

228

7.5.1.3 What mechanisms were used to facilitate

229

forgetting?

7.5.2

7.5.1.4 Discussion

232

Triggers

233

7.5.2.1 What events triggered the memories?

233

7.5.2.2 Discussion

236

7.5.2.3 Was hypnosis involved?


236

7.5.2.4 Discussion

238

7.5.2.5 Were you in therapy when your memories

238

returned?
7.5.2.6 Discussion
7.5.3 The Process of Remembering

240
240

7.5.3.1 In what form did your memories return?

241

7.5.3.2 Discussion

243

7.5.3.3 Were your initial memories clear?

244



CSA Adult Survivor Memory

xvi

7.5.3.4 Discussion

247

7.5.3.5 Were you able to corroborate your memories in

249

any way?
7.5.3.6 Discussion
7.6

8

Chapter Summary

252
254

Stage Two Analysis Four: The Outlier

259

8.1


False Memories

261

8.2

Section Summary

267

8.3

Methodological Issues

269

8.4

Method

273

8.4.1 Participant

273

8.4.2 Materials

273


8.4.3 Procedure

273

8.4.4

274

8.5

The Exemplary Case Study

Case Study Material

276

8.5.1

Case 12 Overview

277

8.5.1.1 History

277

8.5.1.2 Forgetting

277


8.5.1.3 Triggering

278

8.5.1.4 Remembering

278

8.5.1.5 Corroboration

279

Case 12 Survey Results

279

8.5.2.1 Symptom Checklist 90 Revised

280

8.5.2.2 Dissociative Experiences Scale II

280

8.5.2.3 Loftus Persistence of Memory

280

8.5.2



CSA Adult Survivor Memory

8.5.3

8.6

8.7

xvii

8.5.2.4 Impact of Events Scale Revised

280

8.5.2.5 Williams Emotional Intensity

281

Case 12 Interview Transcript

281

8.5.3.1 Post Interview Debrief

298

Discussion

300


8.6.1 Category 1

300

8.6.2 Category 2

302

8.6.3 Category 3

304

8.6.4 Category 4

305

8.6.5 Category 5

307

8.6.6 Category 6

308

8.6.7 Category 7

309

Conclusions and Limitations


311

Chapter Nine: General Discussion and Conclusions

315

9.1

Research Structure and Process

315

9.2

Review of the Research Findings

316

9.2.1

Review of Quantitative Findings

316

9.2.2

Review of Qualitative Findings

318


9.3

Strengths and Limitations of the Research

320

9.4

Theoretical Contributions of the Research

321

9.5

Practical Applications of the Research

324

9.6

Future Research Directions

325

9.7

Conclusions

326


References

328


CSA Adult Survivor Memory

xviii

Appendix A: Specific Corroboration Details for Participants in this
Study

346

Appendix B: Consent Form

350

Appendix C: Test Booklet

352

Appendix D: Participants Responses to TEQ Item 25

376

Appendix E: Participants Responses to TEQ Item 26

384


Appendix F: Participants Written Comments about Abuse-Related
Emotions

390

Appendix G: Comments about Participating in CSA Research

394

Appendix H: Stage Two Interviews A and B

403

Appendix I:

Participants Survey Scores

408

Appendix J:

Stage Two, Analysis Three, Raw Data

420

Appendix K: Case Summaries

432



CSA Adult Survivor Memory

xix

LIST OF FIGURES

1.1

Research Organisation and Theoretical Model

5

2.1

Research Organisation and Theoretical Model

51

3.1

Research Organisation and Theoretical Model

78

3.2

Deductive Mode of Quantitative Research

89


3.3

Inductive Mode of Qualitative Research

89

3.4

Research Design Flow Chart

95

4.1

Research Organisation and Theoretical Model

117

5.1

Research Organisation and Theoretical Model

142

5.2

Stage Two Flow Chart

144


6.1

Research Organisation & Theoretical Model

161

7.1

Research Organisation and Theoretical Model

207

8.1

Research Organisation and Theoretical Model

258

9.1

Research Organisation and Theoretical Model

314


CSA Adult Survivor Memory

xx


LIST OF TABLES
1.1

Previous Studies on CSA and Long-Term Effects Reviewed by

10

This Study
1.2

Memory Types and Descriptions

30

1.3

Reasons Given by CSA Survivors for Forgetting

38

1.4

Factors Leading to Persistent Dissociative Amnesia

44

3.1

Percentages of Types of Corroboration by Category of Forgetting


86

3.2

Sample Demographics

3.3

Van Ijzendoorn & Schuengel Means of DES Scores by
Diagnostic Group

3.4

100

103

SCL-90-R Internal Consistency and Test-Retest Reliability
Coefficients

105

3.5

IES-R Reliability Coefficients

108

4.1


Participants Responses to Streaming Question about Category of

120

Forgetting
4.2

Descriptive Data for the Abuse Parameters of Adult CSA Survivor

123

(N = 76)
4.3

Descriptive Data for the Abuse Parameters for Participants who

124

Always Remembered (n = 28)
4.4

Descriptive Data for the Abuse Parameters for Participants who

125

Partially Forgot (n = 16)
4.5

Descriptive Data for the Abuse Parameters for Participants who


126

Extensively Forgot (n = 32)
4.6

Statistical Profile for CSA Survivors who Always Remembered

138

4.7

Statistical Profile for CSA Survivors who Partially Forgot

139


CSA Adult Survivor Memory

xxi

4.8

Statistical Profile for CSA Survivors who Extensively Forgot

139

6.1

Statistical Profile for CSA Survivors who Always Remembered


168

6.2

Statistical Profile for CSA Survivors who Partially Forgot

179

6.3

Statistical Profile for CSA Survivors who Extensively Forgot

187

7.1

Camerons’ (2000) Results on Why and How CSA Amnesia Occurs

212

7.2

Camerons’ (2000) Results on Triggers to CSA Remembering

215

7.3

Andrews et al (2000) Triggers to CSA Remembering


216

7.4

Camerons’ (2000) Initial Forms of Abuse Memories

219

8.1

Case 12 Survey Results

279

8.2

Case 12 Williams Emotional Intensity Scores – Then and Now

281


CSA Adult Survivor Memory

xxii

Acknowledgments

I would like to take this opportunity to acknowledge the people and organisations
who supported me during the completion of this thesis. Firstly, I would like to thank
the participants of this study for their courage, honesty and ability to trust a stranger

with their childhood experiences. Without their openness, this thesis would not be.
Thank you to the organisations and private therapists who helped make the
connection between the participants and this research project, in particular the
Queensland Crime Commission, Hetty Johnson, Dr. Wendall Rosevar and the After
Care Resource Centre.

Many thanks go to QUT for awarding me a three-year scholarship to conduct the
research, and to the School of Psychology and Counselling and Professor Ross
Young for the research support, which included access to funding, personnel and
sage advice.

I wish to thank my supervisory team. Sincere thanks to Professor Gary Embelton for
providing emotional support during the period of time I spent interviewing the abuse
survivors, and for believing in the merit and structure of this thesis topic, and to Dr.
Barbara Adkins for showing me the way regarding analysis of the qualitative data
with great clarity.

My deepest gratitude to Dr. Kathryn Gow, my chief supervisor, who deserves her
own paragraph for always believing in this project and my ability to complete the
process, especially when I doubted I would see the end, and for her superb “other”
management skills. I will never forget your words of encouragement and fighting
spirit, which always materialised just when I needed them the most. Finally,
Kathryn, I would like to give thanks for your sense of humour, patience, and
empathy.

The word “thanks” seems somewhat inadequate when I think of the sacrifices my
family members have made throughout the completion of my thesis. To my


CSA Adult Survivor Memory


xxiii

husband, Steven, and my children, Jon, Kelly and Nathan, thanks for putting up with
an often emotionally and mentally absent wife and mother.
Finally, thanks to my friends for supporting me when I made the life-changing
decision to return to full-time study. Your words were challenging at the time, and
opened me up to a new world of possibilities.


CSA Adult Survivor Memory

1

CHAPTER ONE
TRAUMA AND MEMORY
Chapter Contents

1

Trauma and Memory

3

1.1

Research Aim

4


1.2

Thesis Organisation & Theoretical Model

4

1.3

The Theoretical Context

7

1.3.1

1.3.2

1.4

1.5

1.6

1.7

Trauma defined: Can Childhood Sexual Abuse
be defined as trauma?

7

The long-term effects of childhood sexual abuse


9

1.3.2.1 Studies 1988-1999

13

1.3.2.2 Studies 2000-2002

18

1.3.3

Positive mediating factors

21

1.3.4

Section summary

22

DSM-IV and CSA: The Trauma Response

24

1.4.1

DSM-IV 308.3 Acute Stress Disorder


24

1.4.2

DSM-IV 309.81 Post Traumatic Stress Disorder

25

1.4.3

The relationship between CSA, ASD and PTSD

27

What is the type of memory under investigation by
this study?

29

1.5.1

32

Section summary

The Effect of Trauma on Memory

34


1.6.1

40

Section summary

The Dissociative Mechanism

41

1.7.1

41

DSM-IV and dissociation


CSA Adult Survivor Memory
1.7.1.1 DSM-IV 300.12 Dissociative Amnesia

41

1.7.1.2 DSM-IV 300.6 Depersonalisation Disorder

42

1.7.1.3 DSM-IV 300.15 Dissociative Disorder
Not Otherwise Specified (DDNOS)

1.8


42

1.7.2 Dissociation theory

42

1.7.3

46

Section summary

Chapter Conclusion

47

2