A memory-based model of posttraumatic stress disorder: Evaluating basic assumptions underlying the PTSD diagnosis.

Abstract

In the mnemonic model of PTSD, the current memory of a negative event, not the event itself determines symptoms. The model is an alternative to the current event-based etiology of PTSD represented in the DSM. The model accounts for important and reliable findings that are often inconsistent with the current diagnostic view and that have been neglected by theoretical accounts of the disorder, including the following observations. The diagnosis needs objective information about the trauma and peritraumatic emotions, but uses retrospective memory reports that can have substantial biases. Negative events and emotions that do not satisfy the current diagnostic criteria for a trauma can be followed by symptoms that would otherwise qualify for PTSD. Predisposing factors that affect the current memory have large effects on symptoms. The inability-to-recall-an-importantaspect-of-the-trauma symptom does not correlate with other symptoms. Loss or enhancement of the trauma memory affects PTSD symptoms in predictable ways. Special mechanisms that apply only to traumatic memories are not needed, increasing parsimony and the knowledge that can be applied to understanding PTSD. Keywords autobiographical memory; gender; neuroticism; dissociative amnesia; trauma This paper is a about posttraumatic stress disorder (PTSD) and more specifically about its assumed etiology. We evaluate basic theoretical assumptions underlying the PTSD diagnosis and present an alternative model. By its current diagnostic criteria in the U.S.A., which we refer to as the DSM, (i.e., the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision, American Psychiatric Association, 2000) and by the World Health Organization (2006), the diagnosis of PTSD requires the occurrence of a traumatic event. However, in practice, the diagnosis does not involve measuring the occurrence of an actual event, only the patient's report of the event at least one month, and sometimes years, after the Corresponding Author: David C. Rubin, Department of Psychology and Neuroscience, Box 27708-0086, Duke University, Durham, NC, 27708, U.S.A. david.rubin@duke.edu. Publisher's Disclaimer: The following manuscript is the final accepted manuscript. It has not been subjected to the final copyediting, fact-checking, and proofreading required for formal publication. It is not the definitive, publisher-authenticated version. The American Psychological Association and its Council of Editors disclaim any responsibility or liabilities for errors or omissions of this manuscript version, any version derived from this manuscript by NIH, or other third parties. The published version is available at www.apa.org/journals/rev NIH Public Access NIH-PA Author ManuscriptNIH-PA Author Manuscript NIH-PA Author Manuscript event occurred. The memory report, in practice, is not questioned (McNally, 2003b). We examine the implications of a diagnosis based on a pathogenic memory rather than a pathogenic event. The change has major consequences: the event, which is not m...

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