Is There A False Memory Syndrome?

A Review of Three Cases

Robert Kaplan and Vijaya Manicavasagar
The controversy over recovered memories of childhood sexual abuse (CSA) is whether such experiences can be forgotten for long periods and retrieved later in therapy or in response to cues or triggers from the environment. False memory syndrome (FMS) is caused by memories of a traumatic experiencemost frequently CSAwhich are objectively false, but in which the person strongly believes. Personality factors often play a role in the development of FMS. Because CSA is such a devastating experience, false accusations of sexual abuse have enormous, if not shattering, consequences for families. We present three case reports to illustrate features of the FMS. FMS should be listed for further study to establish valid criteria for making the diagnosis under the category of factitious disorders, and a subcategory of false memories/beliefs of abuse, with a further subdivision of induced by therapy. The FMS controversy occurred in the context of a general moral panic about sexual abuse in the early 1980s. Psychiatrists should have a high degree of scepticism to moral panics. Copyright 2001 by W.B. Saunders Company

VER THE LAST DECADE there has been considerable debate over the veracity of reports of childhood sexual abuse (CSA) derived from recovered memories. A recovered memory is dened as the emergence of an apparent recollection of childhood sexual abuse of which the individual had no previous knowledge.1 Recovered memory therapy (RMT) describes the practices of a heterogenous group of clinicians who share a particular set of beliefs, namely, that a wide range of somatic and physiological symptoms are caused by past sexual abuse, the memory of which is lost to consciousness.2 A key tenet of RMT is that recovery of these memories is an essential aspect of the treatment process. The debate on recovered memory extends from scientic circles in psychiatry and psychology to the public arena and has important clinical, social, and legal ramications.3 In essence, the controversy is whether CSA occurring at a very early age can be forgotten for long periods and then retrieved, or recovered, later in therapy or in response to cues or triggers from the environment. CSA has been associated with psychiatric disorders in later life, including mood, personality, and eating disorders. Estimates of CSA in women range from 3% to 63% (with little distinction made between incidence and prevalence).4 A considerable body of evidence has shown that the longFrom the Liaison Clinic, Wollongong, Australia. Address reprint requests to Dr. Robert Kaplan, The Liaison Clinic, 310 Crown St, Wollongong, NSW 2500 Australia. Copyright 2001 by W.B. Saunders Company 0010-440X/01/4204-0013$35.00/0 doi:10.1053/comp.2001.24588
342

term effects of CSA are largely nonspecic: there is no pathognomonic post-abuse syndrome.5,6 There are numerous studies of personality-disordered subjects reporting CSA (Medline search). For example, in parents who raise allegations of CSA, up to 80% have personality disorder, about six times the rate one would expect in the general population.7 Many researchers have concluded that CSA is the cause of borderline personality disorder. As is increasingly the nature of controversies, much of the debate has taken place in public, with scientic debate occurring on a secondary and often reactive basis. The appeal of the recovery paradigm is the explanatory power of its jargon: healing, victim, repression, remembering, disclosure, perpetrator, and survivor. Critics, such as Ofshe and Watters,8 Crews,9 and Pendergrast,10 have cogently questioned the irrational, emotive and inconsistent basis of the recovery movement. The theoretical underpinning for RMT was derived from the early work of Freud on hysteria.11 Severe trauma was repressed to the unconscious mind because it was too painful to tolerate. The preserved memory could emerge years later under therapy when the traumatic events were re-experienced in accurate detail. However, Freud recanted from his initial belief that hysterics suffered reminiscences of sexual abuse, establishing instead the concept of the Oedipal complex.12 Thus, sufferers from hysteria were victims of fantasies about their fathers, not actual abuse. However, after 60 years of study, there has been no scientic validation of the concept of repression.13 Workers like van der Kolk and Kadish believe

Comprehensive Psychiatry, Vol. 42, No. 4 (July/August), 2001: pp 342-348

IS THERE A FALSE MEMORY SYNDROME?

343

that traumatic memories of CSA are laid down in the brain through a unique process that does not apply to other forms of trauma. In their view, a child represses, or involuntarily forces out of awareness, each instance of sexual abuse until it is recalled in therapy.14 They expect that the recall during therapy will lead to recovery from a condition they term complex posttraumatic stress disorder. Studies of hypnotism, borderline states, trancemediumship, multiple personality, hysteria, brain disorders, epilepsy, and psychosis reveal that memory associated with these states is qualitatively different from that found in laboratory studies of healthy individuals.15 Loftus has demonstrated how to trigger false recall in normal volunteers, rendering them incapable of differentiating conrmed events of their childhood from experimentally implanted false narratives.16 Mainstream psychiatrists and psychologists approached CSA on the basis of feminist beliefs, others had a special interest in dissociation, seen as a more sophisticated and less simplistic explanation of the problem than repression.17 Dissociation comes as much from the work of Janet, as Freud. Janet postulated a split in the psyche where traumatic memories were disconnected from normal consciousness, the so-called condition seconde. He later retracted this belief, a fact which has not received wide publicity.18 Dissociation was rst linked with repression and sexual abuse with the publication of the book Sybil by Flora Rheta Schreiber.19 Frank Putnam, a leading authority on dissociative disorders, stated The case of Sybil . . . is the one most often credited with reintroducing the public and mental health professions to the syndrome of multiple personality.20 RMT was made popular by a number of books which implicated a wide range of symptoms and signs said to be indicative of childhood sexual abuse. Diagnosis by therapist and patient was facilitated by the use of check lists. The most famous (or alternately, notorious) came from The Courage to Heal,21 a best seller that ran into many editions. Written by two feminist counselors who did not have formal training in psychology, their ndings were drawn from sexual abuse victims in womens groups. The Courage to Heal became the bible of the repressed memory movement and it was not

too long before recovered memories of sexual abuse were a regular feature on talk shows. So-called abuse therapists proliferated in the 1970s and 1980s in response to growing awareness of the extent of CSA.22 These therapists usually had limited or minimal training and could be considered marginal in relation to registered psychologists or social workers. Advertising for clients was often placed on bulletin boards at womens centers, in the alternative press, or on the internet. Abuse therapists followed a one size ts all approach. Any problem in life, including depression, anxiety, poor relationships, emotional difculties, alcohol and drug abuse, eating disorders, studying problems, low self-esteem, difculty with assertiveness, or marital problems was considered to be a pointer to CSA. Using an unabashedly directive approach, and by continually insisting that all problems were due to sexual abuse, therapists wore down the resistance of any patient who had doubts whether it actually had occurred. Patients who insisted that they did not remember being abused were regarded as in denial and encouraged to hold the belief of being abused in their minds until they did believe itscarcely an objective means of conrming matters of considerable legal signicance. Once the patient believed that they had been abused, the usual approach was to close off all other means of conrming what had happened with external sources. Patients were encouraged to confront the alleged abuser and then cut off all contact. Therapists would refuse to see parents to hear their side of the story on the grounds that it would interfere with their relationship with the client. According to repressed memory theory, the repressed memories emerged in highly symbolic fashion. This was explained by the concept of body memories, in which physical changes were regarded as mnemonic of the repressed trauma.23 For example, baggy shapeless clothing was indicative of a desire to reduce sexual attractiveness. Vomiting, a symptom of bulimia, was a reaction to being forced to perform oral sex. On the same basis, both promiscuous behavior or sexual avoidance could be seen as a reaction to being abused. The misunderstanding of common symptoms resulted in a similar interpretation. Typically, these included panic attacks, hypnagogic hallucinations, sleep paralysis, and bulimia.

344

KAPLAN AND MANICAVASAGAR

A range of treatments was used by therapists to uncover repressed memories. These included validation, survivor groups, guided visualization, hypnosis, age regression, dream interpretation, art therapy, and other activities intended to bring the memories to consciousness.24 Some psychiatrists used drug interviews or abreactions, the truth drug technique, despite overwhelming evidence that chemical abreaction was discredited and notorious for producing fantastic stories.25 RMT had the most impact in the legal arena. In trials held across America (and in other countries), people were convicted by juries on evidence that accepted the existence of repressed memories, even when the case could defy rational belief that it had occurred or was contradicted by the material evidence. Much of the credit for conviction went to prominent psychiatrists, believers in repressed memory, who gave testimony. The false memory syndrome (FMS) is dened as a condition in which a persons identity and interpersonal relationships are centered around the memory of a traumatic experience that is objectively false but in which the person strongly believes. The recovered memories often rule the individuals personality and lifestyle and overrule adaptive behavior; it can take on a life of its own, become encapsulated, and is often resistant to correction. Individuals with FMS often avoid confrontations that challenge the resulting beliefs and are effectively distracted from coping with real problems of living and family relationships.26,27 As the controversy over convictions based on repressed memory increased, the False Memory Syndrome Foundation was established. Sister organizations were soon established in the United Kingdom, Australia, The Netherlands, and Israel. A study of accused family members of the British False Memory Society showed that 87% of the accusers were women; 50% of accusations were made against biological fathers and only 3% against stepfathers.28,29 This was in marked contrast to the large body of work on CSA, where the majority of abusers were stepfathers, rather than biological fathers.30 Accusations were often nonspecic, arose during a therapeutic relationship and were reported to start at a much younger age than never-forgotten abuse, which is usually in pre- or early adolescent children.

We present three brief cases that illustrate aspects of the FMS.

CASE REPORTS

Case 1: R., Age 40

R. traveled to Europe on a regular basis for business purposes. Five months before presentation, she went on a trip lasting a month. While away, she kept in regular contact by phone with her husband, sometimes speaking twice daily. After she returned home, R. had a sense of something wrong, which she could not explain. To nd an explanation, she saw a hypnotherapist for four or ve sessions. The sessions were conducted in the presence of her husband, who insisted on accompanying her. After the rst session, she became convinced that she had been the victim of extensive sexual abuse involving a number of men and women over a period of 16 days while traveling. Further sessions conrmed and reinforced these memories, including the belief that she had been drugged and hypnotized during this time to remove all memories of what had happened. Increasingly frightened by these concerns, she terminated the sessions when the hypnotist insisted he see her alone to clarify her recollections. R. then saw another hypnotist for a similar number of sessions, which reinforced her beliefs. Since then, she had been in a state of distress, convinced that she was repeatedly anally and vaginally raped in a drugged state by the people with whom she had stayed in Europe. R. and her husband made investigations, which apparently conrmed that some of these people were drug dealers. There was further evidence when she developed red wheals in her antecubital fossae, thought to be consistent with marks caused by the insertion of intravenous needles. She also developed anal pain. Visits to a neurologist and gynecologist however excluded physical pathology and, in particular, any indication of sexual trauma. On presentation, R. was not depressed or anxious. She was leading a normal life and going to work when the opportunity presented. Her relationship with her husband had been difcult since the revelations emerged. He initially doubted what she remembered and accused her of having sexual relationships with other men, which she denied. On examination, she did not appear to be manic, thought disordered, disorientated, or confused. Her manner was breathless and her account of what happened appeared to be melodramatic. There was no history of past psychiatric problems. R. described herself as not suggestible in nature. She was competent at her job and had coped well with family problems, such as the death of her father and the break-up of her rst marriage. When it was suggested that hypnosis may have induced her beliefs, R. said she would consider this but did not believe that it was correct. She did not accept treatment or return for follow up. R. was treated by two hypnotherapists. Treatment reinforced her belief that she was a victim of multiple sexual abuse. As a result, she developed anal pain and what can be regarded as hysterical stigmata: red wheals on her arms. R.s description of what purportedly happened to her during her travels deed rational belief that it could have occurred over

IS THERE A FALSE MEMORY SYNDROME?

345

such a period without her being aware of it, without anyone else around her being aware, or that she could have suppressed all memory of what happened in such a short period of time until she went for hypnosis. Signicantly, R. phoned her husband on a daily basis during the trip without reporting any problems. The alleged perpetuators of the abuse were business colleagues whom she had regularly dealt with over the years without any problems. Once R. came to the belief that she was victimized, she and her husband interpreted minor physical signs and changes as conrmation of what they believed. Yet, despite the allegations of extensive and repeated sexual abuse, there was no physical evidence of such events. Gynecological examination excluded any changes that could be attributed to the repeated and brutal rapes she alleged. R.s husband, initially suspecting indelity, later accepted her version of events. While this further reinforced her convictions, it is difcult to avoid the conclusion that it must have been a convenient means for R. to deect the accusation that something more likely, namely, an affair, had occurred. Hypnosis had most likely promoted the false memories, although it can be questioned whether R.s husbands accusation of affairs did not have any factual basis, not revealed, in their past relationship. R.s style at interview was histrionic. Histrionic personality has been associated with high hypnotizability.31 This case involved recent memories of alleged abuse, occurring within the past few months. With FMS, the issue is not the extreme nature of the beliefs or the tenacity with which they are held in the face of rational contradiction, but the circumstances in which they occur. In particular, the role of suggestion during therapy and the retrospective extension of memories to early youth incompatible with neurological development of valid memory.

Case 2: D., Age 40

D. was referred with a history of anxiety and agoraphobia. She had been seeing a psychologist but developed an intense fear of dying, which was interfering with her daily life. D. was the third of ve children. Her father had been an alcoholic. She was a quiet, shy girl who had school phobia in her early years. She attributed this to intense self-consciousness when any attention was drawn to her. After nishing school, D. went to work, married, and had three children. Her anxiety had become more intense over the 10 years prior to presentation. Although she had coped with marriage and work, her social phobia worsened, resulting in panic attacks and agoraphobia. To overcome her problems, D. saw several counselors for hypnosis. This had no benet and she never stayed with them for long. Five years before presentation, she began seeing a psychologist who interpreted her anxiety symptoms as being due to sexual abuse in childhood. She saw him on an intense basis, with sessions twice a week over a period of several years. The psychologist would urge her to go into the fear, by which he meant she should focus intently on the anxiety. He frequently suggested that D. had repressed memories of sexual abuse. This led D. to believe she had been molested by her

grandfather between the age of 4 and 8 years. D. became convinced that he had intercourse with her a dozen times. Her initial recollection was of feeling uncomfortable in the bath with her sister when her grandfather came in and looked at them. Later she visualized having intercourse with him. To nd evidence to support her claims, D. told her mother, whose only comment was that her grandfather asked her into his room when she was young and she had felt afraid. As he had died, he could not be confronted about the allegations. As a result of her conviction that she had been molested, D. ceased sexual relations with her husband, which put strain on the marriage. Nevertheless, she felt able to return to work and ended the sessions with the psychologist. However, D.s anxiety continued to worsen. She became increasingly agoraphobic and experienced intense depersonalisation. Her sleep was disturbed and she experienced frightening dreams. After a nocturnal panic attack, she went back to the psychologist. He interpreted this as a premonition that she was going to die. Asked if he believed that was possible, he said he could not exclude it. Since then D. had been acutely distressed, in a state of panic, convinced she was going to die and despairing at the thought of losing her family. At interview, it was noted that there was a family history as her sister also had anxiety. Treatment followed along routine lines. D. was commenced on antidepressants, reassured that she was likely to have a full recovery, and the nature of panic attacks explained. At the rst session it was pointed out that while the possibility she had been molested was not high, discussion of this issue was to be postponed until she felt less anxious. D. had a mixed response to treatment. Within weeks her panic attacks abated, leaving a residual degree of agoraphobia, depersonalization, and illness phobia. She was referred to a clinical psychologist (V.M.) for cognitive behavioral therapy. D. was seen over 18 months. At intervals, she was asked about her recollections of being molested. Her belief that this had occurred progressively withered over the course of treatment. By the time it nished, D. was quite certain that she had never been molested and expressed anger that she has been misled into believing as such. During the time that D. was attending, her sister, by coincidence, also sought help for panic attacks. Her problem required less attention. D.s sister was emphatic that no sexual abuse could have occurred, citing the closeness of the family, opportunities for her grandfather to be alone with D. were minimal, and the difculty he would have had molesting D. without detection. Features strongly suggestive of FMS in D.s case include: a therapist who believed her symptoms were due to CSA in the absence of any memory or history of this; hypnotic suggestions that D. was abused; misunderstanding of D.s anxiety symptoms; accusation of her grandfather as the offender; recovered memories extending before the age of 4. The issue of lookismdrawing extreme conclusions from someones expression or gazereinforced D.s growing belief that her grandfather was an abuser. Yet, with more appropriate management, D. lost the conviction that she had been abused, her symptoms settled and she resumed normal relations with her mother and husband. Some corroborative evidence was supplied by her sister, although in itself, this would not have been conclusive.

346

KAPLAN AND MANICAVASAGAR

Case 3: F., Age 42

F. was referred by a family doctor who stated that F. had multiple personality disorder and required assessment for Social Security benets. F. was accompanied by her Exit Counselor, who insisted that she come in to the interview with her. Later the Exit Counselor spoke to the psychiatrist (R.K.) on her own. She had received media publicity for her work with ritual sexual abuse. She ran a home for victims of sexual abuse. She acted as their counselor and described the aims of treatment as restraining the various alters from continuing to attend satanic rituals, as well as protecting the index personalities from their inuence. At the age of 37, 5 years before presenting, F. began reading literature on CSA, satanic rituals, and multiple personalities. This convinced her she was a victim of extreme sexual abuse by her father from an early age, assisted by her mother, who allegedly cooperated in the satanic rituals. F. was reluctant to discuss the abuse, saying that it had involved intercourse with other people. Her father died over a decade earlier, so she could not confront him. The Exit Counselor met F. the previous year and diagnosed her as having multiple personalities. Several months later she moved to the area, commenced counseling and moved into the home run by the Exit Counselor. F. had several siblings and came from a background of abuse. She led an isolated life and never had any relationships. In her late teens, she sought psychiatric help for what appeared to be depression and had a long admission to hospital. F.s subsequent lifestyle was peripatetic, moving to new towns every few years. Over this time, she had made 10 attempts to kill herself by slashing her wrists. She saw a psychiatrist who thought she had 10% delusions, for which she was treated with chlorpromazine and uoxetine. F. took the latter for a year and thought that it had a benecial effect on her mood. On examination, F. was reluctant to discuss her symptoms, but spoke vaguely of mood swings, voices in her head, and fears about her security. She stated emphatically that satanic covens were trying to control her mind, send electric shocks through her body, and kill her. F. presented as a withdrawn woman with a at affect, but was not depressed or anxious. She had voices in her head since the age of 2 but did not believe that this was due to external phenomena. She denied other psychotic phenomena, specically passivity events, and was not thought disordered. She was reluctant to describe her other personalities or state how many there were, but conceded that they took over her index personality and made her speak in different voices. The overall impression was of an articulate, intelligent woman with a fragile, dependent personality showing borderline traits. The Exit Counselor was extremely defensive about her role. She was emphatic F. had multiple personalities and was making progress in therapy as each personality cleared up. She refused to concede that she had no professional qualications. F. refused any treatment and would not make a return booking. This case has the most typical features of FMS in view of the association with dissociative identity disorder [DID]. F. had

almost two decades of dense amnesia before recovering the abuse memories. She alleged extensive and extreme ritual abuse, which had never been discovered or commented on by anyone else. She had obtained extensive information about CSA. F. became involved with a distinctly marginal counsellor who worked as an abuse therapist. The two continued a highly unusual relationship by moving into a house where other purported victims with multiple personalities were staying.

DISCUSSION

Objections can be raised to the FMS on the grounds that it is a syndrome and has not received any validation as a formal diagnosis. In the sense that all illnesses are social constructs, this syndrome, a product of the media-driven junk science era in which we live, is an example of a disorder that requires scientic validation. Based on these and other cases we have encountered, we believe the following features are typical of the FMS: 1. The retrieval of memories of sexual abuse, usually but not always occurring in early childhood, in the course of therapy without any pre-existing awareness in the patient. 2. Retrieval of dense and extensive memories occurring before the age of 4 years. 3. Association with claims of satanic ritual abuse or DID. 4. Claims of extensive sexual abuse which went on without discovery by other sources, or other corroborative evidence. 5. Absence of medical or forensic conrmation of abuse. 6. Presence of somatization or borderline personality disorder. 7. Evidence of suggestion during therapy and/or use of hypnosis or related techniques. We are not claiming that these features are consistent or mutually exclusive and we accept that others would dispute some of these criteria or add their own. We note the strong association of FMS with claims of satanic ritual abuse and DID. DID, the condition most frequently attributed to CSA, has been extensively documented as an artifactual condition which is unlikely to persist when subjected proper scrutiny.32 Investigations of satanic ritual abuse in the United States, United Kingdom, and Australia have revealed no convincing evidence that this exists or is producing the outcomes that are claimed.33,34

IS THERE A FALSE MEMORY SYNDROME?

347

Hypnosis or related techniques are frequently used to elicit symptoms in the FMS. Hypnosis has a strong capacity for producing false memories or memories that are distorted by therapist suggestion.35 As a variation on this theme, we have documented the capacity of a new therapy, eye movement desensitization reprogramming, to cause similar problems.36 Precisely because CSA is such a devastating experience, a situation in which false accusations of sexual abuse become accepted as genuine will have enormous, if not shattering, consequences for families.37 Furthermore, when the revelation of CSA becomes public, the welter of ambivalence, confusion, divided loyalties, misguided pressures, and directed questioning can lead to false as well as truthful accusations. While it is the province of the law to determine the truth of an accusation of sexual abuse, it is very much the business of psychiatry and psychology when false accusations arise specically as a result of misguided, if not egregious, therapeutic practices. FMS is associated with primary gain: the desire to enact the role of a patient. Cases 1 and 3, for all their limitations, suggest an aspect of the FMS which has not received comment: secondary and tertiary gain.38 In R.s case, it was an obvious rebuttal to her husbands accusation that she had been having affairs. With F., the presentation was a blatant request to retain Social Security benets, essential to fund the group home in she lived. The tertiary gain obtained was the nancial benets to her therapist, which played a not-insignicant role in the presentation. While F. had difculty forming relationships and led an isolated life, she had not sought help for many years after leaving home. This augmented the likelihood that she did not have any memories of abuse, which were only later established in someone of a highly suggestible nature seeking an explanation and solution to her problems. In our cases, secondary gain was an important feature because it led to contact with the medical profession which might not otherwise have occurred. We have encountered two other cases where contact with the medical profession was only sought to obtain Social Security benets. In one case, a referred patient refused to see a psychiatrist (R.K.) on the stated grounds that her therapist had told her he was a known perpetrator and retractor supporter. Based on our experience with

these cases, we question whether FMS cases should have access to Social Security benets without conrmation of the actual diagnosis, especially when associated with DID. We present these three case vignettes without any pretence that they are detailed or denitively exclude CSA. Among the limitations are that two of the cases were only seen on one occasion. The rst case was more unusual in that it was not the memory of childhood abuse, but events occurring within the previous few months to an adult. Nevertheless, this serves to illustrate the point that FMS can apply to a wide range of circumstances occurring at different ages. In describing these cases and attempting to clarify the features of the FMS, we are not adopting a particular ideological view or siding with perpetrators. We are, however, strongly of the view that memories of sexual abuse arising directly out of therapy in the absence of any previous evidence constitute a signicant problem with legal, moral, social, and psychiatric implications. By describing cases with features of the FMS, we are encouraging the study of how such a problem arises, and how it can be predicted, recognized, and prevented. We propose that FMS should be diagnosed under the category factitious disorders, with a subcategory false memories/beliefs of abuse, and a further subdivision, induced by therapy. Feigon and de Rivera have expressed concern that the approach of some therapists who automatically identify abuse survivorship in their patients will petrify the diagnostic process and solidify the patients belief that he or she is, above all, a survivor.39 What cannot be disputed is that unfortunate treatment outcomes can occur when the diagnosis of abuse survivorship is mistaken. A substantial minority of therapists have functioned as authorities for the disputed core beliefs. This approach occurred in the context of a general moral panic about sexual abuse in the early 1980s. Psychiatrists are vulnerable to social inuences, but should have a high titer of scepticism to moral panics. In the words of Harold Merskey, an authority on hysteria, when the critical faculty is even slightly loosened . . . there is no end to the developments that can occur.40 We could not agree more.

348

KAPLAN AND MANICAVASAGAR

REFERENCES
1. Brandon S, Boakes J, Glaser D, Green R. Recovered memories of childhood sexual abuse: implications for clinical practice. Br J Psychiatry 1998;172:296-307. 2. Yapko MD. Suggestions of Abuse. New York, NY: Simon & Schuster, 1994. 3. Crews F. The Revenge of the Repressed. The New York Review of Books, November/December, 1994. 4. Ferguson DM, Mullen PE. Childhood Sexual Abuse: An Evidence-Based Perspective, Vol. 40. Thousand Oaks, CA: Sage Publications, 1999. 5. Kendall-Tackett KA, Williams LM, Finkelhor D. Impact of sexual abuse on children: A review and synthesis of recent empirical studies. Psychol Bull 1992;113:14-18. 6. Brandon S, Boakes J, Glaser D, Green R. Recovered memories of childhood sexual abuse: implications for clinical practice. Br J Psychiatry 1998;172:296-307. 7. Wakeeld H, Underwager R. Personality characteristics of parents making false accusations of sexual abuse in custody disputes. Issues Child Abuse Accus 1990;2:121-136. 8. Ofshe R, Watters E. Making Monsters. Berkeley, CA: University of California Press, 1994. 9. Crews F. The Memory Wars: Freuds Legacy in Dispute. New York, NY: New York Review, 1995. 10. Pendergrast M. Victims of Memory: Sex Abuse Allegations and Shattered Lives. Hinesberg, VT: Upper Access, 1995. 11. Schimek JG. Fact and fantasy in the seduction theory: a historical review. J Am Psychoanal Assoc 1987;35:937-965. 12. Masson JM. Assault on Truth: Freuds Suppression of the Seduction Theory. Middlesex, England: Penguin Books, 1984. 13. Pope HG, Hudson JI. Can memories of childhood sexual abuse be repressed? Psychol Med 1995;25:121-126. 14. van der Kolk BA, Kadish W. Amnesia, dissociation, and the return of the repressed. In: van der Kolk BA (ed): Psychological Trauma. Washington, DC: American Psychiatric Press, 1987:173-190. 15. Erdelyhi MH. The Recovery of Unconscious Memories: Hyperamnesia and Reminiscence, Chicago, IL. University of Chicago Press, 1996. 16. Loftus E. Creating false memories. Sci Am 1997;2:5055. 17. van der Kolk B, Fisher R. Dissociation and the fragmentary nature of human memories: overview and exploratory study. Br J Psychother 1995;12:352-366. 18. Hacking I. Rewriting the Soul: Multiple Personality and the Sense of Memory. Cognitive Development. Princeton, NJ. Princeton University Press, 1995. 19. Schreiber F. Sybil. Chicago, IL: Henry Regnery, 1973. 20. Putnam FW. Diagnosis and Treatment of Multiple Personality Disorder. New York, NY: Guilford Press, 1989:35. 21. Bass E, Davis L. The Courage to Heal: A Guide for Women Survivors of Child Sexual Abuse. New York, NY: Harper & Row, 1988. 22. Crews F. The Revenge of the Repressed. New York Review of Books, November/December 1994. 23. van der Kolk B. The body keeps the score: memory and the evolving psychobiology of post traumatic stress. Harvard Rev Psychiatry 1994;1:253-265. 24. McConkey KM, Sheehan PW. Hypnosis, Memory and Behaviour in Criminal Investigations. New York, NY: Guildford Press; 1995. 25. Sargant W, Slater E. Acute War Neuroses. Lancet 1940; 2:1-2. 26. Khilstrom J. Exhumed memory. In: Lynn SJ, McConkey KM (eds): Truth and Memory. New York, NY: Guildford Press, 1988;3-30. 27. Brandon S, Boakes J, Glaser D, Green R. Recovered memories of childhood sexual abuse: implications for clinical practice. Br J Psychiatry 1998;172:296-307. 28. Gudjonsson GH. The member of the BFMS, the accusers and their siblings. Psychologist 1997;10:111-114. 29. Gudjonsson GH. Accusations by adults of child sexual abuse, a survey of members of the British False Memory Society. Appl Cogn Psychol 1997;9:348-346. 30. Russell D. The incidence and prevalence of intrafamilial sexual abuse of female children. Child Abuse Neglect 1983;7: 133-176. 31. Spiegel H. The grade ve syndrome: the highly hypnotizable person. Int J Clin Exp Hypnosis 1974;22:303-319. 32. Merskey H. Multiple personality and false memory syndrome. Br J Psychiatry, 1995;166:281-283. 33. La Fontaine JS. The Extent and Nature of Organised and Ritual Abuse. London, UK: HMSO, 1994. 34. Guilliatt R. Talk of the Devil: Repressed Memory and Ritual Abuse Witch-Hunt. Melbourne, Australia: Text Publishing, 1996. 35. Loftus E. Creating false memories. Sci Am 1997;2:5055. 36. Kaplan R, Manicavasagar V. Adverse effects of EMDR: a case report. [letter]. Aust ANZ J Psychiatry 1998;32:731-732. 37. Loftus E. Repressed memory accusations: devastated families and devastated patients. Appl Cogn Psychol 1997;11: 25-30. 38. Bokan JA, Ries RK, Katon WJ. Tertiary gain and chronic pain. Pain 1981;10:331-335. 39. Feigon EA, de Rivera J. Recovered-Memory therapy: profession at a turning point. Compr Psychiatry, 1998;39:338344. 40. Merskey H. Multiple personality disorder and false memory syndrome. Br J Psychiatry 1995;166:281-283.