Neurocognitive Profiles Associated with Remote History of Sexual Trauma

Little is known about the neuropsychological profiles associated with sexual abuse (SA). Using a serial case study design, we examined the cognitive profile from 11 patients medically referred for neuropsychological evaluation who endorsed a remote history of SA. The data can be best summarized as the co-existence of strong psychometric evidence of non-credible responding [operationalized as multiple failures on performance validity tests (PVTs)] and intact (often better than expected) performance on difficult tests designed to measure cognitive ability across various domains. Five (45.5%) of the patients had strong evidence for noncredible responding and another three (27.3%) had indeterminate profiles (i.e., neither clearly valid nor clearly invalid). We propose that the paradoxical co-occurrence of multiple PVT failures and intact cognitive abilities may be a psychometric marker of complex trauma history. Naturally, this hypothesis needs extensive independent replication before it can be incorporated into routine clinical interpretation of neuropsychological data. Given the small sample size and the variability in demographic and clinical characteristics, results are considered preliminary. The effects of developmental timing and recurrence of SA, the survivor-perpetrator relationship, protective factors, and post-traumatic growth on cognitive functioning in people who have experienced SA are discussed. Future research is needed to better understand the long-term effects of SA on the neurocognitive profile of adult survivors. In the meantime, assessors may want to consider complex trauma history as a potential alternative explanation to feigning for multiple PVT failures and unexplained internal inconsistencies within the cognitive profile.