Is Trauma Memory Special? Trauma Narrative Fragmentation in PTSD

Seminal theories posit that fragmented trauma memories are critical to posttraumatic stress disorder (PTSD) and that elaboration of the trauma narrative is necessary for recovery. According to fragmentation theories, trauma narrative changes, particularly for those receiving trauma-focused treatment, should accompany symptom reduction. Trauma and control narratives in 77 men and women with chronic PTSD were examined pre- and posttreatment, comparing prolonged exposure (PE) and sertraline. Utilizing self-report, rater coding, and objective coding of narrative content, fragmentation was compared across narrative types (trauma, negative, positive) by treatment modality and response, controlling for potential confounds. Although sensory components increased with PE ( d = 0.23–0.44), there were no consistent differences in fragmentation from pre- to posttreatment between PE and sertraline or treatment responders and nonresponders. Contrary to theories, changes in fragmentation may not be a crucial mechanism underlying PTSD therapeutic recovery.