Cultic Studies Journal, Vol. 13, No. 1, 1996, page 42
The notion that ICA is commonly hidden by total amnesia for the abuse (Gelinas, 1983) has
frightening implications for those concerned with the iatrogenic creation of false memories
of ICA. The problem is that literally anyone can be suspected of being an ICA victim. This
enormously increases the number of patients who may be caught up in the highly
suggestive exploration for hidden ICA discussed at the beginning of this article. For
example, Ganaway (1995) reports a communication from Chris Sizemore, the actual patient
described in Thigpen and Cleckley‟s (1957) The Three Faces of Eve: “Sizemore reports being
openly confronted at speaking engagements with accusations that despite her claims of
having been successfully treated for multiple personality disorder, she must still be in denial
about her sexual abuse (Sizemore, personal communication, 1994)” (p. 131, fn. 4).
How will the presence or absence of ICA as an etiologic factor be diagnosed among patients
who may be amnesic for its presence? In the popular literature (e.g., Fredrickson, 1992),
lists of allegedly telltale symptoms are long and contain common enough problems to create
a “Barnum effect”--a description that fits one and all (Ofshe &Watters, 1994). Less
inclusive, professional guides to the diagnosis of hidden ICA often suggest superficially
plausible relationships between specific symptoms and ICA (e.g., bulimia).
However, the early research supporting this view is methodologically flawed and the
relationships between ICA and various forms of adult psychopathology may reflect
nonspecific effects (cf. Pope &Hudson, 1992). For example, two careful, methodologically-
sophisticated studies of the relationship between bulimia and ICA failed to find any
relationship between the two (Kinzl, Traweger, Guenther, &Biebl, 1994 Rorty, Yager, &
Rossoto, 1994), though many clinicians mistakenly continue to see conditions such as
bulimia as strong indicators of “hidden” ICA. As an example, the psychologist Ms. Borawick
consulted before seeing Valerian St. Regis espoused such views (Affidavit of Anthony E.
Reading, Ph.D., labeled as Exhibit F [a part of the record not under seal] and included as
part of the Plaintiff‟s Submission Re: Ruling on Defendant‟s Motion in Limine submitted to
the U.S. District Court, District of Connecticut).
Some therapists feel that experiences such as dreams or memories of Aodd feelings” can be
used as a guide to the diagnosis of hidden ICA. More vivid experiences, such as flashbacks
or revivification of memories during hypnosis, with or without an abreaction, are usually
seen as confirmation of ICA both by the patient and therapist. However, like hypnotically
influenced memories, flashbacks quite often have little or no relationship to objective,
historical reality (Frankel, 1994). As is the case for most events that occur in
psychotherapy, appropriate interpretation has to do with the patient‟s inner world, not the
external one (Spence, 1994). Similarly, many clinicians feel that poor memory for
childhood, especially early childhood, is diagnostic of a history of sexual abuse. However,
people can generally remember only scattered moments before age 5 or 6 and have almost
no retrievable memories before age 2 or 3. If they were under 4 years old at the time, for
example, most people remember very little, if anything, about the birth of a younger sibling
(Usher &Neisser, 1993). Little memory of early childhood is normal, not a sign of pathology
(Lindsay &Read, 1994).
Without reliable pathognomic signs, the identification of patients who endured, but do not
remember, childhood sexual abuse involves a complex series of decisions. It is too easy to
make mistakes. ICA is a hidden etiologic problem which can only be inferred, not observed.
From the “Research Diagnostic Criteria” that preceded DSM-III (Spitzer, Endicott, &Robins,
1977) through the ongoing process of revising DSM-IV (American Psychiatric Association,
1994), attempts to create reliable diagnostic categories have eschewed such supposed
etiologic factors in favor of overt, verifiable symptoms because experts will routinely
disagree about hidden causes.
A Statistical Approach to the Incidence and Prevalence of False Positives

Cultic Studies Journal, Vol. 13, No. 1, 1996, page 43
Lindsay and Read (1994) used Bayesian statistical methods to predict the rate of false
positives and false negatives in the diagnosis of ICA. If a patient is suspected of a hidden
presentation of ICA (Gelinas, 1983), false positives occur when a history of ICA is
diagnosed, but, in fact, ICA never occurred. Deliberately using unrealistic assumptions
intended to minimize the prediction of false positives, Lindsay and Read (1994) estimated
that a minimum of 30% of the patients diagnosed as having repressed memories of ICA
would be false positives.
Extending the unrealistic assumptions of Lindsay and Read (1994) still further, Pezdek
(1994) was able to reduce the predicted false positive rate to 18%. This figure does not
assume incompetent diagnosticians--quite the contrary. Both the Lindsay and Read (1994)
prediction and the predictions made in the two tables below assume the ability to diagnose
the hidden presence of an etiologic factor (ICA) with as much accuracy as experts can
diagnose many overt conditions.
While the Lindsay and Read (1994) predictions provide a good starting place, their
assumptions were deliberately unrealistic, perhaps in part to avoid the appearance of
making overly pessimistic predictions about the proportion of false positives. In order to
establish a range for the incidence of incorrect diagnoses of hidden ICA, we will use two sets
of somewhat more realistic assumptions. One set of assumptions will be more realistic than
that of Lindsay and Read, but still strongly minimize false positives. The second set of
assumptions will be more middle of the road. Comparing these predictions may provide a
conservative range for the proportion of incorrect diagnoses of hidden ICA.
The authors‟ first set of assumptions--and computation of resulting false positive rate--
follows. Presuming that interested clinicians will be very careful not to miss a case of
repressed ICA memories, we assign a sensitivity of .95 to the diagnostic process: 1 patient
in 20 with a hidden presentation of ICA will be overlooked. Given the human tendency to
interpret data in light of our ideas (i.e., confirmation bias), let us assume a specificity of
.85, which is as good as or better than that for overt DSM-IV diagnoses. A specificity of .85
means that 85% of patients wrongly suspected of ICA will be correctly identified as
unabused. Assuming a specificity of .85 is unrealistically optimistic, but it provides a lower
limit on the proportion of false positives.
In this first computation, we will use a 33% prevalence estimate for ICA, similar to that
suggested by Bass and Davis (1988). However, we will make it more realistic by using the
33% figure as an estimate of prevalence in the population of women seeking
psychotherapy, and not the population as a whole. Given a sample of 1,000 women seeking
therapy, 330 would have suffered from ICA and 670 would not. Again, we use this figure
not because we think it correct, but because it establishes a lower limit on the proportion of
false positives.
The best study of the incidence of amnesia for ICA to date was done by Williams (1994),
who found that 12% of the abused women were entirely amnesic for ICA. If we assume
12% of the 330 women are amnesic for the ICA they really experienced, 40 women (.12 x
330) would have been abused and become totally amnesic for it, and there would be 290
women who were abused and remembered the abuse. These last 290 women raise no
diagnostic questions in the context of finding patients entirely amnesic for ICA and will be
excluded from further analysis. Given .95 sensitivity and .85 specificity, the following table
results: