Dissociative Amnesia DSM-5 300.12 (F44.0)

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DSM-5 Category: Dissociative Disorders 

Introduction

Dissociative amnesia (DA) is one of three dissociative disorders listed under DSM-V. The disorder involves the temporary loss of recall memory caused by disassociation, which may last for a period of seconds or years. The interruption in memory may be voluntary or involuntary and is most often a result of psychological trauma. DA involves episodic autobiographical memory loss inconsistent with normal forgetfulness. Episodic autobiographical information is associated with contextual information, such as what happened in the minutes leading up to a traumatic event. The individual may, however, remember semantic autobiographical information such as the date, time and weather conditions of the accident.

Dissociative amnesia often arises from traumatic childhood events. It can be difficult to identify in children due to their undeveloped memory and communication skills. In adulthood, DA can appear as a result of trauma such as from war, avoidance such as from aberrant sexual behavior, and stressful situations with extreme emotions such experiences causing rage, fear or shame.

Brain imaging studies have identified changes and fiber degeneration in the right temporo-frontal cortex area in individuals with dissociative amnesia (Staniloiu and Markowitsch, 2010).

Dissociative Amnesia Symptoms

Under DSM-V, the symptoms and criteria for dissociative amnesia are (American Psychiatric Association,2013):

  • Unable to recall autobiographical memory associated with a traumatic event. The recall of traumatic events is usually unconscious.
  • The inability to recall traumatic events creates distress.
  • The memory dysfunction does not have a physiological cause.
  • The memory dysfunction is not dissociative identity disorder.
  • The memory loss is not a result of substance abuse or other substance.

Suppressed memories can be harmful and should be treated even if the individual re-establishes a good quality of life. If the memory is being repressed so too is the traumatic events that triggered the disassociation. The individual may have partial memory recall through flashes or nightmares. DA is often comorbid with post-traumatic stress disorder (PTSD). The repression of memories can lead to maladaptive behavior in adolescence and adulthood such as self-harming or harming others. Men with a dissociative identity disorder are at a higher risk of going to prison as a result of directing their aggression towards society.

Dissociative fugue, formerly a separate disorder, is a subtype of amnesia under DSM-V. It may involve a temporary or permanent loss of one’s personal identity or the development of a new identity. It is often triggered by stressful life events and involves travel.

Dissociative Amnesia in Daily Life

Dissociative amnesia can be a stressful experience for families dealing with the stress, depression and confusion of a loved one who has lost memories. The family may also be dealing with a stressful event that caused the amnesia, such as abuse or an accident. Daily activities may trigger the underlying cause and cause the individual to further disassociate. This risk is higher when the triggering event is related to the home and family life – child or spousal abuse, for example.

DA can have adverse effects on a career. The individual will likely be able to recall basic knowledge, routines and rules, but other important information may be lost, such as remembering important contacts.

Families, friends and professional peers can play an important role in the recovery of lost memories. Recall can be aided by cues and storytelling. However, these techniques should be applied with the guidance of a therapist to ensure negative associations do not cause further disassociation. The relief of stress can release negative emotions and help memories resurface. Relaxation techniques can easily be employed in daily life. Individuals with dissociative amnesia practicing mindfulness-based therapy (MBT), a practice easy to follow at home, have produced improvements in memory.

Dissociative Amnesia Therapy

Minimal evidence-based research exists to support the successful treatment of memory disorders, including for pharmacotherapy. An objective of dissociative disorder (DD) treatment is to reintegrate the dissociated selves. DA sometimes spontaneously resolves, and may do so in days or months, or it could take years. Generally, the disorder is difficult to treat. Typical DD treatment involves three phases: trauma exposure, trauma experience processing and personality integration (Brand, B. and Loewenstein R, 2010) A review of 16 DD studies has shown that treatment can reduce symptoms, including depression, suicidality and post-traumatic stress disorder.Reducing the underlying symptoms helps to ease the stress associated with the repressed memories.

In DA, memory recall must also be addressed. A multicomponent treatment may be pursued. The main treatment approaches involve psychotherapy, including dream analysis, to retrieve the hidden memories, and memory training. The use of computer aids and visual imagery is increasing the effectiveness of memory training. Since DA is often triggered by trauma some form of PTSD therapy may be incorporated. One survey of treatment approaches found cognitive-based therapies to be the most effective at reducing symptoms and improving memory recall.(Markowitsch, H. J., and Staniloiu, A.2012)

Hypnotism is an increasingly explored treatment but also a controversial one. Many recovered memories of childhood sexual abuse have proven to be false. Hypnosis, as well as other meditative techniques, can help to relax the patient thereby relieving stress and making memories more accessible. A similar result may be achieved through interviewing under sedation, possibly using cues to guide the patient (Sau Kuen Kwan, P.,2009).

The media and mental health field are fascinated by cases of dissociative fugue, a rare condition that is no longer classified as a disorder but a subtype of DA under DSM-V. The media exposure typically ends when the person is identified and we do not hear about their recovery process. These individuals who may have experienced a splitting of their personality following a trauma or accident often slowly or spontaneously recover their memory once reintegrated back into their regular environment.

References

Staniloiu, A., & Markowitsch, H. J. (2010). Searching for the anatomy of dissociative amnesia. Zeitschrift für Psychologie/Journal of Psychology, 218(2), 96-108.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

Brand, B., & Loewenstein, R. J. (2010). Dissociative disorders: An overview of assessment, phenomenology, and treatment. Psychiatric Times, 27(10), 62-69.

Brand, B. L., Classen, C. C., McNary, S. W., & Zaveri, P. (2009). A review of dissociative disorders treatment studies. The Journal of nervous and mental disease, 197(9), 646-654.

Markowitsch, H. J., & Staniloiu, A. (2012). Amnesic disorders. The Lancet, 380(9851), 1429-1440.

Sau Kuen Kwan, P. (2009). PHASE-ORIENTATED HYPNOTHERAPY FOR COMPLEX PTSD IN BATTERED WOMEN: AN OVERVIEW AND CASE STUDIES FROM HONGKONG. Australian Journal of Clinical & Experimental Hypnosis, 37(1).


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