Edit concept Question Editor Create issue ticket

Dissociative Amnesia

Dissociative amnesia is a condition in which retrograde memory loss occurs, usually involving a specific period of time. Emotional trauma is thought to be the primary cause, whereas numerous other factors have been implicated in its pathogenesis. The diagnosis is confirmed once all other potential causes of memory loss (drugs, organic diseases) have been excluded. Psychotherapy is the main therapeutic modality.


Presentation

The clinical presentation of patients with dissociative amnesia can significantly vary. Mental status may be completely normal, but confusion and the presence of other dissociative disorders, such as personality changes, are not uncommon [5]. In terms of memory loss, pure retrograde amnesia is identified in most cases and primarily involves episodic-autobiographic memories [3]. Some individuals may not be aware of memory loss, while rare cases have described loss of both semantic and functional memories that can impair normal daily activities [1], which should be recognized by the physician either during patient history or physical examination.

Turkish
  • Turkish Journal of Psychiatry, 15 (2), 161-165. (Ankara Numune Eğitim ve Araştirma Hastanesi 2. Psikiyatri Kl., Ankara.) Abstract : Incest is a kind of sexual abuse that causes serious disorders during childhood and adulthood.[blogs.brown.edu]
Prostitute
  • The main risk factors for dissociative amnesia in the general population are drug abuse, alcoholism, female gender, a career in prostitution or being an exotic dancer.[lecturio.com]
Choking
  • Symptoms of a panic attack include shortness of breath/hyperventilation, racing heart, a choking feeling, sweating, hot/cold flashes, and a fear of dying or losing control or going crazy. [26] When ruling out a panic disorder, one must ask what immediately[wikihow.com]
Left Ventricular Dysfunction
  • Transient left ventricular apical ballooning syndrome (TLVABS), also known as takotsubo cardiomyopathy, is characterized by transient left ventricular dysfunction, electrocardiographic changes, and release of myocardial enzymes that mimic acute myocardial[ncbi.nlm.nih.gov]
Ganser Syndrome
  • We report a single case of "chameleon" syndrome that challenges the current international criteria for somatoform disorders, dissociative amnesia, and Ganser syndrome.[ncbi.nlm.nih.gov]
  • ., "2 plus 2 equals 5") as in Ganser syndrome.[psychone.net]
  • ., “2 plus 2 equals 5”) as in Ganser syndrome.[recurrentdepression.com]
  • An example of DDNOS is Ganser syndrome. This entity occurs primarily in men (80%) and is currently regarded as a dissociative means of withdrawal from a traumatic or stressful circumstance.[emedicine.medscape.com]
  • Other forms of DDNOS include possession and trance states, Ganser's syndrome, derealization unaccompanied by depersonalization, dissociated states in people who have undergone intense coercive persuasion (e.g., brainwashing, kidnapping), and loss of consciousness[strangerinthemirror.com]
Panic Attacks
  • It may be related to panic attacks or anxiety. For more information about panic attacks, check out How to Recognize Panic Disorder.[wikihow.com]
  • […] by Mrsderby0624 » Fri Mar 06, 2015 8:16 am 9 Replies 2045 Views Last post by brockovich4321 Tue Apr 19, 2016 11:14 am Panic attack led to amnesia by DianaL60 » Mon Feb 29, 2016 7:15 pm 1 Replies 1861 Views Last post by DianaL60 Tue Mar 01, 2016 5:56 pm[psychforums.com]
  • Medication There's no specific medication to treat dissociation, but medication, such as antidepressants , may be prescribed to treat associated conditions like depression, anxiety and panic attacks.[nhs.uk]
  • People with Dissociative Disorders may also experience depression, mood lability, suicidal thoughts or attempts, sleep disorders (insomnia, night terrors, and sleep walking), or panic attacks and phobias (flashbacks, reactions to reminders of the trauma[pchtreatment.com]
  • People with undetected dissociative disorders often experience generalized anxiety, panic attacks, obsessive compulsive symptoms. Treating only their anxiety will not help their dissociative symptoms.[strangerinthemirror.com]
Self-Mutilation
  • Other problems that sometimes accompany this disorder include sexual dysfunction, impairment in work and interpersonal relationships, self-mutilation, aggressive impulses, and suicidal impulses and acts.[psychone.net]
  • Some individuals may have amnesia for episodes of self-mutilation, violent outbursts, or suicide attempts. Less commonly, Dissociative Amnesia presents as a florid episode with sudden onset.[recurrentdepression.com]
  • Some patients diagnosed with dissociative amnesia have problems or behaviors that include disturbed interpersonal relationships*, sexual dysfunction*, employment problems, aggressive behaviors, self-mutilation*, or suicide attempts*. (* symptoms I exhibit[thekellies.wordpress.com]
  • The gaps are usually related to episodes or abuse or equally severe trauma, although some persons with dissociative amnesia also lose recall of their own suicide attempts, episodes of self-mutilation, or violent behavior.[minddisorders.com]
Self Mutilation
  • Other problems that sometimes accompany this disorder include sexual dysfunction, impairment in work and interpersonal relationships, self-mutilation, aggressive impulses, and suicidal impulses and acts.[psychone.net]
  • Some individuals may have amnesia for episodes of self-mutilation, violent outbursts, or suicide attempts. Less commonly, Dissociative Amnesia presents as a florid episode with sudden onset.[recurrentdepression.com]
  • Some patients diagnosed with dissociative amnesia have problems or behaviors that include disturbed interpersonal relationships*, sexual dysfunction*, employment problems, aggressive behaviors, self-mutilation*, or suicide attempts*. (* symptoms I exhibit[thekellies.wordpress.com]
  • The gaps are usually related to episodes or abuse or equally severe trauma, although some persons with dissociative amnesia also lose recall of their own suicide attempts, episodes of self-mutilation, or violent behavior.[minddisorders.com]
Delusion
  • BACKGROUND: Natural human psychological phenomena, such as depression, anxiety, delusions, hallucinations and dementia, are documented across the ages in both fictional and non-fictional works.[ncbi.nlm.nih.gov]
  • Some of the indications for inpatient assessment or hospitalization include severe depression over a long period, anxiety and delusion disorders that lead to compulsive acting out of behaviors, cognitive reactions (eg, nightmares, flashbacks), physical[emedicine.medscape.com]
Amnesia
  • We asked whether 'dissociative amnesia' was similarly documented throughout history.[ncbi.nlm.nih.gov]
  • Additionally, a subtype of dissociative amnesia, known as dissociative fugue, is a term that describes intentional avoidance from harmful stimuli and further indicates that amnesia is most likely a protective response.[symptoma.com]
Confabulation
  • Confabulation does not occur in all amnesias, and it is often present only in the acute stage.[jaapl.org]
  • In the realm of other psychiatric disorders, amnesia occurs often in patients with moderate-to-severe depression. 2 However, amnesia associated with depression is characterized by “I don’t know” rather than near misses or confabulations, and it is less[consultant360.com]
  • The ability to remember past events and previously familiar information is impaired in retrograde amnesia False memories may be either completely invented or consist of real memories misplaced in time, in a phenomenon known as confabulation.[medicalnewstoday.com]
Temporary Amnesia
  • The etiology of temporary amnesia. American Journal of Psychiatry , 91, 10791088. Google Scholar Lewis, D. O., and Bard, J. S. (1991). Multiple personality and forensic issues. Psychiatric Clinics of North America , 14 ,741–756.[link.springer.com]
Slurred Speech
  • No muscular activity was witnessed during these episodes, and upon regaining consciousness the patient had slurred speech, disorientation, dissociative amnesia, and bizarre behavior that resolved spontaneously.[ncbi.nlm.nih.gov]

Workup

Patient history is the single most important part of the diagnostic workup, since a careful and gentle approach to the patient may reveal key information regarding memory loss and its onset. It is important to establish the absence of anterograde amnesia, which is rarely present in patients with dissociative amnesia [3]. Before making the diagnosis, other organic conditions that present with similar complaints need to be excluded. Prior physical trauma to the temporal lobe or the hippocampus, seizures and drug abuse should be included in the differential diagnosis. Blood and urine toxicology tests should be done, together with imaging studies including CT or MRI to exclude trauma. EEG is necessary to perform in order to rule out seizures [11]. Studies have confirmed that functional brain imaging such as PET scanning shows reduced glucose uptake in various regions, such as the inferolateral prefrontal cortex, which is known to be the site where retrieval of autobiographical memories occurs [4].

Treatment

Depending on the severity of memory loss, various therapeutic measures should be implemented. Ensuring a safe, supportive and pleasant environment for patients who experience severe emotional trauma is the first step in treatment and is often sufficient for milder cases [5]. Drug-induced hypnosis using benzodiazepines or barbiturates have shown to be effective in a subset of patients [5], but psychotherapy is considered to be the mainstay of managing both mild and severe forms of amnesia [7]. Cognitive behavioral therapy (CBT) and acceptance and commitment therapy (ACT) have shown to be successful. Sedative-anxiolytic treatment and relaxation training are also considered as options [7]. Regardless of the approach, it is very important for physicians to be very patient and careful when dealing with individuals who experienced significant emotional trauma that resulted in memory loss, since an abrupt and often severe reaction may be seen with reintroduction of those memories.

Prognosis

The prognosis significantly varies from patient to patient. Memory loss may include a span of several days to years and the success of therapy primarily determines the outcome. Fortunately, many patient recover fully from memory loss and are able to cope with trauma they experience with the aid of therapists, but some, on the other hand, may never recover [5]. It is important to emphasize that the risk of suicide is increased and underestimated in these patients [10], which is why it is important to obtain a diagnosis as soon as possible and initiate appropriate treatment.

Etiology

Significant stress and psychological trauma are thought to be responsible for the onset of dissociative amnesia [2]. In the vast majority of patients, a profoundly stressful event (death of a loved one, or physical abuse) precipitates the onset of memory loss. Current theories suggest overt activity of glucocorticoids in the amygdala and the hippocampus, resulting in suppression of neural activity [4]. Amnesia is, by some authors, considered as a defense mechanism against the traumatic event and that repression or dissociation serves to protect against these harmful stimuli. Although genetic factors and individual baseline cortisol levels have been considered as important etiological factors as well [2] [3], their clear association remains the be determined.

Epidemiology

Exact prevalence and incidence rates of dissociative amnesia are unknown, but crude rates suggest that between 2-6% of the population suffered from this condition [5]. It is most frequently diagnosed in young adults, implying that younger age is a significant risk factors, as are history of previous emotional trauma (including its severity, repetitiveness and longer duration), injury to the hippocampus and the temporal lobe, but also elevated baseline levels of cortisol [2]. Personality features, presence of either psychiatric or non-psychiatric comorbidities and the environment in which the individual resides have also shown to be important determinants [2].

Sex distribution
Age distribution

Pathophysiology

In the setting of extensive emotional trauma, dissociative amnesia is considered as a mechanism of protection [6] and various biological events have been described. Additionally, a subtype of dissociative amnesia, known as dissociative fugue, is a term that describes intentional avoidance from harmful stimuli and further indicates that amnesia is most likely a protective response [8] [9]. Namely, excess levels of glucocorticoids, the main stress hormones, have been identified in this subset of patients and their activity on the central nervous system and structures responsible for learning and memory have been well-documented. The amygdala and the hippocampus, the two most important structures that mediate arousal and memory, respectively, possess a very large number of glucocorticoid receptors [3]. This abundant secretion of corticosteroids impairs normal activity of these structures and induces hippocampal atrophy, as well as defects in neural activity [2]. Despite these discoveries, many elements in the pathogenesis remain to be confirmed.

Prevention

Despite the fact that the presumable cause is more-or-less established, not all individuals respond equally to stress caused by unpredictable situations, which is why little can be done in terms of prevention. Child abuse has shown to be one of the most important events that trigger dissociative disorders and its prevention may lead to reduced rates of dissociative amnesia in the population.

Summary

The term dissociative (also known as psychogenic) amnesia denotes a retrograde blockade of memories that occurs in the setting of emotional trauma without evidence of organic disorders that may have triggered this event [1]. In the vast majority of cases, inability to recall episodic-autobiographical memory is the main clinical symptom, but various studies have identified impairment of both semantic and procedural memories [2], which may have an effect on daily activities. Severe stressful and psychotraumatic events presumably influence the activity of the amygdala and hippocampus, as well as the frontal lobe and levels of corticosteroids [3]. It is thought that abundant amounts of glucocorticoids are secreted in the setting of psychological stress, causing detrimental effects on the hippocampus, one of the main structures responsible for memory [4]. Because dissociative amnesia is most frequently diagnosed in young adults [5], brain development has also been implicated as an important pathogenic factor [3]. In order to make the diagnosis, it is imperative to obtain heteroanamnestic data (from both the patient and his/her family or friends) and identify traumatic events that may have triggered memory loss. In virtually all patients, only retrograde amnesia is evident, whereas anterograde amnesia is absent [6]. Memory loss may include a time span of several hours of it may involve an extensive period of time, up to a few years [6]. Other forms of dissociation may be included in the clinical presentation, such as personality disorder, which further emphasizes the importance of the patient interview. The diagnostic workup should exclude conditions that may have similar symptoms, such as physical trauma or drug abuse, which is why both imaging studies and a toxicology panel (if high clinical suspicion is present) should be conducted. Computed tomography (CT) and magnetic resonance imaging (MRI) are sufficient imaging studies to exclude trauma, while electroencephalography (EEG) should be done to rule out seizures [5]. Functional activity of the brain can be evaluated through positron emission tomography (PET), with some studies showing decreased glucose utilization in the prefrontal cortex of patients who suffered from memory loss [4]. Psychotherapy is the most important therapeutic measure and has shown marked success in retrieval of memories and dealing with psychological stress that was induced by these events [7]. With successful therapy, many patients are able to fully recover, but a small number of individuals may never be able to restore their memory [5].

Patient Information

Dissociative amnesia is a condition in which severely stressful events (such as sexual abuse or death of a family member or friend) trigger a defensive mechanism that results in blockade of memories regarding that particular event. Although the exact reason why this happens is not completely clear, it is known that very high concentrations of stress hormones, such as cortisol, induce detrimental changes to the hippocampus, the part of the brain that is responsible for memory. Various contributing factors have been proposed, including genetic, environmental and prior physical trauma to the head. Because of the fact that dissociative amnesia is most commonly diagnosed in younger adults, age and appropriate brain maturation are termed to be one of the most important precipitating factors, together with baseline levels of cortisol. All of these components are through to be the reason why some individuals develop this condition, while some do not. Patients may present with variable mental state changes, ranging from normal to severely confused and it is not uncommon for other dissociative disorders, such as personality disorder, to be present. It may not be easy to obtain a diagnosis, which is why physicians should try to obtain information regarding previous trauma as patient and as careful as possible. Before making a definite diagnosis, drug abuse, physical trauma and epilepsy as potential causes should be excluded. Blood and urine toxicology tests, imaging studies such as computed tomography (CT scan) or magnetic resonance imaging (MRI) are done to rule out drug abuse and trauma, respectively, whereas electroencephalography (EEG) is done to rule out seizures. Ensuring a safe and pleasant environment for the patient is the first step in management, while further strategies include use of sedatives and anxiolytic drugs for hypnosis and psychotherapy, which has shown to be effective in both recovering memories and coping with emotional distress. The prognosis is generally good with appropriate treatment, as majority of individuals recover from dissociative amnesia, but a careful clinical approach is necessary in order to identify the exact type of amnesia and ensure proper therapy.

References

Article

  1. van der Hart O, Nijenhuis E. Generalized dissociative amnesia: episodic, semantic and procedural memories lost and found. Aust N Z J Psychiatry. 2001;35(5):589-600.
  2. Staniloiu A, Markowitsch HJ. The Remains of the Day in Dissociative Amnesia. Brain Sciences. 2012;2(2):101-129.
  3. Joseph R. The neurology of traumatic “dissociative” amnesia: commentary and literature review. Child Abuse Negl. 1999;23:715–727.
  4. Brand M, Eggers C, Reinhold N, Fujiwara E, Kessler J, Heiss WD, et al. Functional brain imaging in 14 patients with dissociative amnesia reveals right inferolateral prefrontal hypometabolism. Psychiatry Res. 2009;174(1):32-39.
  5. Porter RS, Kaplan JL. Merck Manual of Diagnosis and Therapy. 19th Edition. Merck Sharp & Dohme Corp. Whitehouse Station, N.J; 2011.
  6. Brandt J, Van Gorp WG. Functional ("psychogenic") amnesia. Semin Neurol. 2006;26(3):331-340.
  7. Cassel A, Humphreys K. Psychological therapy for psychogenic amnesia: Successful treatment in a single case study. Neuropsychol Rehabil. 2016;26(3):374-391.
  8. Sharma P, Guirguis M, Nelson J, McMahon T. A Case of Dissociative Amnesia With Dissociative Fugue and Treatment With Psychotherapy. The Primary Care Companion for CNS Disorders. 2015;17(3):10.4088/PCC.14l01763.
  9. Reinhold N, Markowitsch HJ. Retrograde episodic memory and emotion: a perspective from patients with dissociative amnesia. Neuropsychologia. 2009;47(11):2197-2206.
  10. Staniloiu A. Dissociative amnesia. Lancet Psych. 2014;1(3):226-241.
  11. Lips W, Mascayano F, Lanfranco R. Diagnostic indicators of dissociative amnesia: a case report .Psychiatr Danub. 2014;26(1):70-73.

Ask Question

5000 Characters left Format the text using: # Heading, **bold**, _italic_. HTML code is not allowed.
By publishing this question you agree to the TOS and Privacy policy.
• Use a precise title for your question.
• Ask a specific question and provide age, sex, symptoms, type and duration of treatment.
• Respect your own and other people's privacy, never post full names or contact information.
• Inappropriate questions will be deleted.
• In urgent cases contact a physician, visit a hospital or call an emergency service!
Last updated: 2019-07-11 21:04