health of the nervous system

Dissociative Amnesia

Generality

Dissociative amnesia is a disorder characterized by a loss of retrospective memory, linked to disturbing events from a physical and emotional point of view. This manifestation represents a defense mechanism implemented in an unconscious way to protect one's mental balance.

Among the triggering events can be traumatic or highly stressful experiences directly suffered or witnessed (sexual abuse, murders, natural disasters, abandonment, financial problems, etc.) and serious internal conflicts (eg guilt for having committed criminal acts ).

In practice, dissociative amnesia is a reaction that allows the "disconnection" of some elements (ie the negative experiences experienced) by mental processes (which are usually integrated), avoiding conscious mnemonic recovery. Thus, although forgotten information may be inaccessible to consciousness, memory or perception, they continue to influence behavior, causing flashbacks and "unexplained" states of physiological hyperactivation.

Dissociative amnesia is not due to normal forgetfulness.

The diagnosis is based on anamnesis and is formulated after excluding other causes of amnesia (head trauma, neurological disorders, etc.).

The treatment is represented by psychotherapy, sometimes in association with hypnosis or some drugs that facilitate interaction with the patient and stimulate him to face the problem.

What's this

Dissociative amnesia is the inability to remember important autobiographical information, often associated with traumatic or highly stressful events.

Memory loss can involve selected memories or entire periods of a person's life. Less often, the patient can present a continuous amnesia, which prevents him from remembering events that follow one another from a certain moment onwards. In any case, this memory loss is too wide to be explained as a normal forgetfulness.

Dissociative amnesia is common among both men and women. "Dissociation" occurs when a set of mental processes separates from the others in action, with which they are normally integrated. The affective contents of these experiences are acted out or emerge, however, at the level of consciousness, procuring "inexplicable" states of physiological hyperactivation and intrusive images (flashbacks) . Thus it may happen that we do not remember the episode unleashed, but that we become agitated if we approach the place where the trauma was suffered, because some visual or olfactory perceptions associated with the previously lived experience are activated.

Causes

The most frequent cause of dissociative amnesia is emotional trauma . In fact, the disorder can be interpreted as a complex defense reaction, implemented by the person's psyche, to protect his mental balance. This mechanism can be induced by experiences lived in first person or of which one has been witnesses, which have turned out to be highly stressful and shocking.

Triggering events can be represented by:

  • Physical or sexual abuse;
  • Rape;
  • Aggression;
  • Migration experiences;
  • War situations;
  • Abandonment during a natural disaster;
  • Death of a person to whom one was very fond;
  • Financial problems.

Furthermore, dissociative amnesia can result from significant internal conflicts, as in the case of:

  • Impulses moved by guilt;
  • Apparently unsolvable interpersonal difficulties;
  • Sense of horror for committing criminal acts.

Dissociative amnesia can be part of a more relevant and structured psychopathological framework (eg avoidant or borderline personality disorder).

Note

Dissociative amnesia is probably under-diagnosed. Although the prevalence of the disorder has not been well established, it appears that 2–6% of the general population is affected.

Dissociative amnesia can occur in any age group, but seems more common among young adults.

Symptoms and complications

Dissociative amnesia is frequently a sudden onset and episodes of the disorder have a self-limiting course.

The main symptom of dissociative amnesia is memory loss . Normally, lost memories belong to the subject's consciousness or "autobiographical memory" (who he was, in what places he was, what he did, with whom he spoke, etc.).

Characteristically, people who experience dissociative amnesia forget part of the events that occurred in a certain period of time (one or more episodes) or do not remember entire periods of life. In other words, these memory gaps can be relative to a few hours or even several years. Usually, however, the forgotten period of time is clearly delimited.

Immediately after the onset of dissociative amnesia, people may appear very confused . Some experience a sense of anguish, while others are indifferent to this manifestation. When dissociative amnesia is related to events of a remote past, then, people might not even be aware of it, only to realize the time lost from their memory when they find evidence of having done things they don't remember or when they are forced to take note of it.

In any case, the disorder is responsible for a very strong discomfort in the person, when he becomes aware of not remembering the episodes of his life.

Dissociative amnesia can affect interpersonal relationships due to memory loss and sometimes a dissociative flight can occur: the person suffering from memory failures may feel disoriented and suddenly run away from home. Often, this occurrence occurs as a result of severe stress (eg, major marital conflicts or problems at the workplace) and, although rare, the subject may come to assume a new identity.

Alarm signals

With the exception of memory loss, there is no real symptomatology associated with dissociative amnesia. However, pathological stress can be one of the first alarm bells of the disorder, and can be recognized through specific manifestations, such as:

  • Progressive difficulty of concentration and memory;
  • Disturbed sleep;
  • Irritability compared to changes;
  • Tendency to do things "automatically", without thinking about it.

Diagnosis

The diagnosis of dissociative amnesia is based on clinical and psychiatric evaluation.

According to the Diagnostic and Statistical Manual of Mental Disorders (DSM), this manifestation belongs to the category of dissociative disorders . The characteristic that unites these problems is the "disconnection" of consciousness, memory, identity and perception of the environment; as a rule, these functions are integrated with each other.

In addition to dissociative amnesia, this group of problems also includes:

  • Depersonalization disorder;
  • Dissociative escape;
  • Dissociative identity disorder (or multiple personality);
  • Dissociative disorder not otherwise specified.

The central manifestation of dissociative amnesia is memory loss, frequently with sudden onset. The mnemonic gaps concern personal experiences and events, usually, physically and emotionally traumatizing.

Dissociative amnesia is frequently observed in hospital emergency rooms, where people found to be wandering in an apparently confusing state are easily conducted.

Unlike the dissociative identity disorder, the fundamental traits of character and the usual modalities of social behavior are generally preserved.

The dissociative amnesia must be differentiated, moreover, from the pictures of head trauma or from epileptic or vascular neurological disorders. Other pathological conditions that must be excluded are the transient global amnesia syndrome, Ganser syndrome (or simulated amnesia) and the intake of psychotropic substances.

Therefore, the evaluation of dissociative amnesia must include:

  • Electroencephalography (EEG) to rule out an epileptic disorder;
  • Magnetic resonance to assess the presence of possible structural causes;
  • Blood and urine tests to exclude intoxication, such as the use of illicit substances.

Psychological tests can be useful to better understand the nature of the dissociative experience.

Therapy

The treatment of dissociative amnesia is based on psychotherapy ; the purpose of this intervention is to recover the lost memory, improving awareness and favoring the overcoming of the patient's unconscious conflict problems.

If the disorder is related to a single very brief episode, supportive treatment is generally sufficient, especially if patients do not have an obvious need to recover the memory of some painful event. When memory loss is more serious, psychotherapy begins with the creation of a supportive, safe and favorable environment. This approach often leads to a gradual recovery of lost memories and is sufficient to resolve amnesia.

If the treatment is not effective or the person needs to recover the memory urgently, the patient's hypnosis can be effective. Alternatively, to collect lost memories, the hypnotic state can be drug-induced (by administration of barbiturates or benzodiazepines). In both cases, these techniques must be practiced with delicacy, as recalling the traumatic events that have favored memory loss can be shocking.

The specialist who interrogates the patient must ask questions carefully, so as not to suggest the existence of an event and risk creating a false memory. The reliability of the medical history recovered with these strategies can only be determined through external confirmations.

Regardless of the degree of historical accuracy, filling in the gaps as much as possible is often therapeutically useful to restore continuity to identity and sense of self.

To address issues related to recovered memories, psychotherapy can help to give meaning to the underlying conflict or trauma. The intervention also allows to address the problems associated with the medical history, allowing patients to go on with their lives.

Along with this rehabilitation process, the use of pharmacological therapy to reduce anxiety-depressive symptoms, irritability, impulsiveness and insomnia can be indicated, with the aim of achieving emotional stabilization.

The most used are:

  • SSRI antidepressants (selective serotonin reuptake inhibitors) : often used to treat depressive symptoms and / or manifestations of post-traumatic stress disorder;
  • Anxiolytics : used primarily as a short-term approach to treating anxiety;
  • Neuroleptics or antipsychotic drugs : used to successfully manage chronic anxiety, hyperactivation and disorganization of thought.

Prognosis

Generally, episodes of dissociative amnesia have a short and self-limited course. Most patients recover their memories and amnesia is resolved, especially if appropriate care measures are in place. However, some people are never able to reconstruct lived events.

Prognosis is mainly determined by the patient's life circumstances, in particular by the events and conflicts associated with dissociative amnesia, and its overall mental adaptation.