Dissociative amnesia: causes, symptoms, diagnosis, treatment

Dissociative amnesia is the inability to remember important personal information, and the inability is so severe that it cannot be explained by ordinary forgetfulness. The cause is usually trauma or severe stress. Diagnosis is based on the history after other possible causes have been ruled out. Treatment consists of psychotherapy, sometimes combined with hypnosis or medications that facilitate interviews.

The lost information is usually part of the conscious, which can be described as autobiographical memory, i.e. who he is, what he did, where he went, who he talked to, what he said, thought, felt. The forgotten information sometimes affects behavior.

The prevalence of dissociative amnesia is unknown, but it is most common in young adults. Amnesia occurs as a result of a traumatic or stressful event that the person participated in or witnessed (e.g., physical or sexual abuse, combat, deprivation during a natural disaster, death of a loved one, financial problems) or an intolerable internal conflict (e.g., severe guilt, apparently unresolved internal problems, criminal behavior).

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Symptoms of dissociative amnesia

The main symptom is memory loss. Typically, there are one or more episodes in which some patients forget some of the events that occurred during this period of time, but not all; other patients cannot remember anything. These periods, or lapses in memory, may last for several hours or for several years, even for a lifetime. Usually, the period of time forgotten is clearly defined. If the patient is observed soon after the onset of amnesia, he or she may appear confused and depressed. Some patients experience marked anxiety, while others are indifferent.

A medical and psychiatric evaluation is necessary to establish an accurate diagnosis, including blood and urine tests to rule out toxic causes of the condition, such as substance abuse. An EEG examination helps to rule out epilepsy. Psychological testing can help to describe the origin of dissociative experiences.

Prognosis and treatment of dissociative amnesia

Most patients recover and regain their memory. However, some patients remain unable to recall forgotten events. The prognosis is primarily determined by the patient's life circumstances, especially stress and conflict associated with amnesia, and the person's overall mental fitness.

If the memory loss is short-term, supportive intervention is the only treatment option available, especially if full memory recovery for any painful events is not clearly necessary. Treatment for more severe memory loss begins with creating a safe and supportive environment. Sometimes these measures are sufficient to gradually restore the lost memory. If this does not happen or immediate memory recovery is necessary, interviewing the patient under hypnosis or, less commonly, under a drug-induced hypnosis-like state (methohexital) is effective. These approaches are used very carefully, since memories of the circumstances that led to the memory loss, which can be very distressing, are also being restored. The interviewer must formulate questions carefully so as not to suggest the existence of any event and to avoid the risk of forming false memories. The correctness of memory recovery with such strategies can only be determined by external confirmation. On the other hand, regardless of the sequence of the narrative, delving into the memory gap is also likely to be helpful in restoring continuity in the patient's identity, self-awareness, and creating a coherent narrative. Once the amnesia has been resolved, treatment helps to assess the underlying conflict or trauma in order to resolve issues related to the amnestic episode.