145 Dissociative Amnesia (formerly Psychogenic Amnesia) (300.12)

DSM-IV-TR criteria

• The predominant disturbance is one or more episodes of inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness.
• The disturbance does not occur exclusively during the course of Dissociative Identity Disorder, Dissociative Fugue, Post traumatic Disorder, Acute stress Disorder, or Somatization Disorder and is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a neurological or other general medical condition (e.g., Amnestic Disorder Due to Head Trauma).
• The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Diagnostic Features

The essential feature of Dissociative Amnesia is an inability to recall important personal information. Dissociative Amnesia most commonly presents as a retrospectively reported gap or series of gaps in recall for aspects of the individual’s life history. This acute form is more likely to occur during wartime or in response to a natural disaster or other form of severe trauma.

Localized amnesia

• The individual fails to recall events that occurred during a circumscribed period of time, usually the first few hours after the event (e.g., the uninjured survivor of a car accident in which a person has been killed may not be able to recall anything that happen from the time of the accident until two days later).

Selective Amnesia

• The person can recall some, but not all, of the events during a circumscribed period of time (e.g., a combat veteran can recall only parts of a series of violent combat experiences).

Generalized Amnesia

• The person has a failure of recall encompasses the person’s entire life.

Continuous Amnesia

• It is defined as the inability to recall events subsequent to a specific time up to and including the present.

Systematized Amnesia

• The person’s loss of memory for certain categories of information, such as all memories relating to one’s family or to a particle person.

Individuals who exhibit these latter three types of Dissociative Amnesia may ultimately be diagnosed as having a more complex form of Dissociative Disorder (e.g., Dissociative Identity Disorder).

Associated Features

Some individuals may report depressive symptoms, anxiety, depersonalization, trance states, analgesia, and spontaneous age regression. Other problems that have been reported include sexual dysfunction, impairment in work and interpersonal relationships, self-mutilation, aggressive impulses, and suicidal impulses and acts. Individuals with Dissociative Amnesia may also meet the criteria for Conversion Disorder, a Mood Disorder, a Substance-Related Disorder, or Personality Disorder. Associated laboratory findings.Individuals with Dissociative Amnesia often display high hypnotizability as measured by standardized testing.

Child vs. Adult Presentation

This disorder is especially difficult to assess in preadolescent children, because it may be confused with inattention, other childhood disorders, or learning disorder. Outside observation or evaluations by several different examiners may be used to make an accurate diagnosis.

Epidemiology

In the last twenty years there has been an increase in reported case that involves previously forgotten early-childhood traumas. It has been debated if this is due to the growing awareness of this disorder, or the over diagnosed in Individuals who are highly suggestible.

Etiology

Has been linked to overwhelming stress, which could be due to a traumatic event (war, abuse, or disasters). There may also be a genetic link to Dissociative Amnesia. *Note: Many people with this disorder tend to have close relatives with similar conditions.

Empirically supported treatments

• Psychotherapy, for mental and emotional disorders uses psychological techniques designed to encourage communication of conflicts and increase insight into problems.
• Cognitive therapy, focusing on changing dysfunctional thinking patterns and the resulting feelings and behaviors.
• Pharmacotherapy, there is no medication to treat the dissociative disorders themselves; however, a person with a dissociative disorder who also suffers from depression or anxiety might benefit from treatment with a medication such as an antidepressant or anti-anxiety medicine.

PROPOSED DSM-5 CHANGES (DSM5.org)

Dissociative Amnesia

A. Inability to recall important personal information, usually of a traumatic or stressful nature, that is inconsistent with ordinary forgetting. Note: There are two primary forms of Dissociative Amnesia: (1) localized amnesia for a specific event or events, and (2) Dissociative Fugue: generalized amnesia for identity and life history. Fugue may be accompanied by either purposeful travel or bewildered wandering.
B. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.
C. The memory loss is not due to the direct physiological effects of a substance (e.g., a drug of abuse, a medication) or a neurological or other general medical condition (e.g., Amnestic Disorder Due to Head Trauma).
D. The memory loss is not restricted to the symptoms of another mental disorder (e.g., inability to remember an important aspect of the traumatic event in Posttraumatic Stress Disorder or Acute Stress Disorder, or amnesia occurring as a symptom of Dissociative Identity Disorder or Somatization Disorder).

Specify if:

Dissociative Fugue subtype:
1. Amnesia includes inability to recall one’s past, confusion about personal identity, or assumption of a new identity (partial or complete)
2. Sudden, unexpected travel away from home or work.

Rationale:

Minor wording changes for clarity.
B and C switched.

Changes to new C allow comorbid diagnoses to be made when warranted.

Severity:

Brief Dissociation Scale (Carlson E & Dahlenberg C, 2009)