Types of Dissociative Amnesia Disorder, Possible Misdiagnosis and Treatment

Dissociative Amnesia Disorder began to take part in psychotraumatology literature at 19. century and become a popular issue at 20. century with wars. Then firstly, it took place in DSM-III with other dissociative disorders. It is the most common disorder between dissociative disorders.

This disorder also known as 'Psychogenic amnesia' and it is a mental disorder that includes inability to recall personal information which usually occurs as a response to a traumatic or stressful event. Patients experience distruption of self. (Anterion, 2017). The personal informationwhich is forgatten by the patient should be: 1) stored clearly in memory system and 2) normally would be remembered.

The condition of diffuculty in recalling information causes impairements in social, occupational or other important areas. These impairements can not be explained by neurological, physiological effects of a substance or medical condition. People with dissociative amnesia usually do not realize that they have memory problems.

According to Freudian psychology, The dissociative amnesia is a self-defense way which includes blocking unpleasant, unwanted memories. These memories enters the consciousness but the brain protects itself and these memories stay in unconscious.

Dissociative amnesia disorder takes place in dissociative disorders which usually occurs as a survival mechanism to a traumatic or stressful experiences. These disorders affect an individual’s functionability within a range changing mild to severe. The impairements can be about personal identity, experiences/memories, awareness. Dissociative Identity Disorder and Depersonalization / Derealization Disorder other mental disorders in this category.

According to some clinical reports, patients with dissociative amnesia can experince dissociative flashbacks about their traumatic experince. Traumatic experiences, childhood abuse, victimatizations are common features for most dissociative amnesia patients. Also genetic factors are closely related with the disorders. Dissociative Amnesia includes five categories. These categories are:

1)Generalized Amnesia: The peak form of the dissociative amnesia is generalized amnesia. It ıncludes inability to recall entire life experencies. It is an uncommon category in people with dissociative amnesia disorder. People with generalized amnesia also can forget their identity or personality even things like well-learned skills, knowledge about world or previous knowledge.

This disorder has an acute onset and people with generalized amnesia can easily appreciable from other people because these individuals have more purposeless movements, confusion about their location or about others. These people may need to help of psychiatric services. People who exposed to extreme stressful events have higher risk then other people like combat veterans, sexual/physical abuse sufferers.

2)Localized Amnesia: The most common form of the dissociative amnesia which an individual can not remember specific period of time. An individual thinks that he/she has no memories about that specific time. This time period can be about minutes(about an traumatic event) or decades(such as forgetting childhood memories). This forgetting condition usually occurs hours or days after a stressful situation and individiuals can experience this forgetting condition more than once in their entire life. Memory loss not seems significant for patient with localized amnesia and when other people give more attention to their memory loss, patients become uncomfortable.

3)Selective Amnesia: An individual with selective amnesia can remember some details about a traumatic event/situation but he/she is not able to recall complete details about it. Selective amnesia and localized amnesia can occur together in some patients. It usually has gradual onset. This type of amnesia rarely awared from the patients.

4) Systematized Amnesia: Patients with systematized amnesia can not able to recall specific part of information such as forgetting a specific person, memories about family, group of people, childhood abuses etc.

5)Continuous Amnesia: Continuous amnesia occurs when an indivudual can not remember every new situation in their entire life.

Dissociative Fugue

In Latin, the word 'fugue' means “escaping”. Patients with dissociative fugue temporarily forgets their names, identities, who they are or where they are and they have tendency to quit their jobs and move another places. These patients are not easily observable from other people. They have many confussions about their identities and it can closely related with stress or trauma. Some drugs or alcohol can cause fugue symptoms but generally its about stressful events such as wars, abuse, disasters etc. Usually episodes includes short periods and resolves easily.

Prevelance

The 12 month prevelance for dissociative amnesia among adults in a small U. S commity study was 1. 8%(1. 0% for males;2. 6% for females. )(DSM V) it affects about 1% of men and 2. 6% of women in the general population. The environment also plays a role; rates of dissociative amnesia tend to increase after natural disasters and during war. (cleveland clinic)

Development and Course:

The onset of the dissociative amnesia may be delayed hours, days months after the traumatic, stressful event and this situation may be related with internal continuty of the traumatic situation for the patient. According to most cliniciants, dissociative amnesia is an defense mechanism of the brain and it is closely related with change in the releasing level of stress hormones.

Dissociative amnesia disorder usually progress with many episodes at patients and some episodes can resolve easily but others can take years. An individual may begin to recall memories years after an traumatic event and this recalling process may be stressful for the patient. This can cause suicidal attempts, ptsd etc.

Dissociative amnesia disorder may diagnose at young children, adolescents and adults but it is diffucult to observe and diagnose it at childrens because of making differantation from inattention, absorption, anxiety, oppositional behavior, and learning disorders. It should be observe carefully and collect information from many types of sources.

Risk and Prognostic Factors

Environmental:Traumatic experiences such as wars, natural disasters, genocide, childhood maltrematments(physical/sexual abuse), violence of the trauma are common features which increases risk for dissociative amnesia.

Genetic and physiological

Genetic factors have an important role on dissociative disorders.

Course modifiers

When the patient be freed of from the stressful situations, dissociative amnesia symptoms may disappear. The recalling process may include flashbacks.

Suicide Risk

The patients with dissociative amnesia have high level of tendency about self-harm or suicide especially when they unexpectedly expose to recovery of amnesia episodes and begin to remember unwanted memories.

Differential Diagnosis

Medical Amnesia

Dissociative amnesia cannot explain with normative forgetfulness or medical amnesia which caused by illnesses, strokes or brain injuries. Medical amnesia generally includes slow and gradual recall process and recovery process is harder than dissociative amnesia. Also in Most cases of dissociative amnesia are relatively short. Usually, when memories come back, they come suddenly and completely. Memory recovery can occur on its own or after being triggered by something around the person or after therapy. Also in medical amnesia people may have more concern about the forgetting the memories.

Dissociative Identity Disorder

In dissociative identity disorder, patients are mainly experince distruption of their identities. The patient has two or more different identities in the self. The identities have different behaviours consciousness, memories, perceptions, cognition, motor functioning from each other. In this disorder, the patients can also experience dissociative amnesia episodes. But this episodes are different from dissociative amnesia disorder. The dissociative amnesias of them appears with three ways:

1)disconnetion in memory which includes personal information such as birth date, childhood etc.

2)gaps in functional memory such as reading driving etc.

3)having awareness about different/unexpected situations such as finding unexpected objects at different places, realizing some injuries in their bodies etc.

Both amnesia and identity disorder may be the way of escaping reality but in the amnesia the patients do it with forgetting the memories and identity disorder patients do it with creating new identities. Patiences not just have amnesias about traumatic events mostly their amnesia includes general experiences and also because of having different identities the patient may have diffuculty to recall personal details about his/her host identity's information.

Posttraumatic Stress Disorder

Patience with posttraumatic stress disorder may experience amnesia episodes. They may be inable to remember major parts of their traumatic experience. But this episodes are completely about an traumatic event. In dissociative amnesia disorder, amnesia episodes do not have to be about a traumatic event, it can be about personal information, specific events or specific people.

Neurocognitive Disorders

In neurocognitive disorders the decrease in mental functioning occurs because of a mental disease such as brain injury caused by a trauma, breathing conditions, cardiovascular disorders, degenerative disorders, dementia, drug-alcohol related disorders, infections. In this disorders the loss of personal information includes, attentional, affective, behavioral, cognitive, linguistic distruptions. But in dissociative amnesia, the condition of forgetting mostly in the autobiographical memory.

Substance-related Disorders

Alcohol, drugs or other medications may cause memory loss on an addicted individual after repeated intoxications. But this memory loss can only explain with the effect of the substance not with an traumatic/stressful event as observed by dissociative amnesia. Also the condition of memory loss occurs only when the intoxication occured. If a dissociative amnesia disorder patient uses addictive substances for preventing amnesia episodes, making distinguish between two disorders may became diffucult.

Posttraumatic Amnesia due to brain injury

This situation occurs when the patient takes an injury to brain skull and it affects the way of behaving or talking way of the patient. The patient shows unexpected/uncharacteristic behaviours. The patient forgets details about him/herself or family, what happened to him/her, the accident or injury. Patiens may feel distress, confusion, anxiety, agression. Also the the existion of the brain injury distinguishing this disorder from dissociative amnesia because in this disorder besides memory loss neurocognitive problems can cause impairements in attention, executive functioning, information processing.

Seizure Disorders

Seizure is an abnormal electrical activity in the brain which can cause many symptoms. Unprovoked seizures has no clear sources which causes seizures but provoked seziures has clear sources such as low blood sugar, alcohol etc. Two main types of seizures are:focal and generalized seizures. The focal seizures includes a small region of the brain and generally affects the consciousness, responsiveness, memory. The generalized seizures includes both sides of the brain and causes loss of muscle tone, staring. blinking, jerking movements, stiffening of limbs. Especially in focal seizures, the patients may experience amnesia during or after the seizure.

Seizures in the temporal or frontal lobes can cause memory loss. If it occurs in the temporal lobe the patient may have diffuculty in recalling words, remembering people's face, finding locations. If it occurs in the frontal lobe, the patients may have diffuculty in remembering future works that she/he has to do. Also after a seizure, the patients may experince post-ictal confusion and diffuculty in remembering what happened to them. Also the patients with epileps disorder, a seizure disorder, ıf the patient have temporal lobe epilepsy, he/she may consistently experince memory loss because of the memory creation process in the temporal lobe. All this memory losses can explain with abnormalities at brain areas and do not associated with traumatic or stressful events in the patient's life. These features provides discrimination between dissociative amnesia and seizure disorder.

Catatonic Stupor

Catatonia is a clinical syndrome which includes motor dysregulation connected with many mental diseases. It includes inability to move normally. Muscular rigidity, stupor, agitation, staring, negativisim, mutism, echolalia, echopraxia, posturing are features of the catatonia. Mutism in the catatonia may seem as dissociative amnesia but the this patients do not have memory loss.

Factitious Disorder and Malingering

Any test or process can make distinguish between dissociative amnesia and feigned amnesia(acting like have memory loss). People who have acute-florid amnesia, financial-sexual, legal problem or people who are escaping from stressful situations have more tendency to show feigned amnesia. Normal and age-related changes in memory

Normally, people’s capacities about remembering memories about childhood, adolescence can decrease. Childhood amnesia is different from dissociative amnesia because it is normal to remember little information about the age before 4-5. Also memory decreases at the neurocognitive disorders can not explain with dissociate amnesia symptoms.

Schizophrenia

In dissociative amnesia, there are some changes in consciousness and some patients may experience visual-auditory hallocinations and delusional thoughts but these symptoms do not include disorganization and affective proccess as seen as schizophrenia.

Comorbidity

The dissociative amnesia patients may have feelings of shame, guilt, conflict and suicidal-homicidal thoughts. They may experience mood swings and panic attack during the amnesia episodes. Some other mental disorders may be seen together with dissociative amnesia:

Dysthymia, Major Depressive Disorder, Adjustment Disorder, Posttraumatic Stress Disorder, Somatic Symptom Disorder, Conversion Disorder, Personality Disorders(Borderline, Avoidant, Dependent), Anxiety Disorders.

The Diagnosis of Dissociative Amnesia

Physical examinations make from experts for to be sure that the patient do not have any physical illness or affected from a substance. Then, If the patient do not have any physical illnesses, a psychologist or psychiatrist focuses on the life history of the patient and finding the experiences that might be a factor for amnesia.

Treatment Approaches of Dissociative Amnesia Disorder:

The main purpose of the treatment includes easing symptoms, providing appropriate connection with the patient and his/her memories. Also treatment provides facing with traumatic/stressful circumstances effectively, improving functionability and the interpersonal relationships.

Some approaches for treatment of the dissociative amnesia disorder:

Psychotherapy

The main therapy method for this disorder. A supportive attempt toward the patient is important for the recovery process. The motivation of the patient should be increased and the patient should be encourage by the clinician to recall memories. Stress management techniques are important techniques to help the patient to cope with problems effectively.

Cognitive-Behavioral Therapy

The goal is to change the patient’s harmful thoughts about his/herself, distorted beliefs, behaviours.

Dialectic-behavior Therapy

This treatment approach often uses for the trauma or abuse sufferers. It provides changing inappriopriate thoughts and behaviours of the patient and learn to manage diffucult behaviours, accepting and regulating emotions.

Family Therapy

This method gives detailed information about the patient’s disorder to the family and teaching them to how can they help to patient. Creative therapies ( art therapy, music therapy etc. )

These methods help the patient to explain his/her emotions, thoughts in a different but safety setting.

Meditation and relaxation technique

This method provide awareness about dissociation situation to the patient and provides more effective coping.

Clinical hypnosis

With this method, the patient’s concentration, motivation increases and hidden patterns in the consciousness appears more easily and quickly. There is no medication uses in the treatment of the dissocative amnesia disorder but antidepressant may be helpful fort he treatment.