The essential feature of Dissociative Amnesia (DA) is an inability to recall important personal information that is more extensive than can be explained by normal forgetfulness. Remembering such information is usually traumatic or produces stress.

DSM-IV diagnostic criteria for Dissociative Amnesia include a predominant disturbance of one or more episodes of an inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness. Also, the disturbance does not occur exclusively during the course of DID, dissociative fugue, posttraumatic stress disorder (PTSD), acute stress disorder, or somatization disorder and is not due to the direct physiological effects of a substance or of a neurological or other general medical condition. The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning.

Different types of memory loss have been identified in persons with DA. These include localized, generalized, continuous, and systematized amnesia. Localized amnesia occurs when patients cannot remember certain time periods or events such as experiences in battle or situations of torture. Generalized amnesia occurs when patients cannot remember anything in their lifetime, including their own identity. Continuous amnesia occurs when patients have no memory of events up to and including the present time. This means that patients are alert and aware of their surroundings but are not able to remember anything. Systematized amnesia occurs when patients have a loss of memory for certain categories of information, such as certain places or persons.

Mental status

Patients present with symptoms and behaviors that help determine their condition and subsequent diagnosis. Two factors help distinguish between the forms of Dissociative Amnesia present in the patient.

The first is a sudden, dramatic disturbance in which a vast amount of memories related to personal information are not available for conscious verbal recall. Although this presentation is rare, it is frequently featured in the media and is portrayed as a common occurrence. Patients with this manifestation often present in the emergency department or at neurology departments because the acute onset of memory loss requires immediate medical assessment. Patients present as disoriented, perplexed, and in a purposeless, wandering state. For example, one young lady, who discovered her boyfriend of 1 year was married with 2 children, handled the information by forgetting who she was for several weeks.

The second is a more common presentation and is a patient with a deletion of a large aspect of personal history from the conscious memory. These patients ordinarily do not complain of memory loss, and their condition is usually discovered after obtaining a thorough life history.

DA usually has a clear-cut onset and finish. This means that the patient is aware of the deletion in continuous memory, as opposed to a gradual loss of normal memory. For example, patients may not remember a certain year of schooling or a certain job, even though they remember other years of schooling and other jobs. This is usually due to a traumatic experience during that time period, such as a rape or a kidnapping. In extreme cases, patients cannot remember their teenage years or other periods of their lifetime.

An acute onset of Dissociative Amnesia usually begins after a psychologically stressful life event that threatens the patient physically or emotionally (eg, a patient who is a victim of a rape or who is witness to the accidental death of a loved one). Onset and termination of the amnesia are usually abrupt. Patients usually recover the memory after proper treatment, but sometimes the patient develops a chronic form of amnesia. Unfortunately, some patients develop Dissociative Amnesia as an alternative to suicide, and if the memory is recovered without proper psychotherapy, patients can be at risk for suicide.

DA occurs in 2-7% of the general population and has a high occurrence in those involved in wars, in patients with a history of child abuse or sexual abuse, in survivors of concentration camps, in victims of torture, and in survivors of natural disasters. Studies have shown that the extent of trauma is correlated with the development of amnesia.

Differential diagnoses

The differential diagnoses of Dissociative Amnesia are any organic mental disorders, dementia, delirium, transient global amnesia, Korsakoff disease, postconcussion amnesia, substance abuse, other dissociative disorders, and malingering factitious disorder.

continue: Treatment of Dissociative Amnesia

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Reviewed: 04/2006