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Memory loss in organic mental disorders is typically gradual and incomplete. Clinicians may encounter difficulty in differentiating substance abuse and DA because many patients minimize their abuse and also misattribute their amnesia to alcohol or drugs because of fear of a diagnosis of dissociation. Obtaining a careful history from multiple informants is often necessary to clarify the situation. However, unlike DA, memory loss due to substance abuse is seldom reversible.

Korsakoff disease may also be confused with DA. This disease, also known as alcohol amnestic disorder, is associated with heavy and prolonged alcohol abuse and is not associated with psychological stress. However, unlike DA, patients with Korsakoff disease are not able to learn new information and they often experience significant deterioration in personal functioning.

Amnesia from brain injury or head trauma can be differentiated from DA based on a history of trauma; patients usually have retrograde amnesia before the trauma, unlike patients with DA, who have anterograde amnesia. In addition, patients with brain injury do not show the susceptibility or response to hypnosis so frequently observed in patients with dissociative disorders. Because dissociative disorders are associated with some evidence of biological causality, not every case of trauma results in symptoms that produce the disorder, nor does every person with the disorder have a history of childhood or adult trauma.

Indications for hospitalization

In most instances in which patients present a clear and present danger to themselves or others, when medication effects must be evaluated, and in instances in which a diagnosis has not been determined, hospitalization is often necessary. Hospitalization allows patients to separate themselves from the environmental stimuli, sexual and physical abuses, and stresses that may be contributing to their reactions and episodes of amnesia, compulsive behaviors, and recklessness. It also protects them during a perplexing period of their lives when they honestly do not know who they are.

Patients may experience problems with concentration and feelings of rejection, reoccurrence of preexisting psychiatric conditions, intrusive reexperiencing of trauma or negative thinking, feelings of emotional overwhelm, paranoia or general distrust, and episodes of schizophrenia and fear.

Treatment

Importantly, when psychotherapeutic techniques are applied in treatment, do not overwhelm patients with the force of intervention and the speed at which recovery is estimated to occur. Hence, in psychotherapy, timing and progressing at the appropriate speed are critical. Many cases of DA resolve spontaneously when the individual is removed from the stressful situation. The treatment of choice for DA is psychotherapy with augmentation by hypnosis or drug-facilitated interview. Patients with DA frequently have comorbid disorders of mood and anxiety disorders and PTSD. These disorders should be treated with pharmacological agents.

Hypnosis as a treatment process is supported by the state-dependent learning theory, in which therapeutic hypnosis is undertaken in a context of a consenting contract and is guided by the therapist. It has been viewed as a controlled form of dissociation; therefore, clinicians assume that the mental content and images that emerge are also controlled and that the patient can control the pace of the therapy. Although hypnosis is helpful, it is not necessary for recovery of historical material or for dealing with that which is recovered. It can be used as a vehicle to gain confidence in the patient. Self-hypnosis methods are available that help the patient apply some control over the pace and style of therapy.

According to Freud, the unconscious is affected by external stimuli on many levels; therefore, the suggestions made by medical practitioners to their patients influence the processing of information, traumatic memories, and patients' perception of their own experiences. For this reason, hypnosis can be a valuable tool for helping heal the trauma and assessing or retrieving additional historical data, which may clue the practitioner into the patient's needs and developmental health. This is not always the case when dealing with DA. Freud indicated that trauma depletes the ego of the patient when he or she is overstimulated. In this way, providing the patient with tools to rebuild the ego is imperative to better mental health and appropriate behavior.

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Reviewed: 04/2006