1, 2 Nevertheless, it has been diagnosed with increasing frequency. 6, 18, 19, 20ĭissociative amnesia is considered, in comparison to many other psychiatric diseases, to be relatively rare, although prevalence rates have ranged between 0.2% and 7.3%, apparently depending on cultural background and methodology. his Table 23.2), describing the likely etiology of dissociative amnesia and its possible alterations in the brain, which were investigated in a number of functional imaging studies, especially by using glucose positron emission tomography. 1, 2, 11 Markowitsch 17 proposed a model (cf. Also, a forensic background can be found in a minority of the patients. For example, patients with a background in migration are frequently affected, 16 which is a confirmation for the stress hypothesis of dissociative amnesia. 1, 13, 14, 15 Such stress or trauma situations make individuals especially vulnerable, if they occur in childhood and youth and if there is later “revival” of such stress or trauma conditions in adult (or later) life (“two-hit hypothesis”, cf. The etiology is regarded as being related to major stress and (psychic) trauma situations with which the individual could not cope properly. 10 Other, closely related terms are ‘functional amnesia’, 11 implying that the amnesia has a function for the patient, and ‘mnestic block syndrome’ 12 – indicating that the “forgotten” memories are not lost, but just blocked from access to consciousness and subsequently may at a later stage recover.
This term has remained until today though its use is nowadays much rarer than that of dissociative amnesia. 9 At their time and even until after the Second World War it was labeled ‘hysteria’. 6, 7, 8 While it was stated in classical textbooks that the amnesia is usually transient and functional recovery will be complete, more recent research shows that patients with dissociative amnesia may remain amnesic for years and decades, though those with the retrograde version of dissociative amnesia can learn about their past in a neutral, emotionally distant manner.ĭissociative amnesia as a psychiatric condition has a long background, which reached increased awareness with Charcot, Janet, and Freud. This may be accompanied by changes in other cognitive and emotive domains and may also lead to changes in personality. In very rare cases the reverse amnesia picture may be true, namely a preservation of old episodic-autobiographical memories, but an inability to store new personal information long-term 4, 5. All the more their lack of access to their personal past appears puzzling to their social environments (partners, friends, etc.). 3) 3 are usually preserved, implying that the patients on first glance appear quite normal: They can read, write, calculate, behave in a normal social way, and know details about the world and famous people. 1, 2 Semantic memory, which is memory for neutral facts, and procedural memory and priming (cf. Usually patients “forget” (or alternatively said: have no conscious access to) their total personal past. Furthermore, detailed treatment strategies are provided.ĭissociative amnesia is characterized by amnesia in the episodic-autographical domain. They are divided into (a) psychopharmacological and somatic treatments, (b) psychotherapeutic interventions, and (c) neuropsychological rehabilitation. Nevertheless, a number of quite divergent, though largely not evidence-based, therapeutic approaches exist and are described.
Patients also seem to a high degree to possess immature, unstable personality features. As many patients show the phenomenon of “la belle indifference”, their motivation for therapy or treatment of their amnesia is reduced. That means, most of them show severe retrograde amnesia for their biography, usually accompanied by changes in their personality and sometimes also by alterations in other cognitive and emotive domains.
It is emphasized that dissociative amnesia has a stress or trauma-related etiology and that affected individuals, contrary to the still dominant clinical belief, are frequently more severely and enduringly affected. The psychiatric disease of dissociative amnesia is described and illustrated with case reports.
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