Most of us have experienced the well-known mental blackouts, where we are not able to remember something that we normally have on the tip of our tongue every day (for example, birthday dates or names of someone we know). Sometimes, we are also unable to remember how we got to the room or why we entered the room and we have to go back to try to remember it.
In dissociative amnesia, waiting or returning to the room where we were in order to remember something is not functional. Therefore, in this Psychology-Online article we explain What is dissociative amnesia: its symptoms, types and treatment.
What is dissociative amnesia
The DSM 5 (2013) defines dissociative amnesia as a inability to remember autobiographical information. This pathology goes beyond ordinary forgetfulness, since this It is part of dissociative disorders and causes clinically significant discomfort and deterioration in different important areas of life such as social and work.
The characteristic of dissociative amnesia is then the inability to remember important autobiographical information, which is generally traumatic in nature (for example, sexual abuse, violence or having been a spectator of the traumatic event).
This autobiographical information should normally be successfully stored in memory and should be easily recalled, since traumatic brain injuries, infections, diseases in areas of the brain involved with memory or related to the decoding of traumatic stimuli, neurodegenerative diseases and synucleinopathies have been ruled out. .
Dissociative amnesia: symptoms
Below are the characteristic symptoms of dissociative amnesia:
- Inability to remember dates or years (may be related to abuse received or witnessed).
- Inability to remember addresses (including one’s own address).
- Inability to remember names.
- Inability to remember certain events, people, or even personal information (own name, address, age).
- Feeling of separation from oneself.
- Inability to remember some prior knowledge (for example semantic knowledge that causes the problem in recognizing objects or remembering the name of objects).
- : the inability to process sensory information.
- Alteration of procedural knowledge (long-term memory). Procedural learning is the actions that we know how to do and that we have automated, such as speaking our language or driving.
- Associative visual agnosia (inability to pair photographs or semantically related objects).
- Disorientation.
- dissociative fugue (wandering on the streets without purpose), this symptom of dissociative amnesia is usually what begins to attract attention.
- Anosognosia: People are unable to recognize their memory problems or are only partially aware.
- Chronic difficulty in the ability to form and maintain satisfactory relationships.
- Dissociative flashbacks (for example, re-experiencing traumatic events).
- Depressive symptoms and functional neurological symptoms such as depersonalization are common.
- Sometimes the .
- Feeling of lost time or not having felt the passage of time.
Dissociative amnesia: types
Below are the types of dissociative amnesia that exist according to DSM 5 (2013):
- Located: is the inability to remember events during a period of time restricted, is the most common form of dissociative amnesia. This type of amnesia can be more extensive than amnesia for a single event. For example, months or years of abuse during childhood are forgotten.
- Selective: In selective amnesia the person can remember some, but not all, events during a limited period of time. For example can you remember part of a traumatic event but not other parts; External and internal stimuli can be remembered in a fragmented way, such as the intensity and color of the light that was there while the sexual abuse occurred, the face or just the height of the sexual abuser. Some may state that they present both, selective and localized.
- Generalized: is the total memory loss which covers the entire life of the person and is the least common. In this type of amnesia, personal identity, prior and procedural knowledge can be forgotten.
- Systematized: the person loses memory a specific category of information. For example only memories associated with one’s own family or memories with a particular person or only memories of sexual abuse.
- Keep going: In this type of amnesia the person forgets every new event that occurs from a certain event to the present.
Duration of dissociative amnesia
Dissociative amnesia usually has a acute onset (sudden or fast). The duration of forgotten events may vary from minutes to decades. Some episodes of dissociative amnesia usually resolve quickly (for example, when a person is removed from the stressful situation or stimulus). Dissociative abilities can decrease with age but this does not always happen.
Risks when remembering what is forgotten
As the amnesia subsides, a deep and marked anguish, suicidal behaviors and characteristic symptoms of . These risks, especially suicidal behavior, can arise from the intolerable memories that begin to appear.
Causes of dissociative amnesia
Dissociative disorders often arise as a result of trauma (e.g. sexual abuse, war, physical abuse, child abuse, natural disasters, car accidents, homicide, and physical torture). But, although they are not part of the category of disorders related to trauma and stress factors, they do reflect a close relationship between these two types of diagnoses.
Dissociative amnesia: treatment
As Van der Kolk (2015) refers, if the thalamus is altered, trauma is not remembered as a storya, a story with a beginning, a middle and an end, but as isolated sensory traces: images, sounds and physical sensations.
The treatment given to dissociative amnesia must be understood in these aspects where sensory experiences are integrated.
The psychological treatment that can be offered in dissociative amnesia is called EMDR. It allows her to reprocess freely associated memories and images from the past. This seems to help put the traumatic experience into a larger context or perspective. EMDR allows you to observe your experiences in a new waywithout a verbal exchange with another person.
Dissociative amnesia: clinical case
Below is a clinical case of a woman with dissociative amnesia as a result of having suffered domestic sexual abuse:
It is a 20 year old young man who went to the National Hospital of Guatemala, consulted about a acute abdominal pain. The clinical laboratory tests performed showed only some values outside the normal parameters. What caught the attention of the clinical staff is the patient’s overweight and some unusual purple lesions on the breasts and abdomen.
The gastroenterologist requests an x-ray or endoscopy on the patient to rule out any injury and laboratory tests to measure the level of cortisol and the hormone T3 and T4. The x-ray results showed gastric ulcers that were probably related to the laboratory results presented high cortisol levels.
In addition to these clinical manifestations, the patient was unable to provide some data related to her personal information. He said he only remembered his name. but not their last names, nor could he remember their address. The patient therefore presented autopsychic and allopsychic disorientation (she is unable to identify the people around her and personal data).
The clinical staff suggests that the memory alterations are related to their physical symptoms that were the reason for the consultation, but they needed to rule out that they were not brain alterations (especially the areas involved in the adrenal gland, which is what could be related to their high cortisol levels) or due to a psychological cause.
Pierre Janet (1986) highlighted the link between trauma and dissociation, proposing a theory of pathological dissociation as a consequence of people who have experienced a traumatic event. Conceptualizing there dissociation as a defense against anxiety caused by traumatic experiences, which can remain as “subconscious fixed ideas” in the patient’s mind, damaging their mood and behavior.
was able to observe that repressed experiences do not remain in a latent state, but are re-experienced through dreams and nightmares, regressions and the overflow of feelings and sensations linked to traumatic experiences.
Wilbur (1984) maintains that abuse creates a state of threatening and unacceptable anger in children. Thus, they learn that these sensations are not okay to be expressed and should not be felt consciously, so they repress these sensations and the memories that cause them remain in the unconscious.
Dissociative amnesia is usually due to a long-term repressed memory as a result of trauma, whether psychological or emotional. In the present case, the probable relationship between her difficulty in remembering and her physical symptoms was reached through an interview with the patient and people close to her.
The psychologist in charge was in charge of exploring her history and the patient reported having lived her entire life on the streets, but the person who accompanied her explained that a few weeks ago the 20-year-old girl had never been seen on the streets and that she knew To his family: an alcoholic father and two uncles, well the mother had abandoned her with them from a very young age.
As Van der Kolk (2015) referred to, when problems are solutions; Generally, patients who have been sexually abused use their own body as a defense mechanism; they begin to eat in exorbitant quantities with the intention of gaining weight and thus not seem more attractive to the abuser. In the case of the patient, her overweight was also related to her high levels of cortisol, which in turn caused the ulcers and were what caused her acute abdominal pain.
Through the application of EMDR and psychoanalysis, the patient was able to reprocess through memory inductionthe regression and the transference of all those memories of the abuse that had been repressed, starting by showing him with his identification document the surnames of the father and mother that he had forgotten (which with a psychoanalytic interpretation was a defense mechanism to forget and protect himself from those people or agents who had caused the trauma or pain).
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