Dissociative Amnesia Harkarn Sodhi Millions of people across the globe forget simple tasks and even some memories, but some bury the memories so far into their mind that they can not be recalled.
The involuntary escape from reality is characterized as dissociative disorders, in which the normally well-integrated functions of memory, identity, perception, or consciousness are separated (dissociated). Some say that the dissociative mental disorder (DID) dates back to Paleolithic cave paintings in the images of shamans! Dissociative amnesia (DA) is generally considered the most common dissociative disorder and is defined in the Diagnostic and Statistical Manual (Fourth Edition), Text Revision (DSM-IV-TR) in 2006 as, “one or more episodes of inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness”. Unlike medical amnesia after an injury or stroke, people with dissociative amnesia show no concern nor have problems learning new material with their condition, and the patient’s memory loss is almost always anterograde (limited to the period following the traumatic event). Although there are no lab tests to specifically diagnose dissociative disorders, doctors will begin an examination with a complete medical history and physical exam. They may order a MRI to identify structural causes, EEG to identify a seizure disorder, or blood and urine tests to identify toxic causes. In addition, The diagnosis is based on the Diagnostic and Statistical Manual (Fourth Edition), Text Revision (DSM-IV-TR) which states, “The symptoms cause clinically significant distress or impairment in social, occupational, or other important areas of functioning”. If the physicals exams come negative, then doctors may refer patients to a psychiatrists and psychologists, who use specially design an interview to evaluate a person for a dissociative disorder. For example, “The SCID-D is a semi-structured interview, which means that the examiner’s questions are open-ended and allow the patient to describe experiences of amnesia in some detail, as distinct from simple ‘yes’ or ‘no’ answers.
” Therefore, malingering can usually be detected in patients who are faking amnesia because they typically exaggerate and dramatize their symptoms for obvious financial, legal, or personal reasons. However, dissociative amnesia is rare and only affects about 1% of men and 2.6% of women in the general population. Even though it can occur any time after infancy, women are more prone to experience dissociative amnesia than men. The frequency tends to increase during traumatic experiences, such as in wartime, natural disasters, or during life problems.
There is not a higher prevalence in a certain race, and sports do not affect the chances of getting the disorder. Dissociative amnesia may be confused with amnesia, which usually is a result of disease or injury to the brain. In dissociative amnesia, the memories still exist but can not be recalled and might resurface with time or triggered by the person’s surroundings. The primary cause of dissociative dementia is overwhelming stress experienced from traumatic encounters that the patients has witnessed or survived and are coping with.
Such major life changing events include: war, accidents, abuse, disasters, financial problems, the death of a loved one, or any other difficulties experienced by the patient. While anyone may have the dissociative disorder, children and war time soldiers are most susceptible to it because they may have gone through long-term physical, sexual or emotional abuse or a frightening home environment, and experienced a massive amount of blood shed and tragedies respectively. In addition, there may be a genetic link to dissociative amnesia. The central symptom of dissociative amnesia is loss of memory for a period or periods of time in the patient’s life. It is different from amnesia caused by medical problems, such as illness, strokes or brain injuries.
Dissociative Amnesia can be localized, Selective, Generalized or Fugue. Localized Amnesia involves being unable to recall a specific event or events or specific period of time, such memory loss focuses on a specific trauma. An episode of localized amnesia usually occurs suddenly and may last minutes, hours, or rarely, months or years.
In Selective Amnesia, patients usually forget only some of the events during a certain period of time or only part of a traumatic event. Patient may suffer from both localized and selective amnesia. Another symptom of dissociative Amnesia is when patients forget their identity and life history. This type of Amnesia is called Generalized Amnesia and is common among combat veterans, people who have been sexually assaulted, and people experiencing extreme stress or conflict. It also happens when a patient has generalized amnesia and adopts a new identity, that is dissociative fugue Amnesia.
Recovering memories in dissociative amnesia is rare and a generally slow and gradual process. In most of the cases of dissociative amnesia, patients seem to have little concern over their amnesia and memories can return suddenly or completely. While there are no evidence-based treatments, techniques such as psychoanalysis, medication/relaxation, psychotherapy, clinical hypnosis, or drug-assisted question-and-answer sessions may help some people retrieve their memories. Treatment depends on the person and how severe the symptoms are.
Psychoanalysis also known as talk therapy, involves the dream analysis, interpretation and psychotherapy to deal with recovered memories of traumatic and stressful events. Once the memories are recalled, psycho therapy and dialectical behavior therapy can help the person understand how trauma caused their amnesia and how to resolve their issues to avoid this situation later in their lives. Clinical Hypnosis is a treatment that uses intense relaxation, concentration, and focused attention to achieve an altered state of consciousness, allowing people to explore their thoughts, feelings and memories hidden from their conscious minds. Also questioning patients while they are under hypnosis, or rarely in a drug induced (benzodiazepine) semi hypnotic state can be successful.
The questionnaire should be very careful as not to suggest the existence of event or to avoid the risk of false memory. Antidepressants and anti anxiety medications or antipsychotic drugs may also be prescribed to help control the mental health symptoms associated with dissociative disorder. People with dissociative amnesia usually respond well to treatment; however, progress and success depend the person’s life situation and if he or she has support from family and friends. If family and friends are there to support the individual, then the patient has a much faster and better chance of recovery. Although there are not any prevention techniques, immediate intervention and treatment after experiencing symptoms may help accelerate the treatment process for dissociative amnesia. References Mental Health and Dissociative Amnesia.
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