Dissociative Amnesia and Its Clinical Prespective

Introduction

Dissociative amnesia is a clinical disorder that is characterized by the loss of a few memories of the past. People with dissociative anesthesia often experience an inability to recall past events, mainly stressful or traumatizing ones. Dissociative amnesia is often associated in patients with psychiatric conditions like personality disorders like cluster C personalities (a clinical segmentation of personality disorder, where the patient is characterized by symptoms like intense anxiety, fearful behavior, etc.).

The forgetful nature of the person can be specific in a theme orientation like accidents or trauma or personal like memories of a person or place. In dissociative amnesia, the forgetfulness is usually greater than the extent of normal forgetfulness. This condition in such a situation is called a dissociative fugue.

Dissociative amnesia is an illness of the mind where the normal functions of the mind, like orientation toward oneself, awareness of the situation, memory, and perception, are affected, resulting in a condition called a dissociative disorder.

How Commonly Is Dissociative Amnesia Seen?

Dissociative amnesia is a rare clinical condition seen in around one percent of the male and 2.6 percent of the female population. However, environmental situations also play an important role in the rates of amnesia, where an indefinite rise in the rates of dissociative anesthesia is seen after natural disasters.

What Are the Factors Causing Dissociative Amnesia?

The factors that contribute to the occurrence of dissociative amnesia are often brutal and disheartening, pushing the patient to the extent of losing his or her memory. And they are:

• Trauma due to abuse.

• Trauma due to the occurrence of a natural calamity.

• Prolonged exposure to traumatic events.

• Fear of dying.

• Exposure to threats.

• Childhood trauma.

• Physical assault or injury due to trauma.

• Direct or close relationship with victims of trauma.

What Are the Symptoms of Dissociative Amnesia?

The clinical symptoms of dissociative anesthesia are:

• Frequent loss of memories about oneself (details of autobiography).

• Reversible memory loss.

• Can register new memories.

• More pronounced response to emotions.

• Memory loss is mostly anterograde.

• Shows an increased response to hypnotizing and dissociative treatments.

• Occasional blackouts.

• Occurrence of unusual fluctuation in habits, behavior, skills, knowledge, and taste.

What Are the Types of Dissociative Amnesia?

Based on the loss of memory, dissociative amnesia can be classified into different types. The types of dissociative amnesia are:

• Localized Amnesia: This type of amnesia is characterized by the inability to remember events that happened during a particular period.

• Selective Amnesia: It is characterized by the ability of the person to retain some of the memories of the past that occurred during a particular period.

• Generalized Amnesia: The inability of the person to remember the entire past.

• Continuous Amnesia: This is a type of amnesia where a person fails to remember the same events successively.

• Systematized Amnesia: This type of amnesia is called so as the person fails to remember memories related to a particular person or family.

How Is Dissociative Amnesia Diagnosed?

By assessing the patient and gaining the patient's symptoms, dissociative amnesia is diagnosed by the following methods, and they are :

• Collecting complete medical history.

• Physical examination of the patient.

• Reviewing a patient's memory.

Although there is no specific laboratory test for the diagnosis of this condition, blood cultures and imaging tests like radiographs, computed tomography (CT), and magnetic resonance imaging (MRI) are taken to rule out any associated medical conditions causing it.

However, a specialized test is suggested by psychiatrists or psychologists in the absence of any predisposing physical illness. This test is called structured clinical interview for dissociation (SCID-D). Here, the SCID-D test is used as a diagnostic tool by providing a comprehensive questionnaire for assessing dissociative symptoms like failure to identify oneself or their personal information.

How Is Dissociative Amnesia Treated?

The method of treating patients with dissociative amnesia was framed and reviewed by Loewenstein in the year 1995. It was originally reviewed by Herman in 1992 and by Van der Hart, Steele, Brown, and Boon in the year 1993. The significance of treating patients with dissociative amnesia is to relieve symptoms of fear, provide a feeling of safety, and help to reconnect with the memories lost. The treatment also aims to:

• Help the patients to deal with and overcome painful events by being sensitive and valuing their emotions.

• Improve interpersonal relationships.

• Restore functional ability.

• Teach life skills and coping mechanisms.

And all these features are achieved by the clinical, medical, and therapeutic approaches of the patients. These approaches are:

• Psychotherapy: This therapy is given by talking to the patient as a mainstream approach; the psychologist or psychiatrist gets to know the patient's views on the scenario and can put in his opinions and views on managing the condition.

• Behavioral Therapy: Behavior therapy is targeted at focusing on and altering a person's behavior. This therapy is classified into two types, and they are:

  • Cognitive Behavioral Therapy: It focuses on changing the patient's mindset from unpleasant feelings like thoughts of harming oneself, harmful behavior, and feelings.

  • Dialectic Behavioral Therapy: This is often done in patients with severe disturbances in their personalities. It is usually seen in persons who have undergone trauma or abuse.

• Reprocessing and Desensitising Eye Movements: This is a treatment approach given to patients who go through flashbacks of the past, nightmares, or other symptoms like, anxiety due to post-traumatic stress disorder (PTSD).

• Family Therapy: This therapy is done by explaining the patient’s conditions to the family members and carefully watching for the recurrence of symptoms, if any.

• Meditation: Meditation helps the patient go into a state of calmness and a feeling of safety.

• Creative Therapy: Diverting the mind of the person by occupying creativity skills like art and craft helps the patient calm their mind and improve focus.

• Clinical Hypnosis: This form of treatment is done by putting the patient into a deep sleep, making them relaxed, and focusing their attention and concentration on their feelings, thoughts, and memories that lie hidden in their minds.

• Medication: Although there is no specific medication for the management of these disorders, drugs like antidepressants or anti-anxiety drugs help relieve the patient temporarily, allowing them to sleep.

Conclusion:

Although the occurrence of dissociative amnesia and the occurrence of traumatic events can be disheartening and bothersome. The condition is often temporary, and the patient regains his memory within a period of time. The forgetfulness of the mind occurs as a self-healing mechanism of the mind shutting down the triggering factors that bother it. However, with proper treatment and creative therapies, it relieves a person's mind of all the bad events, giving them the strength to regain the lost memory and overcome it without any lingering complications like anxiety or depression.