psychiatric disorders
Dissociative Amnesia
Symptoms and Signs of Dissociative Amnesia
The main symptom of dissociative amnesia is Memory Loss that is inconsistent with normal forgetfulness. The amnesia may be for a discrete period of time, for certain types of experiences, or for large portions of childhood. Localized Selective Generalized Rarely, dissociative amnesia is accompanied by purposeful travel or bewildered wandering, called Dissociative fugue (from the Latin word Localized amnesiainvolves being unable to recall a specific event or events or a specific period of time; these gaps in memory are usually related to trauma or stress. For example, patients may forget the months or years of being abused as a child or the days spent in intense combat. The amnesia may not manifest for hours, days, or longer after the traumatic period. Usually, the forgotten time period, which can range from minutes to decades, is clearly demarcated. Typically, patients experience one or more episodes of memory loss. Selective amnesiainvolves forgetting only some of the events during a certain period of time or only part of a traumatic event. Patients may have both localized and selective amnesia. Ingeneralized amnesia, patients forget their identity and life history—eg, who they are, where they went, to whom they spoke, and what they did, said, thought, experienced, and felt. Some patients can no longer access well-learned skills and lose formerly known information about the world. Generalized dissociative amnesia is rare; it is more common among combat veterans, people who have been sexually assaulted, and others experiencing extreme stress or conflict. Onset is usually sudden. Insystematized amnesia,patients forget information in a specific category, such as all information about a particular person or about their family. Incontinuous amnesia,patients forget each new event as it occurs. Most patients are partly or completely unaware that they have gaps in their memory. They become aware only when personal identity is lost or when circumstances make them aware—eg, when others tell them or ask them about events they cannot remember. Patients seen shortly after they become amnestic may appear confused. Some are markedly distressed; others are indifferent. If those who are unaware of their amnesia present for psychiatric help, they may do so for other reasons. Patients have difficulty forming and maintaining relationships. Some patients report flashbacks, as occur in Posttraumatic Stress Disorder (PTSD) (PTSD); flashbacks may alternate with amnesia for the contents of the flashbacks. Some patients develop PTSD later, especially when they become aware of the traumatic or stressful events that triggered their amnesia. Depressive and functional neurologic symptoms are common, as are suicidal and other self-destructive behaviors. Risk of suicidal behaviors may be increased when amnesia resolves suddenly and patients are overwhelmed by the traumatic memories. Dissociative fugue is an uncommon phenomenon that sometimes occurs in dissociative amnesia. It is classified as a type of dissociative amnesia in theDiagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision (DSM-5-TR), since amnesia is a prominent symptom, and fugue is relatively rare. Dissociative fugue often manifests as Sudden, unexpected, purposeful travel away from home Bewildered wandering Patients, having lost their customary identity, leave their family and job. A fugue may last from hours to months, occasionally longer. If the fugue is brief, they may appear simply to have missed some work or come home late. If the fugue lasts several days or longer, they may travel far from home, assume a new name and identity, and begin a new job, unaware of any change in their life. Many patients with fugue appear to represent disguised wish fulfillment or the only permissible way to escape from severe distress or embarrassment, especially for people with a family or interpersonal conflict they cannot resolve. For example, a stressed executive facing business reverses leaves a hectic life in the city and lives as a farm hand in the country. During the fugue, patients may appear and act normal or only mildly confused. However, when the fugue ends, patients report suddenly finding themselves in the new situation with no memory of how they came to be there or what they have been doing. They often feel shame, discomfort, grief, and/or depression. Some are frightened, especially if they cannot remember what happened during the fugue. These manifestations may bring them to the attention of medical or legal authorities. Most people eventually recall their past identity and life, although recalling may be a lengthy process; a very few remember nothing or almost nothing about their past indefinitely. Often, a fugue state is not diagnosed until patients abruptly return to their pre-fugue identity and are distressed to find themselves in unfamiliar circumstances. The diagnosis is usually made retrospectively, based on documentation of the circumstances before travel, the travel itself, and the establishment of an alternate life. 