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Dissociation can be understood as a disruption in the integrated sense of self. This may involve lapses in autobiographical memory (amnesia) and feelings of detachment from one's self (depersonalization) or from one's surroundings (derealization). These symptoms often develop in the context or aftermath of significant trauma, particularly during childhood. Dissociation may initially help buffer the impact of a trauma, but can also become pathological and maladaptive. While the dissociative disorders are closely related to the stressor- and trauma-related disorders, they are classified separately in the DSM-5.
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WARDS QUESTION
Q: When do dissociative responses typically occur?
A: During stressful and traumatic events.
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Individuals with dissociative amnesia are unable to remember important personal information or history, often traumatic in nature. Procedural memory (e.g., how to ride a bike) is preserved, distinguishing dissociative amnesia from other conditions resulting in memory loss (e.g., major neurocognitive disorders/dementias). The unrecalled autobiographical information has been stored in memory and is thus potentially retrievable. Dissociative amnesia rarely generalizes to encompass complete memory loss. More commonly, a single period of time (localized amnesia) or certain events (selective amnesia) are forgotten. Affected individuals often do not have insight regarding their deficits. There is a significant incidence of comorbid major depressive disorder or persistent depressive disorder (dysthymia) and an increased risk for suicide—particularly as amnesia resolves and the overwhelming memories return.
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KEY FACT
Dissociative amnesia refers to disruption in the continuity of an individual's memory. Patients with dissociative amnesia report gaps in the recollection of particular events, usually traumatic ones.
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WARDS TIP
Patients suffering from dissociative amnesia can experience periods of flashbacks, nightmares, or behavioral reenactments of their trauma.
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Diagnosis and DSM-5 Criteria
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An inability to recall important autobiographical information, usually involving a traumatic or stressful event, that is inconsistent with ordinary forgetfulness.
May present with dissociative fugue: Sudden, unexpected travel away from home, accompanied by amnesia for identity or other autobiographical information.
Not due to the physiological effects of a substance, another medical or neurological condition (e.g., traumatic brain injury), or another mental disorder.
Symptoms cause significant distress or impairment in daily functioning.
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KEY FACT
Although dissociative fugue is now considered a subtype of dissociative amnesia disorder, it more commonly occurs in patients with dissociative identity disorder.
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Epidemiology/Etiology
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Lifetime prevalence is 6–7%.
Higher incidence in female patients.
Amnesia often develops after trauma.
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KEY FACT
Abreaction: The strong emotional reaction patients may experience while retrieving traumatic memories.
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Important to establish the patient's safety.
Psychotherapy (e.g., supportive, CBT, hypnosis) is the mainstay of treatment.
Medications have not demonstrated efficacy in dissociative amnesia.
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