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We are planning to collect survey data from both Chinese and Belgian university students to examine their potential differences in beliefs surrounding repressed memory and dissociative amnesia.

Introducción: La Amnesia Disociativa (AD) es una amnesia de tipo retrógrada caracterizada por una alteración en la memoria episódica. Objetivo: identificar el consenso científico actualizado sobre las bases neurales que subyacen al desarrollo de la amnesia disociativa. Metodología: revisión bibliográfica sistemática y evaluativa de tipo cualitativa. Resultados: La bibliografía encontrada sugiere inhibición funcional en hipocampo, amígdala, lóbulos temporales, corteza prefrontal y tálamo. Además, se observó hipoglucemia en la corteza cerebral derecha, en la unión fronto-temporal. Una inhibición en del potencial de acción P300 también fue observada. Conclusión: Hay información suficiente para decir que la AD es una patología con base biológica objetivable. Se hace necesaria la revisión de la conceptualización actual de este síndrome amnésico y el planteamiento de nuevos criterios que distingan la AD de la orgánica.

Autobiographical-episodic memory is considered to be the most complex of the five long-term memory systems. It is autonoetic, which means, self-reflective, relies on emotional colorization, and needs the features of place and time; it allows mental time traveling. Compared to the other four long-term memory systems-procedural memory, priming, perceptual, and semantic memory-it develops the latest in phylogeny and ontogeny, and is the most vulnerable of the five systems, being easily impaired by brain damage and psychiatric disorders. Furthermore, it is characterized by its fragility and proneness to distortion due to environmental influences and subsequent information. On the brain level, a distinction has to be made between memory encoding and consolidating, memory storage, and memory retrieval. For encoding, structures of the limbic system, with the hippocampus in its center, are crucial, for storage of widespread cortical networks, and for retrieval again a distributed recollection network, in which the prefrontal cortex plays a crucial role, is engaged. Brain damage and psychiatric diseases can lead to what is called "focal retrograde amnesia." In this context, the clinical picture of dissociative or functional or psychogenic amnesia is central, as it may result in autobiographical-emotional amnesia of the total past with the consequence of an impairment of the self as well. The social environment therefore can have a major impact on the brain and on autobiographical-episodic memory processing. This article is categorized under: Psychology > Memory

A 20-year-old woman with no prior psychiatric and medical history presented with acute autobiographical memory loss and a psychogenic tremor. Her laboratory and imaging work-up revealed no infectious, inflammatory, or other organic etiologies. A lorazepam infusion-assisted interview successfully facilitated recovery of memories and elucidated precipitating events. We discuss the utility of drug-assisted interviews and the safety of benzodiazepine infusions for dissociative amnesia.

Multiple personality disorder (MPD) or dissociative identity disorder is the mental disease in which one can observe the existence of two or more than two personalities in a single person. We define the controversies nearby the diagnosis of MPD with its associated mental disorders. We discuss the various symptoms of MPD, dissociative amnesia, depersonalization or derealization disorder, and major depression disorder. After this exploration, we perceive that these disorders enclose parallel symptoms and it is difficult to identify the accurate type of disorder with its severeness. Since in experimental diagnosis the indeterminacy and falsity parts are often neglected. Due to this problem, we cannot see the accuracy in the patient’s improvement record and cannot predict the duration of treatment. To eradicate these boundaries, we present the m-polar neutrosophic soft set (MPNSS) and m-polar neutrosophic soft mapping (MPNS-mapping) with its inverse mapping. These notions are proficient and valuable to diagnose the disorder appropriately by connecting it with the mathematical modeling. The connection of m-polar neutrosophic set (MPNS) with the soft set characterizes a relation among patients, symptoms, and treatments which decreases the complexity of the case study. We build a chart based on a fuzzy interval [0, 1] to range the types of disorders. We establish an algorithm based on MPNS-mapping to identify the disease appropriately and to select the finest treatment for the corresponding disease of every patient. At last, we introduce the generalized MPNS-mapping which will helps a doctor to save the patient’s improvement record and to predict the period of treatment until the disease is cured.

BackgroundEven though recent research indicates that sexual symptoms are highly prevalent in post-traumatic stress disorder following childhood sexual abuse and cause severe distress, current treatments neither address them nor are they effective in reducing them. This might be due to a lack of understanding of sexual symptoms' specific role in the often complex and comorbid psychopathology of post-traumatic stress disorder following childhood abuse.MethodsPost-traumatic, dissociative, depressive, and sexual symptoms were assessed in 445 inpatients with post-traumatic stress disorder following childhood sexual abuse. Comorbidity structure was analyzed using a partial correlation network with regularization.ResultsA total of 360 patients (81%) reported difficulties engaging in sexual activities and 102 patients (23%) reported to suffer from their sexual preferences. Difficulties engaging in sexual activities were linked to depressive and hyperarousal symptoms, whereas sexual preferences causing distress were linked to anger and dissociation. Dissociative amnesia, visual intrusions, and physical reactions to trauma reminders were of central importance for the network. Dissociative amnesia, depressed mood, lack of energy, and difficulties engaging in sexual activities were identified as bridge symptoms. Local clustering analysis indicated the non-redundancy of sexual symptoms.ConclusionsSexual symptoms are highly prevalent in survivors of childhood sexual abuse with post-traumatic stress disorder. Further research is needed regarding the link of difficulties engaging in sexual activities, depression, and post-traumatic stress disorder, as well as regarding the association of dissociation and sexual preferences causing distress. Sexual symptoms require consideration in the treatment of post-traumatic stress disorder following childhood sexual abuse.

The reality of dissociative amnesia has been debated at length. From a clinical perspective, there is support for the existence of this phenomenon, with attempts to extrapolate it to legal contexts. However, there is little evidence to confirm it and, moreover, dissociative amnesias or repressed memories would go against evidences about the functioning of memory. The confusion between clinical psychology and forensic psychology, an inadequate definition of amnesia, the lack of a complete knowledge regarding the mechanisms of memory, and the problems inherent to the research of traumatic memories could explain the lack of agreement.

Background and objectives In the literature there are inconsistent data regarding the role of dissociation in OCD. No study explored the association between obsessive beliefs and dissociative symptoms in OCD. It is important to understand which clinical factors are related to dissociation in OCD as more severe dissociative symptoms, particularly absorption, have been found to be predictors of treatment non-response. In the present short report we describe the results of an exploratory study aimed to investigate the role of the obsessive beliefs as predictors of the different dissociative symptoms controlling for anxiety and OCD severity in a group of OCD patients. Methods Sixty treatment-seeking patients consecutively referred to psychiatric services were included (mean age=31.17 years, 53.30% females). The Dissociative Experiences Scale-II, the Obsessive Beliefs Questionnaire-46, the Yale-Brown Obsessive-Compulsive Scale, and the Beck Anxiety Inventory were administered. Results Higher anxious symptoms predicted higher Dissociative Amnesia, Depersonalization/Derealization, and Absorption/Imaginative Involvement. Higher OCD severity predicted higher Dissociative Amnesia. More severe Perfectionism predicted higher Absorption/Imaginative Involvement. Conclusion Perfectionism in OCD patients may be associated with a higher tendency to absorption and imaginative involvement. Future research should explore whether a psychotherapeutic intervention on perfectionism might improve the outcomes of the OCD patients with higher absorption tendencies.

Background Although numerous studies have supported the role of childhood maltreatment in the etiology of psychosis, underlying mechanisms have not been well understood yet. The present study aimed to investigate the mediating role of particular forms of dissociation in the relationship between five major types of childhood abuse and psychotic symptoms among patients with schizophrenia spectrum and other psychotic disorders. Methods In this cross-sectional correlation study, 70 first-episode psychotic patients and 70 chronic psychotic patients were selected by systematic random sampling (with the sampling interval of 3) from among inpatients and outpatients referring to Baharan Psychiatric hospital, Zahedan, Iran, and were matched based on age, gender, and education level. Moreover, 70 age-, gender-, and education level-matched community controls were recruited from hospital staff and their relatives and friends. All of the participants completed a research interview and questionnaires. Data on experiences of childhood maltreatment, psychosis, dissociation, and demographics were collected and analyzed by SPSS V25 software. Results The obtained results revealed that the mean scores of sexual abuse, emotional abuse, and physical abuse were higher in psychotic patients than community controls (without any significant difference between first-episode psychotic patients and chronic psychotic patients). Furthermore, the highest mean scores of dissociative experiences belonged to chronic psychotic patients. Multiple-mediation also indicated that absorption and dissociative amnesia played a mediating role in the relationship between sexual abuse and positive symptoms. Moreover, this study demonstrated the role of physical abuse in predicting psychotic symptoms even in the absence of sexual abuse. Conclusions This study illustrated specific associations among childhood maltreatment, dissociative experiences, and psychotic symptoms in the clinical population. Thus, to provide appropriate interventions, patients with schizophrenia spectrum and other psychotic disorders were asked about a wide range of possible adverse childhood experiences and dissociative experiences. Nevertheless, further studies using prospective or longitudinal designs need to be carried out to realize the differential contribution of various forms of childhood maltreatment and their potential interactions, more precisely.

Child sexual abuse (CSA) has been implicated in dissociative peritraumatic and post-traumatic symptoms and disorders. Although explicitly relevant to the legal process following alleged CSA, very little is known about dissociative manifestations in the context of forensic interviews with children following abuse. The current study was designed to uncoverperi- and post-traumatic dissociation of abused children as revealed in forensic interviews. The study examines the display of dissociation in 42 forensic interviews with children (29 girls, aged 4-14) following intra familial child sexual abuse (IFCSA). Thematic analysis was used to identify key expressions of dissociation in all of the forensic interviews. The analyses identified depersonalization and derealization in the children’s description of the abuse. This was manifested both in an inability to feel things that happened during the incidents or imagination and fantasies that were reported as part of the abusive incidents. The children’s interviews also revealed the potential manifestations of dissociative amnesia, which was evident in the children’s attempts to communicate their retrieval difficulties to the forensic interviewers. Finally, it was identified that the forensic interviews were a platform in which dissociative post-traumatic reactions were activated and often displayed in sensory flashbacks. The current findings uncover the importance of acknowledging trauma and dissociation in the context of forensic interviews with abused children and the urgent need to implement unique responses to trauma within practical guidelines.

Background: Dissociative amnesia, also referred to as psychogenic amnesia, is a type of retrograde memory loss often associated with traumatic or stressful life events. While its prevalence in the medical literature is limited and it is understood to be a rare disorder with no changes noted on imaging studies, functional imaging analysis has identified impairments in a number of regions including the hippocampus, prefrontal cortex, and temporal lobe. The etiology of dissociative amnesia may include triggers such as stressful or traumatic events such as war, natural disasters, and physical assaults. Current studies reviewed indicate that disparities exist when managing distress-based amnesia when compared to those amnesias that present with organic etiologies. Methods: A case report, as well as a review of research and literature for dissociative amnesia, was conducted. Results: This case report describes a healthy middle-aged man who experienced retrograde autobiographical memory loss following a recent divorce and job loss. The patient presented to the emergency room after claiming to be attacked by strangers on the street. Radiographic imaging of the head revealed no acute changes. The patient suffered mostly from autobiographic memory loss, while semantic memories remained intact. During his admission to the medical unit, the patient had a suicide attempt via hanging and poor recall of the event. Management of comorbid anxiety and depression allowed progressive relearning of information. Recent history showed evidence of multiple traumatic events giving support that the main cause of dissociative amnesia and fugue state is due to psychogenic phenomena. Conclusion: While a rare occurrence, the presence of dissociative amnesia may present with a challenging clinical course including comorbid psychiatric and organic diagnoses. Ensuring a thorough diagnostic workup is critical to prevent disparities in managing distress-based amnesias.

In everyday life, we are often exposed to traumatic experiences which can lead to diagnosis of posttraumatic stress disorder (PTSD). In Diagnostic and Statistical Manual of Mental Disorders (DSM)-5 (2013), PTSD, as part of trauma and stressor-related disorders, is defined by diagnostic criteria which include: (1) Exposure to actual or threatened death which, in the new version of DSM-5, compared to DSM 4, includes not only directly experiencing or witnessing the traumatic event but also learning that the traumatic event occurred to a close friend or family member. Also, experiencing repeated or extreme exposure to aversive details of the traumatic event can be criteria for the diagnosis of PTSD: (2) Presence of intrusion symptoms associated with the traumatic event (memories, dreams, dissociative reactions, distress, and physiological reactions); (3) Persistent avoidance of stimuli associated with the traumatic event; (4) Negative alterations in cognition and mood, which include the inability to remember an important aspect(s) of the traumatic event(s) often due to dissociative amnesia. Also, distorted cognitions, feelings of detachment, and persistent inability to experience positive emotions are described, among other symptoms, within these criteria.

Network theory promises new ways for conceptualizing, methods for investigating, and state-of-the-art lines of research that will improve our knowledge of mental health in high-risk children and adolescents. This study constructed a symptom network to examine associations between a wide range of trauma symptoms in a sample of children and adolescents ( N = 270; Mage = 12.55 yrs, SD = 1.19; 67% = Female) who experienced different forms of abuse (i.e., sexual, physical, emotional and neglect). Symptom-pairs regularized partial correlations, with the Extended Bayesian Information Criterion Graphical Least Absolute Shrinkage and Selection Operator (EBICglasso), were computed to estimate the network structure and centrality measures of the TSCC-SF items. Results show sadness, dissociative amnesia, and sexual arousal to be the most central symptoms in the network, while suicidality was found to be the shortest pathway across all other symptoms (domains). By providing clinicians with specific symptoms to target in interventions, the network framework has the potential to guide and enhance the effectiveness of psychological therapies in high-risk populations.

THE RELATIONSHIP BETWEEN EPISODES OF DISSOCIATIVE AMNESIA, SYMPTOMOLOGY OF POST-TRAUMATIC STRESS DISORDER, AND CHILDHOOD SEXUAL ABUSE by Jennifer E. Perkins

The psychiatric disease of dissociative amnesia is described and illustrated with case reports. It is emphasized that dissociative amnesia has a stress or trauma-related etiology and that affected individuals, contrary to the still dominant clinical belief, are frequently more severely and enduringly affected. That means, most of them show severe retrograde amnesia for their biography, usually accompanied by changes in their personality and sometimes also by alterations in other cognitive and emotive domains. As many patients show the phenomenon of “la belle indifference”, their motivation for therapy or treatment of their amnesia is reduced. Patients also seem to a high degree to possess immature, unstable personality features. Nevertheless, a number of quite divergent, though largely not evidence-based, therapeutic approaches exist and are described. They are divided into (a) psychopharmacological and somatic treatments, (b) psychotherapeutic interventions, and (c) neuropsychological rehabilitation. Furthermore, detailed treatment strategies are provided.

This is a case study involving a female patient (NN) with complete loss of autobiographical memory and identity despite normal neurological assessment. To test the hypothesis that patients with dissociative amnesia (DA) possess the ability to covertly process facial identities they are unaware of, we conducted functional magnetic resonance imaging (fMRI) and assessed skin conductance responses (SCR) to (a) strangers, (b) celebrities, and (c) familiar faces not seen since the onset of DA. We also performed associative face-name memory tasks to test the patient's ability to learn and recall newly learned face-name pairs. Although NN did not recognize any of the faces of her friends and relatives, their images triggered a stronger involvement of the left fusiform gyrus, the bilateral hippocampus/amygdala region, the orbitofrontal cortex, the middle temporal regions, and the precuneus, along with higher SCR. During recollection of previously learned face-name pairs, NN (compared to healthy controls) demonstrated a weaker involvement of the hippocampus. Our findings suggest that, in DA, specific arousal systems remain capable of being activated by familiar faces outside of conscious awareness. The decreased activation observed in the hippocampus demonstrates that the functioning of memory-sensitive regions may be impaired by trauma.

SUMMARYContrary to the assertion of Paris, diverse indicators suggest that the diagnosis and treatment of dissociative identity disorder (DID) are resurgent rather than retreating. This commentary reviews the evidence that justifies the description of this condition as controversial, including research into dissociative amnesia. The potential harm that can result from a diagnosis of DID and risky treatment techniques, including hypnosis and abreaction, are described. It is suggested that this scientifically unproven and potentially harmful treatment model should be confronted and quelled and its diagnosis and treatment subjected to critical clinical review, including randomised controlled trials, as a matter of urgency. A plea is made for the Royal College of Psychiatrists to update its 1997 guidance document and for professional training to incorporate updated psychological and neurobiological research on human memory.DECLARATION OF INTERESTNone.

The purpose of this study was to examine the relationships between child sexual abuse (CSA) and components related to the CSA experience, betrayal, dissociative amnesia, and childhood autobiographical memory loss (CAML). The a priori hypothesis was that components related to the CSA experience (such as abuse characteristics, disclosure characteristics, betrayal, and dissociative amnesia) would act as direct risk factors/predictors for CAML. It was further hypothesized that betrayal and dissociative amnesia would each act as a mediator of the relationships between these components related to the CSA experience and CAML. This retrospective survey was conducted online, anonymously, and contained a sample of 297 participants who were adult survivors of CSA. Data was analyzed using logistic and linear regressions, as well as path analysis. The results of this study suggest that betrayal, dissociation, duration of abuse, and dissociative amnesia had direct effects on CAML, and age at onset of abuse had indirect effects on CAML through dissociative amnesia. These results have both research and clinical implications, in terms of both prevention and intervention with survivors of CSA.

There has been a growing interest in determining the antecedents of the significant associations between dissociative symptomatology and sleep. The aim of this study was to investigate the mediation effect of a tendency to elicit uncontrollable and excessive worry on the relationship between dissociation and poor sleep quality among non-shift working health staff. Eighty-five participants with a mean age of 31.19 ±7.14 (ranging from 18 to 54) involved within the study. The Penn State Worry Questionnaire (PSWQ), Dissociative Experiences Scale (DES), Pittsburgh Sleep Quality Index (PSQI) and a demographic questionnaire were administered. Mediation regression models were utilized to evaluate direct and indirect associations between worry, dissociation and sleep quality after controlling for age, gender, marital status, education, prior psychiatric disorders, familial loading and time spent watching TV series in a week. Regression models indicated that direct dose-response relationship between dissociative symptomatology and sleep quality was not statistically significant. However, indirect effects of dissociative symptoms though pathological worry were substantial. More specifically, we found that the DES total, absorption/imaginative involvement and dissociative amnesia had significant indirect effects on poor sleep quality via excessive worry as measured by the PSWQ. We concluded that dissociative symptoms are indirectly associated with sleep through negative repetitive thoughts such as pathological worry. Therefore, new generation therapeutic approaches particularly mindfulness therapy should be considered in the first-line treatments of sleep disturbance.

The diagnostic criteria set for posttraumatic stress disorder (PTSD) has gradually evolved from DSM-III, to DSM-IV, to DSM-5. Besides a broadening of the event criterion for PTSD, the symptom domain now involves many different brain circuits and types of symptoms, including: fear and anxiety; anger and aggression; negative cognition and mood; hypo-arousal; and dissociative symptoms. The dissociative subtype of PTSD in DSM-5 is defined by the presence of depersonalization or derealization. However, the diagnostic criteria for PTSD also include dissociative flashbacks and dissociative amnesia. If these symptoms were included in the definition of the dissociative type of PTSD in future editions of the manual, then most cases of PTSD would be dissociative in nature, and non-dissociative cases would be a minority subtype. There does not appear to be any sound conceptual reason for excluding amnesia and flashbacks from the criteria for dissociative PTSD.

Alcohol use disorder (AUD) frequently co-occurs with dissociative disorders and disorders with dissociative symptoms, suggesting a common neurobiological basis. It has been proposed that facilitated information processing under the influence of alcohol, resulting in the formation of dissociated memories, might be an important factor controlling alcohol use. Access to such memories is facilitated under the effect of alcohol, thus further reinforcing alcohol use. To interrogate possible mechanisms associated with these phenotypes, we used a mouse model of dissociative amnesia, combined with a high-alcohol preferring (HAP) model of AUD. Dissociated memory was induced by activation of hippocampal extrasynaptic GABA type A receptor delta subunits (GABAAR-δ), which control tonic inhibition and to which ethanol binds with high affinity. Increased ethanol preference was associated with increased propensity to form dissociated memories dependent on GABAAR-δ in the dorsal hippocampus (DH). Furthermore, the DH level of GABAAR-δ protein, but not mRNA, was increased in HAP mice, and was inversely correlated to the level of miR-365-3p, suggesting an miRNA-mediated post-transcriptional mechanism contributing to elevated GABAAR-δ. The observed changes of DH GABAAR-δ were associated with a severe reduction of excitatory projections stemming from GABAAR-δ-containing pyramidal neurons in the subiculum and terminating in the mammillary body. These results suggest that both molecular and circuit dysfunction involving hippocampal GABAAR-δ receptors might contribute to the co-occurrence of ethanol preference and dissociated information processing.

Zusammenfassung. Dissoziative Amnesie verläuft unter Umständen chronisch und kann zu lebenslanger Arbeitsunfähigkeit führen. Die Krankheit tritt gehäuft im Zusammenhang mit Migration auf und verläuft dann schwerer als in anderen Fällen. Sie ist im Grunde reversibel, d. h., der Abruf der Gedächtnisinhalte ist nur blockiert. Betroffen sind Patienten, die nicht verarbeitete Stress- und Traumaerlebnisse als Hintergrund haben und dann ein erneutes Stresserlebnis erfahren, welches zum dissoziativen Amnesiezustand führt. Es wird postuliert, dass in erster Linie Patienten betroffen sind, die im neuen Heimatland nicht ausreichend und ihrem Anspruch entsprechend Fuß fassen konnten. Mangelnde Sprachkenntnisse und eine nicht den Erwartungen entsprechende neue Arbeitssituation sind am ehesten als Gründe anzuführen.

Dissociative amnesia is defined as the retrograde memory loss in the absence of detectable structural brain damage caused by disassociation. Although the classification criteria of dissociative amnesia are based solely on the clinical image and do not refer to biological mechanisms, recent neurobiological studies using applied modern brain imaging techniques suggest that biological mechanisms play a crucial role in this disorder. Research on this phenomenon indicated that the main biological factors that trigger dissociative amnesia are an excessive arousal of the prefrontal cortex, hippocampus and amygdalae. The prefrontal cortex is a structure, which integrates internal and external experience. In the case of an excessive arousal, its functions become deregulated, which results in the inability to register the received stimuli. The hippocampus is a very flexible structure, yet highly vulnerable. As a result of the exposure to stress factors, stress hormones are secreted, which leads to an arousal of the hippocampus. Too rapid or too long secretion of stress hormones may lead to an excessive arousal of the hippocampus, which may then lead to hippocampus damage. Meanwhile, the amygdalae primarily regulate the intensity of an emotional reaction to a traumatic event, and hence affect the arousal of other brain structures. Yet, individual differences in the predisposition to the occurrence of dissociative amnesia might be an important factor in developing this disorder; such as the predisposition to overreact to distressing factors. As a result, current research indicates that neurobiological mechanisms at least partially explain mechanisms of dissociative amnesia. Nevertheless,despite the recent progress in the identification of the biological mechanisms underlying this disorder, the research cannot be considered as completed and further investigation is needed.

Acute amnestic syndromes are usually rare clinical events occurring in emergency situations. Etiological diagnosis can be challenging and underlying causes diverse. They can be transient and totally reversible, or accompanied by other neurological symptoms resulting in serious and irreversible brain damage. Pathophysiology of these syndromes mainly corresponds to structural or functional alteration of memory circuits, including those in the hippocampus. One of the most frequent forms is transient global amnesia (TGA), characterized by sudden onset of anterograde amnesia lasting less than 24 hours, in the absence of other neurological signs or symptoms. Another acute and transient memory disorder is transient epileptic amnesia (TEA), due to focal crisis activity. Stroke injuries occurring at strategic memory-related sites can also present as sudden episodes of amnesia. In addition to neurological etiologies, amnesia may be a symptom of a psychiatric disorder (dissociative amnesia). Traumatic brain injuries, autoimmune encephalitis and acute toxic metabolic disorders can also cause amnesia and should be included among the differential diagnoses. In this review, we summarize the most relevant clinical findings in acute amnestic syndromes, and discuss the different ancillary tests needed to establish a correct diagnosis and management as well the best treatment options. Relevant anatomical and pathophysiological aspects underlying these conditions will be also be presented.

This Chapter explores a case of a young male adult suspect reporting (psychogenic) amnesia during violent altercations with a female victim that he subsequently murdered. He reported blacking out while experiencing an adrenaline rush of fear, panic, and anger when the alleged victim provoked him with aggressive verbal insults. His defense of dissociative amnesia, arising from a traumatic or extremely emotional event, was discrepant with the hypervigilance produced from release of epinephrine (adrenaline) and its effects of enhancing his sensory and cognitive awareness of events preceding, during, and after the felony. The case study offers an example of looking inside obvious contingencies (i.e., intracontingencies) to discover biophysical functional relationships existing concurrently, sequentially, and contributing to motivational operations underlying the suspect’s actions. Analysis of the intracontingencies also illustrates how a behavioral forensic (systems) analysis can dispel fictional or reified explanations used in traditional forensic evaluations and add legitimate empirical support for the opinion of criminal responsibility.

OBJECTIVE Retrograde amnesia (RA) with a "transposition in the past" phenomenon has been rarely reported. Patients presenting disproportionate RA for all events over a defined period of time offer an opportunity to investigate the unclear relationship between autobiographical memory and the self, through the well-known self-memory system (SMS). METHOD We report the case of a 31-year-old right-handed woman who presented to the emergency department of our tertiary care center with an ongoing episode of RA. After resolution of the episode, she had a second transient episode of RA. An extensive neuropsychological battery was performed to assess her autobiographical and nonautobiographical memory during and after the 2 episodes of RA. She also had an 18F-Fluorodeoxyglucose Positron Emission Tomography (FDG PET) scan during the second RA episode. RESULTS During the 2 RA episodes, results showed lacunar amnesia for autobiographical as well as nonautobiographical memories of the time period between the present and the past 15 years, with preserved anterograde memory. Moreover, her memories before this lost period were more accurate than those after the 2 RA episodes. During the 2 RA episodes, our patient experienced a "transposition in the past" phenomenon. Statistical analysis of the PET scan demonstrated a significant hypometabolism within the right hippocampus. CONCLUSION The "transposition in the past" phenomenon illustrates the relationship between both episodic and autobiographical memories and the functioning of self, according to the SMS model. Moreover, this case suggests the involvement of the hippocampus in this phenomenon. (PsycINFO Database Record (c) 2020 APA, all rights reserved).

Post-Traumatic Stress Disorder (PTSD) is common among asylum-seekers and manifests with symptoms uniquely problematic to the United States asylum-seeking process. Chiefly, hyper-vigilance, avoidance behavior, dissociative amnesia and a tendency towards non-linear narratives hinder the articulation of an effective asylum claim. Moreover, the format and environmental circumstances of the asylum-seeking process further heighten these difficulties.

Memory disorders without a direct neural substrate still belong to the riddles in neuroscience. Although they were for a while dissociated from research and clinical arenas, risking becoming forgotten diseases, they sparked novel interests, paralleling the refinements in functional neuroimaging and neuropsychology. Although Endel Tulving has not fully embarked himself on exploring this field, he had published at least one article on functional amnesia (Schacter et al., 1982) and ignited a seminal article on amnesia with mixed etiology (Craver et al., 2014). Most importantly, the research of Endel Tulving has provided the researchers and clinicians in the field of dissociative or functional amnesia with the best framework for superiorly understanding these disorders through the lens of his evolving concept of episodic memory and five long term memory systems classification, which he developed and advanced. Herein we use the classification of long-term memory systems of Endel Tulving as well as his concepts and views on autonoetic consciousness, relationships between memory systems and relationship between episodic memory and emotion to describe six cases of dissociative amnesia that put a challenge for researchers and clinicians due to their atypicality. We then discuss their possible triggering and maintaining mechanisms, pointing to their clinical heterogeneity and multifaceted causally explanatory frameworks.

Psychological stress can impact memory systems in several different ways. In individuals with healthy defense and coping systems, stress results in the formation of negatively valenced memories whose ability to induce emotional and somatic distress subsides with time. Vulnerable individuals, however, go on to develop stress-related disorders such as post-traumatic stress disorder (PTSD) and suffer from significant memory abnormalities. Whether expressed as intrusive trauma memories, partial amnesia, or dissociative amnesia, such abnormalities are thought to be the core source of patients’ symptoms, which are often debilitating and implicate an entire socio-cognitive-affective spectrum. With this in mind, and focusing on stress-responsive hippocampal microcircuits, this article highlights recent advances in the neurobiology of memory that allow us to (1) isolate and visualize memory circuits, (2) change their activity using genetic tools and state-dependent manipulations, and (3) directly examine their impact on socio-affective circuits and global network connectivity. By integrating these approaches, we are now in a position to address important questions that have troubled psychiatry for a long time—questions such as are traumatic memories special, and why are stress effects on memory diverse. Furthering our fundamental understanding of memory in the framework of adaptive and maladaptive stress responses has the potential to boost the development of new treatments that can benefit patients suffering from psychological trauma.

More than a third of the population report childhood adversity, and these experiences are associated with an increased risk of clinical and subclinical psychosis. The reason why some people go on to develop mental health problems and others do not is a key question for study. It has been hypothesized that dissociative processes mediate the relationship between early adversity and psychosis. The current study assessed whether dissociation, and specifically depersonalization (one component of dissociation), plays a mediating role in the relationship between childhood maltreatment and both hallucination proneness and delusional ideation. The study used a cross-sectional design and recruited a student sample to assess these relationships in a nonclinical group. Dissociation mediated the relationship between early maltreatment and both hallucination proneness and delusional ideation. In terms of specific dissociative processes, depersonalization did not mediate hallucination proneness or delusional ideation. Absorption mediated hallucination proneness; dissociative amnesia (negatively) and absorption mediated delusional ideation. It is likely that dissociation interferes with the encoding of traumatic information in nonclinical as well as clinical groups and in certain ways. Absorption may be particularly relevant. For some people, traumatic memories may intrude into conscious awareness in adulthood as psychotic-type experience.

Introduction Psychogenic nonepileptic seizures (PNES) and functional movement disorders (FMD) seem to represent the two ends of a continuum where different clinical phenotypes represent the manifestation of a common framework, involving dissociation. The aim of the present study was to assess dissociation and its subcomponents through the Mirror Gazing Test (MGT) in these functional neurological disorders (FNDs). Materials and methods Eleven patients with PNES, 17 with FMD, and 18 healthy controls (HCs) underwent a 10-minute MGT and completed the Strange Face Questionnaire (SFQ), an ad-hoc questionnaire assessing the sensations and perceptions they had looking in the mirror, and a short version of the Clinician-Administered Dissociative States Scale (CADSS). Results Patients with PNES, FMD, and HCs did not differ at the total score of the SFQ. Patients with PNES scored higher than HCs at the SFQ-subscale Dissociative Identity/Compartmentalization, at the CADSS Total Score and at its subscale Dissociative Amnesia, while patients with FMD scored higher than HCs at the CADSS subscale Depersonalization. Conclusions Patients with FMD reported more sensations falling in the detachment facet of dissociation, while patients with PNES in the compartmentalization one. We hypothesized that both facets of dissociation might be important pathophysiological processes for PNES and FMD and that different instruments (self-report clinical scales vs experimental tasks) might be able to detect different facets in different populations because they assess, respectively, “trait” and “state” dissociation.

The interrelationships between the symptom domains of dissociation, such as the loss of continuity in subjective experience, the inability to access personal information, and the distortions about the perception of self and the environment, need to be better understood. In the current study, 2274 adults from Italy completed the Dissociative Experiences Scale-II (DES-II), and their responses were examined within a correlation network analysis framework. Fifteen dissociative experiences showed the strongest associations with the other dissociative experiences included in the measure, and they were selected for further analysis. A partial correlation network was calculated to reveal the associations between such experiences, and a community detection analysis was used to explore whether they formed distinct clusters in the network. Subsequently, a Bayesian network was estimated to examine the direction of the associations among the dissociative experiences, and a directed acyclic graph (DAG) was generated to estimate a potentially causal model of their relationships. The community detection analysis revealed three clusters of experiences that were conceptualized in terms of trance, experiential disconnectedness, and segregated behaviors. Dissociative amnesia was a common denominator of all the three clusters. The analysis of the DAG further suggested that dissociation can be conceptualized as a network in which dissociative experiences are layered into groups of symptoms that interact among them. Cognizance of the configuration and interactions among the dissociative domains and their related symptoms may be critical for better understanding the internal logic behind the dissociative processes and for addressing them effectively in clinical practice.

Dissociative disorders are heterogeneous with respect to clinical features, course, antecedents and treatment. Among them, dissociative amnesia occupies a special place, at times encroaching on the borders between neurology and psychiatry. Herein we describe dissociative amnesia according to the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders and outline data on its epidemiology, neurobiology, neuroimaging, clinical and differential diagnosis, neuropsychology, comorbidities, prognosis, treatment and rehabilitation. To enable a neuroscientific approach to its diagnosis, we outline the memory division into short-term and long-term memory, elaborating on the content-based classification of the long-term memory systems. Dissociative amnesia most commonly manifests itself in its retrograde variants (including dissociative fugue), but anterograde variants can also occur. Dissociative amnesia may be overlooked when it occurs on a background of mixed antecedents and comorbidities. Comprehensive neuropsychological assessment – including tests tapping on all memory systems and symptom validity tests – is still insufficiently integrated in the clinical practice, although it could aid in securing an accurate diagnosis, especially in cases with mixed antecedents or concomitant forensic or litigation backgrounds. Presently there is a paucity of treatment and rehabilitation methods for dissociative amnesia. Developing research evidence-based consensus guidelines for diagnosis and treatment is an essential goal. This review contains 6 figures, 7 tables, and 60 references. Key Words : consciousness, episodic-autobiographical memory, mnestic block syndrome, neuroimaging, serial-parallel-independent model, personal identity, stressful life events, malingering, trauma, feigning

Objective Few studies have assessed malingering in individuals with complex trauma and dissociation. This is concerning because these individuals' severe and ranging symptoms are associated with elevations on some, but not all, validity scales that detect symptom exaggeration. Dissociative individuals may experience dissociative amnesia, yet no study to date has examined how to distinguish clinical from malingered amnesia with dissociative samples. The current study examined whether the Test of Memory Malingering (TOMM) can accurately distinguish patients with clinically diagnosed dissociative identity disorder (DID) and simulators coached to imitate DID. Method Utility statistics classify individuals' TOMM scores as suggestive of clinical or simulated DID. TOMM scores from 31 patients diagnosed with DID via structured interviews were compared to those of 74 coached DID simulators. Results Discriminant analyses found scores from TOMM Trials 1 and 2 and total TOMM scores accurately classified clinical or simulated DID group status. In addition, TOMM Trial 1 demonstrated high specificity (87%) and positive predictive power (94%), as well as moderate sensitivity (78%), negative predictive power (63%), and overall diagnostic power (81%). Despite exposure to DID-specific information, simulators were not able to accurately feign the DID group's TOMM scores, which is inconsistent with the iatrogenic/sociocultural model of DID. Conclusion The TOMM shows promise as useful in clinical and forensic contexts to detect memory malingering among DID simulators without sacrificing specificity. Accurate distinction between genuine and feigned complex trauma-related symptoms, including dissociative memory, is integral to the accurate diagnosis of traumatized populations. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Introduction: Autobiographic memory allows shaping self identity over the time. Its main function is storing of information about oneself, which allows consolidating one’s own identity and provides the sense of stability. Its disfunction might be organic or functional in origin and may often be a manifestation of a serious disease. Aim: The purpose of the study was to compare cognitive functioning in the scope of autobiographical memory between a female patient with diagnosed dissociative amnesia and five female patients with diagnosed recurrent depressive disorders. Method: The following tools were used in the study: episodic memory test and MMPI-2 questionnaire (Gough Dissimulation Index). Results: The general results achieved by patient diagnosed with dissociative amnesia in the individual tasks used to examine autobiographical memory are comparable with the results achieved by the patients with diagnosed depression. However, the results suggest the presence of qualitative differences related to the type of remembered information and location of the events on the life line.

Objectives Malpractice cases involving electroconvulsive therapy (ECT) are rare. Even rarer are those malpractice cases alleging ECT-related brain damage. The few cases of ECT malpractice lawsuits are not described in the medical literature in detail. Methods We provide a detailed account of a case of a patient and subsequent alleged ECT-related malpractice. The details of the case were collated using the handwritten notes of one of the authors who was present at the trial and the pretrial documents of discovery that were entered into evidence. Results The plaintiff alleged complete autobiographical amnesia after ECT, supposedly as a result of ECT-related brain damage. The defense was aided by the presence of extensive neurological examination and brain imaging both before and after ECT. The defense team also offered to the jury the concept of "dissociative amnesia" as an alternative explanation for the plaintiff's memory complaints. The case went to trial and was successfully defended. Discussion Electroconvulsive therapy malpractice cases alleging brain damage can be successfully defended, and the successful defense is aided by adequate documentation before, during, and after ECT. Conclusions Malpractice cases, especially if they are baseless, can occur unpredictably, but they can be defended if the medical documentation is thorough.

Objective:The death of a loved one is one of the most stressful events of life, and such stress affects the physical and psychological well-being of the bereaved. Dissociative amnesia is characterized by an inability to recall important autobiographical information. Dissociative amnesia in the bereaved who have lost a loved one to cancer has not been previously reported. We discuss herein the case of a patient who developed dissociative amnesia the day after the death of here beloved husband.Method:A 38-year-old woman was referred for psychiatric consultation because of restlessness and abnormal behavior. Her 44-year-old husband had died of pancreatic cancer the day before the consultation. On the day of the death, she looked upset and began to hyperventilate. The next day, she behaved as if the deceased were still alive, which embarrassed her family. At her initial psychiatric consultation, she talked and behaved as if her husband was still alive and in the hospital.Results:Her psychiatric features fulfilled the DSM–V criteria for dissociative amnesia. The death of her husband had been very traumatic for her and was considered to have been one of the causes of this dissociation.Significance of Results:This report adds to the list of psychiatric symptoms in the bereaved who have lost a loved one to cancer. In an oncology setting, we should consider the impact of death, the concomitant defense mechanisms, and the background of the families.

Dissociative experiences are thought to occur acutely (e.g., during or immediately following trauma) or chronically and are considered to reduce the subjective distress accompanying stressful events. Growing evidence is consistent with a model that distinguishes between two qualitatively different types of phenomena—“compartmentalization” and “detachment.” Compartmentalization involves a deficit in the ability to deliberately control processes or actions that would normally be amendable to such control (e.g., amnesia and dissociative identities). Detachment refers to an experienced state of disconnection from the self or the environment (e.g., depersonalization, derealization, and numbing). In the present contribution, we discuss both detachment and compartmentalization phenomena. In addition, we discuss both dissociation as an acute response to trauma and persistent dissociation in the form of the most severe and chronic of the dissociative disorders, dissociative identity disorder (DID). We attend to the burgeoning empirical literature on memory processing and dissociation given the central role of these cognitive operations in the development and maintenance of the dissociative disorders, and more broadly, posttraumatic symptomatology. We end with a more general appeal for more transdiagnostic studies of dissociative phenomena, both in the areas of detachment and compartmentalization, emphasizing that dissociative disorders are not a category of mysterious diagnoses that need to be understood outside of well-known cognitive operations. Keywords: dissociation; dissociative identity disorder (DID); trauma; detachment; compartmentalization; dissociative amnesia

Objective The purpose of this study was to examine the co-occurrence of posttraumatic stress disorder (PTSD) and dissociation in a clinical sample of trauma-exposed adolescents, first evaluating evidence for the depersonalization/derealization dissociative subtype of PTSD as defined by the DSM-5, and then examining a broader set of dissociation symptoms. Method A sample of treatment-seeking, trauma-exposed adolescents ages 12 to 16 (N=3,081) from the National Child Traumatic Stress Network Core Data Set was used to meet the study objectives. Two models of PTSD/dissociation co-occurrence were estimated using latent class analysis, one with two dissociation symptoms and the other with ten dissociation symptoms. After model selection, groups within each model were compared on demographics, trauma characteristics, and psychopathology. Results Model A, the depersonalization/derealization model, had five classes: (1) dissociative subtype/high PTSD; (2) high PTSD; (3) anxious arousal; (4) dysphoric arousal; and (5) a low symptom/reference class. Model B, the expanded dissociation model, identified an additional class characterized by dissociative amnesia and detached arousal. Conclusion These two models provide new information about the specific ways PTSD and dissociation co-occur and illuminate some differences between adult and adolescent trauma symptom expression. A dissociative subtype of PTSD can be distinguished from PTSD alone among adolescents, but assessing a wider range of dissociative symptoms is needed in order to fully characterize adolescent traumatic stress responses.

Autobiographical amnesia is found in patients with focal or diffuse brain damage ("organic amnesia"), but also without overt brain damage (at least when measured with conventional brain imaging methods). This last condition is usually named dissociative amnesia at present, and was originally described as hysteria. Classically and traditionally, dissociative amnesia is seen as a disorder that causes retrograde amnesia in the autobiographical domain in the aftermath of incidents of major psychological stress or trauma. In the present study one of the probably largest published collections of patients (28) with psychogenically caused autobiographical amnesia, who were assessed with comprehensive neuropsychological tests, will be described and documented in order to identify variables which are central for the occurrence of dissociative amnesia. The presented cases demonstrate that autobiographical amnesia without direct brain damage can have very mixed clinical presentations, causes and consequences. The described cases of psychogenic amnesia are clustered according to a number of manifestations and features, which include a reduced effort to perform cognitively at a normal level, a forensic background, anterograde (instead of retrograde) autobiographical amnesia, the fugue condition, concurrent somatic diseases, and their appearance in childhood and youth. It is concluded that autobiographical amnesia of a psychogenic origin may occur within a variety of symptom pictures. For all patients, it probably serves a protective function by offering them a mechanism to exit a life situation which appears to them unmanageable or adverse.

This study examined the association between exposure to domestic violence and dissociative symptoms. A sample of 68 Israeli opiate use disorder patients in recovery, 80 battered Arab Israeli women, and 103 respondents from a community sample participated in structured interviews that included the Dissociative Disorders Interview Schedule (DDIS), the Dissociative Trance Disorder Interview Schedule (DTDIS), and the Dissociative Experiences Scale (DES). As predicted, community participants reported significantly less exposure to traumatizing events and lower levels of dissociative psychopathology than individuals sampled from specialized treatment centers. In all, 91% of battered female participants were taxon-positive for dissociative disorder with 1 of every 2 respondents reporting symptoms corresponding to dissociative amnesia and depersonalization disorder, suggesting that this group may be particularly vulnerable to dissociative psychopathology. Extrasensory and paranormal experiences (ESP) and dissociative trance disorder experiences were strongly related to dissociative experiences and features of dissociative identity disorder (DID). These statistical associations suggest that dissociative disorders and ESP/trance experiences may share an underlying construct. Further research is needed on trauma and dissociation among female victims of domestic abuse in patriarchal, collectivist societies, particularly in the Arab world.

Dissociative amnesia is characterized by an inability to retrieve information already saved in memories. 5-HT has some role in neural regulatory control and may be related to the recovery from dissociative amnesia. To examine the role of 5-HT 1A receptors in the recovery from dissociative amnesia, we performed two positron emission tomography (PET) scans on a 30-year-old patient of dissociative amnesia using [ 11 C]WAY-100635, the first at amnesic state, and the second at the time he had recovered. Exploratory voxel-based analysis (VBA) was performed using SPM software. 5-HT 1A BP ND images were compared between the patient at amnesic and recovery states and healthy subjects (14 males, mean age 29.8±6.45) with Jack-knife analysis. 5-HT 1A receptor bindings of the patient at the recovery state were significantly higher than those of healthy subjects in the right superior and middle frontal cortex, left inferior frontal and orbitofrontal cortex and bilateral inferior temporal cortex. The increase in BP ND values of recovery state was beyond 10% of those of amnesia state in these regions except in the right superior frontal cortex. We considered that neural regulatory control by the increase of 5-HT 1A receptors in cortical regions played a role in the recovery from dissociative amnesia.

Tradicionalmente, a questão da identidade pessoal é considerada a questão a respeito ao que faz uma pessoa ser a mesma ao longo do tempo. Recentemente, porém, atenção à experiência fenomênica trouxe uma nova perspectiva ao debate. À luz dessa mudança de perspectiva, Klein sugere que indivíduos com amnésia episódica retrógrada retêm uma noção de quem são, além de terem senso de continuidade. Ele, portanto, argumenta que a memória episódica não é necessária para se ter sensação de si mesmo diacrônica. Desafiamos a conclusão de Klein apontando que existem tipos mais extremos de amnésia—amnésia psicogênica—que parecem problemáticos à sua proposta de que o senso de continuidade é suficiente para se ter sensação de si mesmo diacrônico. Esse é o caso, porque alguns exemplos de amnésia psicogênica são casos de amnésia dissociativa, que mostram que ter uma experiência consciente contínua não resolve o problema.

Although the issue of dissociative amnesia in adult survivors of child sexual abuse has been contentious, many research studies have shown that there is a subset of child sexual abuse survivors who have forgotten their abuse and later remembered it. Child sexual abuse survivors with dissociative amnesia histories have different formative and therapeutic issues than survivors of child sexual abuse who have had continuous memory of their abuse. This article first discusses those differences in terms of the moderating risk factors for developing dissociative amnesia (e.g., age, ethnicity, gender, etc.) and then mediating risk factors (e.g., social support, trait dissociativity, etc.). The differences between the two types of survivors are then explored in terms of treatment issues.

Present neuroimaging findings suggest two subtypes of trauma response, one characterized predominantly by hyperarousal and intrusions, and the other primarily by dissociative symptoms. The neural underpinnings of these two subtypes need to be better defined. Fourteen women with childhood abuse and the current diagnosis of dissociative amnesia or dissociative identity disorder but without posttraumatic stress disorder (PTSD) and 14 matched healthy comparison subjects underwent functional magnetic resonance imaging (fMRI) while finding their way in a virtual maze. The virtual maze presented a first-person view (egocentric), lacked any topographical landmarks and could be learned only by using egocentric navigation strategies. Participants with dissociative disorders (DD) were not impaired in learning the virtual maze when compared with controls, and showed a similar, although weaker, pattern of activity changes during egocentric learning when compared with controls. Stronger dissociative disorder severity of participants with DD was related to better virtual maze performance, and to stronger activity increase within the cingulate gyrus and the precuneus. Our results add to the present knowledge of preserved attentional and visuospatial mnemonic functioning in individuals with DD.

The rationale, research literature, and proposed changes to the dissociative disorders and conversion disorder in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) are presented. Dissociative identity disorder will include reference to possession as well as identity fragmentation, to make the disorder more applicable to culturally diverse situations. Dissociative amnesia will include dissociative fugue as a subtype, since fugue is a rare disorder that always involves amnesia but does not always include confused wandering or loss of personality identity. Depersonalization disorder will include derealization as well, since the two often co-occur. A dissociative subtype of posttraumatic stress disorder (PTSD), defined by the presence of depersonalization or derealization in addition to other PTSD symptoms, is being recommended, based upon new epidemiological and neuroimaging evidence linking it to an early life history of adversity and a combination of frontal activation and limbic inhibition. Conversion disorder (functional neurological symptom disorder) will likely remain with the somatic symptom disorders, despite considerable dissociative comorbidity.

Objective: To examine the impact of correlates of trauma on the appropriateness for group therapy (GT) in 60 participants based on the similarity of the exclusion criteria for GT to the features of posttraumatic disturbances and borderline personality. Method: We assessed the correlates of trauma (PTSD, complex PTSD, dissociation), features of BPD, psychopathological distress and the readiness for GT. Results: There were inverse correlations between the motivation for GT and multiple symptoms, as well as weak associations with the correlates of trauma. Pessimistic expectations of GT and dissociative amnesia were linked to worse outcomes, while phobic anxiety predicted continuation of therapy. Conclusion: Dissociative amnesia and the expectation of GT are potential targets for pre-group preparation for trauma-related disorders.