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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.

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.

Background. Natural human psychological phenomena, such as depression, anxiety, delusions, hallucinations and dementia, are documented across the ages in both fictional and non-fictional works. We asked whether ‘dissociative amnesia’ was similarly documented throughout history.Method. We advertised in three languages on more than 30 Internet web sites and discussion groups, and also in print, offering US$1000 to the first individual who could find a case of dissociative amnesia for a traumatic event in any fictional or non-fictional work before 1800.Results. Our search generated more than 100 replies; it produced numerous examples of ordinary forgetfulness, infantile amnesia and biological amnesia throughout works in English, other European languages, Latin, Greek, Arabic, Sanskrit and Chinese before 1800, but no descriptions of individuals showing dissociative amnesia for a traumatic event.Conclusions. If dissociative amnesia for traumatic events were a natural psychological phenomenon, an innate capacity of the brain, then throughout the millennia before 1800, individuals would presumably have witnessed such cases and portrayed them in non-fictional works or in fictional characters. The absence of cases before 1800 cannot reasonably be explained by arguing that our ancestors understood or described psychological phenomena so differently as to make them unrecognizable to modern readers because spontaneous complete amnesia for a major traumatic event, in an otherwise lucid individual, is so graphic that it would be recognizable even through a dense veil of cultural interpretation. Therefore, it appears that dissociative amnesia is not a natural neuropsychological phenomenon, but instead a culture-bound syndrome, dating from the nineteenth century.

IntroductionWe present the case report of a 21-year-old Chinese female, who was brought to the emergency department. We open the debate between the operative criteria stablished by DSM-5 of the clinical entity dissociative amnesia and Shenjing Shuairuo - the Chinese “culture-bound syndrome”.ObjectivesTo expose the relevance of the cultural formulation in the clinical evaluation of patients with a different non-Western culture in Psychiatry.AimsThe Shenjing Shuairuo syndrome (“nervous system weakness”) was originally descripted in China, it has a gradual onset, usually after a stressful event. It involves a minimum 3 of 5 symptoms group: weakness, emotions, excitement, neurological pain and sleep. This complex group of symptoms overlap with dissociative syndrome such as dissociative amnesia.Methods/resultsThe cultural formulation interview (CFI) was used for the diagnostic and subsequent treatment of dissociative amnesia with fugue in a different culture patient who met the clinical criteria of this two divergent clinic entities.ConclusionsIn our clinical practice, we will deal with different culture patients, who could present common clinical entities or with the so-called “culture-bound syndromes”. The cultural formulation of the clinical cases will help the clinicians to diagnose and have better treatment's options in clinical manifestations do not correspond to the conventional entities included in mostly Western-based nomenclatures.Disclosure of interestThe authors have not supplied their declaration of competing interest.

IntroductionIn the last decade, accumulating evidence has been produced on the role of dissociation in Obsessive Compulsive Disorder (OCD). Understanding which dissociation dimensions are specific to OCD could suggest the integration of therapeutic strategies for dissociation in the treatment of patients with OCD.ObjectivesThe current study explored the role of dissociation in a sample of patients with OCD, patients with anxiety disorders and healthy controls with the aim to understand which dissociation dimensions could be specific to OCD.MethodOne hundred seventy-one participants were included in the study (56% females, mean age = 35.96, SD = 12.61), of which 52 were patients with primary OCD, 59 were patients with Anxiety Disorders (AD), and 60 were healthy controls. The Dissociative Experiences Scale (DES), Beck Depression Inventory-II (BDI-II), Beck Anxiety Inventory (BAI), Yale-Brown Obsessive Compulsive Scale (Y-BOCS) were administered.ResultsPatients with OCD had significantly higher dissociative amnesia symptoms than patients with AD and health controls (F = 6.08, P < 0.01) and higher depersonalization/derealization symptoms than healthy controls but not than patients with AD. Patients with OCD did not report significantly higher dissociative absorption than healthy controls and patients with AD.ConclusionsStrategies targeting dissociative amnesia and depersonalization/derealization symptoms in OCD are discussed. Future studies should examine which OCD subtypes are more strongly associated to dissociation dimensions.Disclosure of interestThe authors have not supplied their declaration of competing interest.

Introduction Episodic-autobiographical memory (EAM) is the highest ontogenetic human achievement and is defined as the conjunction of subjective time, autonoetic consciousness and the experiencing self. The EAM system is more susceptible to insults than other memory systems and is predominantly affected in amnesic disorders. Dissociative amnesia is triggered by psychological stress and usually presents with retrograde memory impairment in the EAM domain. Objectives This work's objectives are establishing greater recognition of the changes in the area of personality dimensions, self and autonoetic consciousness, accompanying dissociative amnesia. Aims We review data from own patients with dissociative amnesia or fugue Methods Patients were investigated medically, neuropsychologically and neuroradiologically. Results We found impairments of self and self-referential processing in patients with dissociative amnesia, such as profound loss of personal identity, decreased ability for self-reflection and self projection and anomalous self-face processing. We also identified changes in personality dimensions involving affectivity, perception, cognition (e.g. social cognition) and behavior. Conclusions The observed changes in self and autonoetic consciousness may represent a consequence of amnesia. Studies indicate a right hemispheric bias for higher forms of self awareness. In retrograde dissociative amnesia, we found a hypometabolism in right fronto-temporal areas, suggesting a defective synchronization during retrieval between processing of affectively-loaded personal events and fact-based processing. This synchronization abnormality in our opinion not only leads to a memory blockade, but also to a shrinkage of self and loss of autonoetic consciousness in dissociative amnesic conditions.

Introduction A growing interest is raising on the issue of prisoners’ mental health (Birmingham, 2003). Scholars have mainly addressed the psychiatric and personality disorders among prisoners (Fazel & Seewald, 2012) and other authors have stressed the importance to highlight the role of psychopathological and specifically dissociative symptoms (Ruiz, Poythress, Lilienfeld, & Douglas, 2008). Objectives This study sought to examine the presence and the severity of dissociative symptoms, as well as their relationships with psychopathology. Aims We analyze three different kinds of dissociative experiences (dissociative amnesia, depersonalization/derealization, and absorption in imaginative processes) in order to investigate potential links between them and a broad range of psychopathological symptoms. Methods A sample of 28 male inmates (mean age=41.04) was assessed by administering the Dissociative Experiences Scale-II (DES-II; Carlson & Putnam, 1993), and the 53-items Brief Symptom Inventory (BSI; Derogatis, 1975, 1983) in order to assess the current psychopathological distress with a total score and 9 subscales. Results The mean level of dissociation (DES-II, total score= 17.94) was in line with the normative data for clinical samples, as previous studies have already shown (Snow, Beckman, & Brack, 1996). Several positive correlations among the three types of dissociative experiences and all the different domains of psychopathological symptoms are explored in depth. Conclusions Dissociation and psychopathology seems to be much prevalent among prisoners, as well as strongly related. Further studies should aim to clarify the direction of this link, and try to address the question as to whether they are more personally-rooted or situationally-determined.

Introduction Despite suggestions that chronic stress is involved in the pathogeny of dementias, no systematic studies investigated the possibility of a link between dissociative amnesia and neurodegenerative dementias. Methods We analyzed data from over a dozen patients with functional dissociative amnesia, whom we investigated with neuropsychological methods, structural and functional neuroimaging. We followed prospectively approximately half of these patients for more than a decade. Results We evidenced in a substantial sample of patients with dissociative amnesia with preponderant retrograde memory impairments a hypometabolism during resting state in the right temporo-frontal region, with a decrease in the infero-lateral prefrontal cortex. Additional preliminary data from DTI suggested a decreased integrity of long distance fiber tracts important for conscious mnemonic processing. We found a chronic course of the memory impairments in a substantial number of patients with dissociative amnesic conditions. In some chronic cases of dissociative amnesia we noted a fairly stable course, while in other cases we observed a progressive global cognitive deterioration. Discussion These findings point to a non-homogenous course of dissociative amnesia. Conclusion The search for a link between dissociative amnesic conditions and dementia should take into consideration multiple variables, such as the age at the onset of trauma, gender, the recurrence, type and severity of trauma, the presence of psychiatric and medical co-morbidity, pre-morbid personality characteristics (e.g. neuroticism), genetic polymorphisms, educational and occupational attainment, cognitive reserve and the progression of metabolic and microstructural brain changes.

In clinical practice dissociative experiences are common and reports that range from positive experiences in healthy subjects to severely stressful occurrences linked to disabling mental disorders (see more in pathological dissociation) . For long now two problems subsist (1) the nosology of dissociative experiences is at odds (as in DSM-V and ICD-10) and (2) its conceptualization doesn't make justice to patients array of experiences (Simeon, 2008). The gap is presented at (1) the phenomenological level where one symbol stands for fundamentally different experiences but also at the (2) epistemological level as they are still portrayed as a separation of mental functions . This understanding ignores (1) empirical research (being depersonalization disorder fundamentally different from dissociative amnesia in the type of mental functions and in presentation), (2) neuroscientific evidences (mental faculties are heterogeneous in nature and allegedly unrelated when it comes to their brain representation) and (3) conceptual investigation. The hypothesis behind the building such checklist detail and theory is also supported in conceptual and empirical research on anomalous (1) narratives (see appendix 2 for detailed review), (2) perceptual experiences (see appendix 3 for detailed review) and (3) Self-experiences (see appendix 4 for detailed review). The model has 2 fundamental propositions: 1. Dissociation, instead of splitting memory, identity, perception, emotions and will, is the separation of singular (1) levels of Self-experience and/or (2) perceptual moments and 2. That experiences should be divided in 6 domains of inquiry including: corporal experiences, embodied self-experience, embodied world-experience; embodied meaning; cognitive reasoning and autobiographical portrayal

Introduction Across various cultures, dissociative amnesia is triggered by psychological stress or trauma. Its hallmark is a severe (usually retrograde) memory impairment, occurring without evidence of significant brain damage (as detected by conventional structural brain imaging). In a substantial number of cases, the memory impairment follows a chronic course. Sometimes dissociative amnesia occurs on a background of a personality disorder (narcissistic or borderline). Other times, amnesia itself triggers long lasting personality changes. Objectives This work’s objectives are establishing greater recognition among health care providers of the spectrum of the personality changes that may accompany chronic forms of dissociative amnesia. Aims We review data from own patients with chronic forms of dissociative amnesia. Methods Patients were investigated medically, psychiatrically, neuropsychologically and and neuroradiologically. Results Changes in personality dimensions occur after the onset of amnesia. These may involve affectivity, perception (e.g. impaired self face or face-emotion processing), cognition (e.g. social cognition) and behaviour (e.g. changing in eating, smoking, drinking or working habits). Conclusions The observed personality changes may represent a consequence of amnesia. Functional imaging studies show metabolic changes in dissociative amnesia in brain areas involved in conscious mnemonic processing. Several structures engaged in processing within episodic-autobiographical memory system were also implicated in self and reward-related processing. Alternatively, the personality changes may be viewed as being pivotal in the development and maintenance of dissociative amnesia; this personality shift may subsequently lead to enduring changes in ways of cognitive processing, self-processing, perception and affect.

Introduction Dissociative amnesia is triggered by psychological stress or trauma. Its hallmark is a severe (usually retrograde) memory impairment within episodic-autobiographical domain, occurring without evidence of significant brain damage on conventional structural brain imaging. Objectives This work’s objectives are establishing greater recognition of possible relations between memory performance and social cognition in patients with dissociative amnesia. Aims We review data on social cognition (affective and cognitive theory of mind, simulation, empathy, social judgment, moral judgment) from our own patients with dissociative amnesia. Methods Patients were investigated medically, psychiatrically and with neuropsychological and neuroimaging methods. Results Patients with dissociative amnesia show variable degrees of impairments of components of social cognition, based on their comorbid conditions (e.g. concurrent clinical or subclinical depression), types of memory impairments (e.g. extent of retrograde amnesia, presence of autobiographical semantic deficits), pattern of brain metabolic changes, personality characteristics, neuropsychological profile (performance on executive functions or emotional processing) and testing paradigms. Conclusions The impairment in dissociative amnesia seems to go beyond the conscious mnemonic deficit, encompassing various aspects of social information processing. Knowledge about the pattern of metabolic and micro-structural brain changes in patients with dissociative amnesia as well as a fine-grained analysis of the neural correlates of various aspects of social cognition might provide an understanding of when and how episodic-autobiographical memory contributes to social cognition. As several studies emphasized, some structures involved in mnemonic processing may also play a role in social perception, cognition and behavioural regulation, including future-minded choice behaviour.

Introduction Dissociative disorders are characterized by disturbances of integration of memory, perception, consciousness or identity. They were linked to psychological stress or trauma across various cultures. Dissociative amnesia and fugue, depersonalization disorder, dissociative identity disorder and dissociative disorder not otherwise specified (such as Ganser syndrome) belong to dissociative disorders in DSM-IV-TR. In contrast to DSM-IV-TR, ICD-10 also subsumes the conversion disorder under the category of dissociative (conversion) disorders. Objectives This work's objective is establishing greater recognition of the neural correlates of dissociative disorders. Aims We review neuroimaging data pertaining to dissociative amnesia and fugue, depersonalization disorder, dissociative identity disorder (multiple personality disorder), Ganser syndrome and various forms of conversion disorder, which were obtained with functional and structural imaging techniques, including diffusion tensor imaging or magnetization transfer ratio measurements. Methods In addition to own imaging data from patients with dissociative amnesia and fugue, a comprehensive review of the scientific literature on the neuroimaging of dissociative disorders was performed. Results Neuroimaging research data point to metabolic and sometimes even structural brain alterations in dissociative disorders, involving regions that are agreed upon to play roles in mnemonic processing, self referential processing (including body schema), perception, consciousness and/or emotional processing. Conclusions The use of functional and newer structural brain imaging methods has improved and will continue to further our understanding of the neural correlates of dissociative disorders and has provided evidence that environmentally-driven (stress-related) alterations of cognition, identity, body schema, perception, affectivity and behavior are accompanied by metabolic and even structural brain changes.

Dissociative memory disturbances characterize dissociative disorders (such as dissociative amnesia, dissociative fugue, dissociative identity disorder, Ganser syndrome) and certain anxiety disorders (post-traumatic stress disorder). Across various cultures, they are recognized to be precipitated by psychological stress. In immigrant populations, stressful experiences arising during migration and acculturation could lead to somatic and psychiatric symptoms (including dissociative ones). A delayed onset of these symptoms - that at times occurs - may reflect a kindling sensitization or an incubation effect.ObjectivesWe review four patients who developed Dissociative Disorders (Dissociative Amnesia and Ganser Syndrome) on a background of stresses related to immigration.MethodsPatients were investigated medically, psychiatrically and neuropsychologically and in part neuroradiologically.ResultsPatients were adult males with Eastern or Central European background and no known previous psychiatric or medical illnesses. They immigrated to Germany or Canada and encountered several difficulties in the process of migration or adaptation to the new country. All developed severe psychiatric dissociative symptoms after objectively minor stresses, which occurred several years after their immigration to the new country of residence. Despite adequate treatment, their symptoms followed a chronic course. The patients’ neuropsychological profiles shared similarities, such as executive functioning deficits (e.g. limited cognitive flexibility) and impairments of emotional processing in addition to severe autobiographical amnesia.ConclusionsWe propose that stresses related to immigration and acculturation could trigger dissociative memory disorders in immigrants via a dysregulation of the hormonal stress responses, which is mediated by individual characteristics (cognitive flexibility, emotional processing abilities, language competence and cultural affiliations).

Aims:Since the end of 19th century, mental health professionals have noticed that individuals who have experienced traumatic situations often present dissociative symptoms, such as amnesia or fugue states. Dissociation is a defensive mechanism that allows an individual to separate from conscience the psychological distress produced by the trauma. Our aim was to remark the association between Post-traumatic Stress Disorder (PTSD) and long-term dissociative disorders through the study of a clinical case.Method:A clinical case was followed and reviewed to illustrate this relationship.Results:Ten years ago, a 49-year-old man was diagnosed of PTSD after having witnessed several colleagues burnt in a tragic accident at work and having helped the emergency fire brigade to rescue other victims. His symptoms required treatment with antidepressants and psychotherapy, and fully remitted after one year. Nevertheless, during the last year, he has presented two dissociative amnesia episodes lasting for three days each, which were examined by a neurology service. More recently, he has suffered a ten-day episode of dissociative fugue, which required psychiatric hospitalization. Although the patient has been asymptomatic during a decade, it is remarkable that he has presented three dissociative episodes in a short period of time. One of them, the fugue state, is interesting because of its long duration and its relatively low prevalence in the general population.Conclusions:This clinical case allows us to appreciate the long-term relationships between psychological trauma and dissociation, in addition to the well-known short-term effects.

The boundaries of simulation and dissociative amnesia are thin and not rarely unclear. Diagnostic criteria and a thorough clinical history are sometimes not enough to shed light on the nature and essence of one's will and conduct. Throughout history, psychiatry has been challenged to testify before society over patients’ truth and deceit. Do they share common grounds or must we accept that uncertainty is the inevitable price of truth?The authors present a clinical case of a young man coming to the emergency services with multiple lacerations in the upper abdomen and limbs, referring “amnesia” for the last five years of his life. The patient had no previous psychiatric record or any known family or social dysfunction. Approach, management and diagnosis are discussed.