Recognition of the Reality of Dissociative Amnesia

American Psychiatric Association. (1994). Diagnostic and Statistical Manual of Mental Disorders, 4th Edition (DSM-IV)

The Diagnostic and Statistical Manual of Mental Disorders (DSM-VI) recognizes memory problems to be a common feature of five post-traumatic conditions: Post-Traumatic Stress Disorder, Dissociative Amnesia, Dissociative Fugue, Dissociative Disorder Not-Otherwise-Specified , and Dissociative Identity Disorder.

Code No. 300.12 (Dissociative Amnesia) “Dissociative amnesia is characterized by an inability to recall important personal information, usually of a traumatic or stressful nature, that is too extensive to be explained by ordinary forgetfulness…. The reported duration of the events for which there is amnesia may be minutes to years. . . . Some individual with chronic amnesia may gradually begin to recall dissociated memories” (pp. 478-9).

Code No. 300.14 (Dissociative Identity Disorder): “Individuals with this disorder experience frequent gaps in memory for personal history, both remote and recent. . . . There may be loss of memory not only for recurrent periods of time, but also an overall loss of biographical memory for some extended period of childhood” (pp. 484-5).

World Health Organization, International Classification of Diseases, 9th Revision (ICD-9)

See Code Nos. 300.12 (Psychogenic amnesia; hysterical amnesia); 300.14 (Multiple personality, dissociative identity disorder; 300.15 (Dissociative disorder or reaction, unspecified)

U.S. Department of Health and Human Services and the National Center for Health Statistics, International Classification of Diseases, DHHS Pub. No. (PHS_ 94-1260)

See Code Nos. 300.12 (Psychogenic amnesia; hysterical amnesia); 300.14 (Multiple personality, dissociative identity disorder; 300.15 (Dissociative disorder or reaction, unspecified)

American Medical Association, Council on Scientific Affairs. (1994). Memories of Childhood Abuse. CSA Report 5-A-94. Chicago: Author.

This statement was formulated in response to the growing concern regarding memories of sexual abuse. The validity of some memories of sexual abuse, as well as some of the therapeutic techniques which have been used have been debated. The APA states that it is concerned that the passionate debates about these issues have obscured the recognition of a body of scientific evidence that underlies widespread agreement among psychiatric treatment in this area. “We are especially concerned that the public confusion and dismay over this issue and the possibility of false accusations not discredit the reports of patients who have indeed been traumatized by actual previous abuse.”

Major points:

• • Sexual abuse of children and adolescents lead to severe negative consequences and is a risk factor for the development of many classes of psychiatric disorders.
  • Children who have been abused cope with the trauma by using a variety of psychological mechanisms. “These coping mechanisms may result in the lack of conscious awareness of the abuse for varying periods of time. Conscious thoughts and feelings stemming from the abuse may emerge at a later date.”
  • Human memory is a complex process about which there is a substantial base of scientific knowledge.
  • Implicit and explicit memory are two different forms of memory. This distinction between explicit and explicit memory is fundamental because they have been shown to be supported by different brain systems.
  • “Some individuals who have experienced documented traumatic events may nevertheless include some false or inconsistent elements in their reports. In addition, hesitancy in making a report, and recanting following the report, can occur in victims of documented abuse. Therefore, these seemingly contradictory findings do not exclude the possibility that the report is based on a true event.”
  • Memories can be significantly influenced by questioning especially in young children.
  • There is no completely accurate way of determining the validity of reports in the absence of corroborating information.
  • Advises “an empathic, nonjudgmental, neutral stance towards reported memories of sexual abuse.”
  • Psychiatrists are urged to base their treatment plan on a complete psychiatric assessment and the full range of the client’s clinical needs. “A strong prior belief by the psychiatrist that sexual abuse, or other factors, are or are not the cause of the patient’s problems is likely to interfere with appropriate assessment and treatment.”
  • Many individuals who have experienced sexual abuse have a history of not being believed by their parents, or others in whom they have put their trust. Expression of disbelief is likely to cause the patient further pain and decrease his/her willingness to seek needed psychiatric treatment. Similarly, clinicians should not exert pressure on patients to believe in events that may not have occurred, or make other important decisions based on these speculations.”
  • The intensity of debate about these topics should not influence psychiatrists to abandon their commitment to basic principles of ethical practice. Notes that psychiatrists should refrain from making public statements about the veracity or other features of individual reports of sexual abuse.

See: Report on memories of childhood abuse. American Medical Association Council on Scientific Affairs. (1995, April). International Journal of Clinical & Experimental Hypnosis, 43(2), 114-7.

American Psychological Association, Working Group on Investigation of Memories of Childhood Abuse: Final Report (issued on February 14, 1996)

Final conclusions included:

1. Controversies regarding adult recollections should not be allowed to obscure the fact that child sexual abuse is a complex and pervasive problem in America that has historically gone unacknowledged.
2. Most people who were sexually abused as children remember all or part of what happened to them.
3. It is possible for memories of abuse that have been forgotten for a long time to be remembered.
4. It is also possible to construct convincing pseudomemories for events that never occurred.
5. There are gaps in our knowledge about the processes that lead to accurate and inaccurate recollections of childhood abuse.

See also:

Questions & Answers About Memories of Childhood Abuse

URL: http://www.apa.org/pubinfo/mem.html

British Psychological Society, Report of the Working Group on Recovered Memories. (1995). Recovered memories. Leicester, UK: Author.
Executive Summary

The working party was charged with reporting on the scientific evidence relevant to the current debate concerning Recovered Memories of Trauma and with commenting on the issues surrounding this topic. After reviewing the scientific literature, surveying relevant members of the British Psychological Society, and scrutinizing the records of the British False Memory Society, the formed the following conclusions:

1. Complete or partial memory loss is a frequently reported consequence of experiencing certain kinds of psychological traumas including childhood sexual abuse. These memories are sometimes fully or partially recovered after a gap of many years.
2. Memories may be recovered within or independent of therapy. Memory recovery is reported by highly experienced and well qualified therapists who are well aware of the dangers of inappropriate suggestion and interpretation.
3. In general, the clarity and detail of event memories depends on a number of factors, including the age at which the even occurred. Although clear memories are likely to be broadly accurate, they may contain significant errors. It seems likely that recovered memories have the same properties.
4. Sustained pressure or persuasion by an authority figure could lead to the retrieval or elaboration of ‘memories’ of events that never actually happened. The possibility of therapists creating in their clients false memories of having been sexually abused in childhood warrants careful consideration, and guidelines for therapists are suggested here to minimize the risk of this happening. There is no reliable evidence at present that this is a widespread phenomenon in the UK .
5. In a recent review of the literature on recovered memories, Lindsay and Read commented that “the ground for debate has shifted from the question of the possibility of therapy-induced false beliefs to the question of the prevalence of therapy-induced false beliefs.” We agree with this comment but add to it that the ground for debate has also shifted from the question of the possibility of recovery of memory from total amnesia to the question of the prevalence of recovery of memory from totally amnesia.

A copy of this report can be obtained from:

The British Psychological Society

48, Princess Road East

Leicester LE1 7DR

United Kingdom

Http://www.bps.org.uk/

International Society for Traumatic Stress Studies (ISTSS). (1997, June). Childhood Trauma Remembered: A Report on the Current Scientific Knowledge Base and Its Applications for Professionals. Northbrook, Illinois: Author. (PDF)

This document addresses childhood trauma, traumatic memory, the memory process, clinical issues and forensic implications pertaining to the ongoing debate on this subject.

International Society for Traumatic Stress Studies also recognizes dissociative amnesia in their practice guidelines for the treatment of post-traumatic stress disorder (PTSD). See: Foa, E. B., Keane, T. M., Friedman, M. J. (Eds.). (1999). Effective Treatments for PTSD: Practice Guidelines from the International Society for Traumatic Stress Studies. Northbrook, Illinois: International Society for Traumatic Stress Studies. (Available from their website at http://www.istss.org/ )

State of Kentucky, Attorney General’s Final Report of the Task Force on Child Sexual Abuse (1995)

In reviewing this issue, the Task Force looked at research studies which revealed that up to 60% of child sexual abuse survivors report incomplete, or a total absence of, abuse-specific memories at some point after victimization. Research has also shown that this type of delayed recall is often associated with more violent and terrorizing cases of abuse.