Treatment for Dissociative Amnesia and Substance Abuse

What Is Dissociative Amnesia?

Dissociative amnesia is one of several dissociative disorders, which are mental health conditions in which a person experiences an involuntary separation from certain aspects of their identity—in this case, memories. People who experience episodes of dissociative amnesia are unable to recall personal information. These gaps in memory are often associated with prior traumatic experiences or other stressful events. The person may forget events over a period of a few minutes to decades or even an entire lifetime. ¹

Details the person may not be able to recall include:¹

• Who they are.
• Where they went.
• People they spoke to.
• What they did, said, thought, or felt.

The disorder is more common among women than men, and usually occurs in people who have witnessed or been involved in traumatic events such as physical or sexual abuse. However, the memories the person is unable to recall are often related to the traumatic event.¹

The disorder is uncommon and affects about 1% of men and 2.6% of women. Rates of the disorder usually increase after a natural disaster or during war.²

How to Recognize Dissociative Amnesia

The key symptom of dissociative amnesia is memory loss.¹

However, dissociative amnesia can present itself in a variety of ways. Different forms of the disorder can include:³

• Selective amnesia: This is when a person remembers only certain aspects of a traumatic episode or limited events from a specific period of time.
• Localized amnesia: This occurs when a person can’t remember a specific event or an entire period of time (e.g., when childhood abuse was taking place or intense combat situations).
• Systemized amnesia: This refers to forgetting information within a specific category (e.g., information about a specific person or place)
• Continuous amnesia: This refers to a person’s inability to remember new events as they happen.
• Generalized amnesia: This is quite rare, but is similar in character to the near complete amnesia sometimes featured in movies. It occurs when a person can recall almost nothing, including their name, life history, well-understood information about the world, or even previously learned skills. Generalized amnesia is most common in combat veterans and victims of sexual or physical abuse.¹

Another challenge in recognizing dissociative amnesia is that it may not appear immediately after someone experiences trauma or stress. It can sometimes take days, weeks, or even longer to appear.¹

When the memory loss occurs, a person may suddenly seem confused or distressed. The person may not be aware that they have gaps in their memory until they are shown evidence of something they did but could not remember.¹

In addition, those with dissociative amnesia may experience other symptoms. These can include tiredness, generalized weakness, or insomnia. Depression, suicidal behavior, and substance abuse are also commonly present. The risk of suicidality may be particularly high if the amnesia resolves suddenly and the person is overwhelmed by traumatic memories.¹

What Causes It?

Dissociative amnesia is usually related to an overwhelming traumatic event, either in childhood or in the recent past. These events can include abuse, rape, war, genocide, accidents, natural disasters, or the death of a loved one. The events might have directly involved the person, or they may simply have witnessed an incredibly stressful incident.¹

The disorder can also arise from critical financial trouble or an overpowering internal conflict. This can arise, for instance, from guilt over certain actions or desires that the person is unable to resolve or deal with in an emotionally honest way, such as guilt over a crime.¹

Dissociative amnesia is not caused by a medical problem such as stroke, brain injury, or toxic exposures. In cases such as these with an underlying organic cause of the amnesia, recovering the memories is difficult and generally a slow process. With dissociative amnesia, most cases do not last very long, and the person may recover the memories suddenly and all at once. The recovery may occur on its own, through a trigger, or through therapy.²

It’s possible there is a genetic component with dissociative disorders like dissociative amnesia, as researchers have noted that people with dissociative amnesia sometimes have close relatives with similar dissociative conditions.²

Do People With Dissociative Amnesia Abuse Substances?

Concurrent substance abuse is sometimes seen in cases of dissociative amnesia. That is, many people who have dissociative amnesia may also abuse drugs or alcohol. Drug and alcohol abuse not only increases the likelihood of developing a co-occurring or comorbid substance use disorder, but it can exacerbate the symptoms of dissociative amnesia.^1,4,5

This phenomena is not unique to dissociative amnesia. Many people who struggle with a mental health condition abuse drugs and alcohol, and vice versa. When someone struggles with a substance use disorder and a mental health disorder simultaneously, it’s known as a dual diagnosis. In some instances, drug and alcohol use may reflect an attempt at self-medication to help people cope with their otherwise untreated mental health symptoms.⁶

Sometimes, it can be difficult to tell if amnesia is the result of substance abuse or a dissociative condition, because the effects of alcohol, recreational drugs, and prescription medications can cause memory loss and, over time, other neurocognitive disorders that resemble dissociative amnesia.⁵

Many people who have a substance use disorder and dissociative amnesia will also attribute their memory loss to substance abuse to avoid a diagnosis of dissociation.⁷

To make a proper diagnosis, a clinician must determine if the memory loss only occurs when the person is intoxicated and not in other situations. The clinician can often distinguish dissociative amnesia from other substance-related neurocognitive disorders because dissociative amnesia is not associated with any intellectual impairment. Substance-related neurological disorders may lead to cognitive changes that extend beyond memory deficits.⁵

How Is It Treated?

The goals of treatment for dissociative amnesia are to:²

• Relieve symptoms.
• Help the person feel safe.
• Uncover the lost memories.

The therapist will also help the person:²

• Manage painful memories and events.
• Develop coping skills.
• Get back to normal functioning.
• Improve relationships.

Types of therapy that may be used in treatment include:

• Cognitive behavioral therapy—helps to change thoughts, feelings, and behaviors that can perpetuate symptoms.
• Eye movement desensitization and reprocessing (EMDR)—treats people who have symptoms of post-traumatic stress disorder (PTSD) such as nightmares and flashbacks.
• Dialectical behavior therapy—also treats people who have experienced abuse or trauma.
• Family therapy—educates the family about the disorder and works to resolve conflicts in the family that may contribute to the disorder.

Doctors or therapists will sometimes use drug-assisted interviews or hypnosis to reduce the anxiety associated with the troubling memories and overcome some of the psychic defenses a patient may have established in order not to recall traumatic or painful experiences. However, the memories recalled through these techniques may not always be accurate and may need to be confirmed by another person.¹

After memories have been recalled, therapy can help individuals deal with the specific trauma or stressors associated with the onset of amnesia and help them avoid future triggering situations.

There are no medications that specifically treat dissociative disorders. But medical professionals may prescribe antidepressant or anti-anxiety medications to help people manage symptoms of depression or anxiety that accompany their dissociative amnesia.²

If there is a dual diagnosis of substance abuse and dissociative amnesia, treating both conditions in an integrated fashion is critical to avoiding a relapse of both conditions. Treatment for substance abuse may involve some of the same therapies, such as cognitive behavioral therapy. But depending on the severity and specific type of substance abuse, the person may need to go through a period of supervised medical detoxification before they begin treatment.

People with dissociative amnesia often find success in treatment. However, their chances of recovery may be improved by factors such as support from family and friends.²

Sources

[1]. Spiegel, D. (2017). Dissociative Amnesia. The Merck Manual.

[2]. Cleveland Clinic. (2016). Dissociative Amnesia.

[3]. Hosein, M., and Treisman, G. (2017). Dissociative Amnesia. Johns Hopkins Psychiatry Guide.

[4]. National Alliance on Mental Illness. Dissociative Disorders.

[5]. American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders (5th ed.). Arlington, VA: American Psychiatric Publishing.

[6]. National Alliance on Mental Illness. (2017). Dual Diagnosis.

[7]. Sharon, I. (2018). Dissociative Disorders. Medscape.