1
Q
Write an introduction for dissociative amnesia
A
- Dissociative amnesia (DA) is a rare and remarkable condition that would fit perfectly within the psychological thriller genre
- Due to its rarity, there is scarce research predominantly in the form of case studies
- This essay will discuss the condition, its aetiology, and potential management and the evidence
2
Q
Describe the presentation of dissociatve amnesia
A
- Autobiographical memory loss that is inconsistent with normal forgetting (Spiegal et al, 2011)
- Memory loss may include aspects of identity and/or life history
- Episodes may revolve around a single past event (retrograde localised amnesia), entire periods lasting months to years (retrograde generalised amnesia), and even successive events as they occur (anterograde continuous amnesia)
3
Q
Describe the current state of knowledge of dissociative amnesia
A
- Current understanding is preliminary
- One small study reported US prevalence of 1.8%, yet overall prevalence remains unknown but likely underestimated (Spiegel et al, 2017)
- Literature exists as in-depth case studies or small case series
- These are detailed accounts of patient and managment, often providing individual success stories
4
Q
Critique the problems of predominantly case studies in dissociative amnesia
A
- Publication bias and lack of normotive values (Cassel & Humphreys, 2016) may exaggerate positive findings
- Lack of normotive values make it difficult if not impossible to calculate statistical significance
- Without this, outcome cannot be said to soley result from technique factor (Cassel & Humphreys, 2016)
- Other factors such as supershrinks, patient factors and/or therapeutic alliance may contribute
- Assay and Lambert (1999) suggested that technique only accounts for 15% of outcome
- In the discussion section of case studies it is often noted that results should be taken with caution, and larger samples ar needed for more definitive and generalisable conclusions (Speigel et al, 2011)
5
Q
Differentiate dissociative amnesia from organic amnesias
A
- Amnesia is relatively common in organic conditions such as head trauma, Korsakoff syndrome, and dementia (Shin et al., 2018)
- Diagnosis of DA requires absence of organic or substance-related causes
6
Q
Differentiate dissociative amnesia from normal forgetting
A
Dissociative amnesia is more pervasive, disruptive and/or distressing than normal forgetting or absent-mindedness (Spiegal et al, 2017)
7
Q
Describe the aetiology of dissociative amnesia
A
- Most widely accepted explanatory model is the Posttraumatic model (Lynn et al, 2012)
- DA is an avoidant coping mechanism to inhibit recollection and processing of difficult and often emotional memories
- Not without criticisms for its central focus on trauma (Lynn et al, 2012)
- Amnesia is the symptom with the most difference amongst PTSD (dissociation-related disorder) and non-PTSD patients (Bremner, 2010)
8
Q
Outline the treatment for dissociative amnesia
A
- DA can always, in principle, be revered (Spiegel et al, 2011)
- Treatment involves memory recovery
- Plus psychotherapy to resolve any issues arising from recovered memories
- Memory recovery consists of a supportive environment and some form of psychotherapy, with greatest support for hypnosis, or drug-induced semi-hypnosis (Speigel, 2017)
- Supportive treatment is often sufficient in memory loss of a short period of time
- Supportive environment is frequently efficient for gradual recovery, even in severe memory loss (Speigel, 2017)
9
Q
Describe the case study of hypnosis for DA (Degun-Mather, 2002)
A
- Theatre-technique hypnosis: a non-directive, client-led type that imagines a stage to help voice emerging painful memories and facilitate better coping
- 14 sessions contained 6 hypnotic sessions with 8 non-hypnotic to discuss recovered memories
- Individuals with DA are noted as highly hypnotisable (APA, 1994)
- Patient suffered a 12-year period of retrograde generalised amnesia, onset after a car crash
- The DA resulted in significant distress, manifesting as depression and suicidal thoughts
- Memory significantly improved over sessions, relieving distress as patient gained clarity on circumstances
- Clinically significant improvement achieved, enabling patient to “get on with her life”
10
Q
Discuss the case of CBT and ACT for DA (Cassel & Humphreys, 2016)
A
- First case study to use quanitified outcome measures
- Combination of CBT and ACT to successfully treat DA
- Patient presented with both retrograde generalised and anterograde continuous amnesia, following marraige separation
- Latter was more detrimental affecting patient’s personal and professional life
- Formulation highlighted an avoidant coping style that extended to emotional experiences
- CBT develops awareness of impact of avoidance, and teaches better flexible coping
- ACT works to challenge and broaden rules of living
- Clinically significant improvement in anterograde memory, patient did not want to recover lost memories
11
Q
Discuss the similarities between both hypnosis and CBT cases of DA
A
- Vast variability in reported cases means lack of consensus over aetiology
- Equally, creates heterogenous formulations
- In both examples, avoidance was key
- Hypnosis (Degun-Mather, 2002): avoidance of troubling memories over loss of loved on in prior car crash
- CBT (Cassel & Humphreys, 2016): anterograde amnesia to avoid emotionla experiences of present
12
Q
Discuss what factors determine successful treatment of DA
A
- Based on the two cases (Degun-Mathers, 2002; Cassel & Humphreys, 2016)
- Careful formulation and understanding of presenting complaints
- Memory recovery was key to first case and absent in second, both reported clinical improvement
- Highlights need of humanistic approach, where technique implemented best fits needs of the patient
- Presently, therapist and alliance factors are crucial to identify the best tailored management
z Human Behaviour Term 1
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