Seizure disorders. Individuals with seizure disorders may exhibit complex behavior dur- ing seizures or post—ictally with subsequent amnesia. Some individuals with a seizure disorder engage in nonpurposive wandering that is limited to the period of seizure activity. Con- versely, behavior during a dissociative fugue is usually purposeful, complex, and goal- directed and may last for days, weeks, or longer. Occasionally, individuals with a seizure dis- order will report that earlier autobiographical memories have been ”wiped out” as the seizure disorder progresses. Such memory loss is not associated with traumatic circumstances and ap— pears to occur randomly. Serial electroencephalogram usually show abnormalities. Telemet- ric electroencephalographic monitoring usually shows an association between the episodes of amnesia and seizure activity. Dissociative and epileptic amnesias may coexist.
Catatonic stupor. Mutism in catatonic stupor may suggest dissociative amnesia, but fail- ure of recall is absent. Other catatonic symptoms (e.g., rigidity, posturing, negativism) are usually present.
Factitious disorder and malingering. There is no test, battery of tests, or set of procedures that invariably distinguishes dissociative amnesia from feigned amnesia. Individuals with factitious disorder or malingering have been noted to continue their deception even during hypnotic or barbiturate-facilitated interviews. Feigned amnesia is more common in individ- uals with 1) acute, ﬂorid dissociative amnesia; 2) financial, sexual, or legal problems; or 3) a wish to escape stressful circumstances. True amnesia can be associated with those same cir- cumstances. Many individuals who malinger confess spontaneously or when confronted.
Normal and age-related changes in memory. Memory decrements in major and mild neurocognitive disorders differ from those of dissociative amnesia, which are usually as— sociated with stressful events and are more specific, extensive, and / or complex.
As dissociative amnesia begins to remit, a wide variety of affective phenomena may sur- face: dysphoria, grief, rage, shame, guilt, psychological conﬂict and turmoil, and suicidal and homicidal ideation, impulses, and acts. These individuals may have symptoms that der, with depressed mood; or adjustment disorder, with mixed disturbance of emotions and conduct. Many individuals with dissociative amnesia develop PTSD at some point during their life, especially when the traumatic antecedents of their amnesia are brought into conscious awareness.
Many individuals with dissociative amnesia have symptoms that meet diagnostic cri- teria for a comorbid somatic symptom or related disorder (and Vice versa), including so- disorder). Many individuals with dissociative amnesia have symptoms that meet diagnos- tic criteria for a personality disorder, especially dependent, avoidant, and borderline.
Diagnostic Criteria 300.6 (F48.1)
A. The presence of persistent or recurrent experiences of depersonalization, derealiza- tion, or both: 1. Depersonalization: Experiences of unreality, detachment, or being an outside ob- server with respect to one's thoughts. teelings, sensations, body, or actions (e.g., perceptual alterations, distorted sense of time, unreal or absent self, emotional and/ or physical numbing).
2. Derealization: Experiences of unreality or detachment with respect to surround- ings (e.g., individuals or objects are experienced as unreal, dreamlike, foggy, life- less, or visually distorted).
B. During the depersonalization or derealization experiences, reality testing remains intact.
C. The symptoms cause clinically significant distress or impairment in social, occupa- tional, or other important areas of functioning.
D. The disturbance is not attributable to the physiological effects of a substance (e.g., a drug of abuse, medication) or another medical condition (e.g., seizures).