ICD-116B61	DISSOCIATIVE AMNESIA Dissociative amnesia
ICD-10F44.0	Dissociative amnesia
DSM-5-TRF44.0	Dissociative Amnesia

1. Definition and nosology

Dissociative Amnesia (ICD-11: 6B61; DSM-5-TR: F44.0) — inability to recall important autobiographical information (usually traumatic or stressful), not explained by ordinary forgetfulness. No medical or neurological cause.

Subtypes: localized (specific period), selective (part of the period), generalized (entire life history), systematized (specific category), continuous.

“Dissociative fugue” — In DSM-5-TR as a qualifier for dissociative amnesia (was a separate diagnosis in DSM-IV); patient travels unexpectedly, assumes a new identity.

2. History

• Janet P. — originator of the concept of dissociation.
• DSM-IV — Dissociative fugue as a separate diagnosis.
• DSM-5 (2013) — fugue integrated as a specifier.
• “False Memory” controversy (1990s) — debate over therapeutically induced “recovered memory”.

3. Epidemiology

• Lifetime prevalence: 1–2%; higher after public misfortunes (war, disaster).
• Sex: relatively higher in females.
• Comorbidity: PTSD, cPTSD, DID, BPD, MDD.

4. Aetiology and pathogenesis

• Trauma — response to severe psychological or physical trauma; hypothesized as ‘defense mechanism’.
• Neurobiological — impaired hippocampal and prefrontal cognitive processing.

5. Clinical features

• Inability to recall the traumatic or stressful event.
• Localized (e.g., wartime), selective, generalized.
• Dissociative fugue — unexpected travel, new identity, usually lasts days to weeks.
• Implicit memory (skills) remains; explicit memory is selective.

6. Diagnosis

6.1 Unified diagnostic criteria

A. Failure to recall significant autobiographical information (typically traumatic), not explained by normal forgetfulness.

B. Significant distress or functional impairment.

C. Exclusion of substance, medical/neurological condition (TBI, encephalitis, dementia).

D. DID, PTSD, cPTSD, is not better explained by a somatic symptom or another mental disorder.

Qualifier: with dissociative fugue.

6.2 Source-specific clarifications

• DSM-5-TR / ICD-11 — same; fugue qualifier.

6.3 Diagnostic algorithm

1. Clinical interview + trauma history.
2. Medical and neurological examination — TBI, dementia, encephalitis, seizure excluded.
3. MRI, EEG in clinical suspicion.
4. SCID-D-R.
5. Toxicology.

6.4 Differential diagnosis

7. Examination and assessment

• SCID-D-R.
• MRI, EEG.
• Neuropsychological test (memory profile).

8. Treatment

1. Safe environment and supportive psychotherapy.
2. Trauma-focused psychotherapy — phased approach.
3. During a fugue episode — reuniting the patient with family and community.
4. Pharmacotherapy for comorbid symptoms; ‘amobarbital interview’ or hypnosis was historically used — caution due to risk of induced false memory.
5. Long-term psychotherapy — trauma processing.

Source-specific specifications

• ISSTD — general guideline for dissociative disorders.
• There is no specific FDA-approved pharmacotherapy.

Treatment methods

1. Trauma-focused phased psychotherapy — Stabilization → processing → reintegration.
2. Structured Clinical Interview for DSM Dissociative Disorders, Revised (SCID-D-R) — Gold standard in diagnosis.
3. Hypnosis — cautious use — False memory induction risk; training only by experienced clinician.

9. Prognosis

• Most spontaneous remission in acute form;
• Chronic form of long-term intervention.

10. Myths and misconceptions

Myth 1: “Hypnosis is a reliable tool for ‘recovered memory’”

Evidence: hypnosis-induced memories can be contaminated with false memory — induced or distorted; especially cautious in legal contexts (Loftus E.F. research).

Myth 2: “Dissociative amnesia is fabricated or ‘drama’ from movies”

Evidence: Clinical condition documented; neurobiological foundations investigated.

Myth 3: “The patient ‘must be forced to remember’”

Evidence: pressure may create trauma or distress; supportive approach recommended.

Myth 4: “Amobarbital interview is effective”

Evidence: Historically used, but not recommended in modern practice due to the risk of false memory and adverse effects.

Myth 5: “All traumatic memories are ‘real’”

Evidence: Some ‘recovered memories’ may be a result of therapeutic induction; cautious clinical approach and source verification are important.

11. Sources

1. WHO. ICD-11. 6B61 Dissociative amnesia. 2024.
2. APA. DSM-5-TR. 2022.
3. ISSTD. Guidelines for Treating DID in Adults, 3rd Revision. J Trauma Dissociation 2011;12(2):115–187.
4. Loftus E.F. The reality of repressed memories. Am Psychol 1993;48(5):518–537.
5. Staniloiu A., Markowitsch H.J. Dissociative amnesia. Lancet Psychiatry 2014;1(3):226–241.