Download Dissociative Memory Disorders and Immigration

ASCS09: Proceedings of the 9th Conference of the Australasian Society for Cognitive Science
Dissociative Memory Disorders and Immigration
Angelica Staniloiu, Sabine Borsutzky and Hans J. Markowitsch
({astaniloiu; sabine.borsutzky; hjmarkowitsch}@uni-bielefeld.de)
Physiological Psychology, University of Bielefeld
P.O Box 10 01 31, 33501 Bielefeld, Germany
Abstract
Studies of immigrant populations have shown that the stresses
associated with the process of immigration and acculturation
could lead to significant psychological, psychiatric or somatic
symptoms. In the current presentation, we review four cases of
patients who developed Dissociative Disorders (Dissociative
Amnesia and Ganser Syndrome, respectively) on a background
of stresses related to immigration. The patients were
investigated psychiatrically, medically, neurologically and by
neuropsychological methods. All four patients developed
severe psychiatric dissociative symptoms after objectively
minor stresses that involved accidents (physical injuries) of
mild severity, which occurred several years after the patients
had immigrated to the new country of residence. The
neuropsychological profile of these patients revealed certain
similar characteristics, such as executive functioning deficits
(such as limited cognitive flexibility) and impairments of
emotional processing. Although no firm conclusions can be
drawn based on the limited number of case reports, we propose
that chronic psycho-social stresses related to immigration and
acculturation could lead to Dissociative Disorders in certain
immigrant populations via a dysregulation of the hormonal
stress responses(“allostatic load”), which is mediated by
factors related to pre-migration experiences, cultural
affiliations and individual characteristics, such as cognitive
flexibility, emotional processing abilities, language skills and
competence and explanatory model of illness.
Keywords: acculturation; dissociative disorder; amnesia;
Ganser syndrome
Introduction
Memory‘s relevance for human beings is captured by the
following quotation of Ewald Hering: “Memory connects
innumerable single phenomena into a whole, and just as the
body would be scattered like dust in countless atoms if the
attraction of matter did not hold it together so consciousness
– without the connecting power of memory – would fall
apart in as many fragments as it contains moments.” (Hering,
1870/1895). The connecting (binding) power of memory
may be also metaphorically conveyed by the etymology of
the word re-collection (“re-collection” derives from the word
“collection” and the latter has similar roots as “colligation”,
which means binding) (Casey, 2000).
Memory Systems
Memory is however not unitary, but is divided along a
chronological and content axis, respectively. Along the
content-dimension, five distinct long term memory systems
Article DOI: 10.5096/ASCS200948
have been described: procedural, priming, perceptual,
semantic and episodic. The episodic memory system is
currently viewed as being equivalent to the autobiographicalepisodic memory (AEM) system and autobiographicalepisodic memory is defined as the conjunction of subjective
time, autonoetic consciousness and the experiencing self
(Tulving, 2005). As not all autobiographical memories have
an episodic quality, a distinction is emphasized between
autobiographical-episodic and autobiographical-semantic
memory (the latter refers to personal knowledge, such as
one’s name or date of birth).
Being the most advanced acquisition both ontogenetically
and phylogenetically, the autobiographical-episodic memory
system is more susceptible to insults induced by
environmental factors (such as physical injuries or
psychological stress) than other memory systems.
Psychologically stressful events can trigger disturbances of
the integrated organization of memory, perception,
consciousness and identity, leading to the so called
dissociative disorders.
Dissociative Memory Disorders
Dissociative amnesia – one of the dissociative disorders in
DSM-IV-TR (2000) – has as its central feature the inability
to recall important personal information. The disturbance is
precipitated by stressful experiences or psychological trauma
and is not better accounted for by normative forgetfulness or
by other psychiatric or medical conditions (such as traumatic
brain injury). Malingering has to be ruled out. The symptoms
of dissociative amnesia cause significant impairment of
functioning or distress. The magnitude of experienced
distress varies according to different factors, including
cultural affiliations and culturally-shaped views of
dissociative experiences, selfhood and past (Kleinman, 1980;
Carlson & Rosser-Hogan, 1991; Douglas, 2009).
Dissociative amnesia is a form of psychogenic amnesia, a
condition that is characterized by the preponderant
contribution of psychological factors to its emergence and
the absence of structural brain changes as identified via
standard structural brain imaging techniques. Amnesic
disturbances of psychogenic nature occur not only in
dissociative amnesia, but also in other dissociative disorders,
such as dissociative identity disorder (DID), dissociative
fugue, Ganser syndrome, and dissociative trance disorder
and possession trance. Ganser syndrome - a diagnostic entity
that has undergone several revisions over the years- is
presently listed under the category of Dissociative Disorder
Not Otherwise Specified in DSM-IV-TR (2000) , where it is
simply defined by giving approximate answers to questions
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(e.g., “2 plus 1 equals 4”). Ganser’s (1894, 1904) original
description of the syndrome was however much broader than
the current DSM-IV-TR one. It included a hysterical semitrance or twilight state, characterized by a tendency to give
approximate answers (vorbeireden), impairments of
consciousness, amnesia and hallucinations, being more
consistent with the later views of this disorder as a “brief
reactive psychosis to stress” (Simeon & Hollander, 2000, p.
1575).
Memory impairments of dissociative nature could also be
encountered in certain anxiety disorders, such as acute stress
disorder or post-traumatic stress disorder (PTSD). PTSD
conditions, which are accompanied by “negative”
dissociative symptoms (such as amnesic conditions or
psycho-physiological hypo-arousal to the reminders of the
trauma) (Markowitsch, 2000), seem to have different neural
correlates in comparison to PTSD conditions that are
characterized by “positive” dissociative symptoms (such as
flashbacks), raising the question of different subtypes
(Lanius et al., 2005).
Psychogenic amnesias can be further classified according
to the degree and timeframe of impairment (global versus
selective,
anterograde
versus
retrograde)
of
autobiographical-episodic memory and the co-occurrence of
deficits in autobiographical-semantic memory and general
semantic knowledge. The most frequent manifestations of
psychogenic amnesias are forms of retrograde amnesias. A
particular type of psychogenic retrograde amnesia has been
termed the ‘mnestic block syndrome’ (Markowitsch et al.,
1999b). This form is characterized by an autobiographicalepisodic memory block, which may comprise the whole past
life. Affected patients can have otherwise largely
uncompromised semantic memories; they can read, write,
calculate and know how to behave in social situations.
Furthermore,
they
can
acquire
new
long-term
autobiographical-episodic memories, although the newly
acquired events may be less emotionally-laden in
comparison to the ones of normal subjects (Brand &
Markowitsch, 2009; Reinhold & Markowitsch, 2009).
When retrograde psychogenic amnesia is accompanied by
suddenly leaving the customary environment – home and
city – and loss or compromise of knowledge about personal
identity – the condition is referred to as psychogenic
(dissociative) fugue (Markowitsch, Fink, Thöne, Kessler, &
Heiss, 1997a). This condition was named a century ago in
Germany Wanderlust (cf. e.g. Burgl, 1900). It was
traditionally thought to preponderantly affect men, although
some studies conducted during non-war periods revealed no
gender differences.
Sometimes the ‘blocked’ autobiographical-episodic
material is content-specific (selective) and/or retrograde
amnesia is limited to specific life epochs (Markowitsch,
Thiel, Kessler, von Stockhausen, & Heiss, 1997b).
Retrograde psychogenic amnesic conditions may be
occasionally accompanied by anterograde memory deficits.
However, cases of psychogenic anterograde amnesia
(inability to store new AEM episodes long-term) with
Article DOI: 10.5096/ASCS200948
preserved retrograde autobiographical-episodic memory are
rare (Kessler et al., 1997; Markowitsch, Kessler, Kalbe, &
Herholz, 1999a; Kumar, Rao, Sunny, & Gangadhar, 2007).
Stress and Dissociative Disorders
Dissociative disorders have been described in a variety of
cultures and have been recognized to occur in response to
traumatic stress (Seligman & Kirmayer, 2008; Friedl &
Draijer, 2000; Mulder, Beautrais, Joyce, & Fergusson, 1998).
Dissociative symptoms and conditions tend to affect younger
people (Reinhold & Markowitsch, 2007) Dissociative
amnesia – the most common of all dissociative disorders
(Maldonado & Spiegel, 2008) – was reported to be more
frequent in the third and fourth decade of life (Putnam, 1997;
Kanzer, 1939; Coons & Milstein, 1972). The younger age
distribution may partly reflect developmentally-dependent
differences in the windows of vulnerability to stress of the
main brain structures involved in autobiographical-episodic
memory processes.
Although several studies reported a direct relationship
between the severity of exposure to trauma and incidence of
amnesia, cases of patients who developed amnesia after a
seemingly minor stressor are however not such a rare
occurrence. In a substantial number of the latter cases the
collateral information revealed a history of repeated
traumatic experiences with early onset, raising the suspicion
of a pathogenetic model of kindling sensitization or
alternatively an incubation effect (Lupien, McEwen, Gunnar,
& Heim, 2009).
Both stress and dissociation have been linked to adaptation
as well as pathophysiology. They could therefore be viewed
as being part of a continuum that ranges from physiological,
adaptive or non-pathological to maladaptive and
pathological.
Some
non-pathological
dissociative
experiences, such as day dreaming, absorption, reverie may
be linked to positive emotions and /or may enhance
performance by focused allocation of cognitive resources
(Seligman & Kirmayer, 2008). Several defensive functions
of dissociation, such as automatization of behavior,
compartmentalization of information and affect, analgesia
and detachment from self have been described. These
functions were hypothesized to be recruited together in an
acute traumatic situation in order to alleviate severe
psychological and probably physical pain (Putnam, 1997).
Similarly to dissociation, stress hormones, such as
glucocorticoids could have an adaptive or pathogenetic role.
Glucocorticoids are involved in processes of brain
maturation and remodelling, cell survival and learning and
memory. During acute stress glucocorticoids hormones are
released to re-establish the homeostasis of the organism in
the face of a challenge (a process called “allostasis”;
McEwen, 2000). Persistently elevated levels of
glucocorticoids could however have detrimental effects on
brain function and/or structure as well as on other systems of
the body (such as immune or cardiovascular system). Apart
from glucocorticoids, stress responses are modulated by a
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variety of other hormones (including arginin-vasopressin
[AVP], oxytocin).
The degree to which chronic repeated stress or massive
acute stress may affect an individual’s homeostasis and lead
to psychiatric and/or non-psychiatric disorders depends on
genetic dispositions, type of stress, duration of stress,
developmental phase, age, gender, context, prior
experiences, personality characteristics (e.g. Becker-Blease
et al., 2004). Certain genetic polymorphisms may on one
hand bias the normal maturation trajectories of key brain
structures that are involved in processes of memory and
emotion, increasing their susceptibility to certain
environmental factors (Pacheco et al., 2009). On the other
hand life experiences (especially early ones) could alter the
gene expression via epigenetic modifications and lead to
long lasting changes in stress hormonal responses, synaptic
plasticity and behavior. Along this line McGowan et al.
(2009) recently showed epigenetic modifications (increased
methylation) of the promoters of several genes of interest in
the brain of victims of suicide with a history of childhood
abuse in comparison to the suicide completers without a
history of childhood abuse. Accumulating evidence suggests
that epigenetic changes might also be involved in processes
of learning and memory such as the extinction of fear-related
memories (Roth & Sweatt, 2009).
Several key brain structures for autobiographical memory
and emotional processing have been identified as being
sensitive to the consequences of exposure to negative or
stressful experiences (such as amygdala and hippocampal
formation, prefrontal cortex and specific white matter tracts).
Reductions
in
the
hippocampi
volumes
and
autobiographical-episodic memory impairments have been
reported in patients with stress-related psychiatric conditions,
such as post-traumatic stress disorders (Bremner et al.,
1997), recurrent major depressive disorders (especially the
ones with history of trauma) (Vythilingam et al., 2002;
Campbell, Marriott, Nahmias, & MacQueen,2004) and
dissociative identity disorder (Vermetten et al., 2006). The
stage of development or declining of these key brain
structures influences their susceptibility to the stress effects
(Lupien, McEwen, Gunnar, & Heim, 2009). This may partly
explain why the same type of traumatic experiences may be
associated with different brain morphological or functional
changes and psychopathology.
The existence of sexually dimorphic brain structures and
functions may partly explain the observed gender differences
in the susceptibility to stress and manifestations of stressrelated psychopathology (Cahill, 2006; Lanius, Hopper, &
Menon, 2003).
Changes in white matter tracts have also been reported in
response to early stress. In children with a history of early
deprivation, microstructural morphological changes of the
uncinate fascicle, which were more prominent on the right
side, were recently reported (Govindan et al., 2009). The
right hemispheric uncinate fascicle plays an important role in
memory processes and damage of its ventral portion has
been involved in the etiology of organic (neurological)
memory disorders (Levine et al., 1998).
Article DOI: 10.5096/ASCS200948
Organic and Psychogenic Amnesia: Two Sides
of the Same Coin
While the term ‘psychogenic’ in psychogenic amnesia
implies that these amnesias are distinct from those with an
organic basis (e.g., Kroll, Markowitsch, Knight, & von
Cramon, 1997), more recent findings obtained with glucose
positron-emission-tomography (PET) and other functional
brain imaging methods indicate that indeed the brain is
affected in these patients as well. In a single case study,
Markowitsch and co-workers (Markowitsch, Kessler, Van
der Ven, Weber-Luxenburger, & Heiss, 1998) found in a
patient a grossly reduced brain metabolism following a
psychogenic condition accompanied by severe retrograde
and anterograde amnesia. Similar reductions in the brain’s
glucose consumption were also found in subsequent
investigations of other patients with a condition of
psychogenic amnesia and are reviewed in Reinhold, Kühnel,
Brand, and Markowitsch (2006) and in Brand and
Markowitsch (2009). In a recent study of Brand et al. (2009),
which reviewed 14 patients with psychogenic amnesic
disturbances functional brain imaging obtained in resting
state showed evidence of metabolic changes in the right
temporofrontal regions with a common significant
hypometabolic zone in the right inferolateral prefrontal
cortex.
Immigration and Stress
Migrants’ physical and mental health reflects the interplay
between their genetic predispositions and environmental
factors (including their life experiences). While certain
factors related to migration seem to be protective (the socalled “healthy immigrant effect”; Breslau et al., 2007;
Alegria et al., 2008), others appear to increase the risk for
certain physical and mental diseases.
Stressful life experiences could occur during any of the
following stages associated with migration, such as during
pre-emigration, migration itself or post migration (Lindert,
Schouler-Ocak, Heinz, & Priebe, 2008). Legal status,
income, living situations, ethnic density in the
neighbourhood, language proficiency (as a measure of
acculturation), and cultural factors modulate the risk for
physical and mental health disorders (Toppelberg, Medrano,
Pena Morgens, & Nieto-Castanon, 2002; Veling et al., 2008).
“The price body pays for being forced to adapt to adverse
psychosocial or physical situations” is defined as “allostatic
load” and “it represents either the presence of too much
stress or the inefficient operation of the stress hormone
system” (McEwen, 2000, p. 110f). Apart from the brain,
several other body systems can be targets of the allostatic
load (including cardiovascular, immune and endocrine
system). Evidence for an increased allostatic load in migrants
comes from several studies that showed an increased risk for
cardiovascular diseases (including hypertension) in
immigrants (Gualdi-Russo, Zironi, Dallari, & Toselli, 2009;
Lear, Humphries, Hage-Moussa, Chockalingam, & Mancini,
2009). In one study the risk was still significant after
adjusting for variables, such as age, sex, ethnicity, income,
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education, family history of heart disease, diabetes, smoking,
physical activity, body mass index, visceral adipose tissue,
lipids, insulin, glucose and blood pressure (Lear et al., 2009).
The risk for cardiovascular disease was found to be higher
among migrants with lower levels of acculturation (as
determined by language proficiency) (Eamranond et al.,
2009). High prevalence of diabetes mellitus was identified
among immigrants (Wändell & Gafvels, 2007), which in one
study correlated with the length of residence in the new
country (USA) (Oza-Frank, Stephenson & Venkat Narayan,
2009). In one study the level of acculturation (language
proficiency) predicted hormonal stress responses and
pregnancy outcomes (gestational age at birth) among
pregnant Hispanic women (Ruiz, Dolbier, & Fleschler,
2006).
Knowledge about the mental and physical health of
immigrants remains, however still limited. Higher rates of
psychoses among immigrants and their descendants were
reported by several studies (Zolkowska, Cantor-Graae, &
McNeil, 2001) and thought to be linked to their immigrationrelated experiences (including acculturative stress, lack of
robust ethnic affiliation) (Veling et al., 2008) or epigenetic
mechanisms (Dealberto, 2007). In several immigrant
populations somatization was found to be prevalent and
related to psychological distress.
For certain psychiatric conditions it was noted that their
risk in migrants might increase with the duration of residence
in the new country. This raises the hypothesis that at least in
the case of certain psychiatric conditions, chronic stress
related to immigration and acculturation might play a role
(Haasen, Demiralay, & Reimer, 2008).
Immigration and Dissociative Disorders
Dissociative symptoms and disorders have a strong
connection to self. Alterations of the bodily pre-reflective
self and minimal phenomenal selfhood accompany
depersonalization symptoms (out of body experiences)
(Blanke & Metzinger, 2009), while dissociative memory
disorders lead to impairments of autonoetic self
consciousness and sense of personal identity. A possible
connection between immigration and dissociative disorders
was suggested many years ago by several psychoanalysts,
who remarked that immigration posed a significant threat to
feelings of identity and self-cohesiveness (Grinberg &
Grinberg, 1989). Dissociative symptoms have extensively
been studied as part of posttraumatic stress disorder in
immigrant populations or refugees who were victims of
torture or war or as part of the culture-bound syndromes. A
higher propensity of certain ethnic groups to react to distress
with dissociative symptoms has been described (Guarnaccia,
Rivera, Franco, & Neighbors, 1996). This propensity was
noted to inversely correlate with successful acculturation to a
Western society (Marshall & Orlando, 2002). Little has so
far been published however in the psychiatric or
psychological literature about the occurrence and
characteristics of other dissociative condition in immigrants,
in particular the ones which belong to the DSM-IV-TR
Article DOI: 10.5096/ASCS200948
category of Dissociative Disorders (such as Dissociative
Amnesia and Dissociative Disorders Not Otherwise
Specified-Ganser Syndrome).
In the current contribution, we review data from four cases
of patients who developed Dissociative Disorders
(Dissociative Amnesia and Ganser Syndrome, respectively)
on a background of stresses related to immigration.
Case Studies
All patients in the study were young or middle aged men,
with a background of immigration, who were referred for
neuropsychological testing by their primary care physicians,
psychiatrists or neurologists. They all gave informed consent
for neuropsychological testing. Prior to neuropsychological
testing, all these patients underwent extensive medical and
neurological work up (including conventional structural
brain imaging studies), which did not yield any significant
findings. They also underwent thorough psychiatric
evaluations.
In terms of demographics, all patients were married and
two of them had children. Their age at the time of the
assessment ranged from late 20’s to early 50’s (26-51). They
all had current legal immigrant statuses in the country of
residence. Two patients immigrated to Germany from
Poland. One immigrated to Germany from Kazakhstan.
Another one immigrated to Canada from Albania. Three
patients had high school education or the equivalent. One
patient finished undergraduate university studies, but did not
yet have fulltime employment matching his qualifications.
All the patients were characterized by severe psychiatric
symptoms of preponderantly dissociative nature, affecting
the memory domains. Their symptoms followed a chronic
course, in spite of various treatment interventions. At the
time of neuropsychological assessment all the patients were
unemployed as a result of their symptoms, with three of them
receiving work disability benefits. The onset of psychiatric
symptoms occurred when the patients were in the second to
early fourth decade of life, several years (ranging from 7 to
22 years) after the patients’ migration to the current country
of residence. In all cases the onset of symptoms followed a
seemingly minor accident (mild traumatic brain injury). In
three cases the accidents were work related. Two accidents
involved a motor vehicle accident. One patient was hit by
mistake in the head with a tool by a co-worker. He was
wearing a helmet at the time of the accident. Another patient
was hit by a small iron bar at his work place. In all cases it is
unclear if loss of consciousness occurred or for how long. In
most cases the collateral information gathered suggested that
if any loss of consciousness had occurred, its duration would
very likely have been brief. The time window between the
onset of symptoms and the date of neuropsychological
assessment ranged from a few months to 7 years.
All patients were extensively interviewed in accordance
with SCID Structured Clinical Interview for DSM-IV-TR) or
the German version of the SCID (First, Spitzer, Gibbon, &
Williams, 2002).
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One patient met DSM-IV-TR diagnosis criteria for major
depressive disorder with psychotic features and Ganser
syndrome. This patient was described in detail in a previous
publication (Staniloiu et al., 2009). Another patient met
criteria for dissociative amnesia and major depressive
disorder, mild. One patient, who in addition to extensive
memory deficits endorsed several somatic complaints of
unexplained medical origin, was diagnosed with Dissociative
Amnesia and Somatoform Disorder Not Otherwise
Specified. Another patient was diagnosed with dissociative
amnesia. In addition he presented with several symptoms of
post-traumatic stress disorder (PTSD), but did not fulfil the
entire DSM-IV-TR diagnosis criteria for PTSD. This latter
patient, who suffered a work related accident during which a
small bar hit his head at the root of the nose, developed both
anxiety and profound memory symptoms after the accident.
He experienced panic attacks, agoraphobia and nightmares.
In addition he had numerous neurological complaints (such
as weakness, ataxia and dizziness) for which no neurological
organic substrate was found.
An extensive neuropsychological test battery was
conducted or attempted with each patient to assess
intelligence, attention, executive functions verbal and figural
anterograde
memory
and
retrograde
memory
(autobiographical –episodic, autobiographical-semantic and
general semantic remote memory). As the patients were
assessed at different sites, unfortunately we did not
administer the same tests to all patients. Only two patients
underwent formal testing of Theory of Mind (ToM)
functions (Baron-Cohen, Wheelwright, Hill, Raste, & Plumb,
2001). A test of memory malingering was administered to all
patients (Tombaugh, 1996). Personality and psychiatric
symptoms were additionally measured with standardized
questionnaires.
Results and Discussion
All patients showed evidence of significant impairments in
multiple cognitive domains. On intelligence tests one patient
scored average-good, two patients scored in the average
(borderline) range and one scored in the below average
range. All patients manifested impaired performance on
attention and concentration tasks, which ranged from mild to
severe. Consistent with our observations, attention deficits
have been documented in previous studies of patients with
psychogenic (dissociative) or functional amnesias (Fujiwara
et al., 2008; Stracciari, Ghidoni, Guarino, Poletti, &
Pazzaglia, 1994; Campodonico & Rediess, 1996). All
patients in the present study demonstrated significant
retrograde impairments of autobiographical-episodic
memory and two showed additional significant impairments
of retrograde semantic memory. Autobiographical-semantic
memory was initially impaired in the patient with Ganser
syndrome, but then was restored. Various degrees of
anterograde memory impairments were evidenced in all
patients. Executive functions were impaired in all patients
and three patients showed evidence of reduced cognitive
flexibility. These findings are congruent with the ones from
Article DOI: 10.5096/ASCS200948
previous studies, which found executive dysfunctions in
patients with dissociative (psychogenic) or functional
amnesia (Fujiwara et al., 2008; Glisky et al., 2004; HennigFast et al., 2009). Based on the broad range of psychiatric
symptoms, the results of malingering tests and/or the lack of
an identifiable external financial or legal motivation,
malingering was considered unlikely or highly unlikely in all
cases of the current study. Mood or anxiety symptoms were
identified in three patients. All patients had a variety of
somatic complaints, which could not be explained by a
general medical condition and one patient received a
diagnosis of Somatoform Disorder Not Otherwise Specified.
These findings mirror the ones of other authors, who
reported the co-occurrence of dissociative disorders with
other psychiatric conditions, such as major depressive
disorder and somatoform disorders (Maldonado & Spiegel,
2008; Saxe et al., 1994; Coons & Milstein, 1992). One recent
study found similarities between the patterns of
hypothalamic-pituitary-adrenal axis dysregulation in major
depressive disorder and dissociative disorders (Simeon et al.,
2007), which may partly explain the frequently described cooccurrence of the two conditions. ToM deficits were
identified in a number of patients with dissociative
(psychogenic) amnesia who were investigated in our
previous studies (Fujiwara et al., 2008; Reinhold &
Markowitsch, 2007). Co-existing impairments of ToM and
AEM have also been described in other psychiatric
conditions, such as schizophrenia, major depressive disorder,
bipolar disorder and autistic spectrum disorders (Corcoran &
Frith, 2003; Inoue, Tonooka, Yamada, & Kanba , 2004;
Shamay-Tsoory, Harari, Szepsenwol & Levkovitz, 2009;
Shalom, 2003; Lind & Bowler, 2009). The two patients in
the current study who were administered ToM tests (Reading
the Mind in the Eyes test) performed within normal limits on
these tests. ToM testing was unfortunately not administered
in the other two patients. One of the patients who did not
undergo ToM testing presented with severe symptoms of
major depressive disorder (in addition to symptoms of
Ganser syndrome), which may have had a significant impact
on ToM test performance (Inoue, Tonooka, Yamada, &
Kanba , 2004)
Though in all the above described patients their symptoms
had their onset after a seemingly minor stress, further
obtained information (including collateral information)
revealed that most of these patients had a history of repeated
stressful experiences which occurred during the process of
migration or before, suggesting a mechanism of kindling
sensitization (Post, Weiss, Smith, Rose, & Frye, 1995) or
alternatively an incubation effect (Lupien et al., 2009).
In all cases the conventional imaging structural studies did
not detect any significant brain changes and the neurological
exams did not point to any organic etiology. Structural brain
investigations, techniques like DTI (Diffusion Tensor
Imaging), which may have provided an estimate of possible
microstructural changes of white matter tracts (Lipton et al.,
2008; Tramoni et al., 2009) were, however not performed.
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Similar to other reports of dissociative memory disorders (Serra, Fadda, Buccione, Caltagirone, & Carlesimo, 2007;
Maldonado & Spiegel, 2008), the onset of psychiatric
symptomatology in the cases in the present study occurred
after a mild traumatic brain injury. Although a biological
contribution of the mild traumatic brain injury cannot be
completely ruled out (Tramoni et al., 2009), the emergence
of psychiatric symptoms in these patients after a seemingly
minor physical accident might from a psychological
perspective be viewed as a legitimate way of escaping a
situation that was perceived as intolerable and inescapable
(Kessler et al., 1997).
Conclusion
In conclusion, the occurrence of dissociative (psychogenic)
memory disorders in immigrants might be viewed as a
reaction to psycho-social and acculturative stress related to
migration, which is modulated by individual characteristics,
such as genetic predispositions, cognitive flexibility,
emotional processing ability, language competence as well
as cultural affiliations and culturally shaped explanatory
models of illness and views of trauma, selfhood and past
(e.g., Markowitsch, 2008; Han & Northoff, 2009).
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Citation details for this article:
Staniloiu, A., Borsutzky, S., Markowitsch, H. (2010).
Dissociative Memory Disorders and Immigration. In W.
Christensen, E. Schier, and J. Sutton (Eds.), ASCS09:
Proceedings of the 9th Conference of the Australasian
Society for Cognitive Science (pp. 316-324). Sydney:
Macquarie Centre for Cognitive Science.
DOI: 10.5096/ASCS200948
URL:
http://www.maccs.mq.edu.au/news/conferences/2009/ASCS
2009/html/staniloiu.html
Article DOI: 10.5096/ASCS200948
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