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Dissociative Amnesia – DSM IV Definition
Dissociative Amnesia is codified 300.12 in DSM-IV. The disorder used to be called Psychogenic Amnesia.
Diagnostic Criteria
According to DSM-IV, the following criteria must be met in order for a diagnosis of dissociative amnesia to be arrived
at:
Criterion A: an inability to recall information of a very personal nature. The inability may be the outcome of an
underlying trauma or stress. The inability to recollect cannot be attributed to normal forgetfulness.
Criterion B: memory is reversibly impaired. Memories of personal nature cannot be recalled in verbal form. Even if it
is temporarily retrieved, the memory cannot be retained wholly in one’s consciousness. The impairment does not
occur exclusively during the course of other dissociative disorders (such as dissociative identity disorder, dissociative
fugue, etc), PTSD, acute stress disorder, or somatization disorder. The impairment is also not a result of substance
abuse, and it is not due to any neurological or general medical condition.
Criterion C: the symptoms of the disorder are such as to cause clinical stress which is significant in nature, and which
can impair the subject’s social, occupational, or other areas of functioning.
The individual afflicted with dissociative amnesia reports gaps in recall for aspects of their personal history. There are
chunks of time in their past which they are unable to recall. Some traumatic or stressful event or events are
associated with the loss of memory. An acute form of dissociative amnesia is a sudden onset caused due to an
elaborate episode, such as finding oneself in the midst of a natural calamity or during wartime.
Types of Dissociative Amnesia
The following types of dissociative amnesia have been identified:

Localized Amnesia: Here, the individual fails to recall events during a specific stretch of time, and only later
manage to remember details of the event. For instance, the survivor of a violent attack who also happens to
witness one of their close family members succumbing to the attack might “forget” all about the episode for up to
2-4 days after the event.

Selective Amnesia: Here, the individual is not able to recall all that happened in an event, just a select few tidbits.
For instance, a rape victim might be able to recall just parts of the event of rape and not the full event in its
entirety.

Generalized Amnesia: This is a less common dissociative amnesia disorder. The individual here is unable to
recall their entire past history. Such cases usually present themselves to the police, to emergency wards, or to
general hospital consultation services.

Continuous Amnesia: This is a less common dissociative amnesia disorder. The individual here is unable to
recall events subsequent to a specific time up to and including the present.

Systematized Amnesia: This is a less common dissociative amnesia disorder. The individual here is unable to
recall specific categories of information. Examples include memory about one’s spouse or about all visits to a
place of worship.
Amongst the above types of dissociative amnesia, the last three types – generalized, continuous and systematized –
may ultimately be diagnosed as having a more complex form of dissociative disorder, such as dissociative identity
disorder.
Associated Features And Disorders
Individuals suffering from dissociative amnesia also tend to report symptoms of depression, anxiety,
depersonalization, trance states, analgesia, and spontaneous age regression. They may also provide inaccurate
answers to relatively simple questions – such as the sum of 3 and 4 is 8.
The disorder usually also co-occurs with sexual dysfunction, impairment in relationships, self-harm and suicidal
impulse, as also aggressive impulse. Individuals with this disorder may also have symptoms that meet the criteria for
Conversion Disorder, a mood disorder, substance-related disorder or a Personality Disorder.
Such individuals have also been found to be prone to be hypnotized more than the normal population sample.
Course
The disorder can present in any age group. The main presenting condition is retrospective gap in memory. The
duration of the condition may last from a few minutes to years. Individuals who have already had one episode of
dissociative amnesia are prone to develop the condition for any future traumatic circumstance.
Dissociative Fugue – DSM IV Definition
Dissociative Fugue is codified 300.13 in DSM IV. The disorder was formerly called Psychogenic Fugue.
Diagnostic Criteria
According to DSM-IV, the following criteria must be met in order for the individual to be diagnosed for dissociative
fugue:
Criterion A: sudden, unexpected travel to some far off place, away from one’s normal surroundings or place of
residence. There is inability to recall any or all of one’s past.
Criterion B: assumption of a new identity, or at the very least, confusion of one’s personal identity (leading to doubts
about “who am I?”).
Criterion C: the impairment is not due to the direct effect of physiological effect of substance or a general medical
condition.
Criterion D: the symptoms are such as to cause distress which is clinically significant, and / or lead to impairment in
important areas of functioning.
The individual affected with dissociative fugue may undertake travel away from their normal surroundings for periods
of time ranging from a few hours or few days to weeks or months. The wandering is relatively unobtrusive and does
not attract attention. There is no apparent psychopathology presented during the episode of the fugue. During the
course of the fugue, amnesia for recent events or lack of awareness of personal identity leads to the individual being
brought to clinical attention. After returning to the pre-fugue state, the individual may lose memory of the events that
transpired during the fugue episode.
Some individuals acquire whole new identity during fugue episode. A new name, a new residence, and engagement
in complex social activities get taken up. Assuming an identity which is well-integrated with the new social milieu does
not lead to any suspicion of an underlying mental disorder to the people around.
Associated Features and Disorders
Individuals suffering from Dissociative Fugue also tend to report symptoms of mood disorder, PTSD, or a substancerelated disorder. After returning to the pre-fugue state, the individual may report symptoms of depression, dysphoria,
anxiety, grief, shame, guilt, psychological stress, conflict and suicidal and aggressive impulses may be present. The
person may also provide inaccurate answers to relatively simple questions – such as the sum of 3 and 4 is 8.
Dissociative fugue has also been found to be prevalent in certain cultures, such as for example, amongst the
members of Eskimo societies living within the arctic circle (piblokto), amongst the members of Miskito People of
eastern Central America (grisi siknis), amongst members of the community of witches in the Navajo tribe of Southwestern United States, and amongst members of Western Pacific cultures such as Malaysia, Singapore, Indonesia,
Philippines and Brunei (amok), and the like.
Course
Dissociative fugue presents in adults in most cases. The onset is usually associated with overwhelming events that
the individual finds unable to cope. Though recovery is rapid, refractory dissociative amnesia may persist in some
cases.
Dissociative Identity Disorder – DSM IV Definition
Dissociative Identity Disorder is codified 300.14 in DSM IV. The disorder was formerly known as Multiple Personality
Disorder.
Diagnostic Criteria
According to DSM IV, the following criteria must be met in order for the individual to be diagnosed for dissociative
identity disorder:
Criterion A: two or more distinct identities or personality states are present in the individual.
Criterion B: these distinct identities take control over the behavior recurrently.
Criterion C: the individual is unable to recall important personal information, and this inability is too severe to be
attributed to mere ordinary forgetfulness.
Criterion D: the disturbance is not an outcome of substance abuse or general medical condition.
The individual affected with Dissociative Identity Disorder finds it challenging to integrate the different aspects of their
identity, memory and consciousness. The disorder is diagnosed three to nine times more frequently in adult females
than in adult males. The number of identities in such an individual is reported to be from 2 to more than 100. Females
tend to have more identities than do males, averaging 15 or more, whereas males average approximately 8 identities.
Each of the personality states that the individual experiences has its own distinct personal history, self-image, and
identity, including different age, different gender, and also a different name. There usually exists a main, primary
identity which carries the individual’s given name. When this primary identity takes over or regains consciousness,
the individual is usually passive, dependent, guilty and depressed. On the other hand, the alternate identities have
personalities which contrast the primary personality, for example, they may be dominating, hostile, aggressive, etc.
These alternate identities emerge and take over the individual’s consciousness due to some trigger such as
psychosocial stress. The time required to switch between two identities may be a few seconds, or may be gradual.
Others around may discern that the switch has happened by specific symptoms such as rapid blinking, facial
changes, changes in voice or demeanor, or sudden change of track of the individual’s thoughts. The alternate
identities take control in sequence, one after another. They may deny knowledge of the existence of the other
alternate identities altogether, or may be critical of the others, or there may be open conflict between the alternate
identities. At times, the role of allocating time to take control over the individual is abrogated by the alternate identity
that emerges as the most powerful.
In terms of memory recall, the individual’s primary identity appears to experience gaps in memory in both recent and
remote episodes, including an overall loss of biographic memory for an extended period of childhood, adolescence or
even adulthood. Amongst the alternate identities, the passive ones have more constricted memory recall, while the
ones with hostile, controlling or protecting personalities have near-complete memory recall. An identity with less
controlling power may gain access to consciousness by producing auditory or visual hallucinations – such as in the
form of a voice that gives instructions.
Associated Features and Disorders
Individuals with Dissociative Identity Disorder have been found to be highly hypnotizable and especially vulnerable to
suggestive influences. These individuals may also concurrently manifest posttraumatic symptoms such as
nightmares, flashbacks and startle responses, or also PTSD. In some alternate identities, self-mutilation and suicidal
and aggressive behavior, along with impulsivity and sudden changes in relationships have warranted a concurrent
diagnosis of borderline personality disorder. In some cases, certain identities have been found to experience
conversion symptoms (e.g. pseudoseizures), or to possess the ability to control pain.
In a number of cases, these individuals report having experienced severe physical and sexual abuse, especially
during childhood. There may also be a repetitive pattern of relationships involving physical and sexual abuse.
Course
The average time period from first symptom presentation to diagnosis is six to seven years. Episodic and continuous
courses have both been described. The disorder may reduce in intensity and frequency after the age of forty.
However, any psychosocial stress such as trauma or substance abuse may trigger a fresh episode.
Depersonalization Disorder – DSM IV Definition
Depersonalization Disorder is codified 300.6 in DSM IV.
Diagnostic Criteria
According to DSM IV, the following criteria must be met in order for the individual to be diagnosed for
depersonalization disorder:
Criterion A: there is persistent feeling of detachment or estrangement from one’s self, as if one is an outside observer
of one’s body and / or one’s mental processes. There is a feeling of being in a dream. Various types of sensory
anesthesia, lack of affective response, and a sensation of not being in control of one’s actions, including one’s
speech, are often present.
Criterion B: there is awareness that the feeling of detachment is but a feeling; the connect with reality is intact.
Criterion C: the persistent feeling causes clinically significant distress or impairment in social, occupational, or other
important areas of functioning.
Criterion D: the experience is not due to direct physiological effects of a substance or a general medical condition.
Also, the experience must not occur exclusively during the course of any other mental disorder, such as
schizophrenia, panic disorder, acute stress disorder, or another dissociative disorder.
The individual afflicted with the disorder has difficulty describing their symptoms. They fear that the experiences are
symptomatic somehow of their being labeled “crazy”. There is a sense of “derealization”, and the external world
appears unreal and fuzzy. People around the individual may appear to be unfamiliar or mechanical. Familiar objects
too appear to be distorted out of shape and size. Such individuals are also highly susceptible to hypnotizability. The
disorder is diagnosed at least twice in females than in males. It is estimated that about half of all adults may
experience at least a single episode of depersonalization precipitated by severe stress, at some point of time in their
lives. In some cultures, experiences of depersonalization and derealization are induced voluntarily, by choice. Such
cases are not considered to be part of the ambit of the depersonalization disorder.
Associated Features and Disorders
The individual suffering from depersonalization disorder also may experience hypochondriasis, major depressive or
dysthymic disorder, anxiety disorders, personality disorders and / or substance-related disorders. During panic
attacks, especially when a truamatic stressor triggers anxiety symptoms, the symptoms of depersonalization and
derealization have been found to concurrently occur too. In such case, a separate diagnosis of depersonalization
disorder may not be made.
Course
The disorder is usually presented for treatment in adolescence or adulthood, though the onset may have taken place
in childhood and remained undetected. The main age at onset is reported to be 16. However, the individual usually
presents with some other symptoms, such as anxiety, panic, or depression.
An episode of depersonalization may last anywhere from a few seconds to several years. The course is usually
chronic and may wax and wane in intensity. It is also episodic sometimes.