Dissociative amnesia and trauma: a perspective from the theory of structural dissociation

In DSM-IV dissociative amnesia is addressed as a discrete clinical entity, which may take the following forms: localized amnesia; continuous amnesia; systematized amnesia; generalized amnesia; and selective amnesia. In the clinical arena, however, it more commonly presents as one of the features of more complex and extensive disorders, primarily of complex dissociative disorders and frequently in acutely or chronically traumatized patients. Dissociation results from faulty integration of the complex and intricately coordinated neuro-bio-psychological systems which constitute the personality, usually developing when traumatizing events are experienced. This deficit entails a dissociation of the personality into two or more dissociative parts of the personality - dynamic and active, but rigid and relatively closed subsystems. Based on this conceptual approach, some of these dissociative parts may contain traumatic memories and, when reactivated, cause re-experiencing and re-enactments, whereas the rest remains relatively intact and is involved in daily living and is phobic of the parts involved in the traumatic memories. Thus, the dissociation is maintained by a series of phobias, that need careful attention in treatment. The standard of care is phase-oriented treatment, preceded by a thorough neurological investigation and the use of standardized diagnostic procedures and scales for dissociative disorders. The difficult challenge of exploring and integrating traumatic memories and further aspects of one’s personality requires that the individual’s integrative capacity be sufficient. Hence, the initial goal is not the rapid (and forceful) resolution of the amnesia, but rather establishing a sense of safety and stability in daily living and in therapy.

Keywords: Amnesia, dissociation, dissociative disorders, diagnosis, treatment.

Onno van der Hart, Amnesia dissociativa e trauma: una prospettiva secondo la teoria della dissociazione strutturale in "RIVISTA SPERIMENTALE DI FRENIATRIA" 2/2012, pp 121-135, DOI: 10.3280/RSF2012-002007