BHS 499-07Memory and Amnesia

Functional Disorders of Memory

Functional Disorders (Hysteria)

Functional disorders are not disorders of structure but of function.

Such disorders are classified as hysteria by the DSM (Diagnostic & Statistical Manual).

They were the only disorders retaining a psychological explanation & etiology, rather than being defined by symptoms.

Sources of Symptoms (Psychodynamic View)

Strangulated affect is converted into physical symptoms by the repressed memory – called conversion symptoms.

Symptoms disappear if the repressed emotion associated with an event is released – called abreaction.

Therapy is needed to overcome resistance to remembering and thereby relive the trauma.

History of Hysteria

In the mid-1800’s hysteria was considered either:• Irritation of the female sexual organs (floating

womb)

• Imaginary, play-acting by women Charcot rejected both explanations,

calling it a neurosis also shown by men.• Charcot thought it required hereditary brain

degeneration.

Charcot shows colleagues a female hysteria patient at Salpetriere Hospital (Paris). Freud studied with Charcot in 1885.

History (Cont.)

Symptoms included:• Paralysis

• Convulsions, contractures (muscles won’t relax), seizures – arc de cercle (arching back in rigid posture)

• Somnambulism (sleepwalking)

• Hallucinations

• loss of speech, sensation or memory Charcot recognized parallels between hysteria

and hypnosis and found he could remove symptoms using hypnosis.

Janet’s View of Hysteria

Symptoms arose from subconscious beliefs isolated and forgotten, thus disassociated from consciousness.

Memory pools are normally disconnected but become connected through mental effort.• Traumatic shock disrupts the mental effort

needed to associate memory pools.

Janet (Cont.)

Memory pools may be associated with fixed ideas that motivate repeated actions.• These are seen in fugue states or

sleepwalking or the emotions seen in multiple personality disorder’s alternative selves.

Freud’s View of Hysteria

Freud studied with Charcot and later wrote “Studies in Hysteria” with Breuer, based on the case study of Anna O.

He thought “hysterics suffer mainly from reminiscences”:• Traumatic memories are pathogenic (disease-

creating)

• Banishment of memories requires repression

• Affect is damned up or strangled.

Freud’s Seduction Theory

Repressed memories nearly always revealed seduction or sexual molestation by an adult.

The patient doesn’t know what is repressed so the therapist must overcome resistance to uncover it.

Later, Freud decided that fantasies, impulses and wishes caused repression.

Classifications of Hysteria

Dissociative disorders Posttraumatic stress disorder (PTSD) Somatoform disorders Sleep disorders

Dissociative Disorders

Disruption of the usually integrated functions of memory, consciousness, identity or perception of the environment.

These include:• Dissociative amnesia

• Dissociative fugue

• Dissociative identity disorder (DID, also MPD)

• Depersonalization disorder

Dissociative Amnesia

Impairment is reversible and usually reported retrospectively (in past tense).

Types of disturbance:• Localized – affects a few hours around a

traumatic event.

• Selective – affects some but not all events during a period of time, or some categories.

• Generalized – affects entire past.

• Continuous – a specific time up to the present

Dissociative Fugue

Sudden, unexpected travel away from one’s home or workplace with inability to recall the past.

The person may assume a new identity or be confused about his or her identity.

Wandering may be motivated by a fixed idea (repetition compulsion).

Return to pre-fugue state brings amnesia

Dissociative Identity Disorder (DID)

Also called multiple personality disorder (MPD).

Presence of two or more distinct identities or personality states with memory loss across states.

Failure to integrate identity, memory and personality.

Primary personality is passive, guilty, dependent, depressed. Alternates may be hostile, aggressive, controlling.

DID (Cont.)

Frequent gaps in memory. Amnesia may be asymmetrical:

• Passive identities have more constricted memories.

• Active or protector identities have more complete memories.

Transitions triggered by stress. May result from sexual abuse, results in a

pattern of disruptive behavior in childhood continuing into adulthood.

Depersonalization Disorder

A feeling of detachment or estrangement from one’s self.

A person may feel like an observer of their own mental processes or body.

Includes sensory anesthesia, lack of affect, a feeling of lack of control of one’s actions.

Voluntarily induced in religious and trance experiences.

An Identity View of Dissociation

One function of consciousness is to construct a mind-space that includes:• Space and time

• Abstractions of meaning (gist) and making sense of what happens

• A self, an imagined or idealized self, self-monitoring

• Narratization (autobiography, hierarchical organization of life events).

Cultural Examples of Dissociation

All cultures have some kind of spirit possession:• Amok syndrome

• Historical examples of demonic possession

• Current religious and spiritual possession

Amnesia is often associated with such possessions.

Social Construction of Dissociative States

Spanos considers possession to be a social construct:• Society provides special status and historical

factors affect its manifestation.

• The possessed role is learned.

• There are benefits to performing the possessed role and it is frequently acted by the powerless.

DID may be a socially constructed role.

Physiological Theories of Dissociation

Only a tiny percentage of individuals exposed to stressors or trauma show dissociative symptoms.

True cases of DID can be distinguished from socially constructed cases through childhood behavior.

True cases of DID, fugue or other amnesias usually show histories of early childhood brain injury or recent damage.

Repetition-Compulsion

PTSD is caused by close-calls rather than injury.

Repetition occurs in the form of intrusive memory.

Normally anxiety protects us from fright but with an unexpected shock there is no chance for anxiety.

Repetition creates retrospective anxiety which builds defenses after the event.

PTSD (Cont.)

Avoidance of reminders of the event can include amnesia for some aspect of the event.• Reexperiencing includes dreams and

intrusive recollections. Dreams and recollections are not factual

but recreations of idealized or feared features of an event.• Content changes during therapy.

Somatoform Disorders

Unintentional symptoms of a medical disorder without a medical cause:• Somatization disorder – multiple symptoms

(formerly just called hysteria)

• Conversion disorder – voluntary motor or sensory dysfunction with psychological cause.

• Hypochondriasis – fear of illness.

• Pain disorder – pain whose onset, severity and maintenance have a psychological cause.

Conversion Disorder

Pseudoneurological – related to voluntary motor or sensory function.

Symptoms include impaired coordination or balance, paralysis, weakness, difficulty swallowing or lump in throat, double vision, blindness or deafness, seizures.

The more medically naïve the person, the more implausible the symptoms.

Conversion Disorder (Cont.)

The symptom represents a symbolic resolution of an unconscious conflict.

Primary gain is keeping the conflict out of awareness.

Secondary gain is external benefits and relief from responsibilities.

Neurological conditions such as MS can be misdiagnosed as conversion disorder.

Sleep Disorders

Dyssomnias – sleep problems. Parasomnias – abnormal behavior associated

with sleep. Nightmares and sleep terrors – nightmares are

not memories, sleep terrors usually cannot be remembered.

Hypnagogic hallucinations – occur at sleep onset, vivid, accompanied by wakefulness.

Sleepwalking Disorder (Somnambulism)

Repeated episodes of complex motor behavior initiated during sleep, with limited recall upon waking.

Difficulty being awakened, with confusion upon awakening.

As with fugue, the person may attempt to carry out a fixed idea.