Peas, Please: A Case Report and Neuroscientific Review of Dissociative Amnesia and Fugue

Abstract

Dissociative amnesia that encompasses one's entire life and identity is a rare disorder, as is dissociative fugue. In evaluating such cases, a dichotomy is often invoked between functional and organic etiologies. However, this dichotomy suffers from both conceptual and ethical flaws. Conceptually, putative brain-based, organic etiologies for many dissociative disorders-including dissociative amnesia-exist. Ethically, such dichotomies may result in dismissive care for patients with distress-based disorders like dissociative amnesia. In support of humane, neurobiologically informed treatment of patients with dissociative amnesia, we present excerpts from 2 post-event interviews with a patient who suffered and recovered from an episode of dissociative amnesia and fugue. Following this, we review current neurobiological models of dissociative amnesia that undermine the dichotomy of functional versus organic, and suggest that the crucial distinction in such cases is between a patient's willful, conscious deceit and processes that occur without conscious intent.

Dissociative Amnesia With Dissociative Fugue- A Case Report With 1-Year Followup

“…During periods of stress, there may be a massive influx of glucocorticoids which may temporarily impair key neuronal structures like amygdala and hippocampus, which have a high density of glucocorticoid receptors. 7 This may further lead to loss of connectivity and synchronous neural function or neuronal degeneration in some cases. 7 Frontal cortical executive systems are also uniquely sensitive to stress and when impaired may inhibit information retrieval.…”

“…7 This may further lead to loss of connectivity and synchronous neural function or neuronal degeneration in some cases. 7 Frontal cortical executive systems are also uniquely sensitive to stress and when impaired may inhibit information retrieval. 7 In this case, patient was neither bankrupt nor in any debt, which he could have avoided by absconding.…”

“…Some studies have postulated an organic basis for dissociative disorders, citing dissociative amnesia as a reversible organic memory disorder. MacDonald et al 7 have attempted to resolve the conceptual problems in the dichotomy between organic and functional amnesia by suggesting that it is possible that the patient has mild brain damage or dysfunction that may fall below the sensitivity threshold of imaging or functional assessments. They also suggest that demonstrable brain damage does not rule out an environmental trigger.…”

“…MacDonald et al 7 have conducted a neuroscientific review of dissociative amnesia and fugue. In this paper, they have quoted studies to explain that explicit memory depends upon the hippocampus, which is uniquely affected by stress.…”

“…7 Frontal cortical executive systems are also uniquely sensitive to stress and when impaired may inhibit information retrieval. 7 In this case, patient was neither bankrupt nor in any debt, which he could have avoided by absconding. His past and current behaviour do not suggest any possibility of malingering.…”