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Author Note
I have no known conflict of interest to disclose.
Correspondence concerning this article should be addressed to
Email:
Case Presentation: Dissociative Amnesia
School of Behavioral Sciences, Liberty University
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Identifying Information
Date of initial assessment: 10/01/2023
Client’s Name: Rosie
Employment Status: Not employed (student)
School Status: High School (Sophmore)
Basic Case Summary
Age: 15
Gender: Female
Race/ Ethnicity: Puerto Rican
Marital Status: Not applicable (minor)
Reason for Referral/Presenting Concern
Rosie, a 15-year-old Puerto Rican female, was referred for counseling due to concerning
episodes of memory loss and identity confusion. Rosie's parents reported a traumatic incident
where Rosie was abducted and had been missing for three months, and they suspect that her
current symptoms of dissociative amnesia might be a result of that ordeal. Her parents reported
that Rosie had experienced two distinct episodes where she seemed disoriented, did not
recognize her family, and could not recall significant personal information. According to her
parents, during these episodes, Rosie would sometimes address them by different names and
express confusion about her age and life circumstances.
During one such episode, Rosie panicked and became extremely anxious, not recognizing
her parents and insisting she was in a different place entirely. Her parents were deeply alarmed
and brought her to seek professional help immediately. Rosie also expressed distress, stating,
"It's like parts of my life just vanish, and it terrifies me. I don't know what's happening to me."
These episodes have significantly impacted her school performance and social interactions,
leading to increased isolation and anxiety.
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In addition to her parents' observations, Rosie's high school counselor also reported
concerning incidents at school. The counselor noted episodes where Rosie displayed signs of
extreme anxiety, often resulting in her forgetting her classes and schedule for the semester.
During these episodes, Rosie would become visibly distressed, struggling to remember where her
classes were and sometimes even forgetting her locker combination. The counselor expressed
concern about how these memory lapses were affecting her academic performance and causing
considerable stress for Rosie. These incidents further underscored the urgent need for a
comprehensive assessment and appropriate intervention to support Rosie in managing her
distressing symptoms and their impact on her daily life.
Furthermore, a friend reported an incident where Rosie seemingly dissociated in a public
setting. They were at the mall when Rosie suddenly appeared disoriented and walked away from
her friend. Later, Rosie was found alone on a city bus, having no recollection of how she got
there. These distressing occurrences highlighted the urgency of a comprehensive assessment and
appropriate intervention to support Rosie in managing her symptoms and their considerable
impact on her daily life.
History
Family and Home/Religious Background
Rosie, a 15-year-old Puerto Rican female, is the focal point of a family residing in a
suburban neighborhood. Her mother, Isabella, works as a nurse, and her father, Miguel, is
employed as a construction worker. Rosie has two siblings: an older sister, Sofia, who is 18 years
old and currently attending college, and a younger brother, Antonio, who is 10 years old and in
elementary school. Rosie perceives her home environment as generally close-knit, with frequent
family dinners and activities together. Prior to the traumatic incident of her abduction, Rosie
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described a strong sense of family unity, often engaging in shared hobbies and spending quality
time with her parents, especially her father. The family, deeply rooted in their Puerto Rican
heritage, celebrated their cultural traditions and maintained strong connections with extended
family members.
However, since the incident, Rosie noticed a shift in the dynamics, with her parents
becoming increasingly overprotective, especially her father, who exhibited signs of anxiety and
worry. Rosie expressed a sense of guilt over how her ordeal impacted her family, particularly her
younger brother, whom she felt she could no longer connect with as effortlessly. The incident
also strained the relationship between her parents, causing occasional disagreements, which
further heightened the tension within the household. Rosie often found solace in her older sister,
Sofia, who became a confidante and a source of emotional support during this challenging time.
Educational History
Rosie, a 15-year-old Puerto Rican female, is a sophomore attending a local public high
school. Academic achievement has been a significant aspect of Rosie's life. Prior to the traumatic
incident of her abduction, Rosie was an exemplary student, maintaining a solid academic record
with grades mainly in the 'A' and 'B' range. She actively participated in school activities,
including sports and clubs, and especially enjoyed basketball, aspiring to drive herself to practice
and events once she turned 16. Her ambition was reflected in her enthusiasm for pursuing
driver’s education, although she had not yet signed up, indicating a typical eagerness for growing
independence and responsibility. Rosie's involvement in extracurricular activities and academic
engagement demonstrated her positive attitude toward education.
However, after the traumatic event, her academic performance took a significant hit.
Rosie experienced difficulties concentrating in school, leading to a decline in her grades. She
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reported that the memories and emotional impact of the abduction often overwhelmed her during
classes, making it challenging to focus on academic tasks. A pivotal instance was the school
counselor's observation of Rosie's anxiety and forgetfulness regarding her class locations,
underlining the disruptive effects of the traumatic experience on her daily school routine.
Furthermore, her friend reported a concerning incident where Rosie left her at the mall, opting
for a city bus alone, reflecting her struggle with anxiety and potential dissociative symptoms
affecting her day-to-day activities, including her engagement with education. This shift in
academic performance and behavior underscored the necessity for intervention and support to
help Rosie regain her previous academic aptitude and enthusiasm for education.
Mental Health
Rosie, a 15-year-old Puerto Rican female, has experienced a severe traumatic event of
abduction and subsequent dissociative amnesia. Historical signs indicate that before this
traumatic incident, Rosie was a well-adjusted, academically successful, and socially active
teenager. However, following the traumatic event, she exhibited distressing signs and symptoms
consistent with dissociative amnesia. These include episodes of memory loss, persistent anxiety,
heightened emotional distress, and a pervasive feeling of sadness. Rosie also displayed
dissociative behaviors, where she was found disoriented in familiar locations, such as school or
the mall, indicating a significant impairment in memory and identity. Furthermore, her hesitancy
to engage in typical activities she once enjoyed, like hanging out with friends or playing sports,
and her withdrawal from her faith community underscored the substantial impact of the trauma
on her overall well-being.
Rosie underwent various mental health assessments to determine the severity and impact
of her symptoms. The DSM-5 cross-cutting symptom measure was administered, revealing
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elevated scores in the domains of depression, anxiety, and dissociation, aligning with the
observed signs. Additionally, Beck's Depression Inventory corroborated the presence of
depressive symptoms, highlighting feelings of sadness, worthlessness, and helplessness. These
formal assessments, along with informal observations and clinical interviews, contributed to a
comprehensive evaluation of Rosie's mental health. The results strongly indicate the need for
specialized therapeutic interventions to address the dissociative amnesia and associated
psychological distress, with a focus on trauma-informed approaches to help Rosie regain her
sense of self and improve her overall mental well-being.
Client’s Physical Health
Rosie, a 15-year-old Puerto Rican female, has an unremarkable significant health history
before the traumatic event of abduction and subsequent dissociative amnesia. She had no chronic
medical conditions or prescribed medications. However, post-traumatic stress disorder (PTSD)
resulting from the traumatic incident has significantly impacted her mental health. Rosie's
current treatment plan involves trauma-focused therapy sessions with a licensed mental health
professional specializing in trauma and dissociative disorders. These therapy sessions aim to
address the dissociative amnesia, manage her symptoms, and aid in her gradual reintegration into
daily life. No medications have been prescribed thus far, as the focus is on psychotherapy and
counseling to support her mental health recovery and healing from the trauma. The treatment
plan is being carefully monitored and adjusted based on Rosie's progress and ongoing assessment
of her mental well-being.
Occupational History
Rosie, the 15-year-old Puerto Rican female, is currently a high school student, and her
vocational history is limited to part-time jobs or school-related activities due to her age. As a
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teenager, she has not engaged in formal employment. However, she is actively involved in school
clubs, particularly those focused on art and literature. Before the traumatic event of abduction
and subsequent dissociative amnesia, Rosie displayed a keen interest in creative fields, especially
drawing and writing. She often expressed her desire to pursue a career related to these interests,
potentially as an artist or writer. However, the trauma has significantly impacted her vocational
aspirations, causing a temporary halt in pursuing these interests. The trauma has affected her
concentration and motivation, impacting her academic performance and her involvement in
extracurricular activities. These challenges may influence her vocational choices and goals as she
progresses into adulthood and begins to consider career options and educational paths beyond
high school. Her therapeutic journey will play a crucial role in helping her rebuild her vocational
aspirations and guide her toward a fulfilling and sustainable career path in the future.
Sexual Adjustment
Rosie is at a critical stage in her sexual development. However, due to her recent
traumatic experience and resulting dissociative amnesia, her sexual adjustment is significantly
disrupted. At present, Rosie's sexual adjustment is marked by fear, anxiety, and an inability to
engage with or explore her burgeoning sexuality. The trauma has created a barrier to forming
healthy and age-appropriate sexual beliefs, attitudes, and behaviors.
The significant disturbance in her sexual adjustment manifests in various ways, including
an aversion to intimacy, difficulties in forming trusting relationships, and a lack of interest or
engagement in romantic or sexual activities. Rosie's trust has been deeply shattered, making it
difficult for her to connect with others emotionally and romantically.
Currently, alternate lifestyles are not a significant consideration for Rosie, given her focus
on healing and reestablishing a sense of safety and stability in her life. Exploring alternate sexual
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identities or lifestyles may come later as she progresses in her therapeutic journey and gains a
better understanding of herself and her trauma.
In therapy, it's crucial to create a safe, supportive environment where Rosie can express
her fears, insecurities, and uncertainties related to her sexual adjustment. Through appropriate
therapeutic interventions and support, Rosie can gradually work towards healing and fostering a
healthy sexual adjustment as she navigates through her teenage years and transitions into
adulthood.
Substance Use History
Rosie has no history of alcohol or drug use. Throughout her life, she has maintained a
stance against substance use, aligning with her parents' values and beliefs. Rosie is dedicated to
her schoolwork and is mindful of the potential detrimental effects substance use can have on her
academic performance and overall well-being.
Rosie's commitment to maintaining a substance-free lifestyle has been reinforced by her
recent traumatic experience. Her focus on healing and recovery further solidifies her
commitment to avoiding substances as a means of coping or escape. As of the last assessment,
Rosie has not engaged in any alcohol or drug use and has shown no interest or intention to do so
in the future.
Spiritual Assessment
Rosie is a devout Catholic and has a strong belief in God. She actively attends church
services at her local Catholic church, which is an essential part of her life. Her religious
affiliation plays a significant role in her daily routine and decision-making process.
For Rosie, her faith provides comfort, strength, and a sense of purpose, especially during
challenging times. It serves as a coping mechanism, helping her navigate through life's
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difficulties. Rosie describes God as a benevolent and omnipotent entity who guides and protects
her. Her spiritual awareness is profound, and she often turns to prayer and reflection as means of
connecting with her faith and finding solace.
Cultural/ Social Justice Factors
Rosie's family migrated from Puerto Rico to the United States when she was a child, and
they have faced challenges related to acculturation and discrimination. Rosie often grapples with
the struggle to balance her Puerto Rican heritage and her desire to assimilate into the American
culture. She sometimes experiences discrimination at school, where she feels isolated due to her
ethnicity and accents. These experiences have contributed to her feelings of alienation and
anxiety, impacting her self-esteem and overall well-being.
From Rosie's cultural lens, her problems may be viewed as a clash between her Puerto
Rican roots and the societal pressures to conform to the American culture. This duality creates a
sense of internal conflict, making it challenging for her to fully embrace either culture. Rosie's
cultural identity and the discrimination she faces are significant sources of stress and emotional
turmoil, affecting her mental health and exacerbating her dissociative amnesia. It is essential to
consider these cultural and social justice factors in her treatment to ensure a comprehensive and
culturally sensitive approach.
Barriers to Treatment/Success
Rosie's personality factors, particularly her resilience and ability to cope with stress, will
influence the success of her treatment. If Rosie demonstrates resilience, a willingness to engage
in therapy, and openness to explore her emotions and experiences, it will enhance the
effectiveness of therapeutic interventions. On the other hand, if she displays resistance,
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avoidance, or difficulty in expressing her emotions, the therapeutic process may be more
challenging.
Understanding Rosie's stage of change (e.g., precontemplation, contemplation,
preparation, action, maintenance) is crucial in tailoring the treatment. For instance, if Rosie is in
the contemplation stage, focusing on building awareness and motivation for change may be
beneficial. If she is in the action stage, strategies to help her actively engage in treatment and
maintain progress will be essential.
Cultural competence is vital in the success of Rosie's treatment. The therapist needs to
understand and respect Rosie's cultural background, traditions, beliefs, and values. Ensuring a
safe space where Rosie feels heard and understood without judgment is crucial. Addressing any
discriminatory experiences and societal pressures related to her ethnicity is essential for her well-
being. Motivation to engage in treatment can also be influenced by her cultural beliefs and the
extent to which she perceives therapy aligns with her cultural expectations.
Considering these factors will guide the therapist in tailoring interventions that align with
Rosie's personality, stage of change, and cultural context, ultimately enhancing the efficacy of
the treatment plan.
Other Pertinent Data (if relevant)
The dissociative amnesia episodes began around three months ago, following the
traumatic event of Rosie being abducted and missing for three months. The severity of memory
loss has varied, with Rosie experiencing intermittent episodes of dissociative amnesia, impacting
her daily functioning and causing significant distress.
Rosie's dissociative amnesia episodes are notably triggered by reminders of the traumatic
event, leading to memory loss and disorientation. These episodes often occur when Rosie faces
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stressors or reminders related to her abduction, such as crowded places, malls, or when
discussing her trauma. The fear and anxiety associated with these triggers worsen her memory
disturbances.
Rosie is aware of her memory lapses and acknowledges the distress they cause. She
expresses a strong desire to regain her lost memories and function normally in daily life. Rosie's
motivation for treatment is fueled by her aspiration to overcome the trauma's lingering effects
and resume a sense of normalcy in her life. She hopes that counseling will help her process the
traumatic events and recover her lost memories, allowing her to reintegrate fully into society and
rebuild her shattered sense of self.
These additional details regarding onset, conditions, and Rosie's insight and motivation
provide a more comprehensive understanding of her dissociative amnesia, aiding in the
development of an accurate diagnosis and an effective treatment plan tailored to her unique
circumstances.
Mental Status Exam
Appearance:
Presenting Appearance: Rosie presents as a 15-year-old Puerto Rican female, appearing
younger than her chronological age. She looks visibly distressed, with signs of fatigue
and weight loss.
Basic Grooming and Hygiene: Rosie's grooming appears neglected. Her clothes, though
appropriate, seem slightly disheveled, suggesting a lack of attention to personal care.
Gait and Motor Coordination: Rosie's motor coordination appears normal, but her gait
is hesitant and somewhat unsteady.
Manner & Approach:
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Interpersonal Characteristics and Approach to Evaluation: Rosie is initially reserved
and evasive, displaying signs of subdued mistrust and a defensive demeanor. She appears
anxious and uncomfortable during the evaluation.
Behavioral Approach: Rosie's approach is cautious and hesitant. She exhibits signs of
anxiety and depressive affect, often showing signs of inner turmoil and worry. She is
generally alert but easily startled.
Speech: Rosie's speech is slightly pressured and often soft-spoken. She exhibits signs of
hesitancy and difficulty in articulating her thoughts.
Eye Contact: Rosie avoids direct eye contact, suggesting discomfort or anxiety.
Expressive Language: Rosie has difficulty expressing herself coherently. She often
struggles to find appropriate words and occasionally mumbles.
Orientation, Alertness, & Thought Processes:
Orientation: Rosie is oriented to person, place, and time but exhibits some disorientation
due to anxiety.
Alertness: Rosie is alert but easily distracted, displaying signs of fatigue.
Coherence: Rosie's responses are generally coherent, but at times, she struggles to
provide detailed or organized information.
Concentration and Attention: Rosie demonstrates difficulty in maintaining
concentration and attention during the evaluation, often getting sidetracked or losing
focus.
Thought Processes: Rosie's thought processes are logical, but she exhibits signs of
anxiety, affecting the clarity and flow of her thoughts.
Mood & Affect:
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Mood: Rosie reports feeling persistently sad, despondent, and anxious. Her overall mood
is consistently low and melancholic, indicating a significant emotional burden.
Affect: Rosie's affect is restricted, with a limited range of emotional expression. She
struggles to convey emotions appropriately, often appearing tearful and subdued. There
are signs of inappropriate affect, notably incongruent with the conversation.
Suicidal and Homicidal Ideation: Rosie admits to recurrent suicidal ideation without a
specific plan or intent. The ideation is associated with her distress and feelings of
hopelessness.
Risk for Violence: Rosie poses a low risk for violence based on her presentation and
interaction during the evaluation.
Impulsivity: Rosie exhibits a low level of impulsivity, particularly in her responses and
actions during the evaluation.
This brief overview provides initial observations and impressions, highlighting Rosie's
depressive affect, anxiety, restricted emotional expression, and persistent feelings of sadness, all
of which support a potential diagnosis of depressive disorder. Further comprehensive evaluation
and diagnostic assessment will be essential to confirm the diagnosis and formulate an appropriate
treatment plan.
Answer Key
DSM-5 Diagnostic Criteria: disorder name Client’s Reported Symptoms:
and code number
Criterion B: Recurrent gaps in the recall of Rosie’s parents and peers reported her
everyday events, important personal inability to recall important personal
information, and/or traumatic events that are information
inconsistent with ordinary forgetting. F44.0
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Rosie’s parents reported gaps in memory in
relation to the abduction
Rosie’s school counselor reported memory
impairment beyond normal forgetfulness
Rosie’s friends reported distress or
impairment in social instances
Rosie’s school counselor reported significant
impairment in functioning due to amnesia
when it comes to matters at school
Treatment Recommendations
Treatment recommendations for Rosie, who is experiencing dissociative amnesia, should
be tailored to her specific needs and the nature of dissociative disorders. Here are two
counseling-focused treatment recommendations:
Trauma-informed therapy, such as Trauma-Focused Cognitive Behavioral Therapy (TF-
CBT), can be highly beneficial for Rosie. This approach helps individuals understand the impact
of trauma on their lives and provides coping strategies to manage traumatic memories. The focus
is on addressing trauma-related symptoms, such as dissociation, while creating a safe and
supportive environment for the client to process their experiences. Techniques like grounding
exercises and mindfulness can help Rosie regain a sense of control over her dissociative
symptoms.
Trauma-informed therapy is appropriate for Rosie given her reported history of a
traumatic event (abduction) and subsequent memory loss. Studies suggest that trauma-focused
interventions effectively reduce dissociative symptoms in individuals with trauma-related
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disorders (e.g., Cloitre et al., 2010). It can aid Rosie in processing the traumatic experience,
managing her dissociative symptoms, and regaining lost memories.
Eye Movement Desensitization and Reprocessing (EMDR) is another effective treatment
approach for dissociative disorders like dissociative amnesia. EMDR involves reprocessing
traumatic memories to alleviate distress associated with them. The therapist uses bilateral
stimulation (e.g., eye movements) while guiding the client to process distressing memories and
their associated negative beliefs, helping them integrate these memories and reduce their
emotional charge.
EMDR has been shown to effectively treat dissociative symptoms and trauma-related
disorders (Bae et al., 2019). Given Rosie's memory loss associated with a traumatic event,
EMDR can help her access and process these memories, potentially reducing her dissociative
amnesia symptoms and improving her overall well-being.
These recommendations focus on addressing trauma and associated dissociative
symptoms, aiming to help Rosie regain control over her memories and work towards healing
from her traumatic experience.
Medication considerations
In Rosie's case of dissociative amnesia, medication should not be the primary
intervention. The focus should primarily be on therapy and counseling approaches tailored to her
specific needs and symptoms. Dissociative disorders are best treated through psychotherapy,
where the individual can work through the underlying traumas and associated symptoms.
Medication is not a direct treatment for dissociative amnesia, as it primarily targets symptoms
related to mood, anxiety, or other mental health conditions.
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However, in some cases, individuals with dissociative disorders may also experience
comorbid conditions like depression, anxiety, or sleep disturbances. If Rosie presents with such
comorbid symptoms, a medication evaluation might be considered. For instance, if she's
experiencing depressive symptoms due to the distress associated with her memory loss and
trauma, antidepressant medications could be considered. Quality of life can be impacted with the
aid of using medications as a secondary means of treatment (Rapaport, 2005). The implications
of medication can vary and dosage should be carefully considered. (Rapaport, 2005).
Antidepressant Medications: Antidepressants like selective serotonin reuptake inhibitors
(SSRIs) or serotonin-norepinephrine reuptake inhibitors (SNRIs) could be considered if Rosie is
experiencing comorbid depression or anxiety. These medications can help alleviate depressive
symptoms and may support her in engaging more effectively in therapy (NICE, 2019).
It's important to emphasize that medication should be considered cautiously and as a
complementary approach to therapy, not as a standalone treatment for dissociative amnesia.
Close collaboration between mental health professionals, including psychiatrists and therapists,
is crucial to ensure a holistic approach to Rosie's treatment.
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References
Bae, H., Kim, D., & Park, Y. C. (2019). Eye movement desensitization and reprocessing for
adolescent depression: A randomized controlled trial. BMC Psychiatry, 19(1), 261.
Cloitre, M., Courtois, C. A., Charuvastra, A., Carapezza, R., Stolbach, B. C., & Green, B. L.
(2010). Treatment of complex PTSD: Results of the ISTSS expert clinician survey on
best practices. Journal of Traumatic Stress, 23(5), 615-627.
Diagnostic and Statistical Manual of Mental Disorders: Diagnostic and Statistical Manual of
Mental Disorders, Fifth Edition, Text Revision. Arlington, VA: American Psychiatric
Association, 2022.
National Institute for Health and Care Excellence (NICE). (2019). Depression in adults:
recognition and management.
Rapaport, M. H., Clary, C., Fayyad, R., & Endicott, J. (2015). Quality-of-Life Impairment in
Depressive and Anxiety Disorders. The American Journal of Psychiatry, 162(6), 1171.
https://doi.org/10.1176/appi.ajp.162.6.1171
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