Dissociative Amnesia is a complex psychological condition primarily characterized by the inability to recall crucial autobiographical information, most often of a traumatic or stressful nature (American Psychiatric Association [APA], 2013). Such memory loss is more extensive than ordinary forgetfulness and is inconsistent with any known neurological or medical conditions (Staniloiu & Markowitsch, 2014). Notably, the onset of these amnestic episodes tends to be abrupt and can vary in duration from brief to extended (Brand et al., 2009). Multiple types of amnesia have been identified, ranging from localized, where memories from a specific time are lost, to generalized, a more pervasive loss of memories, even encompassing one's identity (APA, 2013).

While the mechanism remains a topic of study, some research suggests that amnesia may act as a defense mechanism, offering temporary relief from distressing memories, leading to emotional numbness or reduced responsiveness to the external environment (Dorahy et al., 2014). The awareness and reaction to this memory loss also vary, with some individuals deeply troubled by their inability to recall, while others may appear indifferent or unaware (Brand et al., 2009).

Remember, while the core feature of Dissociative Amnesia is memory loss, the disorder often has emotional and behavioral components, and it is distinct from medical conditions or other psychiatric disorders (like Alzheimer's or other forms of dementia) that might cause memory impairment.

Diagnostic Criteria

Dissociation, in this context, refers to a disruption in the usually integrated functions of consciousness, memory, identity, or perception. In the case of Dissociative Amnesia, the main feature is a sudden inability to remember past experiences or personal information. These are common presentations for Dissociative Amnesia.

Dissociative Amnesia (DA) is defined by specific diagnostic criteria established by the American Psychiatric Association in the DSM-5. According to the APA (2013), the primary diagnostic criterion for DA is the inability to recall essential autobiographical information, typically of a traumatic or stressful nature, that would be too extensive to be deemed as ordinary forgetfulness. This inability to recall cannot be attributed to the direct physiological effects of a substance (e.g., a drug or medication) or a neurological or another medical condition (e.g., retrograde amnesia due to head trauma). Moreover, the symptoms cannot be better accounted for by another mental disorder, such as PTSD, Major Depressive Disorder, or other dissociative disorders.

The disturbance must cause clinically significant distress or impairment in social, occupational, or other vital areas of functioning. Notably, while the criteria are explicit, the individual manifestations of DA can vary widely, with some patients exhibiting specific gaps in their memory for particular times or events. In contrast, others might forget their entire past and even their identity (Brand et al., 2013).

Dissociative Amnesia episodes are periods during which the person cannot recall important personal information or events. The lost information is usually more extensive than what might be attributed to typical forgetfulness. These are the different types of amnesia commonly noted:

• Localized Amnesia: A person cannot remember events during a specific period, typically around a traumatic or stressful event. For instance, they might not recall events surrounding a severe car accident.
• Selective Amnesia: The individual can recall some, but not all, of the events during a specific period.
• Generalized Amnesia: A rare form where the person forgets their entire life, including their identity.
• Systematized Amnesia: Memory loss is specific to a particular category of information, such as all memories related to a specific family member.
• Continuous Amnesia: The person forgets each new event as it occurs.
• Dissociative Fugue: While not as common, some individuals with Dissociative Amnesia might also experience a dissociative fugue, during which they might travel or wander away from their homes or places of work and may even assume a new identity. During a fugue, individuals might appear fine and go about daily tasks, but later, they cannot recall the fugue episode.

Onset and Duration: The onset of amnestic episodes is usually sudden, and the duration can be brief or prolonged. Recovery of the lost memories can be spontaneous and complete, partial, or the memories might never return.

Emotional Impact: Individuals with Dissociative Amnesia might appear emotionally numb or show reduced responsiveness to the external world. This can be because amnesia serves as a psychological defense mechanism against overwhelming stress, which can temporarily remove the distressing memories.

Awareness of Memory Loss: Awareness of amnesia varies among individuals. Some might be deeply distressed by their gaps in memory, while others might be indifferent or even unaware that they are missing portions of their life experiences.

The Impacts

Dissociative Amnesia (DA) can profoundly affect an individual's life, impacting their personal, occupational, and social spheres. At the personal level, the inability to recall pivotal autobiographical events can result in confusion, distress, and a sense of incompleteness, often accompanied by emotional numbness (Brand et al., 2009). This emotional detachment can serve as a psychological buffer against overwhelming stress and inhibit genuine emotional connections and self-awareness. In occupational settings, gaps in memory can challenge an individual's ability to perform tasks, maintain responsibilities, or even hold down a job, especially if the forgotten information is crucial for daily operations or if the amnestic episodes are recurrent (Spiegel et al., 2013).

Socially, DA can strain relationships, as the affected individual might not recall shared experiences, promises, or events, leading to misunderstandings or perceived breaches of trust (Dorahy et al., 2014). Furthermore, these memory disruptions can result in secondary complications, such as depression or anxiety, further exacerbating the overall impact on well-being (Şar et al., 2017).

The Etiology (Origins and Causes)

The etiology of Dissociative Amnesia (DA) is a combination of psychological, environmental, and neurobiological factors contributing to its onset. A prominent theory postulates that DA is a psychological response to traumatic or intensely stressful events (Brand, Vissia, Chalavi, Nijenhuis, Webermann, Draijer, & Reinders, 2016).

When an individual confronts overwhelmingly distressing experiences, dissociation can act as a defense mechanism, allowing them to disconnect from the immediate reality and, in the case of DA, suppress the memory of the event (Brand et al., 2009). This adaptive mechanism can become maladaptive when overutilized, leading to unintentional blocking of essential autobiographical information. Childhood trauma, especially chronic emotional neglect or abuse, is frequently linked with dissociative symptoms in adulthood (Dalenberg et al., 2012).

Psychological Trauma and Stress:

• Trauma-based Theories: One of the most widely accepted theories regarding the etiology of DA posits that the disorder arises as a psychological defense mechanism in response to traumatic or intensely stressful events. When confronted with overwhelming distress, an individual might "disconnect" from the immediate reality, suppressing the memory of the traumatic event as a coping strategy (Brand et al., 2009). Over time, this adaptive mechanism can become maladaptive, leading to significant gaps in memory about the traumatic event or related periods.
• Childhood Trauma: Many cases of DA are associated with childhood adversities, such as physical or sexual abuse, severe neglect, or witnessing domestic violence. Such early traumas might set the stage for developing dissociative symptoms later in life (Dalenberg et al., 2012).

Neurobiological Factors:

• Brain regions involved in memory processing and emotional regulation, primarily the hippocampus and amygdala, have been implicated in DA. Changes in these areas might reflect the brain's attempt to modulate traumatic memories, potentially leading to amnesia (Vermetten et al., 2006).
• Neurochemical imbalances and alterations in neurotransmitter systems, like the noradrenergic system, might also contribute to dissociative symptoms, though research in this area is ongoing (Bremner, 2002).

Environmental and Situational Factors:

• Certain situations or environments might exacerbate or trigger dissociative symptoms. For instance, ongoing stress, the anniversary of a traumatic event, or being in an environment reminiscent of past trauma can lead to episodes of DA (Brand et al., 2016).
• Social and interpersonal dynamics can also play a role. Interactions that invalidate an individual's traumatic experiences or those that reinforce dissociative behaviors might contribute to the onset or persistence of DA (Lynn et al., 2012).

Individual Differences:

• Not everyone exposed to trauma or stress will develop DA, suggesting that individual differences, possibly genetic or epigenetic predispositions, play a role in the disorder's etiology (Jang et al., 1998).
• Early attachment patterns, personality traits, and coping mechanisms might also modulate the risk of developing DA post-trauma (Liotti, 2006).

One of the prominent theories is that neurobiological alterations in the hippocampus and amygdala, brain regions implicated in memory and emotional processing, are observed in individuals with DA (Vermetten et al., 2006). These changes might reflect the brain's attempt to modulate traumatic memories. However, it is worth noting that not everyone exposed to trauma will develop DA, suggesting that individual differences, such as genetic predispositions or early attachment patterns, could influence its manifestation (Lyssenko et al., 2018).

Comorbidities

Comorbidities are the simultaneous presence of two or more disorders in a single individual. Dissociative Amnesia (DA) often does not occur in isolation and frequently coexists with other psychiatric conditions. Among the most common comorbidities associated with DA are other dissociative disorders, such as Dissociative Identity Disorder (DID) and Depersonalization/Derealization Disorder (Brand et al., 2009).

• Dissociative Identity Disorder (DID): Previously known as multiple personality disorder, DID is characterized by two or more distinct personality states. These states may have ways of thinking, feeling, and relating to the environment. Patients with DA might also have these fragmented identities, making it a common comorbid condition (Brand et al., 2009).
• Depersonalization/Derealization Disorder involves feeling that oneself, others, or the surroundings are unreal or detached. A person with DA might also feel disconnected from themselves or their environment, aligning with the symptoms of depersonalization or derealization.
• Additionally, the traumatic or stressful events often precipitating DA make Post-Traumatic Stress Disorder (PTSD) a common co-occurring condition (Şar, 2011).
• Post-Traumatic Stress Disorder (PTSD): Given that traumatic events often trigger DA, it is not surprising that PTSD—a condition that arises in response to traumatic experiences, characterized by flashbacks, nightmares, and severe anxiety—is a frequent comorbidity. Individuals with DA might re-experience the traumatic event, avoid trauma reminders, and exhibit hyperarousal symptoms (Şar, 2011).

Given the distress and emotional turmoil associated with DA, mood disorders, particularly Major Depressive Disorder and anxiety disorders, are also frequently observed in these individuals (Seligman et al., 2004).

• Major Depressive Disorder (MDD): The emotional turmoil and distress associated with DA can predispose individuals to mood disturbances. It is characterized by persistent sadness, hopelessness, and a lack of interest in daily activities. Given the strain of managing lost memories, individuals with DA might develop or already exhibit symptoms of MDD (Seligman et al., 2004).
• Anxiety Disorders: The uncertainty surrounding missing memories can lead to heightened anxiety. This can manifest as generalized anxiety disorder, panic attacks, or other anxiety-related conditions.

Understanding these comorbidities is crucial, as they can influence DA's course, treatment, and prognosis. Effective management often requires a holistic approach that addresses the primary dissociative symptoms and co-occurring disorders.

The complexity of managing traumatic memories and the potential for feelings of guilt, shame, or self-blame can lead to the development of Borderline Personality Disorder in some patients with DA (Brand et al., 2016).

• Borderline Personality Disorder (BPD): The complexity of DA, primarily when rooted in traumatic events, can lead to patterns of instability in relationships, self-image, and emotions—a hallmark of BPD. Individuals might exhibit impulsive behaviors, fears of abandonment, and intense emotional reactions (Brand et al., 2016).

Furthermore, Substance Use Disorders may emerge as affected individuals may resort to drugs or alcohol as coping mechanisms to deal with the distress and memory lapses (Rodewald et al., 2011).

• Substance Use Disorders: To cope with the distress of lost memories and associated emotional disturbances, some individuals might turn to drugs or alcohol. Over time, this can lead to dependency or addiction, complicating the clinical picture of DA and necessitating specialized interventions (Rodewald et al., 2011).

Clinicians must be vigilant about these comorbidities as they complicate treatment and require a multifaceted therapeutic approach.

Risk Factors

Risk factors are attributes or exposures that increase the likelihood of developing a disorder or condition. For Dissociative Amnesia (DA), a multifaceted array of risk factors has been identified. Foremost among these is exposure to traumatic or highly stressful events. Research consistently indicates that individuals who have experienced trauma, particularly during childhood, such as physical or sexual abuse, severe neglect, or witnessing violence, have an elevated risk of developing DA (Dalenberg et al., 2012). These early adverse experiences can set the stage for dissociative coping mechanisms in response to later stressors. Another salient risk factor is having a pre-existing mental health disorder, especially another dissociative disorder or PTSD, which can make individuals more susceptible to DA (Brand et al., 2009).

Genetic factors might also play a role, where a family history of dissociative disorders could indicate a higher predisposition (Jang et al., 1998). Individuals with certain personality traits, like high suggestibility or a tendency towards fantasy proneness, may be more prone to develop DA under distressing circumstances (Merckelbach et al., 2000).

Finally, certain environmental factors, such as ongoing stress, lack of social support, or an environment that may inadvertently reinforce or validate dissociative experiences, can increase the likelihood of manifesting DA symptoms (Lynn et al., 2012).

Case Study

Patient Profile: Laura, age 38, is a school teacher. She is married with two children, ages 10 and 8

Presenting Problem: Laura was referred by her primary care physician after presenting with significant gaps in her memory, particularly regarding certain events from her past. She reported an inability to remember specific periods, most notably her entire senior year of high school.

History: Upon probing, Laura recalled her high school years being stressful due to intense academic pressures and her parent's tumultuous divorce. However, she could not remember any specific events from her senior year, including her graduation ceremony, which her family confirmed she attended. She also mentioned that she had recently encountered a series of photographs from her senior year, which she could not recognize or recollect.

Laura's husband, Jake, noted that she sometimes seemed "distant" and "not present," mainly when discussions about high school or her parents' divorce arose.

Clinical Observations: Laura appeared anxious during sessions and often became tearful when attempting to recall her lost memories. She expressed frustration and fear over her "missing year," worrying that there might be more memories she has forgotten.

Assessment & Diagnosis: Laura underwent a series of psychological evaluations. Tests ruled out medical conditions and other psychiatric disorders that could cause memory impairment. Based on her symptoms and history, she was diagnosed with localized Dissociative Amnesia, most likely triggered by the stress of her parent's divorce and the pressures of her senior year.

Treatment: Laura began a combination of individual therapy and family therapy. The individual sessions focused on cognitive-behavioral techniques to address her anxiety and techniques to access and cope with traumatic or stressful memories. The family sessions involving her husband and children were geared towards educating the family about DA and helping them develop strategies to support Laura.

Over time, through therapeutic interventions, Laura began to recall fragments of her senior year, including attending prom with her now-husband. Although she has not regained all her lost memories, Laura reported feeling less anxious and more connected to her family.

Conclusion: Laura case highlights the complex interplay between trauma, stress, and memory. With timely intervention and a supportive environment, patients like Laura can navigate the challenges posed by Dissociative Amnesia and lead fulfilling lives.

Recent Psychology Research Findings

Recent research on Dissociative Amnesia (DA) has delved into various aspects, from neurobiological underpinnings to treatment approaches. In neurobiology, studies have highlighted changes in the brain's memory and emotional centers in individuals with DA. For instance, alterations in the structure and functioning of the hippocampus and amygdala have been observed in individuals with dissociative disorders, suggesting a potential neural basis for memory disruptions (Vermetten et al., 2016). On a cognitive front, research has investigated the mechanisms through which dissociation impacts memory. It has been posited that DA might involve the inability to retrieve memories and a deficit in memory encoding under high-stress situations (Dorahy et al., 2017).

Therapeutically, studies have underscored the effectiveness of trauma-informed therapies for DA. Eye Movement Desensitization and Reprocessing (EMDR) has gained attention as a promising intervention for those with trauma-related dissociative disorders, helping to reprocess and integrate traumatic memories (Shapiro, 2018). Moreover, research has highlighted the significance of addressing comorbid conditions, such as depression and anxiety, in enhancing the treatment outcomes for individuals with DA (Brand et al., 2019).

Finally, a broader cultural and societal perspective has emerged in the literature, emphasizing the need to understand DA within diverse cultural contexts. Cross-cultural studies indicate variations in the presentation and understanding of dissociative symptoms, underscoring the importance of culturally sensitive diagnostic and therapeutic approaches (Maraldi et al., 2007).

Treatment and Interventions

Treatment and interventions for Dissociative Amnesia (DA) aim to restore the lost memories and help the individual develop coping strategies to manage symptoms and avoid future episodes.

One of the most frequently employed treatments for DA is individual psychotherapy or "talk therapy" (International Society for the Study of Trauma and Dissociation [ISSTD], 2011). This therapy often involves helping the individual feel safe and comfortable enough to discuss and explore past traumatic or stressful events, potentially aiding in recalling forgotten memories. Techniques such as guided imagery, relaxation exercises, or hypnosis might facilitate memory retrieval under controlled settings (Brown et al., 1998). However, it is crucial to approach these techniques with caution, as there is a risk of introducing false memories or confabulations.

Eye Movement Desensitization and Reprocessing (EMDR) is another therapeutic technique that has shown promise in treating DA, especially when the amnesia is linked to traumatic events. EMDR involves the patient recalling traumatic experiences while receiving bilateral sensory input, like side-to-side eye movements (Shapiro, 2018).

For individuals who experience significant distress or functional impairment due to DA, adjunct treatments like group therapy or support groups can offer additional assistance. These groups can provide a safe space for individuals to share their experiences, learn from others, and foster a sense of belonging and understanding (ISSTD, 2011).

In cases where DA coexists with other psychiatric conditions, such as depression or anxiety, appropriate medication might be prescribed to manage those symptoms. However, there is no specific drug for DA itself (Brand et al., 2009).

Lastly, educating the patient about the disorder is pivotal in treatment. Understanding the nature of DA, its triggers, and coping mechanisms can empower the individual and reduce the distress associated with memory lapses (Spiegel et al., 2011).

Implications if Untreated              

If left untreated, Dissociative Amnesia (DA) can have a myriad of repercussions that extend beyond the immediate impact of memory loss. Most fundamentally, untreated DA can result in prolonged periods of lost memories, leaving significant gaps in an individual's life narrative. This disruption can hinder one's sense of self and continuity, leading to feelings of fragmentation and disconnection (Brand et al., 2009). Moreover, DA, particularly when associated with traumatic events, can be accompanied by distressing emotions such as fear, shame, or guilt, and these unresolved emotions can contribute to the onset or exacerbation of mood disorders like depression or anxiety (Dalenberg et al., 2012).

In the broader context of an individual's life, persistent memory gaps can impair daily functioning, disrupting personal relationships and occupational responsibilities. The person might fail to recognize significant others or forget crucial tasks, leading to interpersonal conflicts and professional challenges (Spiegel et al., 2013). Furthermore, there is a potential risk of developing other dissociative symptoms or disorders, with some individuals experiencing dissociative fugues, wherein they might temporarily lose their sense of personal identity and even undertake unexpected travel or assume a new identity (APA, 2013).

Leaving DA untreated can also make individuals more vulnerable to additional episodes of amnesia, especially when confronted with new stressors or triggers (Brand et al., 2016). Over time, the cumulative effect of these episodes and the associated psychological distress can severely impact an individual's overall quality of life, well-being, and potential for personal and professional growth.

Summary

Dissociative Amnesia (DA) has had a controversial and intricate history within psychiatry and psychology. While its core symptom, memory loss not attributable to a typical neurological condition, has been well-documented, the underpinnings and validity of the diagnosis have been points of contention (Dalenberg et al., 2012). Historically, the late 20th century saw an explosion of interest and subsequent skepticism surrounding dissociative disorders, primarily influenced by a rise in reported cases and the controversial nature of recovered memories during therapy. Some believed that specific therapeutic techniques might inadvertently implant false memories in vulnerable patients, leading to the so-called "memory wars" of the 1980s and 1990s (Loftus & Ketcham, 1994).

The heart of the controversy often revolves around the "false memory syndrome," wherein individuals recall events, especially traumatic ones, that never occurred (Loftus & Pickrell, 1995). These debates have implications for clinical practice and legal settings, where the veracity of recovered memories can play a critical role in court cases (Loftus, 1997).

However, in recent years, there has been a shift towards a more nuanced understanding of DA and dissociative disorders. While the potential for therapeutic missteps and the creation of false memories remains a concern, the field recognizes that genuine cases of DA exist, especially in trauma (Brand et al., 2016). Recent research has worked towards distinguishing between actual dissociative symptoms and potential iatrogenic (therapist-induced) ones, aiming to ensure that the diagnosis and treatment of DA are valid and effective.

Today, while the specter of past controversies still lingers, the broader acceptance of DA as a legitimate psychiatric condition is evident, with ongoing research focused on refining diagnostic criteria, understanding its etiology, and optimizing therapeutic interventions.

References

Brand, B. L., Classen, C. C., Lanins, R., Loewenstein, R. J., McNary, S. W., Pain, C., & Putnam, F. W. (2009). A naturalistic study of dissociative identity disorder and dissociative disorder not otherwise specified patients treated by community clinicians. Psychological Trauma: Theory, Research, Practice, and Policy, 1(2), 153-171.

Brand, B. L., Classen, C. C., McNary, S. W., & Zaveri, P. (2009). A review of dissociative disorders treatment studies. Journal of Nervous and Mental Disease, 197(9), 646-654.

Brand, B. L., McNary, S. W., Loewenstein, R. J., Kolos, A. C., & Barr, S. R. (2013). Assessment of genuine dissociative identity disorder: Patterns of response and an analysis of positive and negative symptoms. Psychological Trauma: Theory, Research, Practice, and Policy, 5(4), 301-311.

Brand, B. L., McNary, S. W., Myrick, A. C., Classen, C. C., Lanius, R., Loewenstein, R. J., ... & Putnam, F. W. (2016). A longitudinal, naturalistic study of patients with dissociative disorders treated by community clinicians. Psychological Trauma: Theory, Research, Practice, and Policy, 8(4), 461-469.

Brand, B. L., Vissia, E. M., Chalavi, S., Nijenhuis, E. R. S., Webermann, A. R., Draijer, N., & Reinders, A. A. T. S. (2016). DID is trauma based: Further evidence supporting the trauma model of DID. Acta Psychiatrica Scandinavica, 134(6), 560-563.

Bremner, J. D. (2002). Neuroimaging in posttraumatic stress disorder and other stress-related disorders. Neuroimaging Clinics of North America, 12(3), 515-538.

Brown, D., Scheflin, A. W., & Hammond, D. C. (1998). Memory, trauma treatment, and the law. W. W. Norton & Company.

Dalenberg, C. J., Brand, B. L., Gleaves, D. H., Dorahy, M. J., Loewenstein, R. J., Cardeña, E., ... & Spiegel, D. (2012). Evaluation of the evidence for the trauma and fantasy models of dissociation. Psychological Bulletin, 138(3), 550-588.

Dorahy, M. J., Brand, B. L., Şar, V., Krüger, C., Stavropoulos, P., Martínez-Taboas, A., ... & Middleton, W. (2014). Dissociative identity disorder: An empirical overview. Australian & New Zealand Journal of Psychiatry, 48(5), 402-417.

International Society for the Study of Trauma and Dissociation. (2011). Guidelines for treating dissociative identity disorder in adults, third revision. Journal of Trauma & Dissociation, 12(2), 115-187.

Jang, K. L., Paris, J., Zweig-Frank, H., & Livesley, W. J. (1998). Twin study of dissociative experience. Journal of Nervous and Mental Disease, 186(6), 345-351.

Loftus, E. F. (1997). Creating false memories. Scientific American, 277(3), 70-75.

Loftus, E. F., & Ketcham, K. (1994). The myth of repressed memory: False memories and allegations of sexual abuse. St. Martin's Press.

Loftus, E. F., & Pickrell, J. E. (1995). The formation of false memories. Psychiatric Annals, 25(12), 720-725.

Lynn, S. J., Lilienfeld, S. O., Merckelbach, H., Giesbrecht, T., & van der Kloet, D. (2012). Dissociation and dissociative disorders: Challenging conventional wisdom. Current Directions in Psychological Science, 21(1), 48-53.

Lyssenko, L., Schmahl, C., Bockhacker, L., Vonderlin, R., Bohus, M., & Kleindienst, N. (2018). Dissociation in psychiatric disorders: A meta-analysis of studies using the dissociative experiences scale. American Journal of Psychiatry, 175(1), 37-46.

Maraldi, E. de O., Krippner, S., Barros, M. C. M., & Cunha, A. (2017). Dissociation from a cross-cultural perspective: Implications of studies in Brazil. The Journal of Nervous and Mental Disease, 205(7), 558-567.

Merckelbach, H., Muris, P., Rassin, E., & Horselenberg, R. (2000). Dissociative experiences and interrogative suggestibility in college students. Personality and Individual Differences, 29(6), 1133-1140.

Rodewald, F., Wilhelm-Gößling, C., Emrich, H. M., Reddemann, L., & Gast, U. (2011). Axis-I comorbidity in female patients with dissociative identity disorder and dissociative identity disorder not otherwise specified. Journal of Nervous and Mental Disease, 199(2), 122-131.

Şar, V. (2011). Epidemiology of dissociative disorders: An overview. Epidemiology Research International, 404538. https://doi.org/10.1155/2011/404538

Şar, V., Krüger, C., Martinez-Taboas, A., Middleton, W., & Dorahy, M. J. (2017). Sociocognitive and posttraumatic models of dissociation are not opposed. Australian & New Zealand Journal of Psychiatry, 51(6), 562-570.

Seligman, L., Ollendick, T., Langley, A., & Baldacci, H. (2004). The utility of measures of child and adolescent anxiety: A meta-analytic review of the Revised Children's Manifest Anxiety Scale, the State-Trait Anxiety Inventory for Children, and the Child Behavior Checklist. Journal of Clinical Child and Adolescent Psychology, 33(3), 557-565.

Shapiro, F. (2018). Eye Movement Desensitization and Reprocessing (EMDR) therapy: Basic principles, protocols, and procedures. Guilford Publications.

Spiegel, D., Lewis-Fernández, R., Lanius, R., Vermetten, E., Simeon, D., & Friedman, M. (2013). Dissociative disorders in DSM-5. Annual Review of Clinical Psychology, 9, 299-326.

Spiegel, D., Loewenstein, R. J., & Lewis-Fernández, R. (2011). Dissociative disorders in the DSM-5. Depression and Anxiety, 28(9), 824-852.

Staniloiu, A., & Markowitsch, H. J. (2014). Dissociative amnesia. The Lancet Psychiatry, 1(3), 226-241.

Vermetten, E., Schmahl, C., Lindner, S., Loewenstein, R. J., & Bremner, J. D. (2006). Hippocampal and amygdalar volumes in dissociative identity disorder. American Journal of Psychiatry, 163(4), 630-636.