PSYCHOGENIC
AMNESIA:
A CLINICAL
INVESTIGATION
OF 25 CASES
Philip M. Coons, I.D.
Victor Milstein, Ph.D.
Philip M. Coons, M.D., is Associate Professor of Psychiatry
at Indiana University School of Medicine and Staff Psychiatrist
at Larue D. Carter Memorial Hospital in Indianapolis,
Indiana. Victor Milstein, Ph.D., is Professor of Psychiatry at
Indiana University School of Medicine and Psychophysiologist
at Larue D. Carter Memorial Hospital in Indianapolis,
Indiana.
For reprints write Philip M. Coons, M.D., Larue D. Carter
Memorial Hospital, 1315 West 10th Street, Indianapolis,
Indiana 46202.
Portions of this paperwere presented at the Sixth International
Conference on Multiple Personality/Dissociative States,
October 13, 1989, Chicago, Illinois.
ABSTRACT
Although there have been eight descriptive studies on patients with
psychogenic amnesia between 1935 and 1962, this is the first such
study in thirty years. Using an extensive clinical history, mental sta-
tus examination, collateral interviews, neurological examination,
electroencephalogram (EEG), intelligence testing, Minnesota
Multiphasic Personality Inventory (MMPI), and the Dissociative
Experiences Scale (DES), the authors examined twenty-five consec-
utive psychogenic amnesia patients diagnosed with modified DSM-
11I-R
not of sudden onset. A few cases were repetitive. There were multi-
ple stressful psychological precipitants. There were many similari-
ties to patients with multiple personality disorder, providing further
proof that dissociative disorders occur along a dissociative spectrum.
Psychogenic amnesia is probably the most common dissociative dis-
order diagnosis. It is frequently overlooked because the symptoms are
subtle, and other primary diagnoses are often present.
INTRODUCTION
With the exception of several case reports (Daniel 
Crovitz, 1986; Feldman, 1967; MacHovec, 1981) and an excel-
lent review (Loewenstein, 1991), very little has appeared in
the literature on psychogenic amnesia since the early 1960s.
At least six recent case reports have confused psychogenic
amnesia and fugue (Akhtar, Lindsey, Khan, 1981;
Gudjonsson Haward, 1982; Lyon, 1985; Kaszniak, Berren,
Santiago, 1988; Takahashi, 1988; Eisen, 1989). Since all
of the individuals described in these case reports were dis-
covered far from their usual place of work or residence, they
really met the (American Psychiatric Association, 1980) ,
and DSM-III-R (American Psychiatric Association, 1987) , cri-
teria for psychogenic fugue, atypical dissociative disorder,
or dissociative disorder not otherwise specified (DDNOS).
Although psychogenic amnesia did not become an offi-
cial diagnosis until the publication of DSM-III (American
Psychiatric Association, 1980), it was listed as a symptom under
dissociative reaction in theDSM-Iand under hysterical neu-
rosis, dissociative type, in the (American Psychiatric
Association, 1968).
Between 1935 and 1962, there appeared eight descrip-
tive studies on large series of patients with amnesia (Abeles
Schilder, 1935; Leavitt, 1935; Kanzer, 1939-1940; Sargant
Slater, 1941; Parfitt Gall, 1944; Wilson Rupp, 1950;
Kennedy Neville, 1957; Kiersch, 1962). Numbers of
patients ranged from 30 to 144, Diagnoses for these amnes-
tic patients included what is now known as psychogenic
sia (American Psychiatric Association, 1987), plus sizeable
numbers of patients with psychogenic fugue, epilepsy, vari-
ous types of organic brain disorders, and malingering.
Selected findings from studies are summarized in Table 1.
These earlier studies, excluding those done with armed
forces subjects, showed an approximately equal sex incidence.
Although psychogenic amnesia could occur at almost any
age (range 13 - 66) , the peak incidence of cases occurred in
the third and fourth decades. Although most studies did not
comment on the possibility of recurrence, 15 of 63 (24%)
patients in the Abeles Schilder study (1935) had two or
more episodes. The only studieswhich mentioned incidence
reported widely varying figures (range .26 to 14.4%). The
length of an episode lasted anywhere from a few hours to
three weeks or longer, but the majority lasted from just under
twenty-four hours (43%) to between one and five days (33%) ,
and 75% recovered spontaneously (Abeles Schilder,
1935) . In the majority of studies, malingering was felt to have
been present in some patients. In two more recent studies
(MacHovec, 1981; Schachter, Wang, Tulving, Freedman,
1982; and Kopelman, 1987), memory loss was found to be
autobiographical in nature.
The present study is part of a larger investigation of dis-
sociative disorders including multiple personality disorder
(MPD), psychogenic fugue, and DDNOS (Coons, Bowman,
Milstein, 1988) conducted over a five-year period from
1984 to 1989. The patients reported herein were the first 25
consecutive psychogenic amnesia patients who presented to
a dissociative disorders clinic in a tertiary care hospital and
outpatient clinic which was affiliated with a major medical
73
DISSOCIATION, Vol. V, No. 2, June 1992
PSYCHOGENIC AMNESIA
TABLE 1
Previous Studies of Psychogenic Amnesia
Study (Year) Number of Source of
Decade
of Peak
Gender
Ratio Precipitating
Patients Patients Incidence Incidence MIF Stresses
Abeles & Schilder (1935) 63 Inpatient Psychiatric 3 .26 31132 marital, financial
Leavitt (1935) 104 General Hospital .83 66138 emotional shock
Kamer (1939-40) 71 Inpatient Psychiatric 3 41130 marital, financial
Sargant & Slater (1941) 144 Inpatient Neurology 14.4 combat
Partin & Gall (1944) 30 Royal Air Force 3-4 NA discipline
Wilson & Rupp (1950) 59 General Hospital 3-4 31128 marital
Kennedy & Neville (1957) 74 Emergency Room 52122 marital, financial
Kiersch (1962) 98 Army Gen Hosp 3 9216 legal
Contributing
Factors
conversion, head injury,
epilepsy
psychosis, epilepsy
depression, alcohol,
conversion, epilepsy
depression, head injury,
psychosis
conversion, alcohol
epilepsy, head injury,
psychosis
epilepsy, head injury,
psychosis
alcohol, head injury
center and school. The purpose of the study was to describe
and characterize patients with psychogenic amnesia and com-
pare them to patients with multiple personality disorder.
SUBJECTS AND METHODS
Subjects
The subjects in this study were the first 25 consecutive
patients with amnesia who presented to the dissociative dis-
orders clinic for treatment or consultation. There were 17
inpatients and eight outpatients. All but seven were patients
at our facility. All patients who were administered experi-
mental assessment instruments gave their voluntary informed
consent.
Methods
Psychogenic amnesia was defined according to DSM-IH
and DSM-III-R criteria with the exception that the amnesic
episode was not required to be of "sudden" and presumably
recent onset. This particular convention was adopted because
of the relatively large numbers of patients presenting to the
dissociative disorders clinic with chronic amnesia for large
portions of childhood.
On intake patients were assessed by a comprehensive
history including psychiatric, medical, family, and social por-
tions in addition to a mental status examination. Previous
psychiatric records were requested and the referring clini-
cian was consulted. In most cases a collateral history was
taken from a family member.
Because previous reports of psychogenic amnesia fre-
quently mentioned the presence of organic factors such as
head injury, the patients were given a complete physical exam-
ination including a neurological examination and EEG.
Intelligence was measured by use of the Shipley-Hartford
Vocabulary Test (Zachary, 1986) or WAIS-R (Wechsler,
1981). The MMPI (Hathaway McKinley, 1967) was admin-
istered to measure personality functioning. Other rating instru-
ments including the Global Assessment Scale or GAS
(Endicott, Spitzer, Fleiss,1976) , Hamilton Depression Scale
or Ham-D (Hamilton, 1967) , and the Brief Psychiatric Rating
Scale or BPRS (Overall Gorham, 1962). When the
Dissociative Experiences Scale or DES (Bernstein Putnam,
1986) was developed, it was added to the assessment pack-
age.
The data were analyzed using t-tests where continuous
variables were present and chi square for categorical vari-
ables unless cell frequencies were less than 5 when the Fisher
Exact Test was used. A probability level of .05 wasused as
determining significantdifferences.
RESULTS
Demographic Characteristics
The patients included 23 women and two men ranging
in age from 17 to 51 years (mean, 32 years). Only seven
(28%) were currently married. The remainder were either
single (40%) or separated or divorced (32%). Mean edu-
cational level was 12.7 years (range, 9-18 years). All were
Caucasian except for one Hispanic woman. The majority
(64%) were employed. One was a student, and two were
homemakers.
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DiSSOCI.VrlON, Vol. V, No. 2. fune l992
COONS/MILSTEIN
Onset of Illness
These patients reported that their amnesia began
between the ages of 2 and 37 (mean, 19 years). Five were
unable to give a specific age of onset, other than early child-
hood. Seventeen patients required psychiatric hospitaliza-
tion and their first hospitalization occurred at a mean age
of 27 years (range, 14-41 years) . For all 25 patients, the mean
age of first contact with mental health professionals was also
27 years (range, 5-57 years).
Presenting Psychiatric Symptoms
These patients presented with a wide variety of symp-
toms (Table 2), many of which were interrelated. Although
all of the patients had amnesia, few actually complained of
memory loss. Depression was the most common symptom.
Conversion symptoms were infrequent; there were two cases
of anaesthesia and one case each of blindness, deafness, apho-
nia, and paralysis. A minority of the patients (36%) had a
history of legal difficulties. Two patients were involved with
each of the following offenses: driving while intoxicated,
prostitution, and writing bad checks. One patient was
involved with theft, one with embezzlement, one with sell-
ing drugs, and one with child abuse. The most common type
of sexual dysfunction was inhibited sexual desire, found in
40%. Other somatic complaints, which ranged from 20 to
37%, included nausea, abdominal pain, dysmenorrhea, pal-
pitations, dizziness, and dyspnea. While headaches were the
third most frequent complaint, they tended to be of the ten-
sion variety (N=10), although four patients had migraine
headaches and two had both varieties. Occurrence of other
dissociative symptoms characteristic ofMPD, such as audi-
tory hallucinations, fugues, or alter ego states, were notably
absent or greatly diminished.
The most common presenting personality traits and symp-
tomswere borderline, dependent, and histrionic. These includ-
ed the following: affective instability (84%), dependency or
helplessness(64%v), unstable, intense interpersonal rela-
tionships (60%) , physically self-damaging acts (60%) , impul-
sivity or unpredictability (56%) , identity disturbance (48%) ,
inability to work consistently (48%), self-dramatization
(44%), school grades below expected IQ level (44%), irra-
tional angry outbursts (40%), shallow or lacking genuine-
TABLE 2
Presenting Symptoms of Psychogenic Amnesia
Symptom
Psychogenic Amnesia Multiple Personality
p Value(n=25) (N=50)
N(%) N(%)
Amnesia 25 (100) 50 (100) ns
Depression 21 (84) 44 (88) ns
Headaches 16 (64) 18 (56) ns
Sexual Dysfunction 15 (60) 42 (84) .05
Somatization 11 (44) 18 (36) ns
Depersonalization 10 (40) 19 (38) ns
Auditory Hallucinations 6 (24) 36 (72) .005
Alcohol Abuse 6 (24) 21 (42) ns
Conversion 6 (24) 20 (40) ns
Drug Abuse 5 (20) 23 (46) .05
Self-Mutilation 5 (20) 17 (34) .005
Binge Eating 5 (20) 1 (2) ns
Delusions 3 (1 2) 3 (6) ns
Visual Hallucinations 3 (12) 8 (16) ns
Fugue 1 (4) 24 (48) .005
Anorexia 1 (4 ) 2 (4) ns
Pseudoseizures 0 7 (14) ns
75
DISSOC1ATt0N. Vol. V. No. 2, June 1992
PSYCHOGENIC AMNESIA
ness (40%) , inability to relax (40%) , and intolerance of being
alone (40%).
Previous
The mean number of previous psychiatric diagnoses was
2.6 (range, 0-8) . The most common diagnoses included major
depression (60%), substance abuse or dependence (40%),
eating disorder (28%), borderline personality disorder
(24%), alcohol abuse or dependence (24%), dysthymia (20%),
adjustment disorder (12%), generalized anxiety disorder
(12%), and conversion disorder (8%). The patients aver-
aged four years between their first mental health contact
and being diagnosed with psychogenic amnesia.
Amnesia
The character of the amnesia was quite variable. Few
actually complained of memory loss. Four (46%) had amne-
sia for recent events, 15 (60%), had amnesia for remote
events, and six (24%) had both recent and remote memo-
ry loss. The majority (60%) had only one episode of amne-
sia, but eight (32%) had two episodes, and two (8%) had
four episodes. The duration of an episode of recent amne-
sia ranged from 15 minutes to four hours (mean, 1.2 hours) .
The duration of a remote episode of amnesia ranged from
one month to 20 years (mean, 7.7 years). Typical descrip-
tions of amnesia would include, "I can remember anything
before the age of 12, " or "I can t remember the third and
fourth grades." Most patients (76%) experienced the selec-
tive type of amnesia, but two reported the generalized type,
and four (16%) experienced both types. No cases of con-
tinuous or generalized amnesia were observed.
but also involved mothers, uncles, siblings, and neighbors.
Family History of PsychiatricDisorder
Alcohol abuse or dependency was the most common
psychiatric illness reported in first degree relatives. It was
reported in 16% of fathers, 12% of mothers, and 8% of sib-
lings. Major depression was present equally in mothers and
siblings (12%), while drug abuse or dependence was report-
ed four times as frequently in siblings as compared to moth-
ers (16% vs. 4%) . Personality disorders were reported more
often in fathers (8%) than in mothers or siblings (4% each).
No dissociative disorders were reported in first degree rela-
tives.
Medical and Neurological Problems
Obesity was the most common Axis III diagnosis, fol-
lowed by migraine headaches and spastic colitis (16% each).
Only one patient showed neurological findings, an unre-
lated Bell palsy. None had seizure histories, and only three
had positive EEG findings. These included occasional gen-
eralized spike and wave discharges, diffuse sharp and slow
wave discharges, and bilateral temporal lobe spikes, respec-
tively.
Psychological Testing
The MMPI profile and mean T scores for the 19 female
patients with psychogenic amnesia are shown in Figure 1.
These scores are contrasted with scores from 38 females with
MPD. The curves for both groups are quite similar, and both
show a number of scales with T scores of 70 or greater. For
both groups, the highest score occurred on the schizophre-
nia scale, but depression, psychopathic deviance, paranoia,
Precipitants of Amnesia
The previous literature on psy-
chogenic amnesia was examined for dif-
ferent types of precipitants to an amnesic
episode (See Table 1) . Nine categories
were selected, and the patients were rated
on whether or not a specific precipitant
was present. The results are displayed
in Table 3. The psychogenic amnesia
may have had more than one precipi-
tant. Although child abuse occurred most
frequently, disavowed behaviors (sexu-
al promiscuity, suicide attempt, self-
mutilation, crime, or running away) were
present in many others. Thus, multiple
interrelational as well as dependent
precipitants of psychogenic amnesia
are suggested by the frequency and vari-
ety of factors reported by the patients.
Childhood trauma was very common
in this group of patients. Sexual abuse
was reported by 52% and physical abuse
by 40%. Neglect (16%) and abandon-
ment (12%) were also present. Only 28%
reported no childhood trauma.
Perpetrators of child abuse were usual-
ly fathers (36%) or stepfathers (12%),
TABLE 3
Possible Precipitants of Amnesia of Psychogenic Amnesia
Precipitant N (%v )
Child Abuse 15 (60)
Marital Trouble 6 (24)
Disavowed Sexual Behavior 4 (16)
Suicide Attempt 4 (16)
Criminal Behavior 3 (12)
Death of Relative 1 (4)
Psychotherapy 1 (4)
Runaway 1 (4)
Unknown 4 (16)
N is greater than 25 because of multiple precipitants present in each case.
76
DISSOCGITLON, I'M. V. No. 2, ,lime 1992
COONS/MILSTEIN
(mean = 61.4) manifested only some
mild symptoms (t = 7.206, p < .0001) .
The DES scores from the 22 psy-
chogenic amnesia patients yielded a
mean of 39.5 (range, 26-56), sug-
gesting somewhat less dissociation
than would be expected from a group
of patients with MPD.
DSM-111-R
Diagnoses
Psychogenic amnesia was a prin-
cipal diagnosis in only five patients.
It was a secondary or tertiary diag-
nosis in all of the other patients.
Overall, there were an additional 60
DSM-III-R Axis I or Axis II diagnoses
(mean, 2.4; range 1-5). Personality
disorders were the most common Axis
II diagnoses (68%). In eight indi-
viduals (32%), personality disorder
symptomatology was mixed, and six
(24%) met criteriafor borderline per-
sonality disorder. Affective disorders
were the most common Axis I diag-
nosis (56%). Seven (28%) had dys-
thymia, three (21%) had major
depression, and one (4%) had adjust-
ment disorder with depression.
Alcohol abuse/dependence was pre-
sent in six (24%) and drug
abuse/dependence in five (20%).
Six (24%) had conversion disorder,
and five (20%) had bulimia. Two
patients had schizophrenia, and one
had a brief psychosis.
FIGURE 1
MMPI in Psychogenic Amnesia and Multiple Personality
1
 / 1
1
1 1 1
1 1
1
l
1
1r
7

s
-0  - - - -PSYCHOGENIC AMNESIA(19 FEMALES)
___ t __. MULTIPLE PERSONALITY
(38 FEMALES)
L F K Hs D Hy Pd M t Pa PI Sc M a Si
Nw
cc0
0N
I-
and psychasthenia were also high. The F validity scale was
also quite high for both groups and, combined with the rel-
atively low K score, suggest that all of these patients were
open to admissions of pathology. This does not necessarily
imply faking bad. Intelligence was in the average range for
the 10 patients who were tested with the WAIS-R, with a mean
Verbal IQ of 107, mean Performance IQ of 102, and mean
Full Scale IQ of 102. The Shipley-Hartford Vocabulary Test
yielded a mean IQof 122 for another eight patients.
Standardized Measures of Psychopathology
On the Ham-D(possible scores 24-97), the 17 inpatients
had a mean score of 46.9 (SD, 10.5), which, while suggest-
ing a moderate degree of depression, was significantly high-
er (t = 2.449, p < .02), than the score for the eight outpa-
tients with MPD (mean = 39.9, SD = 9.8). Both inpatient and
outpatient groups showed about the same level of psy-
chopathology on the BPRS, but there was a significant dif-
ference in GAS scores with the psychogenic amnesia inpa-
tients, indicating serious symptomatology or impairment
(mean = 42.8), while the psychogenic amnesia outpatients
DISCUSSION
Although there are many similarities between patients
with psychogenic amnesia in this study and those in previ-
ous studies, there are also many differences. As in previous
studies (Abeles Schilder, 1935; Leavitt, 1935; Kanzer, 1939-
1940; Parfitt Gall, 1944) , the peak incidence of psychogenic
amnesia in our study occurs in the third and fourth decades.
Similarly, we found a significant incidence of somatic com-
plaints, including headaches (Kanzer, 1939-1940; Parfitt 
Gall, 1944) and conversion (Abeles Schilder, 1935),
depression (Kanzer, 1939-1940; Sargant Slater, 1941), and
alcohol abuse (Kanzer, 1939-1940; Parfitt Gall, 1944). We
also found a small number of patients who experienced psy-
chotic symptoms (Leavitt, 1935; Sargant Slater, 1941; Wilson
Rupp, 1950; Kennedy Neville, 1957).
However, unlike previous earlier studies, we found a
much higher incidence of chronicity. Our patients were nei-
ther acute nor did their amnesia resolve spontaneously. Our
77
DISSOCIATION, Vol. V, No. 2, June 1992
PSYCHOGENIC AMNESIA
sample may be biased because our hospital is tertiary-care,
and acute patients are selected out by their rapid recovery.
Likewise, acute financial or marital crises tend to be resolved
prior to admission to a tertiary-care facility. Since we were
not engaged in a war at the time of the study and our facil-
ity is not a Veterans Administration facility, there were no
combat-related cases of psychogenic amnesia. TheDSM-III-
R criteria for psychogenic amnesia effectively excluded any
patients with amnesia secondary to organic causes such as
head injury, alcoholism, etc.
The extremely high incidence of psychogenic amnesia
in women in this study (92%) was an unexpected finding
since previous studies, except those includingveterans, found
an approximately equal sex distribution. The reasons for the
high proportion of women in this study is speculative, but
maybe because women are more often sexually abused than
men in childhood. Or, it may be because men are under-
represented among those seeking psychiatric treatment in
general.
Another unexpected finding was that 40% of our sam-
ple had two or more episodes of psychogenic amnesia. Abeles
Schilder (1935) reported a 24% incidence of recurrence.
The higher rate of recurrence may be explained by the
increased chronicity of patients found in tertiary-care set-
tings.
The incidence of psychogenic amnesia among our adult
service patients is 1.8%; this is between the figures report-
ed in the literature: from the low range ofAbeles and Schilder
(1935) and Leavitt (1935) for patients admitted to psychi-
atric units (.26 and .83, respectively) to the 14.4% rate report-
ed by Sargant Slater (1941) for patients admitted to neu-
rological units. One might expect the incidence of amnesic
syndromes to be higher on neurological units because mem-
ory dysfunction is a common neurological complaint.
Unlike previous studies (Kanzer, 1939-1940; Wilson 
Rupp, 1950; Kennedy Neville, 1957; Kirsch, 1962), we found
no patients whom we thought were malingering. Most
patients with severe legal problems who might have had rea-
son to malinger were selected out of our sample by admis-
sion criteria prohibiting most admissions of the criminally
disordered offender to our hospital. However, a significant
proportion of our patients (30%) had amnesia based on dis-
avowed behaviors such as sexual behavior, suicide attempts,
and running away, and may have had some reason to at least
minimize their behavior. The diagnosis of malingering is
difficult (Resnick, 1984), and has only recently been added
to the diagnostic criteria (American Psychiatric Association,
1980) .
The similarities between patients with psychogenic
amnesia in this study and patients with multiple personali-
ty disorder in other studies is striking (Bliss, 1984; Putnam,
Guroff, Silberman, Barban Post, 1986; Coons, Bowman,
Milstein, 1988). Like patients with MPD, there is a high
incidence of amnesia, depression, headaches, somatization,
conversion, and depersonalization. However, in this study
(See Table 2), there was a significantly lower incidence of
auditory hallucinations, sexual dysfunction, substance abuse,
conversion, self-mutilation, and fugue. In our studies of patients
with MPD and psychogenic amnesia, the occurrence of
abuse was more frequent in patients withMPD (p < .01) and
was more apt to be repeated (p < .05) . Comparing the mean
MMPI profiles of women with psychogenic amnesia in this
study to the mean MMPI profiles of women MPD patients in
our previous study (Coons, Bowman, Milstein, 1988) , reveals
striking similarities (See Figure 1). Only the F and Sc scales
were lower (p < .1) in the psychogenic amnesia group. These
findings lend credence to the theory that dissociative dis-
orders occur along a dissociative spectrum (Braun, 1988).
CONCLUSIONS
The findings in this study have implications for
Since psychogenic amnesia may be chronic (i.e., large blocks
of amnesia may be present in the past lives of individuals),
the term "sudden" should be removed from criterion A of
the diagnosis. The chronic form of psychogenic amnesia
appears to be more common than previously realized. The
more acute forms of psychogenic amnesia are probably quite
unusual, and this may explain why they achieve newspaper
and television notoriety when they do occur.
It is difficult to diagnose psychogenic amnesia because
patients rarely complain of amnesia. Thus, it will only be
reliably diagnosed when clinicians become accustomed to
taking detailed chronological life histories and making
detailed inquiries about areas of memory loss. Merely ask-
ing patients about their knowledge of themselves, such as if
they graduated from high school or what their grades were,
will fail to elicit evidence of psychogenic amnesia (Loewenstein,
1991).
Although psychogenic amnesia usually consists of a sin-
gle episode, it may recur on more than one occasion. In
addition, dissociation exists on a spectrum from normal to
increasingly abnormal. Psychogenic amnesia is perhaps the
simplest form of dissociation since, unlike the other disso-
ciative disorders, amnesia is present with neither identity
change nor wandering.
Modern research about the phenomenology and etiol-
ogy of psychogenic amnesia is in its infancy much like
research of 15 years ago. We now possess powerful tools such
as the DES (Bernstein Putnam, 1986) and the SCID-D
(Steinberg, Rounsaville, Cicchetti, 1990) to study disso-
ciation, and future studies should make use of these tools.
Hopefully, the future will bring a renaissance in the study
of all dissociative disorders, not just Studies on at least
two of the dissociative disorders, depersonalization disor-
der, and psychogenic fugue, will need to utilize a multicen-
ter approach because of the rarity of these disorders. 
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