Abnormal Psychology

Cognitive Disorders 695

most obvious when the person must spontaneously

recall information, such as remembering a friend’s

telephone number. The specifi c types of memory that

are most impaired (such as visual versus verbal and

recent versus distant past) depend on the brain areas

that have been affected. People with extreme mem-

ory problems may need closely supervised care every

day. According to DSM-IV-TR, amnestic disorder

is characterized only by memory problems and not

problems with other cognitive functions. Table 15.4

lists the specifi c criteria.

Memory problems that arise with amnestic

disorder are less likely to affect implicit memory.

For instance, a previously acquired ability to type

or to drive is often preserved, but someone with

amnestic disorder may be unable to explain how to

drive or even to remember that he or she candrive.

Nonetheless, once behind a wheel, the person knows

what to do. In spite of being able to perform certain

basic tasks that rely on implicit memory, the pa-

tient cannot remember factual information—particularly new information—which

clearly impairs functioning. As one man with chronic amnestic disorder notes:

I lead a basic lifestyle. I strenuously avoid what I would call “high-risk” situations.

That is, situations in which my memory diffi culties would leave me lost and disoriented.

I don’t even travel to unfamiliar places unless I am accompanied or have a detailed writ-

ten guide.... If I visit the cinema or theater, I must make sure that I won’t have to leave

my seat during the screening as I would not be able to fi nd my way back.

I don’t read novels. I will never be able to take a job. Familiarizing myself with

the location of the workplace, the nature of the job, the names of my employers and

colleagues, the plan of the building, the extent of my responsibilities, etc. would take

many weeks. In fact it would not be possible.

(Wilson, 1999, p. 42)

Imagine what it might be like to have serious gaps in your memory: Your wallet

isn’t where you thought you left it but is on the kitchen counter instead; at a party,

someone who you think is a stranger seems to know a lot about you. To create a

sense of coherence in their lives, people with memory problems may confabulate—

create stories to fi ll in the blanks in memory. For example, an individual with im-

paired memory may come to believe that his or her wallet ended up on the kitchen

counter because someone else in the family moved it. When a mental health clini-

cian asks such a patient about his or her life or problems, the patient’s report may

be a confabulation and hence be inaccurate. One man, Jack, recounts his experience

with memory problems, beginning with being asked by a professor to relay a mes-

sage to a classmate:

I left the room and promptly forgot the message, where to go, the name of the lecturer

who’d sent me, and how to return to the room I originally been sent from. I was lost.

And I can’t recall what came of the incident... many of my recent memories are like

this. I start off relatively clear and then fade off as I related the story to myself. And I

often fi nd that as faithful to the truth as many of my recollections may be, some are

tinged with pure fi ction, as if without even realizing it, I am fi lling in the gaps, the

empty times with fabricated notions of the past.... But then I am in no position to say

whether this is in fact the case. I cannot gauge how accurate any of my memories are.

(Wilson, 1999, p. 41)

Friends or family members may thus be the best source of information about an

amnestic patient’s symptoms. Case 15.3 describes a woman with amnestic disorder

who did not noticeably confabulate. Additional facts about amnestic disorder are

listed in Table 15.5.

Table 15.4 • DSM-IV-TR General Diagnostic Criteria for

Amnestic Disorder

A. The development of memory impairment as manifested by impairment in the ability

to learn new information or the inability to recall previously learned information.

B. The memory disturbance causes signifi cant impairment in social or occupational

functioning and represents a signifi cant decline from a previous level of functioning.

C. The memory disturbance does not occur exclusively during the course of a Delirium

or a Dementia [discussed later in this chapter] or persists beyond the usual duration of

substance delirium or withdrawal.

D. There is evidence from the history, physical examination, or laboratory fi ndings that

the disturbance is:

• the direct physiological consequence of a general medical condition (including
  physical trauma); or,


• etiologically related to the persisting effects of substance use (e.g., a drug of
  abuse, a medication).
  Source: Adapted from American Psychiatric Association, 2000.

People with amnestic disorder may try to fi ll

the holes in their memories by confabulating—

creating stories that make a coherent narrative of

their circumstances. For instance, a woman with

amnestic disorder might not remember how her

underwear came to be in her pocketbook; she

might then create a story to explain its presence.

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