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Hans J. Markowitsch - One of the best experts on this subject based on the ideXlab platform.
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Dissociative Amnesia – A Challenge To Therapy
International Journal of Psychotherapy Practice and Research, 2018Co-Authors: Angelica Staniloiu, Hans J. MarkowitschAbstract:The psychiatric disease of Dissociative Amnesia is described and illustrated with case reports. It is emphasized that Dissociative Amnesia has a stress or trauma-related etiology and that affected individuals, contrary to the still dominant clinical belief, are frequently more severely and enduringly affected. That means, most of them show severe retrograde Amnesia for their biography, usually accompanied by changes in their personality and sometimes also by alterations in other cognitive and emotive domains. As many patients show the phenomenon of “la belle indifference”, their motivation for therapy or treatment of their Amnesia is reduced. Patients also seem to a high degree to possess immature, unstable personality features. Nevertheless, a number of quite divergent, though largely not evidence-based, therapeutic approaches exist and are described. They are divided into (a) psychopharmacological and somatic treatments, (b) psychotherapeutic interventions, and (c) neuropsychological rehabilitation. Furthermore, detailed treatment strategies are provided.
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Psychological causes of autobiographical Amnesia: A study of 28 cases.
Neuropsychologia, 2018Co-Authors: Angelica Staniloiu, Hans J. Markowitsch, Andreas KordonAbstract:Abstract Autobiographical Amnesia is found in patients with focal or diffuse brain damage (“organic Amnesia”), but also without overt brain damage (at least when measured with conventional brain imaging methods). This last condition is usually named Dissociative Amnesia at present, and was originally described as hysteria. Classically and traditionally, Dissociative Amnesia is seen as a disorder that causes retrograde Amnesia in the autobiographical domain in the aftermath of incidents of major psychological stress or trauma. In the present study one of the probably largest published collections of patients (28) with psychogenically caused autobiographical Amnesia, who were assessed with comprehensive neuropsychological tests, will be described and documented in order to identify variables which are central for the occurrence of Dissociative Amnesia. The presented cases demonstrate that autobiographical Amnesia without direct brain damage can have very mixed clinical presentations, causes and consequences. The described cases of psychogenic Amnesia are clustered according to a number of manifestations and features, which include a reduced effort to perform cognitively at a normal level, a forensic background, anterograde (instead of retrograde) autobiographical Amnesia, the fugue condition, concurrent somatic diseases, and their appearance in childhood and youth. It is concluded that autobiographical Amnesia of a psychogenic origin may occur within a variety of symptom pictures. For all patients, it probably serves a protective function by offering them a mechanism to exit a life situation which appears to them unmanageable or adverse.
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Functional (Dissociative) retrograde Amnesia.
Handbook of Clinical Neurology, 2016Co-Authors: Hans J. Markowitsch, A. StaniloiuAbstract:Abstract Retrograde Amnesia is described as condition which can occur after direct brain damage, but which occurs more frequently as a result of a psychiatric illness. In order to understand the amnesic condition, content-based divisions of memory are defined. The measurement of retrograde memory is discussed and the dichotomy between “organic” and “psychogenic” retrograde Amnesia is questioned. Briefly, brain damage-related etiologies of retrograde Amnesia are mentioned. The major portion of the review is devoted to Dissociative Amnesia (also named psychogenic or functional Amnesia) and to the discussion of an overlap between psychogenic and “brain organic” forms of Amnesia. The “inability of access hypothesis” is proposed to account for most of both the organic and psychogenic (Dissociative) patients with primarily retrograde Amnesia. Questions such as why recovery from retrograde Amnesia can occur in retrograde (Dissociative) Amnesia, and why long-term new learning of episodic-autobiographic episodes is possible, are addressed. It is concluded that research on retrograde Amnesia research is still in its infancy, as the neural correlates of memory storage are still unknown. It is argued that the recollection of episodic-autobiographic episodes most likely involves frontotemporal regions of the right hemisphere, a region which appears to be hypometabolic in patients with Dissociative Amnesia.
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EPA-1384 – The missing link between Dissociative Amnesia and dementia
European Psychiatry, 2014Co-Authors: A. Staniloiu, Hans J. MarkowitschAbstract:Introduction Despite suggestions that chronic stress is involved in the pathogeny of dementias, no systematic studies investigated the possibility of a link between Dissociative Amnesia and neurodegenerative dementias. Methods We analyzed data from over a dozen patients with functional Dissociative Amnesia, whom we investigated with neuropsychological methods, structural and functional neuroimaging. We followed prospectively approximately half of these patients for more than a decade. Results We evidenced in a substantial sample of patients with Dissociative Amnesia with preponderant retrograde memory impairments a hypometabolism during resting state in the right temporo-frontal region, with a decrease in the infero-lateral prefrontal cortex. Additional preliminary data from DTI suggested a decreased integrity of long distance fiber tracts important for conscious mnemonic processing. We found a chronic course of the memory impairments in a substantial number of patients with Dissociative amnesic conditions. In some chronic cases of Dissociative Amnesia we noted a fairly stable course, while in other cases we observed a progressive global cognitive deterioration. Discussion These findings point to a non-homogenous course of Dissociative Amnesia. Conclusion The search for a link between Dissociative amnesic conditions and dementia should take into consideration multiple variables, such as the age at the onset of trauma, gender, the recurrence, type and severity of trauma, the presence of psychiatric and medical co-morbidity, pre-morbid personality characteristics (e.g. neuroticism), genetic polymorphisms, educational and occupational attainment, cognitive reserve and the progression of metabolic and microstructural brain changes.
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epa 1384 the missing link between Dissociative Amnesia and dementia
European Psychiatry, 2014Co-Authors: A. Staniloiu, Hans J. MarkowitschAbstract:Introduction Despite suggestions that chronic stress is involved in the pathogeny of dementias, no systematic studies investigated the possibility of a link between Dissociative Amnesia and neurodegenerative dementias. Methods We analyzed data from over a dozen patients with functional Dissociative Amnesia, whom we investigated with neuropsychological methods, structural and functional neuroimaging. We followed prospectively approximately half of these patients for more than a decade. Results We evidenced in a substantial sample of patients with Dissociative Amnesia with preponderant retrograde memory impairments a hypometabolism during resting state in the right temporo-frontal region, with a decrease in the infero-lateral prefrontal cortex. Additional preliminary data from DTI suggested a decreased integrity of long distance fiber tracts important for conscious mnemonic processing. We found a chronic course of the memory impairments in a substantial number of patients with Dissociative amnesic conditions. In some chronic cases of Dissociative Amnesia we noted a fairly stable course, while in other cases we observed a progressive global cognitive deterioration. Discussion These findings point to a non-homogenous course of Dissociative Amnesia. Conclusion The search for a link between Dissociative amnesic conditions and dementia should take into consideration multiple variables, such as the age at the onset of trauma, gender, the recurrence, type and severity of trauma, the presence of psychiatric and medical co-morbidity, pre-morbid personality characteristics (e.g. neuroticism), genetic polymorphisms, educational and occupational attainment, cognitive reserve and the progression of metabolic and microstructural brain changes.
Mariétte Graafland - One of the best experts on this subject based on the ideXlab platform.
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trauma induced Dissociative Amnesia in world war i combat soldiers
Australian and New Zealand Journal of Psychiatry, 1999Co-Authors: Onno Van Der Hart, Paul K. Brown, Mariétte GraaflandAbstract:Objective: This study relates trauma-induced Dissociative Amnesia reported in World War I (WW I) studies of war trauma to contemporary findings of Dissociative Amnesia in victims of childhood sexual abuse.Method: Key diagnostic studies of post-traumatic Amnesia in WW I combatants are surveyed. These cover phenomenology and the psychological dynamics of dissociation vis-a-vis repression.Results: Descriptive evidence is cited for war trauma-induced Dissociative Amnesia.Conclusion: Posttraumatic Amnesia extends beyond the experience of sexual and combat trauma and is a protean symptom, which reflects responses to the gamut of traumatic events.
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Trauma‐induced Dissociative Amnesia in World War I combat soldiers
Australian & New Zealand Journal of Psychiatry, 1999Co-Authors: Onno Van Der Hart, Paul K. Brown, Mariétte GraaflandAbstract:Objective: This study relates trauma-induced Dissociative Amnesia reported in World War I (WW I) studies of war trauma to contemporary findings of Dissociative Amnesia in victims of childhood sexual abuse.Method: Key diagnostic studies of post-traumatic Amnesia in WW I combatants are surveyed. These cover phenomenology and the psychological dynamics of dissociation vis-a-vis repression.Results: Descriptive evidence is cited for war trauma-induced Dissociative Amnesia.Conclusion: Posttraumatic Amnesia extends beyond the experience of sexual and combat trauma and is a protean symptom, which reflects responses to the gamut of traumatic events.
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Trauma-induced Dissociative Amnesia in World War I combat soldiers. II. Treatment dimensions.
Australian & New Zealand Journal of Psychiatry, 1999Co-Authors: Paul K. Brown, Onno Van Der Hart, Mariétte GraaflandAbstract:Objective: This is the second part of a study of posttraumatic Amnesia in World War I (WW I) soldiers. It moves beyond diagnostic validation of posttraumatic Amnesia (PTA), to examine treatment findings, and relates these to contemporary treatment of Dissociative Amnesia, including treatment of victims of civilian trauma (e.g. childhood sexual abuse).Method: Key WW I studies are surveyed which focus on the treatment of PTA and traumatic memories. The dissociation-integration and repression-abreaction models are contrasted.Results: Descriptive evidence is cited in support of preferring Myers' and McDougalls' dissociation-integration treatment approach over Brown's repression-abreaction model.Conclusion: Therapeutic findings in this paper complement diagnostic data from the first report. Although effective treatment includes elements of both the Dissociative-integrative and abreactive treatment approaches, cognitive integration of dissociated traumatic memories and personality functions is primary, while em...
Angelica Staniloiu - One of the best experts on this subject based on the ideXlab platform.
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Dissociative Amnesia – A Challenge To Therapy
International Journal of Psychotherapy Practice and Research, 2018Co-Authors: Angelica Staniloiu, Hans J. MarkowitschAbstract:The psychiatric disease of Dissociative Amnesia is described and illustrated with case reports. It is emphasized that Dissociative Amnesia has a stress or trauma-related etiology and that affected individuals, contrary to the still dominant clinical belief, are frequently more severely and enduringly affected. That means, most of them show severe retrograde Amnesia for their biography, usually accompanied by changes in their personality and sometimes also by alterations in other cognitive and emotive domains. As many patients show the phenomenon of “la belle indifference”, their motivation for therapy or treatment of their Amnesia is reduced. Patients also seem to a high degree to possess immature, unstable personality features. Nevertheless, a number of quite divergent, though largely not evidence-based, therapeutic approaches exist and are described. They are divided into (a) psychopharmacological and somatic treatments, (b) psychotherapeutic interventions, and (c) neuropsychological rehabilitation. Furthermore, detailed treatment strategies are provided.
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Psychological causes of autobiographical Amnesia: A study of 28 cases.
Neuropsychologia, 2018Co-Authors: Angelica Staniloiu, Hans J. Markowitsch, Andreas KordonAbstract:Abstract Autobiographical Amnesia is found in patients with focal or diffuse brain damage (“organic Amnesia”), but also without overt brain damage (at least when measured with conventional brain imaging methods). This last condition is usually named Dissociative Amnesia at present, and was originally described as hysteria. Classically and traditionally, Dissociative Amnesia is seen as a disorder that causes retrograde Amnesia in the autobiographical domain in the aftermath of incidents of major psychological stress or trauma. In the present study one of the probably largest published collections of patients (28) with psychogenically caused autobiographical Amnesia, who were assessed with comprehensive neuropsychological tests, will be described and documented in order to identify variables which are central for the occurrence of Dissociative Amnesia. The presented cases demonstrate that autobiographical Amnesia without direct brain damage can have very mixed clinical presentations, causes and consequences. The described cases of psychogenic Amnesia are clustered according to a number of manifestations and features, which include a reduced effort to perform cognitively at a normal level, a forensic background, anterograde (instead of retrograde) autobiographical Amnesia, the fugue condition, concurrent somatic diseases, and their appearance in childhood and youth. It is concluded that autobiographical Amnesia of a psychogenic origin may occur within a variety of symptom pictures. For all patients, it probably serves a protective function by offering them a mechanism to exit a life situation which appears to them unmanageable or adverse.
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1687 – Social cognition in patients with Dissociative Amnesia
European Psychiatry, 2013Co-Authors: Hans J. Markowitsch, Angelica StaniloiuAbstract:Introduction Dissociative Amnesia is triggered by psychological stress or trauma. Its hallmark is a severe (usually retrograde) memory impairment within episodic-autobiographical domain, occurring without evidence of significant brain damage on conventional structural brain imaging. Objectives This work’s objectives are establishing greater recognition of possible relations between memory performance and social cognition in patients with Dissociative Amnesia. Aims We review data on social cognition (affective and cognitive theory of mind, simulation, empathy, social judgment, moral judgment) from our own patients with Dissociative Amnesia. Methods Patients were investigated medically, psychiatrically and with neuropsychological and neuroimaging methods. Results Patients with Dissociative Amnesia show variable degrees of impairments of components of social cognition, based on their comorbid conditions (e.g. concurrent clinical or subclinical depression), types of memory impairments (e.g. extent of retrograde Amnesia, presence of autobiographical semantic deficits), pattern of brain metabolic changes, personality characteristics, neuropsychological profile (performance on executive functions or emotional processing) and testing paradigms. Conclusions The impairment in Dissociative Amnesia seems to go beyond the conscious mnemonic deficit, encompassing various aspects of social information processing. Knowledge about the pattern of metabolic and micro-structural brain changes in patients with Dissociative Amnesia as well as a fine-grained analysis of the neural correlates of various aspects of social cognition might provide an understanding of when and how episodic-autobiographical memory contributes to social cognition. As several studies emphasized, some structures involved in mnemonic processing may also play a role in social perception, cognition and behavioural regulation, including future-minded choice behaviour.
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1687 social cognition in patients with Dissociative Amnesia
European Psychiatry, 2013Co-Authors: Hans J. Markowitsch, Angelica StaniloiuAbstract:Introduction Dissociative Amnesia is triggered by psychological stress or trauma. Its hallmark is a severe (usually retrograde) memory impairment within episodic-autobiographical domain, occurring without evidence of significant brain damage on conventional structural brain imaging. Objectives This work’s objectives are establishing greater recognition of possible relations between memory performance and social cognition in patients with Dissociative Amnesia. Aims We review data on social cognition (affective and cognitive theory of mind, simulation, empathy, social judgment, moral judgment) from our own patients with Dissociative Amnesia. Methods Patients were investigated medically, psychiatrically and with neuropsychological and neuroimaging methods. Results Patients with Dissociative Amnesia show variable degrees of impairments of components of social cognition, based on their comorbid conditions (e.g. concurrent clinical or subclinical depression), types of memory impairments (e.g. extent of retrograde Amnesia, presence of autobiographical semantic deficits), pattern of brain metabolic changes, personality characteristics, neuropsychological profile (performance on executive functions or emotional processing) and testing paradigms. Conclusions The impairment in Dissociative Amnesia seems to go beyond the conscious mnemonic deficit, encompassing various aspects of social information processing. Knowledge about the pattern of metabolic and micro-structural brain changes in patients with Dissociative Amnesia as well as a fine-grained analysis of the neural correlates of various aspects of social cognition might provide an understanding of when and how episodic-autobiographical memory contributes to social cognition. As several studies emphasized, some structures involved in mnemonic processing may also play a role in social perception, cognition and behavioural regulation, including future-minded choice behaviour.
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1699 – Long lasting personality changes after the onset of Dissociative Amnesia
European Psychiatry, 2013Co-Authors: Angelica Staniloiu, Hans J. MarkowitschAbstract:Introduction Across various cultures, Dissociative Amnesia is triggered by psychological stress or trauma. Its hallmark is a severe (usually retrograde) memory impairment, occurring without evidence of significant brain damage (as detected by conventional structural brain imaging). In a substantial number of cases, the memory impairment follows a chronic course. Sometimes Dissociative Amnesia occurs on a background of a personality disorder (narcissistic or borderline). Other times, Amnesia itself triggers long lasting personality changes. Objectives This work’s objectives are establishing greater recognition among health care providers of the spectrum of the personality changes that may accompany chronic forms of Dissociative Amnesia. Aims We review data from own patients with chronic forms of Dissociative Amnesia. Methods Patients were investigated medically, psychiatrically, neuropsychologically and and neuroradiologically. Results Changes in personality dimensions occur after the onset of Amnesia. These may involve affectivity, perception (e.g. impaired self face or face-emotion processing), cognition (e.g. social cognition) and behaviour (e.g. changing in eating, smoking, drinking or working habits). Conclusions The observed personality changes may represent a consequence of Amnesia. Functional imaging studies show metabolic changes in Dissociative Amnesia in brain areas involved in conscious mnemonic processing. Several structures engaged in processing within episodic-autobiographical memory system were also implicated in self and reward-related processing. Alternatively, the personality changes may be viewed as being pivotal in the development and maintenance of Dissociative Amnesia; this personality shift may subsequently lead to enduring changes in ways of cognitive processing, self-processing, perception and affect.
Onno Van Der Hart - One of the best experts on this subject based on the ideXlab platform.
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Combat-Induced Dissociative Amnesia: Review and Case Example of Generalized Dissociative Amnesia
Journal of Trauma & Dissociation, 2002Co-Authors: Eliezer Witztum, Haim Margalit, Onno Van Der HartAbstract:Dissociative Amnesia following combat trauma in various wars has been extensively documented. In this article, we describe theo- retical constructs related to Dissociative Amnesia, and integrate them with clinical practice through the presentation of a case. Although there is ample documentation of this condition in combat soldiers, in actual clinical practice such Dissociative Amnesia is probably underdiagnosed and undertreated. This may be detrimental to therapeutic progress, given the fact that ongoing memory deficits constitute one of the core symp- toms of chronic PTSD in combat veterans. As illustrated in our case example of combat-induced generalized Dissociative Amnesia, combat- induced Amnesia may also reflect previously existing dissociated trau- matic memories that become reactivated during trauma. In this case, in- tensive treatment using hypnosis within a larger therapeutic milieu involved both the uncovering and processing of recent dissociated trau-
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trauma induced Dissociative Amnesia in world war i combat soldiers
Australian and New Zealand Journal of Psychiatry, 1999Co-Authors: Onno Van Der Hart, Paul K. Brown, Mariétte GraaflandAbstract:Objective: This study relates trauma-induced Dissociative Amnesia reported in World War I (WW I) studies of war trauma to contemporary findings of Dissociative Amnesia in victims of childhood sexual abuse.Method: Key diagnostic studies of post-traumatic Amnesia in WW I combatants are surveyed. These cover phenomenology and the psychological dynamics of dissociation vis-a-vis repression.Results: Descriptive evidence is cited for war trauma-induced Dissociative Amnesia.Conclusion: Posttraumatic Amnesia extends beyond the experience of sexual and combat trauma and is a protean symptom, which reflects responses to the gamut of traumatic events.
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Trauma‐induced Dissociative Amnesia in World War I combat soldiers
Australian & New Zealand Journal of Psychiatry, 1999Co-Authors: Onno Van Der Hart, Paul K. Brown, Mariétte GraaflandAbstract:Objective: This study relates trauma-induced Dissociative Amnesia reported in World War I (WW I) studies of war trauma to contemporary findings of Dissociative Amnesia in victims of childhood sexual abuse.Method: Key diagnostic studies of post-traumatic Amnesia in WW I combatants are surveyed. These cover phenomenology and the psychological dynamics of dissociation vis-a-vis repression.Results: Descriptive evidence is cited for war trauma-induced Dissociative Amnesia.Conclusion: Posttraumatic Amnesia extends beyond the experience of sexual and combat trauma and is a protean symptom, which reflects responses to the gamut of traumatic events.
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Trauma-induced Dissociative Amnesia in World War I combat soldiers. II. Treatment dimensions.
Australian & New Zealand Journal of Psychiatry, 1999Co-Authors: Paul K. Brown, Onno Van Der Hart, Mariétte GraaflandAbstract:Objective: This is the second part of a study of posttraumatic Amnesia in World War I (WW I) soldiers. It moves beyond diagnostic validation of posttraumatic Amnesia (PTA), to examine treatment findings, and relates these to contemporary treatment of Dissociative Amnesia, including treatment of victims of civilian trauma (e.g. childhood sexual abuse).Method: Key WW I studies are surveyed which focus on the treatment of PTA and traumatic memories. The dissociation-integration and repression-abreaction models are contrasted.Results: Descriptive evidence is cited in support of preferring Myers' and McDougalls' dissociation-integration treatment approach over Brown's repression-abreaction model.Conclusion: Therapeutic findings in this paper complement diagnostic data from the first report. Although effective treatment includes elements of both the Dissociative-integrative and abreactive treatment approaches, cognitive integration of dissociated traumatic memories and personality functions is primary, while em...
Paul K. Brown - One of the best experts on this subject based on the ideXlab platform.
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trauma induced Dissociative Amnesia in world war i combat soldiers
Australian and New Zealand Journal of Psychiatry, 1999Co-Authors: Onno Van Der Hart, Paul K. Brown, Mariétte GraaflandAbstract:Objective: This study relates trauma-induced Dissociative Amnesia reported in World War I (WW I) studies of war trauma to contemporary findings of Dissociative Amnesia in victims of childhood sexual abuse.Method: Key diagnostic studies of post-traumatic Amnesia in WW I combatants are surveyed. These cover phenomenology and the psychological dynamics of dissociation vis-a-vis repression.Results: Descriptive evidence is cited for war trauma-induced Dissociative Amnesia.Conclusion: Posttraumatic Amnesia extends beyond the experience of sexual and combat trauma and is a protean symptom, which reflects responses to the gamut of traumatic events.
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Trauma‐induced Dissociative Amnesia in World War I combat soldiers
Australian & New Zealand Journal of Psychiatry, 1999Co-Authors: Onno Van Der Hart, Paul K. Brown, Mariétte GraaflandAbstract:Objective: This study relates trauma-induced Dissociative Amnesia reported in World War I (WW I) studies of war trauma to contemporary findings of Dissociative Amnesia in victims of childhood sexual abuse.Method: Key diagnostic studies of post-traumatic Amnesia in WW I combatants are surveyed. These cover phenomenology and the psychological dynamics of dissociation vis-a-vis repression.Results: Descriptive evidence is cited for war trauma-induced Dissociative Amnesia.Conclusion: Posttraumatic Amnesia extends beyond the experience of sexual and combat trauma and is a protean symptom, which reflects responses to the gamut of traumatic events.
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Trauma-induced Dissociative Amnesia in World War I combat soldiers. II. Treatment dimensions.
Australian & New Zealand Journal of Psychiatry, 1999Co-Authors: Paul K. Brown, Onno Van Der Hart, Mariétte GraaflandAbstract:Objective: This is the second part of a study of posttraumatic Amnesia in World War I (WW I) soldiers. It moves beyond diagnostic validation of posttraumatic Amnesia (PTA), to examine treatment findings, and relates these to contemporary treatment of Dissociative Amnesia, including treatment of victims of civilian trauma (e.g. childhood sexual abuse).Method: Key WW I studies are surveyed which focus on the treatment of PTA and traumatic memories. The dissociation-integration and repression-abreaction models are contrasted.Results: Descriptive evidence is cited in support of preferring Myers' and McDougalls' dissociation-integration treatment approach over Brown's repression-abreaction model.Conclusion: Therapeutic findings in this paper complement diagnostic data from the first report. Although effective treatment includes elements of both the Dissociative-integrative and abreactive treatment approaches, cognitive integration of dissociated traumatic memories and personality functions is primary, while em...