Anxiety Amnesia
Anxiety amnesia is a difficulty with memory that arises from anxious preoccupation and poor concentration, most often seen in the context of depressive illness or generalised anxiety, rather than from any genuine underlying disturbance of the memory system itself. Because it can look superficially like a more serious memory disorder, it is important to recognise that it generally resolves once the underlying anxiety or depression is treated.
This has traditionally been highlighted as a diagnostic trap: on first impression it can wrongly suggest a dissociative amnesia, or, when more severe, mimic a dementia, when in fact the underlying process is impaired attention and concentration secondary to a treatable mood or anxiety condition.
Recognition features
- Reported memory difficulty in the context of prominent anxiety, worry, or low mood
- Underlying cause is poor concentration and attention rather than a genuine failure to store or retain memories
- Improves as the underlying anxiety or depressive disorder is treated
- Can, in more severe presentations, closely resemble a dementia, which is an important trap to be aware of
Eliciting it at interview
- Assess the person's ability to concentrate and attend directly, since poor performance here, rather than a genuine storage or retrieval deficit, is usually the underlying issue
- Explore the timeline in relation to mood and anxiety symptoms, since a memory complaint that developed alongside a mood change is a useful clue
- Consider reassessing memory after a period of treatment for the underlying mood or anxiety disorder, since substantial improvement supports this explanation over a primary memory disorder
Distinguishing features
- Differs from dissociative amnesia in lacking the sudden onset, sharp boundaries, and preserved general functioning typical of that condition
- Differs from a true dementia or organic amnestic state in that the underlying problem is attention and concentration rather than a primary disturbance of memory storage, and it is reversible with treatment of the underlying condition
- Its close resemblance, in severe cases, to dementia (sometimes termed depressive pseudodementia) makes careful assessment of mood essential before concluding a primary cognitive disorder is present
Common misconceptions
- That significant memory complaints in an anxious or depressed patient necessarily indicate a coexisting dementia; impaired concentration secondary to the mood or anxiety disorder is a much more common explanation and should be considered first
- That anxiety amnesia is a distinct memory disorder in its own right, rather than a downstream consequence of impaired attention
Related phenomena
Amnesia · Depressive Pseudodementia · Inhibition (Slowing) of Thinking
Practice this
A patient with longstanding generalised anxiety describes gradually worsening forgetfulness over several months, closely tracking her worsening worry and poor concentration, which improves noticeably on the days her anxiety feels more settled. What is this? · A patient is found wandering in an unfamiliar town, unable to recall her own name or personal history, though she has been managing daily tasks and behaving appropriately with strangers; this began abruptly after witnessing a violent assault two days earlier. Before revealing the answer: is this anxiety amnesia? · A patient reports memory difficulty in the context of a mood or anxiety disturbance. Before revealing the answer, decide what distinguishes anxiety amnesia from dissociative amnesia. · You suspect anxiety amnesia in a patient. Before revealing the answer, decide how you would assess for this. · Explain why anxiety amnesia is described as an important trap to be aware of in older or more severely anxious patients.
Illustration
A 45-year-old woman with generalised anxiety disorder becomes convinced she is developing dementia after repeatedly forgetting appointments and misplacing her keys, but detailed testing shows her difficulty stems entirely from poor concentration during periods of intense worry, and her memory complaints resolve almost completely once her anxiety is successfully treated.
References
- Casey, P. & Kelly, B. (2019). Fish's Clinical Psychopathology, 4th ed. Ch. 5, 'Disorders of Memory'.