Paramnesia (Distortion of Memory)
Paramnesia is the falsification of memory through distortion, as distinct from amnesia, which is the loss of memory. Rather than a gap, paramnesia produces a memory that is wrong in some way — altered, invented, misattributed, or wrongly tagged as familiar or unfamiliar. It divides naturally into distortions of recall, where the content of a remembered event is falsified, and distortions of recognition, where the feeling of familiarity itself is what goes wrong.
This has traditionally been distinguished from amnesia by what remains: in amnesia there is an absence where a memory should be, while in paramnesia there is content, but the content is not a reliable copy of what actually happened, or the feeling of familiarity attached to it does not match reality.
Recognition features
- A memory is present but altered, invented, misattributed, or accompanied by an incorrect sense of familiarity or unfamiliarity
- Can occur in ordinary, healthy people, as well as in those with emotional difficulties or organic brain disease
- Divides into distortions of recall (the content of what is remembered) and distortions of recognition (the felt sense of familiarity itself)
- Range of severity and cause is wide, from everyday interference between memories to florid, organically driven false recognition
Eliciting it at interview
- Where a memory seems distorted, gently explore how confident the person is in its accuracy and whether it can be checked against other sources or people
- Ask specifically about the feeling of familiarity itself, not just the content of memories, since distortions of recognition can be easy to miss unless asked about directly
- Bear in mind that ordinary forgetting and interference between memories can also produce apparent distortions, and consider these before assuming a more specific paramnesia is present
Distinguishing features
- Differs from amnesia in that memory content is present, just unreliable, rather than simply missing
- Distortions of recall (affecting the content of what is remembered) are distinguished from distortions of recognition (affecting the feeling of familiarity attached to an experience)
- Can occur in normal people under ordinary conditions, which is an important context for interpreting any single instance
Common misconceptions
- That any memory that turns out to be wrong reflects a psychiatric condition; distorted memory is common in healthy people and becomes clinically significant mainly through its pattern, extent, or context
- That paramnesia and amnesia are simply different degrees of the same problem; they are better understood as different kinds of memory disturbance — absence versus distortion
Related phenomena
Amnesia · Distortion of Recall · Distortion of Recognition
Practice this
A patient's memory of a past holiday is present and can be recounted in detail, but on closer examination is found to be altered, with an incorrect sense of unfamiliarity about parts of it that genuinely happened. Nothing is simply missing — the memory exists, just distorted. What general category of memory disturbance is this? · A woman reports a complete blank for an entire week of her life, with no memory content of any kind for that period, however hard she tries or however she is prompted. Before revealing the answer: is this an example of a paramnesia? · A patient has a disturbance affecting a period of personal memory. Before revealing the answer, decide what distinguishes amnesia from paramnesia. · A patient's account of the past seems unreliable. Before revealing the answer, decide what distinguishes a paramnesia from amnesia. · You suspect a patient's account of the past may involve a paramnesia. Before revealing the answer, decide how you would assess this. · Explain why the book's division of paramnesia into distortions of recall and distortions of recognition is clinically useful, rather than simply an academic distinction.
Illustration
A 50-year-old woman confidently recounts a detailed argument with a colleague that, according to two independent witnesses, never actually took place, though a similar disagreement did occur with a different colleague the previous year, and elements of the two seem to have merged in her account without her being aware of it.
References
- Casey, P. & Kelly, B. (2019). Fish's Clinical Psychopathology, 4th ed. Ch. 5, 'Disorders of Memory'.